Ball v. Holland , 142 F. App'x 860 ( 2005 )

NOT RECOMMENDED FOR FULL-TEXT PUBLICATION
File Name: 05a0555n.06
Filed: June 28, 2005
No. 04-5025
UNITED STATES COURT OF APPEALS
FOR THE SIXTH CIRCUIT
CHARLES BALL,
Plaintiff-Appellee;
On Appeal from the United
v. States District Court for the
Eastern District of Kentucky
MICHAEL H. HOLLAND, et al. as Trustees of the
UNITED MINE WORKERS OF AMERICA 1974
PENSION PLAN AND TRUST;
Defendants-Appellants.
Before: BOGGS, Chief Judge; CLAY, Circuit Judge; WALTER, District
Judge*
WALTER, District Judge. Defendants-Appellants, the Trustees of the United Mine
Workers of America 1974 Pension Plan and Trust (“Trustees”), appeal from the district court’s grant
of summary judgment to Plaintiff-Appellee, Charles Ball (“Ball”).
The Trustees denied Ball disability pension benefits after determining that his disability,
affective (mood) and anxiety disorders, was not the result of a mine accident. Ball appealed the
Trustees’ decision by filing a complaint in the United States District Court for the Eastern District
*
The Honorable Donald E. Walter, United States District Judge for the Western District of Louisiana,
sitting by designation.
No. 04-5025 2
of Kentucky. Cross-motions for summary judgment were filed, with the district court granting
Ball’s motion and denying the Trustees’ motion.
The Trustees contend that the district court improperly applied the “arbitrary and capricious”
standard of review and that the Trustees’ administrative decision to deny Ball’s application for
disability pension benefits was supported by substantial evidence. This court agrees with the
Trustees. As such, the district court’s decision is hereby REVERSED and the decision of the
Trustees is reinstated.
I.
Ball worked as a coal miner for Arch of Kentucky from 1975 until January 1997. During
that time Ball was injured in three mining accidents. In May 1993, Ball strained his back and right
shoulder while lifting blocks at work. He did not receive medical attention specifically for that
injury, but a doctor treating him for an unrelated condition in June 1993 noted that his shoulder was
improving and was expected to heal fully within a few weeks. In March 1994, Ball injured his left
shoulder in a mine accident, but did not seek medical attention and lost no time at work. Finally,
in June 1996, Ball sustained neck and back injuries as a result of an explosion in the mine. He was
treated in a hospital emergency room two days later for back pain apparently caused by a bruise on
his lower back, and released the same day. In 1997 Ball resigned from Arch at the suggestion of his
doctor. He then worked briefly as a truck driver, but soon found himself unable to work due to
numerous emotional and physical problems.
In addition to the injuries Ball sustained in the mine accidents, he experienced many other
medical problems. In September 1992, Ball was admitted to a hospital for treatment for persistent
otorrhea (discharge from the ear) caused primarily by herpes zoster of the ear, which caused him
extreme pain. Ball was treated for severe ear pain in 1993, 1995, 1996, and 1999, and was prescribed
No. 04-5025 3
narcotic pain killers, to which he became addicted. The pain and bleeding caused by the herpes
zoster prevented Ball from working on several occasions. In March 1997, Ball’s primary care
physician, Dr. F. Andrew Morfesis opined that Ball was unable to go back to work in the coal mines
due to problems with herpes zoster.
In July 1994, Ball was diagnosed with bilateral carpal tunnel syndrome, for which he
received workers’ compensation. However, Ball never claimed the bilateral carpal tunnel syndrome
was a result of a mine accident. Ball’s primary physician, Dr. Morfesis, and an orthopedic surgeon,
Dr. David E. Muffly, have subsequently opined that Ball’s disabilities are the result of this carpal
tunnel syndrome.
Beginning in 1992, Ball’s physicians also reported that he had emotional problems. Ball was
advised to seek psychiatric help on several occasions. The physicians opined that Ball suffered from
depression, insomnia and anxiety due to stress, financial problems and family issues.
Ball has also been treated several times for back pain and arthritis. In November 1994, Ball
complained of lower back pain allegedly caused by carrying an oxygen tank and compressor in the
mine, but a neurological examination showed no damage. In July 1996, Dr. Morfesis noted that Ball
suffered from arthritis related to repetitive work trauma, and diagnosed back pain syndrome without
any specific cause. During 1999 and 2000, Ball was treated for back pain by at least nine different
physicians. At some of these visits, Ball told the physicians that his back pain began after a 1996
mining accident. However, at other visits, Ball stated that he had no previous back injuries, that his
back had just begun to hurt one morning, he had no hip or back pain in the past, and that his back
pain was “unprovoked”.
