United States District Court, D. Maryland
DEBORAH K. CHASANOW UNITED STATES DISTRICT JUDGE.
pending and ready for resolution in this case brought
pursuant to the Employee Retirement Income Security Act of
1974 (ERISA), 29 U.S.C. § 1001, et seq.,
alleging the wrongful termination and denial of disability
benefits, are the motion for summary judgment filed by
Plaintiff Dana Krysztofiak, (ECF No. 15) and the cross motion
for summary judgment filed by Defendant Boston Mutual Life
Insurance Co. (ECF No. 17). The issues have been fully
briefed, and the court now rules, no hearing being deemed
necessary. Local Rule 105.6. For the following reasons,
Plaintiff's motion for summary judgment will be granted
and Defendant's cross motion for summary judgment will be
Kysztofiak (“Ms. Krysztofiak” or
“Plaintiff”) is a registered nurse. Before the
events of this case, she worked as a Clinical Coordination
Manager for HomeCare Maryland, LLC. In late 2016, Ms.
Kyrsztofiak stopped working due to, among other things,
diagnoses of psoriatic arthritis and fibromyalgia. (ECF No.
11-19, at 103). Ms. Krysztofiak first claimed disability
benefits under a Boston Mutual Life Insurance Co.
(“Boston Mutual” or “Defendant) Long Term
Disability policy (“the Policy”) as of December
29, 2016. Id. About four months later, on April 13,
2017, Boston Mutual began paying Ms. Krysztofiak regular
disability benefits of $4, 377.50 per month. (ECF No. 1, at
spring of 2018, Boston Mutual's claims administrator,
Disability Reinsurance Management Services, Inc.
(“DRMS”), determined that Ms. Krysztofiak was no
longer disabled. (ECF No. 11-20, at 54). Her disability
income benefits were terminated as of May 29, 2018. Her
administrative appeal was denied on March 20, 2019, and this
case was filed on March 25, 2019. Plaintiff seeks a
declaration that she is entitled to the payment of disability
income benefits, a reinstatement of benefits going forward so
long as she remains disabled, an award of benefits accrued
since termination, prejudgment interest, costs, and
before benefits were terminated, Ms. Krysztofiak's
treating physician, Dr. Tazeen Rehman, concluded that
psoriatic arthritis was no longer the cause of Ms.
Krysztofiak's disability. Her report is dated May 18,
2018, and she reports that Plaintiff recently has been on
Cimzia which results in “good control” of the
psoriatic arthritis. (ECF No. 11-1, at 34). Dr. Rehman
concluded instead that “[h]er limitations are due to
fibromyalgia.” (Id.). The denial letter
recounts some of Plaintiff's history concerning treatment
for psoriatic arthritis during 2017 and early 2018. (ECF No.
11-20 at 54-57). Defendant argues that, once Plaintiff's
psoriatic arthritis was under control, she ceased meeting the
definition of disability based on fibromyalgia alone. (ECF
No. 17-1, at 8).
administrative record is replete with descriptions and
analyses of Ms. Krysztofiak's fibromyalgia, but the most
thorough are in her own words in an affidavit executed in
I experience constant generalized pain, swelling, and
stiffness throughout my entire body. The severity of pain
ranges from moderate to excruciating. On a 1-10 scale, my
pain averages 6-7 on a daily basis. The pain is deep,
penetrating, throbbing, and stabbing. It feels like bones are
breaking. The pain is exacerbated by anything that touches
me, or any kind of bodily movement, including sitting down,
standing up, walking, reaching, bending, and turning. When
pain levels become unbearable, I need to lie down until the
pain subsides. When walking, I use a cane or walker. The pain
is often distracting to the point that it impairs my ability
to focus on anything other than the pain. The pain often
keeps me up at night when I am trying to sleep. I have panic
attacks and anxiety because the pain never stops.
(ECF No. 11-19, at 153).
order to assess Ms. Krysztofiak's condition as part of
the review process, DRMS had her participate in a functional
capacity evaluation (“FCE”) on October 2,
2017. (ECF No. 11-5, at 21). During the FCE, Ms.
Krysztofiak “refused Floor to Waist and Waist to
Shoulder lifts, and carry task” and “refused to
try filing, typing and assembly tasks.” Id.
The FCE administrator was careful to note that “[t]he
results of this evaluation were limited, ”
“should be considered to be a minimal representation of
her functional ability, ” and that the evaluation was
“unable to determine her physical demand level[,
]” because “[d]uring various components of the
evaluation, claimant demonstrated lack of effort[.]”
