Moon v. UNUM Provident Corp ( 2005 )


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  •                         NOT RECOMMENDED FOR PUBLICATION
    File Name: 05a0206n.06
    Filed: March 22, 2005
    No. 03-1626
    UNITED STATES COURT OF APPEALS
    FOR THE SIXTH CIRCUIT
    DIANE M. MOON,
    Plaintiff-Appellant,
    v.                                                    ON APPEAL FROM THE UNITED
    STATES DISTRICT COURT FOR THE
    UNUM PROVIDENT CORPORATION,                           WESTERN DISTRICT OF MICHIGAN
    Defendant-Appellee.                            OPINION
    /
    BEFORE:        SILER and CLAY, Circuit Judges; BERTELSMAN, District Judge.*
    CLAY, Circuit Judge. In this action for long-term disability (“LTD”) benefits pursuant to
    an employee benefits plan governed by the Employee Retirement Income Security Act of 1974
    (“ERISA”), 29 U.S.C. §§ 1001 et seq., Plaintiff Diane Moon appeals the district court’s denial of
    her motion for judgment on the administrative record. The district court held that the final decision
    of Defendant Unum Provident Corporation (“Unum”) to uphold the termination of Moon’s disability
    benefits was not arbitrary and capricious. We disagree and REVERSE.
    I. BACKGROUND
    Unum is Moon’s long-term disability insurer. Moon’s insurance plan (the “plan”) is
    sponsored by her employer, Borgess Medical Center (“Borgess”). Moon and Unum agree that the
    *
    The Honorable William O. Bertelsman, United States District Judge for the Eastern District
    of Kentucky, sitting by designation.
    No. 03-1626
    plan vests Unum with discretionary authority to determine eligibility for benefits. The plan defines
    “disabled” as follows:
    You are disabled when Unum determines that:
    - you are limited from performing the material and substantial duties of your regular
    occupation due to your sickness or injury; and
    - you have a 20% or more loss in your indexed monthly earnings due to the same
    sickness or injury.
    J.A. 10. At the outset, we note that this appeal concerns only the first requirement of this definition.
    Moon worked in a clerical capacity in the admitting department at Borgess. Her title was
    “business associate” and her duties included typing, filing, and some writing. On June 17, 2000,
    Moon was admitted to Borgess as a patient due to the onset of various incapacitating symptoms
    associated with hypertension, i.e., unusually high blood pressure. The symptoms included severe
    chest pains. The primary diagnoses, as reported in a “Clinical Resume” prepared by Doctor Stephen
    Reagan, were: (1) atypical chest pain; (2) chronic stage III hypertension; and (3) hypertensive
    emergency. In addition, Moon was diagnosed with a history of hypertensive emergency and
    hypertensive crisis. The clinical resume observed: “[t]his is a 39-year-old woman with a history of
    frequent admissions [to the hospital] for chest pain, who presented to the emergency room with acute
    onset of left sided atypical and typical features of acute coronary disease.” J.A. 8. Dr. Reagan
    consulted Doctor Robert Lapenna, Moon’s hypertension specialist, and the two agreed on June 23,
    2000, that after nearly a week in the hospital, Moon could be discharged. However, the conditions
    of discharge were that Moon receive “VNA home care and [a] prompt followup with her primary
    care physician, Dr. Stacy Watson, with whom [Dr. Reagan] discussed the case.” 
    Id. 2 No.
    03-1626
    Chronic hypertension and the related severe chest pains it caused were not Moon’s only
    health problem. Since 1992, she had suffered from progressively-worsening thumb pain. In
    September 2000, Moon’s primary care physician, Dr. Watson, described Moon’s thumb pain –
    which existed in both hands – as “severely limiting [her] activity.” J.A. 13.
    After her hospitalization in late June 2000, Moon’s condition did not improve. Dr. Watson
    determined that Moon was not able to return to work and on September 16, 2000, Moon filed a claim
    with UNUM for long term disability benefits. The claim form cited uncontrolled hypertension as
    the reason for Moon’s inability to work. In the Physician’s Statement portion of the claim form,
    Watson explained that Moon suffered from “severe labile hypertension” and, secondarily, from
    bilateral thumb pain which “severely limit[s]” her activity. J.A. 13. Watson further expressed
    concern about Moon’s excessively high blood pressure and advised that Moon could not exert
    herself by climbing stairs or remaining active for 1-2 hours without frequent resting. 