II.
This court reviews a district court’s grant of summary judgment de novo. See Roush v.
No. 04-5025 4
Weastec, Inc., 96 F.3d 840, 843 (6th Cir. 1996). In reviewing the district court’s judgment, we must
determine whether the district court applied the proper standard of review in assessing the merits
of the summary judgment motion. In ERISA cases, the decisions of a plan administrator are subject
to review under the “arbitrary and capricious” standard if the plan vests discretionary authority in
the administrator. Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 109 (1989); Wendy’s Int’l
v. Karsko, 94 F.3d 1010, 1012 (6th Cir. 1996). In this case, the parties and the district court agree
that the Plan vests discretionary authority in the Trustees, and that the arbitrary and capricious
standard applies. Therefore, the abuse of discretion standard requires “that the Trustees’ decision
be upheld if it is the result of a deliberate, principled reasoning process and if it is supported by
substantial evidence.” Baker v. United Mine Workers of Am. Health & Ret. Funds, 929 F.2d 1140,
1144 (6th Cir. 1991).
III.
Article II.C. of the Plan provides that:
A Participant who . . . becomes totally disabled as a result of a mine accident . . .
shall, upon retirement, be eligible for a pension while so disabled. A participant
shall be considered to be totally disabled only if by reason of such accident such
Participant is subsequently determined to be eligible for Social Security Disability
Insurance Benefits.
(emphasis added). In order to be entitled to benefits, Ball is only required to show that his mine
accidents were “substantially responsible” for his disabilities, not that the accidents were the sole
cause of his disabilities. See Robertson v. Connors, 848 F.2d 472, 476 (4th Cir. 1988); see also
Boyd v. Trustees of United Mine Workers Health & Ret. Funds, 873 F.2d 57, 59 (4th Cir. 1989)
(addressing the pension plan at issue in this case, and stating that disability “as a result of a mine
accident” requires that the mine injury be “substantially responsible for plaintiff’s inability to
perform his job”).
No. 04-5025 5
The district court misinterpreted the causation requirement of the Plan. The court ruled that
the Trustees’ decision must be based on whether the mine accidents contributed “in some part” to
Ball’s disabilities, and not whether they were substantially responsible for the disabilities (citing
Odom v. Mine Workers of Am. Health & Ret. Funds, 687 F.2d 843, 847 (6th Cir. 1982)). The district
court found that substantial evidence existed that Ball’s depression and anxiety were at least partially
caused by pain resulting from the accidents, and therefore reversed the Trustees’ decision. This
interpretation of the Plan’s causation requirement is not warranted by either the text of the Plan
itself, which simply states that the disability must result from an accident, or by the cases cited by
the district court in support of its reading.
The district court relied on two cases holding that causation may be established by showing
that a mine accident was a cause of a claimant’s disability, even if it was an insignificant cause, or
merely exacerbated a preexisting disability unrelated to the accident. See Boyd v. Trustees of the
United Mine Workers Health & Ret. Funds, 873 F.2d 57, 60 (4th Cir. 1989) (proximate causation
established when injury exacerbated a preexisting condition or combined with pre- or post-accident
conditions); Odom, 687 F.2d at 848 (“the record as a whole permits but one conclusion: that at least
a portion of appellant's disability was caused by his fall while working at his job in the mines.”).
Neither case justifies the district court’s de minimis requirement that Ball’s mining accidents need
only have contributed in some part to his disability. Far from employing a de minimis causation
requirement, Boyd made clear that --- as we noted above --- a worker will only be eligible for
benefits “if the plaintiff was injured in a mine accident and that injury, whether in combination with
a previous or subsequent condition, is substantially responsible for plaintiff’s inability to perform
his job...” 873 F.2d at 59 (emphasis added) (quoting Robertson, 848 F.2d at 476). Odom did employ
a de minimis causation requirement, but did so only after noting that the “proximate cause principle”
No. 04-5025 6
set forth in the Union’s “Health Services Card Processing for Disabled Mine Workers” stated that:
If the mine accident aggravated a pre-existing condition to the extent that the person
became totally disabled, or if the mine accident occurred after a non-mine related
injury and the two injuries combined resulted in total disability, then the mine worker
shall be deemed to be totally disabled as a result of a mine accident. This rule applies
even if evidence establishes that the mine related condition is only a small
percentage of the disability.
