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Vetter v. American Airlines, Inc.

United States District Court, D. Maryland, Southern Division

March 6, 2018

LESLIE R. VETTER, Plaintiff,
v.
AMERICAN AIRLINES, INC. PILOT LONG-TERM DISABILITY PLAN, Defendant.

          MEMORANDUM OPINION AND ORDER

          Paul W. Grimm United States District Judge

         Plaintiff Leslie R. Vetter is a pilot for American Airlines, Inc. (“the Airline”). The Airline sponsored an employee benefit plan, Defendant American Airlines, Inc. Pilot Long-Term Disability Plan (the “Plan), administered by the Pension Benefits Administrative Committee (the “Plan Administrator”). Vetter stopped working in January, 2012 due to health problems including fatigue, depression, and severe stomach pains. Administrative Record (“AR”) 164-65, ECF No. 21. She took sick leave through February 21, 2012, then applied for long-term disability benefits pursuant to the Plan in April 2012. AR 60, 118. The Plan Administrator initially denied the benefits on July 31, 2012. AR 158-62. On appeal, it awarded her benefits of $12, 795.79 for the period from May 3, 2012 through July 23, 2012, but determined that benefits were not appropriate after July 23, 2012 because Vetter no longer was disabled. AR 57-69. It did not address benefits between February 22, 2012, when Vetter stopped receiving pay, and May 3, 2012.

         In this action, filed pursuant to the Employee Retirement Income Security Act (“ERISA”), 29 U.S.C. § 1132, Vetter challenges the denial of benefits for the periods from February 22, 2012 until May 3, 2012, and July 23, 2012 until she returned to work on October 1, 2013. See Compl., ECF No. 1; Pl.'s Reply & Opp'n 1 n.1, ECF No. 29. The parties have filed and fully briefed cross-motions for summary judgment. ECF Nos. 23, 23-1, 26, 29, 30. A hearing is not necessary. See Loc. R. 105.6. I find that the Plan's decision not to award benefits before May 3, 2012 or after July 23, 2012 was not supported by substantial evidence, but also that the onset and duration of Vetter's disability are not clear on the record before me. Therefore, I will deny the parties' cross-motions for summary judgment, and remand the case to the Plan Administrator for further proceedings.

         Background[1]

         Pursuant to agreements that the Airline entered into with the Allied Pilots Association (“APA, ” the union that represents Vetter and other pilots), the Airline provides, administers and funds the Plan, which provides long-term disability benefits for eligible pilots. Plan § I, AR 133. The Plan defines “disability” or “disabled” as “an illness or injury, verified through a qualified medical authority in accordance with Section V of the Plan, which prevents a Pilot Employee from continuing to act as an Active Pilot Employee in the Service of the Employer, ” with exceptions not relevant here. Plan § III.N, AR 135. An “Active Pilot Employee” is “a Pilot Employee who performs or is eligible to perform duties as a pilot for the [Airline].” Id. § III.A, AR 133. It is not disputed that Vetter is a Pilot Employee.

         American Airlines described the Pilot Employee position as follows:

Reports for duty before assigned flight. Access computer terminals for sign-in and acquisition of flight plans, weather information and other associated documents. Analyzes in concert with Flight dispatch, the plan of intended routing and fuel loading taking into account weather and other conditions.
Conducts detailed examination of exterior and interior of aircraft. . . . and determine whether aircraft is acceptable for safe flight operation.
Completes pre-flight checklists (manually & visually), contacts FAA by radio to acquire clearances and brief flight attendants.
Supervises push-back activities and taxi aircraft to runway. . . .
During flight, performs checklist, visually monitors aircraft systems, communicates with FAA facilities, navigates and monitors air traffic. Simultaneously, monitor enroute [sic] weather, and alter routing as necessary while continually analyzing fuel consumption. In the event of abnormal or emergency situations, take immediate required action and determine if immediate landing is necessary.
Plans and executes approach and landings, often at night and in inclement weather. . . .
Taxis aircraft to gate, shut down engines and prepare for the next flight segment.
Must be able to work varying hours of the day or night, on weekdays, and holidays. Frequently on duty for as long as twelve to fourteen hours and will span many time zones and extreme weather differences in the course of a trip. Frequently be away from home for three, or more days and nights, staying in out-of-town hotels.

         Am. Airlines Job Description & Essential Functions, AR 621 (emphasis added). Vetter was required to have, inter alia, an FAA Commercial License and a Valid First Class Medical Certificate. Id. at 622.