    Id. at 14.
    Finally, Watson prohibited Moon from lifting more than 10 pounds and engaging in “strenuous
    activity with any prolonged walking.” 
    Id. On the
    basis of Watson’s diagnosis and instructions, Unum granted Moon’s claim, citing a
    disability onset date of June 17, 2000. In its December 19, 2000 letter, granting Moon’s claim,
    Unum did not explain whether it granted benefits because of the hypertension, the thumb pain, or
    both. On September 6, 2001, Unum reversed course and terminated Moon’s benefits as of August
    27, 2001. In a letter to Moon, Unum asserted that according to its reviewing physician, “there is no
    medical data to support restrictions and limitations preventing you from returning to work in your
    own occupation.” J.A. 27. In reaching this conclusion, Unum relied on its own review of Moon’s
    3
    No. 03-1626
    medical records, including reviews performed by a clinical consultant and by physicians employed
    by Unum.
    Specifically, Unum’s in-house reviewing physician, Dr. Steven Feagin, reported that “[t]here
    is nothing presented to objectively support impairment that would produce limitations or necessitate
    restrictions from [light work] activities.” J.A. 7. Feagin cited an August 10, 2000, “exercise study”
    in which Moon demonstrated what Feagin described as “poor exercise tolerance for [her] age.” 
    Id. Nevertheless, Feagin
    concluded that Moon’s performance “still equates to sustained light work on
    a full-time basis.” 
    Id. Feagin further
    noted that according to Moon’s cardiologist, Dr. Janos Gellert,
    Moon did not have a cardiac problem. J.A. 19. However, in a June 17, 2000 letter to Watson,
    Gellert specifically lists as a risk factor the fact that Moon “has hypertension which is not easy to
    control.” J.A. 18. Regarding Moon’s thumb pain, Feagin concluded that there was no objective
    basis to view Moon as unable to work with accommodations.
    After her LTD benefits were terminated, a Michigan Worker’s Compensation hearing officer
    granted Moon worker’s compensation benefits, finding that Moon’s bilateral thumb pain rendered
    her unable to do the file-lifting and writing that was a necessary component of her job in the Borgess
    admitting department.
    In October 2001, Moon filed an administrative appeal of Unum’s termination of her LTD
    benefits. In the appeal letter, Dr. Watson urged Unum to reconsider, concluding: “Mrs. Moon is
    essentially disabled, and because of her ongoing medical problems, is absolutely not able to return
    to work. Despite multiple cardiac, radiological, and other evaluations, a source for her extremely
    labile and symptomatic hypertension has not been determined. Medication is only moderately
    4
    No. 03-1626
    effective in controlling this and, in essence, she is not able to hold down a full time job. In fact, she
    is unable to do most of her daily activities around the house because of the hypertension causing
    chest pain and shortness-of-breath.” J.A. 36. To this letter, Watson attached medical records from
    cardiologist Dr. Robert LaPenna, who had examined Moon in September 2001, and from Watson
    herself, who had examined Moon in March and June 2001. Watson’s records establish that Moon’s
    severe hypertension did not show a likelihood of abating. In addition, Watson’s patient chart notes
    reflect that Moon suffered bouts of depression, for which Watson prescribed anti-depressants, and
    sharp fluctuations in blood pressure. Lapenna’s records establish that Moon had “typical exertional
    angina,” but her coronary arteries were functioning normally; Lapenna recommended that cardiac
    rehabilitation proceed. Lapenna, however, did not suggest that Moon was able to work.
    As it had with respect to Moon’s initial claim, Unum assigned Feagin the task of reviewing
    Moon’s appeal submissions. On November 7, 2001, Feagin reported that his “prior impressions are
    unchanged and reinforced by appeal submissions.” J.A. 40. Feagin reasoned that Moon’s records
    disclosed no “objective evidence of cardial pulmonary or hypertensive impairment producing
    limitations or necessitating restrictions that would preclude regular sustained full-time sedentary or
    light work endeavors.” 
