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Mental versus Physical Disabilities

DeBofsky, Sherman & Casciari attorney William Reynolds recently won a significant victory on behalf of one of the firm's clients.  In Watson v. Reliance Standard Life Ins. Co., 2017 WL 5418768 (N.D. Ill. November 14, 2017), the court overturned a disability insurer's finding that Cheryl Watson suffered from a psychiatric impairment; thus, her benefits were limited to a maximum 24-month duration. After an earlier portion of the proceedings resulted in a remand and ultimately an award of benefits for 24-months, the plaintiff returned to court to challenge Reliance Standard's invocation of the mental or nervous disorder limitation.  The matter was heard by the court as a trial on the papers pursuant to Rule 52 of the Federal Rules of Civil Procedure accompanied by oral argument; and the court entered findings of fact and conclusions of law in favor of the plaintiff based on the evidence presented.

Cheryl Watson had been a research study coordinator prior to the onset of her claimed disability in March 2013 as the result of unexplained fatigue and numbness.  MRI findings revealed signal abnormalities in the deep white matter of the brain, a small central disc hernation was found in the cervical spine along with stenosis, and a visual evoked potential examination suggested a demyelinating process, although a definitive diagnosis of Watson's physical impairments remained elusive.  Watson was also concurrently diagnosed with major depression, and fibromyalgia was later diagnosed as well. 

Reliance conducted several evaluations.  A neuropsychological assessment concluded that while there were evident psychiatric issues, no organic basis for Watson's symptoms could be found.  A neurological assessment was also deemed indeterminate for a neurological disorder; however, the neurologist issued a diagnosis of chronic fatigue syndrome. 

Watson also concurrently applied for Social Security disability benefits and underwent examinations in relation to that application, which was ultimately successful.  An administrative law judge found Watson disabled due to a combination of physical and psychiatric conditions that limited her physical function and also determined that Watson would be off-task for more than 20% of the workday due to "depression, anxiety, fatigue and pain." 

The court acknowledged that there is a split of authority on the question of which party bears the burden of proving the applicability of a policy limitation; however, the court concluded that it did not have to decide the issue. Rather, the court needed to determine "whether Watson remains totally disabled based on her physical limitations, or, in other words, if her physical symptoms render her disabled regardless of her mental condition."  The court concluded "that Watson cannot perform her occupation based on her physical limitations, a conclusion the Court would draw whether the burden rested with either party." 

The policy at issue was strictly an "own occupation" policy.  Although there was no dispute that Watson's occupation was "sedentary" in its exertional demands, Plaintiff criticized Reliance Standard's failure to consider the non-exertional mental demands of Watson's job.  The court agreed "that it should consider Watson's ability to perform all aspects--the physical and non-physical--of her regular occupation."  The court also found it was required to consider "both qualitative and quantitative reductions in Watson's ability to perform the material duties of her occupation." (citing McFarland v. Gen. Am. Life Ins. Co., 149 F.3d 583, 588 (7th Cir. 1998) - A qualitative reduction is one where the claimant is unable to perform even "one core and essential aspect of [her] job" so as to result in the loss of her position even if the duty comprised only 5% of the claimant's duties. McFarland, 149 F.3d at 588. A quantitative reduction, on the other hand, is one "in which the injury or sickness would not physically prevent an employee from performing any given task, but the injury instead renders the person unable to perform enough of the tasks or to perform for a long enough period to continue working at his regular occupation." Id.). 

Watson maintained that pain and fatigue from chronic fatigue syndrome, fibromyalgia, cervical and lumbar spinal pain, and migraines impaired her ability to work, while Reliance Standard argued that anxiety and depression were the cause of Watson's deficits.  The court agreed with Watson, finding: 

Having reviewed the entirety of the record and considered the parties' arguments, the Court finds that despite some conflicting evidence, the preponderance of the evidence suggests that Watson cannot perform the material duties of her regular occupation due to the physical symptoms of her diagnosed medical conditions. As Watson argues, her own description of symptoms, past examination findings, objective test results, and medical history demonstrate that she suffers from fibromyalgia, chronic fatigue syndrome, spinal stenosis, and migraines. Although Reliance Standard admits that the record includes Watson's own self-reported complaints of fatigue, weakness, numbness, and pain, Watson's evidence goes beyond mere self-reported complaints of pain and fatigue. Her treating physicians have now diagnosed her with, among other illnesses, chronic fatigue syndrome and fibromyalgia, for which "the crucial symptoms, pain and fatigue, won't appear on laboratory tests." Kennedy v. Lilly Extended Disability Plan, 856 F.3d 1136, 1139 (7th Cir. 2017). Even Dr. Kramer acknowledged that she suffers from chronic fatigue syndrome. Nothing in the record undermines her fibromyalgia diagnosis or suggests that those symptoms are exaggerated. Dr. Weisberger completed a fibromyalgia residual functional questionnaire in May 2016 in which she indicated that Watson satisfied the criteria for diagnosing fibromyalgia, noting that Watson had multiple tender points, nonrestorative sleep, severe fatigue, morning stiffness, depression, female urethral syndrome, numbness and tingling, lack of endurance, impaired concentration, and anxiety. 

The court observed that it could not just look at diagnoses but had to also consider the effect of plaintiff's symptoms on her functional abilities.  In the absence of a functional capacity evaluation, the court had to examine the records, some of which reported significant pain and fatigue and other records which did not.  However, the court ultimately concluded: 

[T]he fact that Watson may have been able to perform some daily activities or did not always complain of pain is not disqualifying; "the symptoms of [fibromyalgia] can wax and wane so that a person may have 'bad days and good days.'" SSR 12-2p. Similarly, Reliance Standard's focus on reports of normal range of motion and lack of swelling is misguided. See Sarchet, 78 F.3d at 307 ("Since swelling of the joints is not a symptom of fibromyalgia, its absence is no more indicative that the patient's fibromyalgia is not disabling than the absence of headache is an indication that a patient's prostate cancer is not advanced."). 

The court was unimpressed by the neuropsychological and neurological examinations because both reported findings limited exclusively to the doctors' specialties.  Thus, neither report "rule[s] out or shed[s] any light on whether Watson's fibromyalgia, chronic fatigue syndrome, and other physical symptoms render her unable to perform the material duties of her occupation."  However, the plaintiff's primary care physician reported that Watson's physical symptoms precluded her from performing a sedentary occupation and Reliance Standard's failure to obtain a functional capacity evaluation or a rheumatologic examination was fatal to its cause.  The court also found the Social Security determination persuasive, observing: 

The ALJ did not list somatic symptom disorder as a severe impairment but did find fibromyalgia and chronic fatigue syndrome to be so. The ALJ noted specific evidence concerning her physical limitations, including that provided by her treating physician, Dr. Weisberger, and found Dr. Weisberger's opinion to be "consistent with her treatment notes, the treatment received, and the claimant's reports." SAR 75. The ALJ also conducted a vocational analysis, finding Watson's work history to suggest that "she would be working if she were able to do so." SAR 74. This analysis supports the Court's conclusion that Watson remains totally disabled based on her physical limitations. As a result, Watson is entitled to long-term disability benefits under the Policy, dating back to June 10, 2015. 

The court also awarded prejudgment interest and permitted the plaintiff to petition for fees. 

It is difficult to distinguish between somatic symptoms and symptoms of physical impairments; however, even Reliance Standard's neurologist believed that Watson suffered from chronic fatigue syndrome.  The court carefully weighed the evidence and under a preponderance of the evidence standard, determined that Watson met her burden.

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