WPCr` v~Ih1q4h)"U=R 0oRRGb BV 0UC 0 0 0g 0J 0* 0 0 0 0C! 0! 0" 0z# 0K$ 0% 0% 0& 0q' 0@1( 0q( 0E) 0* 0* 0+ 0w, 0<- 0- 00. 0<. 0'/ 0>/ 0v#0 0`0 0`0 0`Y1 0`1 0`2 08y2 02 023 03 0:4 0Y4 0_D5 0 5 0j6 08 B*9 D/9 D+9 0: D/; 0; 06< 0< 0:= 0^> 0<v> 1e>U6?U>M?U*? 1u? 72*@\@J*AtEN1L3PPRRR]GYZKONICA MINOLTA 7085/IP-602,,,,0X(#$  0  ($XXXX<6X9`("Courier NewTT(F:2#$ !X\XXX        0  <4 9Z+ Courier New <6X9`("Courier NewTTXXx6X@DQX@<6X9`(CourierTTXXw6X@QX@ (A Z6Times New Roman RegularQ 9Z+.Courier New Regular ##Xd#ՠ2s L=1y File3|xTABLE A$U /#Xd#   CastelliniDowling<6X9`(*Courier 12pt10cpi- -\( 9Z+&Courier Regular(G3U$ !X\XXX   d   #$XEXXX      8    _Totheextent_Radford_ԀTrustv.FirstUnumLifeInsurance  CompanyofAmerica,321F.Supp.2d226,239(D.Mass.2004),  suggestsotherwise,wedisagree.ItcitestoHughesv.Boston \ MutualLifeInsuranceCompany,26F.3d264,268(1stCir.1994),a 2 caseconcernedwiththedifferentissueofapplicationofsummary X judgmentrulestointerpretationofambiguitiesinanERISA . contract.Id.at270.Foradiscussionoftheinterplayof   contractandsummaryjudgmentrules,see_McAdams_v.Massachusetts   MutualLifeInsuranceCompany,391F.3d287,298300(1stCir. `  2004). = #$XEXXX      1    _Inseverallettersandpapersintheadministrativerecord,  theappellant'snameisspelled"_Orndorff_."However,thecomplaint  andotherpapersfiledinthedistrictcourtandthebriefsbefore \ thiscourtusethespelling"_Orndorf_,"andthatisthespellingwe 2 useinthisopinion.  #$XEXXX      10    _Byanalogy,wehaveheldwherereview(underanarbitraryand  capriciousstandard)isbasedonanadministrativerecordandno  additionalevidenceisconsidered,jurytrialsarenotavailable. \ SeeRecuperov.NewEng.Tel.&Tel.Co.,118F.3d820,831(1st 2 Cir.1997).Again,thechangeinstandardofreviewfromarbitrary X andcapriciousreviewunderRecuperotodenovoreviewinthiscase . makesnodifference.- - d L #$XEXXX      2    _UnumProvidentwasoriginallynamedasadefendant,buton  September16,2002,thepartiesstipulatedthatReverewasthe  properandsoledefendant.*+ (_2623  ..*G+M (_25   /%` ` hp x /23  ..  5+ ` hp x 5  *D+M (_24   ," hp x ,23  ..  5+ ` hp x 5  *A+M (_23  ` ) hp x )23  ..  5+ ` hp x 5  *>+M (_22   &hhp x &23  ..  5+ ` hp x 5  *;+M (_21   #p x #23  ..  5+ ` hp x 5  *8+M (_20  h  p x 23  ..  5+ ` hp x 5  *5+M (_19   pp x 23  ..  5+ ` hp x 5  *2+M (_18    x 23  ..  5+ ` hp x 5  * (_1723  Ԁ*GM (_16   /%` ` hp x /23  Ԁ  5+ ` hp x 5  *DM (_15   ," hp x ,23  Ԁ  5+ ` hp x 5  *AM (_14  ` ) hp x )23  Ԁ  5+ ` hp x 5  *>M (_13   &hhp x &23  Ԁ  5+ ` hp x 5  *;M (_12   #p x #23  Ԁ  5+ ` hp x 5  *8M (_11  h  p x 23  Ԁ  5+ ` hp x 5  *5M (_10   pp x 23  Ԁ  5+ ` hp x 5  (2M &_9    x 23  Ԁ  5+ ` hp x 5  ( &_823  (GM &_7   /%` ` hp x /23   5+ ` hp x 5  (DM &_6   ," hp x ,23   5+ ` hp x 5  (AM &_5  ` ) hp x )23   5+ ` hp x 5  (>M &_4   &hhp x &23   5+ ` hp x 5  (;M &_3   #p x #23   5+ ` hp x 5  (8M &_2  h  p x 23   5+ ` hp x 5  (5M &_1   pp x 23   5+ ` hp x 5  &2M $_    x 23   5+ ` hp x 5  0.Normal<:Definition T<AA:Definition L , 5+ ` hp x 5  5+ ` hp x 586Definition(''&H1      (&H2  (&H3  (&H4 XXX (&H5  (&H6  20Address8MM6Blockquote , , 5+ ` hp x 5   5+ ` hp x 5,*CITE,dl*CODEKf<6X9`(Courier NewKSg\  `&Times New RomanS42Emphasis64Hyperlink    <:FollowedHype    4go2Keyboard Kf<6X9`(Courier NewKSg\  `&Times New RomanS <:Preformatted/%  ,Kk %#/Kf<6X9`(Courier NewKSg\  `&Times New RomanS/%  ,Kk %#/<:zBottom of 7[(X7  ?h%2A`Arial?  Sg\  `&Times New RomanS7\(X7&  d dZ)1dxd'dxd<:zTop of For7^(X7  ?h%2A`Arial?  Sg\  `&Times New RomanS7\(X7Z)2dxd0KS.SampleKf<6X9`(Courier NewKSg\  `&Times New RomanS0.Strong 8dl6TypewriterKf<6X9`(Courier NewKSg\  `&Times New RomanS42Variable: 8HTML MarkupB      2 0CommentB  456789:; 35;AGMSY_11.1.1.1.1.1.1.1.<6X9`(Courier New\  `&Times New Roman%2A`Arial3#37=CIQYag1.a.i.(1)(a)(i)1)a)ii) #$XEXXX      3    _Thehypertensionclaimhasbeendroppedonappeal. @ #$XEXXX      4    _Theplancontainsspeciallimitationsfor"anydisability  causedorcontributedtobyapsychiatriccondition,alcoholismor  drugabuse,"suchas_Orndorf_'sdisability.First,"anemployee \ willbeconsideredtobedisabled[underthepolicy]onlyifheis 2 satisfactorilyparticipatinginaprogramoftreatmentor X rehabilitationapprovedbyus." Second,forthiskindof . disability,benefitsarelimited:"benefitsarepayableforupto   sixtymonthswhetherornottheemployeeishospitalconfined.   Aftersixtymonths,subjecttoallotherpolicyprovisions, `  [Revere]_pay[s_]benefitsonlyiftheemployeecontinuestobe 6   hospitalconfinedduetothedisability."   #$XEXXX      5    _Asthedistrictcourtfound,"itisundisputedthat  [_Orndorf_'s]drugdependencywillbealifelongconditionandwill  prevent_Orndorf_Ԁfromeverreturningtohisoccupationasa \ _perfusionist_Ԁ...." Thisisconsistentwiththeevidenceinthe 2 administrativerecord,including_Orndorf_'sownadmission._Orndorf_ X stated,"[_A]ddiction_Ԁisalifetimeillness,thismeanslimitingmy .  accesstomedicationsforever[sic]....[I]wouldlovetowork  againinthe[medical]field,butmyillnessmakesthis  impossible."  \   Onappeal,_Orndorf_Ԁinhisbriefsuggeststhatperhapshecould 2 returntohisworkasa_perfusionist_Ԁdespitehisaddiction. X _Orndorf_Ԁcitestoseveral_websites_Ԁwhichhestatesgiveexamplesof . andinformationabouthealthcareprovidersrecoveringand   returningtopractice. Thisinformationwasnotbeforethe   administratorandwasnotadmittedbythedistrictcourt.Wenote n  butdonotconsiderit. D #$XEXXX      6    _Beforethedistrictcourt,OrndorfarguedthatReveres  terminationofhisbenefitsforhisdrugrelateddisabilitywas  arbitraryandinbreachofRevere'sfiduciaryduty.Thedistrict \ courtsummarilyrejectedthisargument,notingthat"noevidencein 2 theRecordindicatesthatPaulReverefailedtopayOrndorfthe X fullamountofthebenefitsowedtohimasaresultofhisinitial . disabilityclaimbasedondrugdependency."Thedistrictcourt   