United States District Court, D. Minnesota
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[Copyrighted Material Omitted]
For Rodney Waldoch, Plaintiff: Denise Yegge Tataryn, KrisAnn Norby-Jahner, LEAD ATTORNEYS, Hellmuth & Johnson PLLC, Edina, MN.
For Medtronic, Inc., Defendant: Charles G Frohman, Jonathan S Parritz, LEAD ATTORNEYS, Stephanie K Bitterman, Maslon Edelman Borman & Brand, LLP, Mpls, MN.
JOAN N. ERICKSEN, United States District Judge.
Plaintiff Rodney Waldoch (" Waldoch" ) brought this action under the Employee Retirement Income Security Act (" ERISA" ), 29 U.S.C. § § 1001-1461 (2006), against Defendant Medtronic, Inc. (" Medtronic" ), his former employer, seeking recovery of Long Term Disability (" LTD" ) benefits under an employee benefit plan. Now before the Court are the parties' Cross-Motions for Summary Judgment.
I. BACKGROUND 
A. The Disability Plan
Waldoch began working for Medtronic as a Senior Buyer/Planner on January 15, 2001. He was terminated for performance reasons on November 24, 2008. During Waldoch's employment, Medtronic maintained a Long-Term Disability Plan (" Plan" ). The Plan is self-funded, and Medtronic serves as the Plan Administrator. Hartford was the appointed Claims Administrator under the Plan.  The Plan provides:
Long Term Disability is designed to provide benefits for qualifying disabilities lasting longer than 26 weeks . . . .
Benefits may not begin until:
o You have been Totally Disabled for 26 weeks in a rolling 12-month period, and
o You have provided documentation satisfactory to Medtronic or its delegated claim administrator proving that you are Totally Disabled.
The Plan defines " Total Disability" and " Totally Disabled" as follows:
During the 26-week elimination period and during the first year that you are receiving Long Term Disability Benefits, you are considered to be Totally Disabled if you are under the care of a Physician and prevented from performing each of the essential functions of your regular occupation because of an illness or accidental injury and you are not working at all. The one year period begins on the first day as of which you have been approved to receive Long Term Disability Benefits.
To be considered Totally Disabled after this period of time, the illness or accidental injury must prevent you from working at any occupation for which you are, or could reasonably become, qualified by education, training or experience, and you are not working at all.
To file a claim for LTD benefits, the employee must submit an application to
the Claims Administrator. The Plan provides that the Claims Administrator must be able to obtain records and other information from physicians, health care professionals, and vocational experts who have treated, diagnosed, or evaluated the employee. If necessary, the " Claims Administrator may secure independent medical or other advice and require such other evidence as it deems necessary to decide your claim." Within a reasonable time, the Claims Administrator will then " render a decision," and provide written notice of an adverse benefit determination. If the claim is denied, the employee " may appeal the decision to the Claims Administrator," who " will review and consider all written comments and other information [the employee] submit[s]" with the appeal. The Claims Administrator must review and decide the appeal within a reasonable time.
The Plan also provides that as part of the application process, the employee " must provide medical evidence, satisfactory to Medtronic or its delegated claims administrator, of your Total Disability." The employee must provide " proof of your claim," which " consists of the application for Long Term Disability Benefits and such additional medical, vocational and financial information satisfactory to Medtronic and necessary in Medtronic's judgment to verify that you are Totally Disabled." The Plan further provides that " [t]he Plan Administrator has complete and total discretionary authority to interpret and administer the Plan." Additionally,
The Senior Vice President of Human Resources, Vice President of Compensation and Benefits or Director of U.S. Benefits, have the authority and responsibility to interpret the Plan, make rules, determine eligibility for benefits, determine coverage and benefit amounts, and resolve all claims and disputes regarding the Plan. The decisions of the Senior Vice President of Human Resources, Vice President of Compensation and Benefits or Director of U.S. Benefits are final and binding on all persons. The Senior Vice President of Human Resources, Vice President of Compensation and Benefits or Director of U.S. Benefits may further delegate any and all authority under the Plan as they deem appropriate.
B. Waldoch's Medical History
Waldoch was diagnosed with Type I Diabetes Mellitus in 1969 at the age of ten. In his late teens, he was diagnosed with diabetes-related retinopathy and peripheral neuropathy. Waldoch was treated by an internal medicine physician as well as an endocrinologist, and in 2000 he began using an insulin pump to help control his blood sugars. Medical records from 1999 and 2000 note that Waldoch maintained good control of his diabetes.
In March 2003, Waldoch saw his primary care physician, Dr. Anita Buckler, to whom he reported that he felt fatigued after a day of work, and that " his stress level has affected his blood sugar level." AR 2856-57. In July 2004, Waldoch's endocrinologist, Dr. John Bantle, wrote a letter to Medtronic advising that Waldoch's " diabetes control has recently been aggravated by the substantial stress he is under at work" and recommended that
Waldoch's work schedule be reduced to thirty-two hours a week if possible. Id. at 2494. In December 2004, Dr. Buckler also advised Medtronic that " due to medical conditions," Waldoch should not work over thirty-two hours a week. Id. at 2495.