    Id. On the
    basis of Feagin’s review and report, Unum denied Moon’s appeal
    on November 12, 2001. Beginning on February 18, 2002 and continuing through May 2002, Moon,
    through counsel, submitted new medical evidence to Unum, including evidence adduced at Moon’s
    Worker’s Compensation hearing and at a Social Security benefits hearing; Moon prevailed on her
    Social Security claim and began receiving disability benefits from the Social Security
    Administration in May 2002. Dr. Feagin again was charged with reviewing Moon’s case. And
    5
    No. 03-1626
    again Feagin concluded that Moon had failed to present any objective evidence to support her claim
    that she was unable to work. Specifically, Feagin observed: “It is of note that the deposition of Dr.
    Watson reveals rather unorthodox opinions with respect to the impact of hypertension on work
    capacity.” J.A. 198.
    The “deposition” to which Feagin referred was testimony Watson gave at Moon’s Social
    Security hearing. Watson testified there that she was Moon’s primary treating physician and had
    treated Moon for severe hypertension. Watson explained that with respect to Moon’s bilateral
    thumb pain, she would defer to Dr. James Smith, who was the specialist treating Moon for that
    condition. Watson testified that Moon suffered from “labile hypertension,” which she described as
    blood pressure that “goes up and down . . . [i]t fluctuates and is mostly uncontrolled.” J.A. 186. In
    Watson’s view, the labile hypertension had a significant impact on Moon’s ability to work on an
    ongoing basis. Specifically, Watson explained: “[Moon’s labile hypertension] is unable to be
    controlled. We can find no other underlying etiology causing it that we can treat. She’s on multiple
    medications, but, yet, she still has fluctuations of very high blood pressure that cause severe
    headaches, even chest pains. She’s really not able to function being up on her feet like going to the
    grocery store for any prolonged length of time because of this blood pressure problem.” J.A. 184-
    85. Watson determined that Moon should sit or stand for “not more than one or two hours out of
    an eight-hour day.” J.A. 182. Watson reached this conclusion on the basis of routine blood pressure
    checks performed between 1999 and 2001 by Watson and other doctors, see J.A. 169, 181-82, which
    demonstrated “dangerously elevated” blood pressure levels. J.A. 180.
    6
    No. 03-1626
    Due to these dangerously high blood pressure levels, Watson insisted that Moon spend most
    of her time reclined. Watson repeatedly asserted that Watson could not work. When asked: “Is
    there any way in your mind that a person could work with this blood pressure,” Watson responded:
    “No.” J.A. 180. Watson further explained that the level of stress at Moon’s job was essentially
    irrelevant because Moon’s blood pressure fluctuated dramatically wherever she happened to be.
    Finally, Watson laid out her reasoning under questioning:
    QUESTION: Let’s suppose that her hands were no problem, that the stuff that Dr.
    Smith’s been treating her for wasn’t any issue. Would you or would
    you not think that solely on the basis of her blood pressure, she was
    disabled from regular, full-time employment no matter how light, no
    matter how simple?
    ANSWER:        Yes.
    Q:             You would?
    A:             I would.
    Q:             Just to give you some examples, one of the jobs that Social Security
    uses is what’s called a security monitor. You watch closed circuit
    TVs and, if you see something on the TV like an intruder or
    something, you call the authorities. You’ve got to be there six or
    eight hours, but, literally, all you’re doing is watching TV. Do you
    think she could do that?
    A:             No, I don’t.
    Q:             Why not?
    A:             Again, just a sitting position for her can make her blood pressures
    rise to the point where she has significant side effects, and, I don’t
    believe that she could sit for a six-hour period.
    Q:             Even with standard breaks and a lunch and that sort of thing?
    7
    No. 03-1626
    A:              Even with those, I don’t believe so.
    Q:              Okay. And, your opinion then is that this has been the case since, I
    think you said, December of 1999, is that right?
    A:              Yes.
    ...
    Q:              . . . Is there anything else that you can think of that would help a
    judge understand the nature of this problem and why it’s disabling
    that we haven’t covered?
    A:              In her case, we don’t know why she has this. We have tried every
    means possible to get it under control, and, although the medication
    that we have can help alleviate some of those side effects, in and of
    itself, the medication can cause side effects such as sedation,
    confusion, so, no matter what we do with her, even if we treat what
    we can treat, which is not completely effective, she gets side effects
    from what we use to treat her as well.
    ...
    Q:              Okay. Anything else you can think of to add, Doctor?
    A:              I think this lady really would like to work if she could. She really
    does have a strong work ethic, and, she wants to provide for her son.