(Id. at 21, 22).
at odds with those caveats, however, the FCE states that
“[b]ased on the results of this evaluation, claimant
would not be able to perform the job functions of Clinical
Coordinator Manager, due to claimant not being able to
perform frequent fingering, modifications required with
walking, sitting limitations, and not being able to
demonstrate productive functional reach pattern.”
(Id. at 21). The FCE also noted that Ms. Krysztofiak
was “consistent throughout both days of the
evaluation[, ]” and that she needed “positional
changes on both days (sit to supine), which would make it
difficult for claimant to perform modified or light duty
work.” (Id. at 21, 22).
of the equivocal results of the FCE, Boston Mutual arranged
for an in-person examination with Dr. John Parkerson on
February 13, 2018. (ECF No. 11-1, at 23). In relevant part,
Dr. Parkerson's report concluded:
On a physical basis, she does not present as having any
physical limitations or restrictions. Her reported
limitations present as psychological or based on
fibromyalgia. . . Fibromyalgia is a condition defined only by
subjective complaints. The person must report pain and
symptoms of severity. There is no objective test known or
physical finding required. The diagnosis is made simply on
the person's complaints. Therefore, there is no objective
finding of limitation or restriction based on this diagnosis.
The diagnosis also requires the exclusion of other reasonable
causes of the complaints. In this particular case, she has
other diagnoses that reasonably explain her complaints
including but possibly not limited to her bipolar depressive
disorder, endocrinopathy, and opioid dependence. A diagnosis
of fibromyalgia does not present her with any physical
limitations or restrictions.
(Id., at 28-29). Dr. Parkerson also concluded that
Ms. Krysztofiak did not exhibit any “symptom
magnification disorder[.]” In other words, Dr.
Parkerson thought she was truthful about the severity of her
symptoms. (Id. at 27).
Dr. Parkerson, Ms. Krysztofiak's doctors did diagnose her
with fibromyalgia. On February 10, 2017, Pamela Lentz, CRNP,
found “18 out of 18 tender points, ” a common
test for fibromyalgia. (ECF No. 11-9, at 25). Dr. Rehman
likewise concluded that Ms. Krysztofiak “suffers from
fibromyalgia which severely limits her activities of daily
living[, ]” (ECF No. 11-10, at 74), and that her
“limitations are mainly due to fibromyalgia, ”
(ECF No. 11-19, at 128).
Dr. Parkerson's report, DRMS had Stewart Russell, D.O.,
review all of Ms. Krysztofiak's medical records. Dr.
Russell concluded that “the insured likely has
fibromyalgia[.]” (Id., at 110). Dr. Russell
nonetheless found “no support for an inability to
perform at least a minimum of full-time sedentary activity[,
]” and that “self-reports of the insured are not
consistent with the overall medical information.”
(Id.). Dr. Russell also disagreed with the treatment
Ms. Krysztofiak was then undergoing, noting that the opioids
she had been prescribed were inappropriate for a fibromyalgia
patient. (ECF No. 11-20, at 105).
course of opioid treatment which Dr. Russell took issue with
had been ongoing since June 2014. (ECF No. 11-6, at 54). In
that year, Ms. Krysztofiak began seeing Dr. Norman Rosen for
pain treatment related to a number of ailments. On June 30,
2017, the Maryland Board of Physicians reprimanded Dr. Rosen
for over-prescription of opioids. (ECF No. 11-20, at 52).
According to media reports, on February 27, 2018, federal
agents raided Dr. Rosen's clinic as part of an ongoing
investigation. (ECF No. 11-1, at 106). By July of 2018,
Plaintiff reported to Dr. Rehman that she had weaned herself
from opioids and was instead relying on medical marijuana to
treat her fibromyalgia, and Plaintiff attested in a December
2018 affidavit submitted as part of her appeal review process
that she “no longer use[s] opioid medications.”
(ECF No. 11-19, at 156).
Russell's review occurred in March 2019 and includes
nothing which refutes Plaintiff's and Dr. Rehman's
timeline of Ms. Krysztofiak's opioid use. Rather, Dr.
Russell appears to have considered Dr. Rehman's July 2018
report that Ms. Krysztofiak was “off all of her pain
medications and is taking medical marijuana which seems to be
helping the fibromyalgia symptoms.” (Id., at
109). Dr. Russell nonetheless addressed his criticism of Ms.
Krysztofiak's treatment specifically and exclusively to
her use of opioids for fibromyalgia, writing that
“[t]he prescribed opiate ...