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Ingram v. Metropolitan Life Insurance Co.

August 25, 2006


The opinion of the court was delivered by: Garnett Thomas Eisele United States District Judge


This case arises under the Employment Retirement Income Security Act ("ERISA"). Plaintiff appeals the denial of benefits under the Long Term Disability Insurance Plan (hereinafter "the Plan"). Presently before the Court is Plaintiff's Motion for Judgment on the Administrative Record and Defendants' Motion for Summary Judgment. As Defendants' Motion requests judgment in its favor based upon a review of the administrative record, the Court will consider Defendant's Motion for Summary Judgment as, instead, a Motion for Judgment on the Administrative Record.

I. Background

Plaintiff William E. Ingram worked as a maintenance mechanic with Defendant Eastman Chemical Company ("Eastman") from December 1988 to September 2003, and was a participant in the Eastman Long Term Disability Plan ("the Plan"). Metropolitan Life Insurance Company ("MetLife") served as the claims administrator of the Plan.

Mr. Ingram submitted a long-term disability claim to MetLife on May 17, 2004, listing Dr. Dennis Davidson as his primary physician, Dr. Bruce Safman as the physician treating his fibromyalgia, Dr. Wayne Bruffet as the physician treating his lumbar diskogenic pain, Dr. M. Ismail as the physician treating his lower back pain and hypertension, and Dr. Margaret Kuykendall as the physician treating his chest pains. With his long-term disability claim, Mr. Ingram submitted an Attending Physician's Statement ("APS") from Dr. Safman.

In the APS, Dr. Safman indicated Mr. Ingram's primary diagnosis to be "fibromyalgia with chronic fatigue, IBS", and the secondary diagnosis to be degenerative disc disease. Dr. Safman noted Mr. Ingram's physical ability "varies with activity of fibromyalgia - may differ day to day" and notes no other physical restrictions or limitations.

MetLife requested an Employability Assessment from a certified rehabilitation consultant, Deborah Mix. Relying upon the medical evaluation report dated July 23, 2004, Ms. Mix noted that Mr. Ingram could lift or carry up to twenty-five (25) pounds, lift up to ten (10) pounds above shoulder level, push or pull up to twenty-five (25) pounds, and stand or sit for up to two hours. With these physical limitations, Ms. Mix concluded that Mr. Ingram was capable of performing a "light duty" job, and identified several positions from a Labor Market Survery which Mr. Ingram was capable of performing.

MetLife denied Mr. Ingram's claim for long-term disability benefits on August 5, 2004. Mr. Ingram appealed this determination. MetLife referred the appeal to Dr. Robert Porter for a medical review. Dr. Porter concluded that Mr. Ingram could perform light to medium duty work and that the medical records did not support a disabling condition requiring any significant restrictions or limitations on Mr. Ingram's work abilities. Dr. Porter noted that Mr. Ingram's angiograms showed only mild hypertension, and that Dr. Safman's diagnosis of fibromyalgia was not supported with evaluations of site-specific tender points or control points. Based upon Dr. Porter's assessment and a finding that light duty positions were available in Mr. Ingram's geographical area, MetLife upheld its initial determination and denied Mr. Ingram's appeal on February 7, 2005.

On September 5, 2004, the Social Security Administration awarded Mr. Ingram with Social Security Disability benefits as of March 2004. (AR054).

II. Medical History

Dr. Dennis Davidson, Mr. Ingram's primary care physician, has been treating Mr. Ingram for several years. On November 25, 2003, Dr. Davidson noted, "This 56-year-old hypertensive, dyslipidemic, white male with CAD, fibromyalgia, and lumbar discogenic pain presents here in the office today for follow-up of these multi clinical problems." (AR039). On May 26, 2004, Dr. Davidson reported "[Mr. Ingram] complains of a productive cough that is greenish in color at times which has been going on for two weeks. His eyes are mattery at times as well. He also wants to discuss the Tricor; he has no leg strength and feels like it is the medicine. He has been out for over one week and would like to try something different. He says his joint/back/leg pain is a limiting factor for activity. His fibromyalgia is acting up and always bothers him a little." (AR082). In September 2003, Dr. Davidson referred Mr. Ingram to a specialist, Dr. Bruce Safman, a physical medicine and rehabilitation physician with Arkansas Specialty Care Centers.

Dr. Safman saw Mr. Ingram on September 5, 2003 and concluded, "I believe this gentleman has classical fibromyalgia. Although I did put him on work restrictions, I suspect that he will be a candidate for social security disability. I suspect fibromyalgia is the major cause of his disability rather than the degenerative disc disease." (AR038). Dr. Safan noted that an MRI revealed that Mr. Ingram "has severe degenerative disc disease L2-L3. There is no significant disc herniation." (AR037). On June 25, 2004, Mr. Ingram complained of an exacerbation of his symptoms associated with the weather, and Dr. Safman gave Mr. Ingram a trigger point injection. Mr. Ingram continued to visit Dr. Safman on a monthly basis from September 17, 2003 through September 25, 2004. By letter dated August 6, 2004, Dr. Safman wrote: "With the fibromyalgia, fatigue and chronic aches and pains, I do not think he is capable of continuing to perform vigorous physical activity on an ongoing basis. The activity with fibromyalgia tends to fluctuate." (AR049). On August 19, 2004, Dr. Safman wrote: "Mr. Ingram was denied disability. He has hired an attorney to assist him. The patient reports that he is having an exacerbation of symptoms. He is in the process of being terminated from work. The patient is under a great deal of stress. He reports that his restless leg syndrome has exacerbated. He is not sleeping at night. His depression has increased. On examination, he has a great deal of tenderness and trigger points in the upper trapezius muscles and lower lumbar paravertebral muscles. He has diffuse trigger points elsewhere but they are less severe." (AR048).

Dr. Bruffett, an orthopedic surgeon, examined Mr. Ingram on July 15, 2002 for back pain. Dr. Bruffett observed that Mr. Ingram walked with a normal gait, could go up on his toes and heels without difficulty, had diminished range of motion of the lumbar spine, had normal and painless range of motion in his hip, and had no edema or atrophy. An MRI revealed no problems requiring surgery and Dr. Bruffett concluded that Plaintiff should be referred to a non-operative specialist if further treatment was warranted. (AR238).

Dr. Kuykendall saw Mr. Ingram on June 11, 2003 and noted "Exertional chest pain -vague, short lived chest pain which is nevertheless suspicious for angina given its predictable occurrence with activity and relief with rest." (AR140). Dr. Kuykendall also noted that Mr. Ingram's hypertension was "well controlled presently", and from a nuclear ...

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