    She just simply is not physically able no matter what she has tried,
    and, she’s been willing to undergo any tests we have asked her to
    undergo, and, we simply can’t determine a cause for her problem.
    J.A. 176-79. The Social Security administrative law judge (“ALJ”) found that Moon’s “allegation
    of intractable and debilitating labile hypertension with chest pain is credible.” J.A. 168. Further the
    ALJ concluded: “[Moon]’s impairment prevents her from sitting, standing, or walking for prolonged
    periods or concentrating upon tasks . . . . [Moon] is unable to perform her past relevant work.” 
    Id. Despite Watson’s
    detailed testimony and the ALJ’s findings, Feagin concluded that Moon’s
    second appeal submissions presented no new objective information. Feagin rejected Watson’s
    8
    No. 03-1626
    conclusion that Moon was unable to perform light sedentary work. Specifically, Feagin found no
    reason to conclude that Moon could not stand or sit because, in contrast to Watson’s “formulation”
    that Moon’s blood pressure typically increased when she was sitting or standing, “one typically sees
    higher pressures in the supine position.” J.A. 198. Feagin relied upon an examination of Moon
    performed by Dr. Mark O’Brien at the request of Borgess, the defendant in Moon’s worker’s
    compensation proceeding. Feagin points out that a blood pressure measurement taken by O’Brien
    in the May 31, 2001 examination reflects a higher blood pressure level in the supine position than
    in the sitting position. Thus, Feagin concluded that the Social Security ALJ “was therefore flawed
    in his acceptance of the unsupported contention that the hypertension prevented prolonged sitting,
    standing, or walking.” J.A. 198-99. Feagin was similarly unswayed with regard to Moon’s bilateral
    thumb pain. Feagin’s report for Unum did not mention that in the discussion section of his May 31,
    2001 report, O’Brien stated: “Diane has chronic severe hypertension, which has been refractory to
    multiple medications. Please note: hypertension means high blood pressure and should not be
    equated with emotional anxiety or tension. She is apparently intolerant of calcium channel blockers,
    which cause flushing. Her blood pressure control is not optimal . . . . The blood pressure currently
    is not well controlled almost one year following her last day of work which implies her occupation
    is not causing the hypertension.” J.A. 114.
    Based on Feagin’s determinations, Unum upheld its termination of Moon’s LTD benefits by
    letter dated July 11, 2002. Just over two months later, on September 18, 2002, Moon filed a
    complaint in the Western District of Michigan under ERISA, 29 U.S.C. § 1001 et seq. Moon moved
    for judgment on the administrative record. After hearing arguments on April 15, 2003, the district
    9
    No. 03-1626
    court denied the motion and affirmed Unum’s final decision upholding the termination of Moon’s
    LTD benefits. Moon then filed this appeal.
    II. STANDARD OF REVIEW
    In an ERISA benefits case, we review de novo a district court’s decision to deny a motion
    for judgment on the administrative record. E.g., Spangler v. Lockheed Martin Energy Sys., 
    313 F.3d 356
    , 361 (6th Cir. 2002). The general rule is to review a plan administrator’s denial of ERISA
    benefits de novo. Firestone Tire & Rubber Co. v. Bruch, 
    489 U.S. 101
    , 115 (1989). However,
    where, as is the case here, a plan vests the administrator with complete discretion in making
    eligibility determinations, such determinations will stand unless they are arbitrary or capricious. 
    Id. Our review
    is confined to the administrative record as it existed on July 11, 2002, when Unum
    issued its final decision upholding the termination of Moon’s LTD benefits. E.g., Wilkins v. Baptist
    Healthcare Sys., 
    150 F.3d 609
    , 615 (6th Cir. 1998) (holding that the district court and the court of
    appeals are limited to reviewing the administrative record as it existed when the plan administrator
    made its final decision). If the administrative record so limited can support a “reasoned explanation”
    for Unum’s decision, the decision is not arbitrary or capricious. Williams v. Int’l Paper Co., 
    227 F.3d 706
    , 712 (6th Cir. 2000).