In April 2005, Dr. Bantle noted that Waldoch " continued to struggle with controlling his diabetes in the face of what he thought was a large amount of stress and pressure in his work place." Id. at 3026. Waldoch reported symptomatic hypoglycemia that occurred once or twice per week, and " [a]ll episodes had been easily recognized and treated." Id. Dr. Bantle described Waldoch's diabetes as " well controlled." Id. On May 9, 2005, Dr. Buckler wrote a letter describing Waldoch's diabetes-related problems, such as retinopathy, neuropathy, and calf-tightening, as well his hypertension, hyperlipidemia, and carpal tunnel syndrome. She explained that because of these difficulties, Waldoch suffered from fatigue and anxiety. Id. at 2509. She stated that Waldoch needed to closely monitor and control his blood glucose and regulate his diet and activity levels closely. Id. According to Dr. Buckler, such monitoring " can interfere with job requirements, at times, if there is a timing issue on the tasks." Id. Waldoch also obtained a letter from Ann Macheledt, a Program Manager for the State of Minnesota's Staying on the Job Program. Ms. Macheledt wrote that Waldoch suffered from fatigue, " [d]ifficulty with concentration and focus, that is more prevalent when he is fatigued," and " [d]ifficulty with stress and the affects [sic] that stress has on his diabetes." Id. at 2507. According to Ms. Macheledt, Waldoch " described stress at work as resulting from the unpredictability or uncertainty of his daily job activities, in a work environment that is primarily tactical and reactive in nature." Id. She also stated in her letter that Waldoch had " [d]ifficulty with fluctuating blood sugars (highs and lows), which are influenced by stress." Id.
On October 4, 2005, Waldoch saw endocrinologist Dr. William L. Isley, who noted that Waldoch had not had " a severe hypoglycemic spell in the last year," but that he had lost certain symptoms as a warning for hypoglycemia. Id. at 265. Dr. Isley also stated that Waldoch " has had fatigue for about four years and has gotten progressively worse." Id. Dr. Isley diagnosed Waldoch as having " hypoglycemia unawareness." Id. at 267. In January 2006, Dr. Isley wrote a letter to Ann Macheledt, again stating that Waldoch suffered from " hypoglycemia unawareness," along with other diabetes-related conditions. Id. at 2528. Dr. Isley stated that he would " support a four-day work week to help Mr. Waldoch more effectively manage his diabetes," and that it would be helpful if Waldoch " did not work extra hours during his regular work days to try to help improve management of his diabetes." Id.
Waldoch saw endocrinologist Dr. Victor M. Montori on October 31, 2007. Dr. Montori noted that Waldoch's diabetes was " well-controlled," but that " examination of his self monitored glucose reveals quite a bit of glucose variability." Id. at 4379-80. Dr. Montori suggested adjusting Waldoch's insulin and improving his carbohydrate counting skills. On April 8, 2008, Kathleen J. Wangen, a nurse in the Mayo Clinic's endocrinology department, entered a note stating that Waldoch " describes some days at work as being very stressful and his insulin needs are greater on those days." Id. at 4365. On May 27, 2008, Dr. Montori noted that Waldoch had " less glucose variability" and had been achieving " good results." Id. at 4363-64. Dr. Montori also stated that Waldoch " clearly is stressed about work (Medtronic has announced a layoff in his area) and this also has chronically affect [sic] his ability to
cope with his disease." Id. " Nonetheless, he is improving and he knows this." Id. On July 30, 2008, Dr. Montori received an email from Waldoch indicating that Waldoch had very elevated blood sugars. Dr. Montori noted that " [t]his appears to be related to stress related to his job," and recommended that Waldoch " engage in physical activity to manage both problems." Id. at 4360.
On September 8, 2008, Dr. Montori noted that Waldoch's " blood sugar control on average is better than before and he does not have the extreme low blood sugars that he had when we first met," but that he continued to have wide blood sugar ranges. Id. at 4358. Dr. Montori stated that " [u]nfortunately, job difficulties have continued and contribute to [Waldoch's] overall stress," in turn leading to more variability in Waldoch's blood sugars. Id. " Confounding this is the presence of binding insulin antibodies." Id. According to Dr. Montori's note, Waldoch was " exploring the impact that his work and stress is causing on his diabetes control and is considering looking for an alternative job accommodations." Id. Waldoch had noted that " every time he is off work or in a better work environment, his blood sugars improve." Id. Dr. Montori encouraged Waldoch " to look for alternative jobs that would provide him with an environment that would be conducive to better self management." Id.