Odom, 687 F.2d at 847. There is no evidence in the record that this document is still in
effect, and neither Ball nor the district court claim that the Trustees are still bound by this
definition of proximate cause. Absent such evidence, the Trustees’ decision must be upheld
if substantial evidence exists that Ball’s mine accidents were not a substantial cause of his
disabilities.
The district court’s conclusion that the Trustees’ denial of benefits was not supported by
substantial evidence is premised on the court’s erroneous application of a de minimis causation
requirement. The district court found that the opinions of Drs. Evans and Riggs and Ms. Taylor
were sufficient to establish that Ball’s 1996 accident was at least a cause of his disabilities. The
Trustees could not reasonably reject those opinions, the court concluded, because the opinions of
Evans and Taylor were relied on by the Social Security Administration in its disability
determination,1 and because the Trustees had no reason to doubt Dr. Riggs’s competency. Given
this evidence that the accident played a role in causing Ball’s disabilities, the district court rejected
as irrelevant the evidence the Trustees relied on that indicated other causes for his depression and
anxiety because -- under the district court’s interpretation of the Plan’s causation requirement -- Ball
1
The district court ascribes undue significance to the fact that the Social Security
Administration relied on the reports of Dr. Evans and Ms. Taylor in determining that Ball was
disabled. The SSA’s determination was limited to the fact of Ball’s disability, not with its ultimate
cause, and the SSA therefore could have accepted Evans’s and Taylor’s conclusions that Ball’s
depression was caused by severe pain without also accepting, or even considering, their further
conclusions that his pain was caused by the 1996 accident.
No. 04-5025 7
was not required to show the accident was a substantial cause of his disabilities in order to be
eligible for pension benefits.
Applying the correct “substantial causation” test, the Trustees’ determination is supported
by substantial evidence. There is substantial evidence, in the form of the SSA’s determination of
the onset date of Ball’s disability, that his depression and anxiety did not rise to the level of total
disability until late 1999, three years after Ball’s last mining accident. There is substantial evidence
that Ball’s depression and anxiety were caused by several factors, among which severe pain was but
one factor. There is also substantial evidence that Ball’s pain was caused by several factors,
including herpes of the ear, degenerative back problems, which cannot be deemed due to a mining
accident under the terms of the Plan, and carpal tunnel syndrome, which two doctors believe to have
been the primary cause of his suffering, and which has never been claimed to be due to a mining
accident. Finally there is substantial evidence that the injuries caused by Ball’s mining accidents
were not particularly serious in comparison with his other problems. Given this evidence that Ball’s
mining accidents constituted, at most, one of many causes of his pain, which was in turn but one of
several causes of his disabilities, the conclusions of Drs. Evans and Riggs and Ms. Taylor that Ball’s
depression was caused by pain resulting from his 1996 accident do not compel a contrary
conclusion. The opinions of Drs. Evans and Riggs and Ms. Taylor appear to have been based on
Ball’s self-reported medical history, in which he emphasized the injuries he suffered in 1996. The
Trustees’ denial of benefits does not entail an unjustified mistrust of the conclusions of these doctors
that Ball suffered from depression caused in part by severe pain; only a mistrust of their conclusion
that the cause of that pain was his 1996 accident. Therefore, the decision of the district court is
REVERSED and the decision of the Trustees’ is reinstated.
No. 04-5025 8
CLAY, Circuit Judge, dissenting. The record in this case demonstrates that Charles Ball’s
disabilities were substantially caused by chronic pain, including pain resulting from a 1996 mining
explosion in which he injured his back. Ball was therefore entitled to receive benefits under the
United Mine Workers of America 1974 Pension Plan, and neither the plan administrator’s decision
denying him those benefits, nor the majority’s endorsement of that decision today, is supported by
substantial evidence.
Under the Pension Plan, a miner is entitled to disability benefits when he “becomes totally
disabled as a result of a mine accident.” The Pension Plan offers no further discussion of the
causation standard to be employed. The majority purports to rely on Robertson v. Connors, 848
F.2d 472 (4th Cir. 1989) to define “as a result of,” but actually employs a standard stricter than that
adopted in Robertson. By doing so, and by glossing over the medical evidence in this case, the
majority arrives at the erroneous conclusion that Ball is not disabled “as a result of a mine accident.”