    Nevertheless, merely because our review must be deferential does not mean our review must
    also be inconsequential. While a benefits plan may vest discretion in the plan administrator, the
    federal courts do not sit in review of the administrator’s decisions only for the purpose of rubber
    stamping those decisions. As we observed recently, “[t]he arbitrary-and-capricious . . . standard
    does not require us merely to rubber stamp the administrator’s decision.” Jones v. Metropolitan Life
    10
    No. 03-1626
    Ins. Co., 
    385 F.3d 654
    , 661 (6th Cir. 2004) (citing McDonald v. Western-Southern Life Ins. Co., 
    347 F.3d 161
    , 172 (6th Cir. 2003)). Indeed, “[d]eferential review is not no review, and deference need
    not be abject.” 
    McDonald, 347 F.3d at 172
    . Our task at all events is to “review the quantity and
    quality of the medical evidence and the opinions on both sides of the issues.” 
    Id. In performing
    that task with respect to Moon’s case, we conclude that the record cannot support a “reasoned
    explanation” for Unum’s decision. See 
    Williams, 227 F.3d at 712
    .
    III. DISCUSSION
    Moon’s primary claim for LTD benefits is based on severe labile hypertension. Dr. Watson
    cited bilateral thumb pain as a secondary debilitation and the parties make passing reference to the
    thumb pain issue in their briefs, but it is clear that our focus must be on Moon’s hypertension. In
    any event, as we explain below, Unum offered a reasoned explanation for terminating Moon’s
    benefits to the extent they related to her thumb pain. However, Unum distinctly failed to do so
    regarding Moon’s hypertension. We now review the various medical evidence and opinions
    available to Unum at the time it decided to uphold the termination of Moon’s LTD benefits. Our
    review of the administrative record in its entirety compels the conclusion that Unum’s final decision
    was arbitrary and capricious.
    A.     Bilateral Thumb Pain
    Initially, we address Moon’s claim to the extent it relates to her thumb condition. We have
    very little to go on because the parties’ briefs discuss this issue only in a cursory fashion. The
    administrative record presented Unum with various evidence relating to Moon’s bilateral thumb pain
    but no definitive medical opinion regarding Moon’s ability to work. As our discussion below
    11
    No. 03-1626
    indicates, this is in contrast to the record regarding hypertension. Dr. Watson’s original physician’s
    statement from the September 2001 claim indicated that Moon’s thumb pain severely limited her
    activity. In addition, the record contained two depositions of Moon’s hand surgeon, Dr. James
    Smith. Smith was deposed in May 1999 and February 2001 pursuant to Moon’s worker’s
    compensation claim against Borgess. In the February 2001 deposition, Smith asserted that it would
    be difficult for Moon to work but admitted in cross examination that in his various examinations of
    Moon during 1999 and 2000, he permitted her to return to work and did not recommend specific
    restrictions that would conflict with her ability to perform her duties. Moreover, the record shows
    that Moon was last examined by Smith on May 25, 2000; subsequent to that examination, Moon
    returned to work at Borgess. The record further shows that the precipitating cause of Moon’s
    medical leave, which commenced on June 16, 2000, was her labile hypertension. In sum, the
    administrative record does not suggest that Moon would have been unable to work solely on account
    of her thumb pain even if her doctors were able to ameliorate her hypertension.1 As it was,
    1
    Unum’s decision with regard to the thumb pain was not arbitrary and capricious merely
    because it was at odds with the findings of a Michigan Worker’s Compensation officer who, in
    September 2001, granted Moon’s claim for worker’s compensation benefits. The hearing officer
    expressly noted that two doctors who had examined Moon, Drs. Smith and Wessinger, arrived at
    different conclusions regarding her ability to work in Borgess’s admissions department in a light
    sedentary capacity. The hearing officer elected to credit Dr. Smith to the extent he disagreed with
    Dr. Wessinger, who would have permitted Moon to work. J.A. 141. As we have previously held,
    where there are two reasoned medical opinions on an issue, it is not arbitrary and capricious to select
    one over the other. See 
    Mcdonald, 347 F.3d at 169
    . In addition, the hearing officer credited Dr.
    Smith even in light of his admissions on cross examination that he had not examined Moon since
    May 25, 2000. Unum observed when it terminated Moon’s benefits, and again when it upheld the
    termination, that the only medical opinions offered by Moon with regard to her thumb pain were
    based on examinations performed at a time when she was still working and by doctors who did not
    recommend that Moon stop working.
    12
    No. 03-1626
    however, her doctors were not able suppress the hypertension; it is to a discussion of this issue that
    we now turn.
