United States District Court, D. Maryland, Southern Division
LESLIE R. VETTER, Plaintiff,
AMERICAN AIRLINES, INC. PILOT LONG-TERM DISABILITY PLAN, Defendant.
MEMORANDUM OPINION AND ORDER
W. Grimm United States District Judge
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
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.
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.
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
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
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.
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.
“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.
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.
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,
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.
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.”
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.,
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.”).
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,
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.
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 ...