In Robertson, the Fourth Circuit explained that under the Pension Plan, a miner’s total
disability results from a mine accident when he is “injured in a mine accident and that injury,
whether in combination with a previous or subsequent condition, is substantially responsible for
plaintiff’s inability to perform his job and for whatever medical and vocational reasons he is unable
to perform an alternative job.” Robertson, 848 F.2d at 475 (emphasis added). The majority claims
to adhere to this standard. However, it essentially ignores the italicized language, with disastrous
results for Ball, as it was the pain caused by a mining accident, in combination with pain caused by
other medical problems, which substantially caused his disabling depression and anxiety.
Before explaining further how Ball is able to meet the requirements of the Robertson
causation standard, it is worth noting the lengths to which the majority goes to prevent Ball from
relying on a lesser standard of causation. The majority strongly urges that Odom v. Mine Workers
No. 04-5025 9
of Am. Health & Ret. Funds, 687 F.2d 843, 847 (6th Cir. 1982), which authorizes a “contributed in
some part” standard of causation, is inapplicable here. According to the majority, Odom is irrelevant
because it was based in part on de minimis language set forth in the UMWA’s “Health Services Card
Processing for Disabled Mine Workers,” and “there is no evidence in the record that this document
is still in effect.”
The majority’s argument in this respect was never made by Defendants. In fact, Defendants
have repeatedly articulated a causation standard identical or similar to that announced in Odom. In
moving for summary judgment, Defendants cited Odom for the proposition that Ball was required
to show either that a mine accident was “substantially responsible for” his disability, or merely that
it “contributed in some part to” his disability. Defendants’ brief suggests that Ball need only
establish a “causal link” between his mining accidents and his disability. Finally, the pension
analyst who wrote the report denying Ball’s application for pension benefits framed the causation
question as whether Ball’s disability was “related to a mine accident.”
There can be no doubt that Ball would prevail if he were simply required to show that his
mine accident “contributed in some part” to his disability, or that his disability was “related to” a
mine accident. This makes the majority’s reliance on arguments never articulated by Defendants
to bar Ball from prevailing via such a showing particularly troubling. Defendants do not challenge
the district court’s enunciation of the causation standard, and it is generally established that an
appellate court will not entertain issues which are not raised in the appellant’s brief. FED. R. APP.
P. 28(a); Bickel v. Korean Air Lines Co., Ltd. 96 F.3d 151, 153 (6th Cir. 1996); Priddy v. Edelman,
883 F.2d 438, 446 (6th Cir.1989).
The majority’s consideration of an argument not raised in the briefs, which resulted in its
rejection of the Odom standard, would less troubling had it correctly applied the Robertson standard.
No. 04-5025 10
A correct reading of Robertson makes it clear that Ball was entitled to benefits under the Plan if the
pain he experienced as a result of injuries sustained in mining accidents, in combination with both
pre- and post-existing factors, is substantially responsible for his disabling mood disorders. Ball
satisfied this standard, and the plan administrator’s determination to the contrary is not supported
by substantial evidence.
As the majority notes, the relevant disability for purposes of the Pension Plan is the disability
determined by the Social Security Administration, which found that Ball was disabled by an anxiety
disorder and depression. Though the majority gives it short shrift, there is much evidence, in the
form of reports from various doctors and a social worker, that those disabilities were substantially
caused by the great pain and suffering affecting Ball as a result of the mining accidents and other
injuries.
It is true that Ball’s pain and depression pre-dated the 1996 mine explosion in which he
injured his back. However, it is also very clear that Ball’s pain was greatly exacerbated by the back
injury. He was treated for the back injury with Percocet. Ball’s medical records indicate that
tenderness in his lower back area and his limited range of motion remained over a month after the
accident. Over the next few years, Ball’s complaints of back pain increased. In 1999, Ball was
treated by Dr. John W. Gilbert, who diagnosed him with various back ailments and noted that his
back pain dated back to the 1996 accident. Dr. George Privett performed an MRI on Ball in July
1999, finding several back problems and observing that Ball’s back pain was the result of the 1996
accident. In December of that year, Ball was seen by licensed social worker Deirdra Fisher Taylor,
who observed signs of a major depressive disorder, and noted that “chronic pain and other issues”
necessitated therapy. Taylor ascribed the pain to the 1996 explosion. On the same day, Ball saw
Dr. Robert Evans, who diagnosed him with various back problems dating back to the 1996 accident.