    B.     Severe Labile Hypertension
    Regarding Moon’s hypertension, the medical evidence and opinions available to Unum were
    as follows. First, Unum had before it various records relating to Moon’s admission to Borgess in
    June 2000 for hypertension. Records compiled at that time by Dr. Reagan show that doctors at
    Borgess, including Reagan and Lapenna, had diagnosed Moon with atypical chest pain, chronic
    stage III hypertension, hypertensive emergency and a history of serious hypertension. The terms
    of Moon’s discharge, Reagan’s records show, were that she receive home care and prompt follow-
    ups from Dr. Watson. In addition, the discharge records from Borgess include a June 17, 2000
    memo from cardiologist Dr. Janos Gellert who found that Moon did not have a heart problem at that
    time but noted that her uncontrollable hypertension was a risk factor. Second, the administrative
    record included Dr. Watson’s September 2000 physician’s statement, filed as part of Moon’s
    original claim for LTD benefits, in which Watson explained that Moon could not engage in
    activities for more than one or two hours without frequent resting and could not lift more than 10
    pounds or engage in any strenuous activity.
    Third, the record contained Moon’s October 2001 appeal submissions, which included a
    letter from Watson to the effect that Moon was “absolutely not able to return to work,” and, indeed,
    could not perform daily activities due to her uncontrollable hypertension. Further records from
    Watson and records from Lapenna accompanied Watson’s letter, with Watson’s records showing
    that Moon’s hypertension continued to endure despite attempts at treatment, and Lapenna’s records
    13
    No. 03-1626
    showing that despite the absence of coronary problems, Moon retained “typical exertional angina.”
    Significantly, Lapenna was not asked, nor spoke to, whether Moon was able to work. Fourth, the
    administrative record included the report of Dr. O’Brien, who examined Moon in May 2001 on
    behalf of Borgess in relation to Moon’s worker’s compensation claim. O’Brien’s single blood
    pressure measurement reflects that Moon’s blood pressure was higher in the supine position than
    in the sitting position. Yet O’Brien did not comment on this; instead, he noted that Moon has
    “chronic severe hypertension, which has been refractory to multiple medications.” J.A. 114.
    Notable is the fact that O’Brien did not speak to whether Moon was able to work. Finally, Unum
    had Watson’s April 2002 Social Security testimony to consult. As recounted in detail above,
    Watson carefully explained in that testimony how Moon’s uncontrollable labile hypertension
    rendered her unable to work.
    As discussed above, Unum committed the analysis of this record to Dr. Feagin each time it
    was further developed with new submissions. Each time, Dr. Feagin rejected Watson’s medical
    opinion. Feagin’s own report indicates that the primary basis for rejecting Watson’s view was the
    blood pressure measurement performed on Moon by Dr. O’Brien in May 2001. Indeed, it is on the
    strength of this one measurement that Feagin described Watson’s view that Moon was unable to
    work as “unsupported.” This does not constitute a reasoned explanation for the termination of
    benefits in light of the administrative record available to Feagin. As we have discussed, O’Brien
    himself declined to make a prediction regarding Moon’s ability to work and did not even refer to
    the blood pressure measurement in his discussion of Moon’s condition. Instead, O’Brien’s analysis
    indicates the severity of Moon’s hypertension and its apparent immunity to various medicines. In
    14
    No. 03-1626
    addition to the fact that O’Brien’s overall analysis is consistent with Watson’s analysis, we note that
    he examined Moon only once. By contrast, Watson is Moon’s primary treating physician. And as
    we have recounted, Watson has consistently offered detailed explanations for her conclusion that
    Moon is unable to work.2
    According to Unum’s own documents, the only medical opinion contrary to Watson’s was
    Dr. Feagin’s. He arrived at his opinion not upon examination of Moon, but rather upon what our
    discussion here shows was a selective review of the administrative record. See 
    Spangler, 356 F.3d at 359-62
    (observing that a selective review of the administrative record is inappropriate).
    Furthermore, Dr. Feagin’s role was not as a neutral independent reviewer, but as an employee of
    Unum. It is not enough for Unum to offer an explanation for the termination of benefits; the
    explanation must be consistent with the “quantity and quality of the medical evidence” that is
    available on the record. 