         Vetter “started experiencing declining health” in June 2011; by January 2012, her symptoms included insomnia, fatigue, nausea, vomiting, headaches, trouble concentrating, stomach pain, and depression. Vetter Decl., AR 164. She no longer felt able to perform the job responsibilities involved in piloting a commercial aircraft as of January 2012, and she began taking sick leave on January 5, 2012. Id. at 164-65; Aug. 12, 2013 Ltr., AR 60. She exhausted her sick leave by February 21 2012, and then was approved for unpaid sick leave of absence. Vetter Decl., AR 165; Aug. 12, 2013 Ltr., AR 60. Vetter originally sought long-term disability benefits on April 12, 2012, Notice of Disability, AR 118; by letter dated July 31, 2012, the Plan denied her claim due to “insufficient evidence that [she had] a Disability as required by the Plan.” Ltr., AR 159.

         Vetter appealed. According to Vetter, her condition worsened in summer 2012 and she “started suffering symptoms similar to Bells Palsy.” Vetter Decl., AR 165. In her January 28, 2013 Declaration, Vetter stated that she recently was diagnosed with Lyme disease and that two physicians, Dr. Kessler and Dr. Corrigan, found that she was “ineligible to fly due to a medical condition and w[ould] not be eligible until [her] illness resolve[d].” Id. at 164, 165. On appeal, the Plan approved Vetter for long-term disability benefits “because of [her] medical inability to act as a Pilot” due to “her claimed condition of insomnia, ” but only for the period May 3, 2012 through July 23, 2012. Sept. 25, 2013 Ltr., AR 52; Aug. 12, 2013 Ltr., AR 57.

         Thus, it is undisputed that Vetter had a qualifying disability from May 3, 2012 until July 23, 2012. Therefore, the issue is whether the Plan abused its discretion in finding that Vetter's disability did not exist prior to May 3, 2012 and ceased to exist after July 23, 2012. A disability “exist[s]” and “continue[s] to exist[] only if the Pilot Employee has received and continues to receive qualified medical care consistent with the nature of the illness or injury that gives rise to such Disability.” Plan § V.A, AR 138. A disability “cease[s] to exist” for purposes of the Plan “if (1) health is restored so as not to prevent the Pilot Employee from acting as an Active Pilot Employee in the service of the [Airline], (2) verification of such Disability can no longer be established or (3) appropriate medical care is wantonly disregarded by such Pilot Employee.” Plan § V.B, AR 138.

         The Plan provides that “[a]ny dispute as to the clinical validity of a Pilot Employee's claim of the existence of a Disability or the continuation of the illness or injury which gave rise to such Disability shall be referred to a clinical authority selected under the Agreements” between the Airline and the APA, “and the findings of such authority regarding the nature and extent of such illness or injury shall be final and binding upon the [Airline], the [APA] and the Pilot Employee . . . .” Plan § V.D, AR 138. The Plan's review of any denial of a claim for disability benefits must “take into account all comments, documents, records, and other information submitted by the Pilot Employee relating to the claim, without regard to whether such information was submitted or considered in the initial benefit determination.” Id. § VIII.F(6), AR 147-48. And, “[i]f the adverse determination was based, in whole or in part, on a medical judgment, the Pension Benefits Administration Committee shall consult with a health care professional who has appropriate training and experience in the field involved in the medical judgment.” Plan § VIII.F(7), AR 148.

         Consistent with this provision, when Vetter appealed, the Plan submitted Vetter's case file to MES Solutions, Inc. (“MES”), “an independent clinical consulting firm mutually agreed upon by [the Airline] and the APA, for its review and medical opinions on the case.” Aug. 12, 2013 Ltr., AR 67. The Plan “request[ed] that MES Solutions perform an evidence-based, forensic medical review/evaluation (‘peer review') . . . conducted by [a] Senior AME [Aviation Medical Examiner] and any additional board-certified physician specialists.” June 3, 2013 Ltr., AR 90. The medical examiner selected was Dr. James W. Butler, M.D., M.P.H. Aug. 12, 2013 Ltr., AR 67, 69, 72. Four specialists also reviewed the file. Id. The Plan asked MES to review “the submitted information” and stated that, if that did “not enable the Senior AME and the board-certified physician specialists to provide a clear and definitive determination on the case, ” MES could “request that the Pilot submit to an Independent Medical Evaluation.” Id.