On January 21, 2009, after his termination from Medtronic, Waldoch saw endocrinologist Dr. Sumit Bhagra. Dr. Bhagra noted that Waldoch " report[ed] that his job schedule was stressful, and there were constant deadlines which prevented him from paying the required amount of attention to diabetes management." Id. at 4352-54. Dr. Bhagra also commented on Waldoch's elevated insulin antibodies, stating that " these might contribute to unpredictable insulin delivery." Id. That same day, Dr. Yogish C. Kudva, another endocrinologist, reported that Waldoch's hypoglycemia was " [m]ild; one to three times in the last 30 days," and that Waldoch did have hypoglycemic awareness. Id. at 4348. On February 4, 2009, Dr. Kudva saw Waldoch for a follow-up of his " significant glucose variation." Id. at 4349. Dr. Kudva noted that Waldoch's " significant titer of insulin antibodies . . . might correlate with increased glucose variation but scientifically we do not have the best proof for this." Id. Dr. Kudva stated that it was very " challenging" for Waldoch to manage his diabetes and perform well at work, although Waldoch had " done this very well for 40 years." Id. After another visit on April 2, 2009, Dr. Kudva noted that Waldoch " has had no hypoglycemic episode entered into the pump" and that Waldoch did have some warning regarding hypoglycemia. Id. at 4338-39. He " congratulated [Waldoch] on his self care" and described Waldoch's diabetes as under " reasonable control." Id.
On May 12, 2009, Waldoch saw primary care physician Dr. Robert B. Howe, who noted that Waldoch " lost his job for under performance but cannot relate that directly to his blood sugar levels." But Waldoch's blood sugar levels " have not been checked in a manner to determine that." Id. at 4246. Waldoch saw Dr. Montori on July 6, 2009 to discuss applying for long-term disability. Dr. Montori stated that " [i]t is clear that Mr. Waldoch has a difficulty associated with type I diabetes and that this difficulty involves mostly the unpredictability of his blood sugars." Id. at 4345. Dr. Montori noted that having a continuous glucose monitor may help Waldoch " achieve better diabetes control and prevent hypoglycemia." Id. Dr. Montori explained the need to deal with the " behavioral aspects of [Waldoch's] condition,"
stating that Waldoch's treatment should include " behavioral psychological support" to deal with Waldoch's " anxiety associated with high blood sugars." Id. Dr. Montori noted the existence of insulin antibodies, to which Waldoch had " attributed . . . the variability in his blood sugars." Id. Dr. Montori believed that " a big part of the work in the future for Mr. Waldoch will be to deal with this and to refocus energies on the behavioral aspects that could help cope and overcome with the difficulties that his biology may pose to him." Id. " Thus, I expect Mr. Waldoch eventually to return to local employment if he is able to manage a more predictable glucose regimen, which again I hope we can achieve with this three-prong approach." Id. With respect to Waldoch's LTD application, Dr. Montori stated that " we have gone ahead and filled the paperwork for his long-term disability to provide him potentially with financial support that will, in addition to the technical and behavioral support, regain his health and hopefully return to work and become, once again, a productive member of society." Id.
Waldoch saw endocrinologist Dr. Bantle on July 16, 2009, who described Waldoch's diabetes as " well controlled." Id. at 4244-45. He noted that although Waldoch " described symptomatic hypoglycemia that occurred on most days," the hypoglycemia " was always easily recognized that treated" and that there " was no history of serious hypoglycemia." Id. On July 30, 2009, Dr. Kudva noted that Waldoch's hypoglycemia awareness was " quite good," but that he had a " variable glucose threshold for recognition" and that " his adrenergic symptoms are not as pronounced." Id. at 4312. Waldoch " still has hypoglycemia about four to five times/week with symptoms and twice a week or so without symptoms." Id. Dr. Kudva described Waldoch has having " significant glucose variability." Id. On September 1, 2009, Dr. Kudva stated that Waldoch's " adrenergic symptoms with hypoglycemia are less," and that Waldoch " more often than not . . . has hypoglycemia with less symptoms now," occurring four to five times per week. Id. at 4327. Waldoch also continued to experience fatigue. Dr. Kudva remarked that Waldoch's " overriding of the bolus [of insulin] does result in some hypoglycemia for him," and Dr. Kudva " [e]ncouraged him to decrease overriding and to work at adjusting his bolus setting." Id.
On September 4, 2009, Waldoch saw another endocrinologist, Dr. Mark Stesin. Dr. Stesin noted that Waldoch had hypoglycemia " at least 50% of days, almost always afternoon [and] evening" and that Waldoch had " [s]ome hypoglycemic unawareness, esp[ecially] if active at time of low sugar." Id. at 4414. He also stated that Waldoch had " good awareness/able to self treat." Id. at 4419. On October 26, 2009, Dr. Stesin reported that Waldoch had " improving control" over his blood sugars, with values mostly between 90-150. Id. at 4420. On January 26, 2010, Dr. Stesin noted that Waldoch's diabetes was " stable overall." Id. at 4421. In other office notes, Dr. Stesin remarked that Waldoch's diabetes was " stable," id. at 4409, and that his control was " improving," id. at 4412.
On December 1, 2010, Waldoch saw endocrinologists Dr. Kalpana Muthusamy and Dr. Kudva. Dr. Muthusamy remarked that Waldoch had " significant glycemic variability and difficult-to-control diabetes over several years in the setting of positive insulin antibodies." Id. at 3455. Waldoch was experiencing " hypoglycemic episodes almost on a daily basis," with " reduced glycemic awareness." Id. Dr. Muthusamy also noted that " [t]here is equal ...