    McDonald, 347 F.3d at 172
    . It must be a “reasoned explanation” that
    supports the outcome reached by the administrator. See id.; see also 
    Williams, 227 F.3d at 706
    . We
    determine whether an explanation is reasonable solely by reference to the administrative record; we
    ask whether, in light of the administrative record as a whole, the explanation to deny or terminate
    benefits makes sense. Furthermore, when a plan administrator’s explanation is based on the work
    2
    We do not hold that Unum was required to defer to Watson’s judgment. The Supreme
    Court has made clear that mandatory deference to treating physicians, while appropriate in the Social
    Security context, is not appropriate in the context of ERISA benefits determinations. Black &
    Decker Disability Plan v. Nord, 
    538 U.S. 822
    , 829-833 (2003). However, Black & Decker does not
    alter the typical arbitrary-and-capricious standard of review. We still must ask whether, viewing the
    administrative record as a whole, Unum has offered a reasoned explanation for its final decision.
    Dr. Watson’s letters and notes as well as her testimony, presented in the context of a Social Security
    hearing, are all part of the administrative record in this case.
    15
    No. 03-1626
    of a doctor in its employ, we must view the explanation with some skepticism. See Univ. Hosp. of
    Cleveland v. Emerson Elec. Co., 
    202 F.3d 839
    , 846 (6th Cir. 2000) (holding that a plan
    administrator’s conflict of interest is a factor to consider when reviewing for whether the
    administrator’s decision was arbitrary or capricious). With these principles in mind, we cannot
    conclude that Feagin’s explanation for rejecting Watson’s recommendation for her own patient was
    “reasoned.” As we have discussed, there was a wealth of medical evidence available to Feagin.
    Rather than contend with the reality that all of the doctors who examined Moon agreed she had
    chronic and severe hypertension which was not susceptible to successful treatment, Feagin seized
    upon a single blood pressure measurement performed by a doctor who himself cautioned that
    Moon’s hypertension appeared to be intractable. Unum does not present us with the opinion of any
    doctor, except Feagin’s, to the effect that Moon’s hypertension was not a barrier to returning to
    work. Cf. 
    McDonald, 347 F.3d at 169
    (observing that a plan administrator’s decision to rely on the
    medical opinion of one examining doctor over another is ordinarily not arbitrary and capricious).
    Indeed, the only independent medical opinion in the administrative record regarding Moon’s ability
    to work was that of Dr. Watson. Viewing the administrative record in its entirety, Unum has not
    offered a reasoned explanation to support its conclusion that Watson’s analysis is flawed and that
    Moon is able to work.
    IV. CONCLUSION
    For the foregoing reasons, we conclude that Unum’s final decision upholding the termination
    of Moon’s LTD benefits was arbitrary and capricious. The district court, therefore, erred in denying
    16
    No. 03-1626
    Moon’s motion for judgment on the administrative record. Accordingly, we REVERSE and
    REMAND for entry of judgment in favor of Moon.
    17
    No. 03-1626
    SILER, Circuit Judge, dissenting. I respectfully dissent because I think under the highly
    deferential arbitrary and capricious standard, the district court did not err in upholding the denial of
    benefits.
    Certainly, as the majority observes, Dr. Feagin was on Unum’s payroll, so that fact must be
    considered. Nevertheless, he is a qualified board-certified internist physician who concluded that
    Dr. Watson’s opinions were “rather unorthodox” because Dr. Watson opined that Moon would have
    higher blood pressure in the sitting position than in the supine position. Dr. Feagin also decided that
    Moon could work based upon Dr. O’Brien’s blood pressure tests revealing that Moon’s pressure was
    higher in the supine position and Dr. O’Brien’s observation that “with proper and effective
    antihypertensive medication, I suspect her blood pressure is indeed controllable and should not alone
    be considered disabling.” Dr. Feagin further found that Moon had no “evidence of significant
    hypertensive end organ damage.” He admitted Moon could not perform medium to heavy work, but
    he concluded she could do sedentary or light work.
    As Black & Decker Disability Plan v. Nord, 
    538 U.S. 822
    , 829-33 (2003), holds that the
    opinion of the treating physician is not to be given deference over that of other physicians, I would
    find that the decision not to award long-term benefits by Unum was not arbitrary and capricious,
    because it was based on Dr. Feagin’s conclusions. Were we to view the matter under a de novo
    standard, I might very well decide otherwise.
    18