         In its June 3, 2013 letter to MES, the Plan stated that Vetter claimed the following conditions: hypothyroidism, perimenopause, chronic insomnia with resulting fatigue, irritable bowel syndrome with constipation, persistent epigastric and abdominal pain, and positive Epstein Barr virus and Cytomegalovirus antibodies. June 3, 2013 Ltr., AR 90. The Plan posed specific questions with regard to each claimed condition and noted that “this request for professional medical consultation is to determine disability and treatment compliance only, as referenced in the Plan” and it “should not address the Pilot's fitness for duty, qualification or disqualification for FAA medical certificate for the Pilot, Pilot loss of license, or factors other than those contained in the questions [posed].” Id. at 91. The Plan explained that its “determining factors for approval of disability benefits focus on whether or not the Pilot meets the Plan's definition of disability, and/or whether or not the Pilot meets the requirement of receiving and complying with qualified medical care.” Id. In response, “MES Solutions, Inc. physician consultants provided their professional medical opinions regarding the Pilot's medical conditions and their relationship, if any, to Disability as defined by the Plan.” Aug. 12, 2013 Ltr., AR 67.

         The Plan informed Vetter that the MES physician consultants considered the “diagnoses/affected organ systems” listed in the June 3, 2013 letter, as well as Lyme Disease, Atypical Bartonella infection, and Atypical Babesiosis. Id. It is true that, although Lyme Disease and the other infections were not included in the instructions to MES, three of the four physicians (whose reviews Dr. Butler agreed with) noted these diagnoses. E.g., Jad A. Khoury, M.D. Review, AR 73 (“She was given a diagnosis of possible babesiosis, possible Lyme disease and atypical bartonellosis and received multiple antibiotics and antimalarials.”); Ronald S. Sims, M.D. Review, AR 79 (considering “claimant's work capacity as regards insomnia and fatigue”; noting diagnoses of “Lyme disease, babesiosis, bartonellosis”); Steven C. Talwil, M.D. Review, AR 84 (“9/6/12 was told by infectious disease to take doxycycline for treatment of Lyme disease. 3/18/13 she reported having 85% of her normal energy level with some G.I. symptoms.”).

         According to the Plan, the physicians opined that Vetter had “[n]o disability attributable to” hypothyroidism, perimenopause, Epstein-Barr virus exposure or Cytomegalovirus exposure, and “[n]o evidence of disability as a result of” Atypical Bartonella infection or Atypical Babesiosis.” Aug. 12, 2013 Ltr., AR 67-68. Similarly, they concluded that her irritable bowel syndrome with constipation and her persistent epigastric and abdominal pain “did not disable her from performing her duties as a pilot.” Id. As for Lyme disease, they found that there was “[n]o evidence of involvement in the central nervous system.” Id. In contrast, with regard to Vetter's chronic insomnia with fatigue, the Plan reported that the MES physician consultants opined: “Her impaired sleep deficiency did disable her from performing her duties as a pilot. However, the records reflect that her insomnia was mostly resolved by July 23, 2012.” Id.

         Dr. Sims, who is board-certified in neurology with a subspecialty certificate in sleep medicine, in consultation with Dr. Butler's office, reviewed Vetter's file with regard to chronic insomnia and fatigue. Specifically, he reviewed Vetter's Declaration, a statement from Dr. James Shaller, various laboratory reports and a polysomnogram, notes from Dr. William Cooper, Jr., M.D., Dr. Mark Richards, M.D., Dr. Manoel Moraes, M.D., Dr. Marina Johnson, M.D., Dr. Brian Turrisi, M.D., Dr. William Stern, M.D., Dr. Lynette Posorske, M.D., and Dr. David Kessler, M.D., and on July 19, 2013, answered questions posed by the Plan. Sims Review, AR 79.

         Dr. Johnson stated that Vetter was “under [her] care for hypothyroidism, perimenopause, chronic insomnia and IBS-C, ” and, that “[a]t her initial visit”-for which Dr. Johnson does not provide a date, although the records reflect that she requested lab work for Vetter on February 28, 2012-“she had severe insomnia . . . that was causing her great fatigue.” Johnson Ltr., AR 37-38. As of Vetter's June 6, 2012 visit, “her sleep [was] normalized, and she average[d] 8 hours nightly.” Id. at 37. At that time, Vetter's “thyroid medicine and dosage [was] stabilized and d[id] not constitute a reason to prevent her from flying.” Id. Dr. Johnson opined that “[a]t th[at] point, the problem that [was] inhibiting her return to work [wa]s her epigastric and abdominal pain.” Id. Dr. Turrisi saw Vetter almost seven weeks later, on July 23, 2012, and made similar observations. Turrisi Ltr., AR 533. Specifically, he noted that “[s]he [wa]s sleeping a lot better . . . after being on ton of herbal supplements that have [been] prescribed by various physicians and she [wa]s ...


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