No. 04-5025 11
In January 2000, Ball was examined by Dr. Christa Muckenhausen. She noted that Ball had
severe low back pain radiating into both legs, as well as neck pain radiating into both shoulders, and
observed that sitting, standing, or walking for more than five to ten minutes increased his pain. Dr.
Muckenhausen further observed that Ball was “extremely anxious and depressed due to the
persistant [sic] pain and the fact that he cannot function as he did previously.”
On February 14, 2000, psychiatrist Dr. Rosa Kathleen Riggs saw Ball and reviewed his
medical records from six different doctors. Dr. Riggs diagnosed Ball with major depression,
generalized anxiety disorder, chronic pain disorder with both psychological factors and a general
medical condition consisting of various physical ailments, including back injury. She noted that
these mental and physical health problems would make it impossible for Ball to “perform simple,
repetitive tasks or relate to others or tolerate the stress and pressures associated with day to day work
activities.” In April 2001, in response to a letter from Ball’s attorney, Dr. Riggs expressed her
opinion that Ball is “totally and permanently disabled as a result of that mining accident in 1996.”
Dr. Riggs explained that the mining accident was the cause of Ball’s depression and pain.
Dr. Morfesis saw Ball again on March 13, 2000, for complaints of diffuse arthritis pain, fever
blister, and back pain with weakness of the left leg; Dr. Morfesis noted that his left leg problem was
due to spinal stensosis. Dr. Morfesis also reported that Ball’s wife had left him recently, and that
consequently Ball was quite depressed. In a letter dated August 28, 2001, Dr. Morfesis identified
himself as Ball’s primary treating physician from 1989 to 2000, and wrote: “Charles E. Ball is
totally disabled from working as a direct result of the 1994 carpal tunnel injury. Mr. Charles E. Ball
sustained this injury at work in the coal mines. In addition he was re-injured in 1996 during an
explosion that injured his lower back.”
On August 31, 2000, Dr. David E. Muffly saw Ball for an orthopedic evaluation. Ball
No. 04-5025 12
complained of back pain dating to the June 1996 injury and continuing problems with carpal tunnel
syndrome. Dr. Muffly’s assessment was that Ball had recurrent carpal tunnel syndrome with failed
second surgery on the right hand and degenerative disc disease, and that he was disabled. Dr.
Muffley noted that Ball could lift nothing heavier than ten pounds, should avoid repetitive use of
his hands, and could not use hand controls.
Finally, Ball saw Dr. Robert S. Spangler, of Appalachian Psychological Consultants, on
August 1, 2002. Dr. Spangler explained that Ball had experienced chronic low back pain as well
as pain and both hips, his left leg, and his neck and shoulder since the 1996 mine accident. Dr.
Spangler also noted that Ball “developed bouts of depression since the explosion in 1996 that
continues to date. This depression has worsened since 1999 but still traces back to his traumatic
injury in the 1996 explosion.”
It is evident that at least seven doctors diagnosed Ball with back pain dating back to the 1996
mining incident. Three doctors and one social worker opined that Ball’s anxiety and depression
were attributable in substantial part to that pain. Moreover, not a single doctor has disputed Ball’s
contention that his mood disorders were substantially caused by his chronic pain, including his back
pain. Some physicians have indicated that there were other stressors in Ball’s life, but none have
suggested that his pain was not a substantial factor. Ball is not required to show that the 1996
accident was the sole cause of his disability. See Robertson, 848 F.2d at 476.
In other words, Ball established that pain caused by the 1996 mining accident, in
combination with pain from other injuries, was substantially responsible for his depression and
anxiety. This suffices under Robertson to satisfy the causation requirement of the 1974 Pension
Plan. Furthermore, the plan administrator’s determination that Ball was not entitled to benefits is
simply not supported by substantial evidence, as required under our precedent; indeed, it is not
No. 04-5025 13
supported by any evidence at all. See Baker v. United Mine Workers of America Health &
Retirement Funds, 929 F.2d 1140, 1144 (6th Cir.1991). The district court correctly found that the
denial of those benefits constituted an abuse of discretion. I therefore respectfully dissent.