concluded,"thereisnomerittoOrndorf'sclaimthatRevere's   decisionto'terminate'hisbenefitswasarbitrary,capricious,and `  inbreachofadutyofgoodfaithandafiduciaryduty." _Orndorf_ 6   doesnotraisethisissueordisputethisfindingonappeal. ) #$XEXXX      7    _Firestoneheldthat"adenialofbenefitschallengedunder  1132(a)(1)(B)istobereviewedunderadenovostandardunlessthe  benefitplangivestheadministratororfiduciarydiscretionary \ authoritytodetermineeligibilityforbenefitsortoconstruethe 2 termsoftheplan."Firestone,489U.S.at115.  #$XEXXX      9    _OrndorfassertsinhisbriefthatRevereappliedthewrong  standardoftotaldisabilitybystatinginitsfirstdenialof  Orndorf'sdisabilityclaimthat"itisouropinionthatyouarenot \ precludedfromperformingthedutiesofyourjoboronesimilarin 2 nature."(emphasisadded).But_Orndorf_Ԁmakesnoseriousargument X thatReveremisinterpretedthepolicyorthatRevereultimately . appliedthisdefinitionofdisabilityasopposedtotheonewhich   requiresthat_Orndorf_Ԁcannotperformtheimportantfunctionsofhis   ownprofession.ItisclearthatthisisthedefinitionRevere `  appliedinmakingitsfinaldeterminationthat_Orndorf_Ԁwasnot 6   entitledtodisability.IntheSeptember2000reviewbyRevere,  \  thereviewerwasspecificallyaskedwhethertheinsuredwas  2  precludedfromperformingthedutiesofhisownoccupation,which   waslistedas_perfusionist_. IntheAugust2001review,Revere   askedwhatthereviewer'sprognosiswasfor_Orndorf_'sreturnto d  work;hisoccupationwaslistedas_perfusionist_.  S #$XEXXX      11    _Thedistrictcourtadmittedthisreportonlyforthelimited  purposeofclarifyingthedutiesofaperfusionist,andstruck  otherportionsofthereport.  #$XEXXX      12    _Orndorfmakesavarietyofotherargumentsconcerning  ReveresdecisionthatOrndorfwasnotdisabled.First,heargues  thatwhileadministratorsarenotrequiredtocreditatreating \ physiciansassessment,Reveremustofferareasonwhyitdidnot 2 credithisstatementincludingeithercollusionbytreating X physicianorareasonablebasisforrejectinghisopinion. He . arguesthatReveredidnotreferbacktothedutiesofthe   _perfusionist_,orspecificallymakeanydeterminationsastowhether   _Orndorf_Ԁcouldperformthedutiesof_perfusionist_,hisown `  occupation. Thesetypesofargumentsarerelevantwhenperforming 6   arbitraryandcapriciousreviewtodeterminewhetherthedecision  \   wasreasonable.Ondenovoreview,wereachourowndecisionbased  ontheadministrativerecord;_Orndorf_sobligationatthispointis  tocarryhisburdentoestablishthatheisdisabledunderthe \ plan. !XEXXX  _TRY,3'X3' Letter 3' Letter3'T ? * ! XXXXE iX X      W#K=EXXdd=UnitedStatesCourtofAppeals ß i  FortheFirstCircuit  ( ß XEX (  A') ` dE< ` A      `     h No.041520 K    @@JACOBM._ORNDORF_,    @@ Plaintiff,Appellant, y   @  @`  @  @  @h  @  @  @p  @ @@tt)v. %u  @@ PAULREVERELIFEINSURANCECOMPANY, ! @@Defendant,Appellee. } A') ` dE<` A O   @@` ` APPEALFROMTHEUNITEDSTATESDISTRICTCOURT 4 FORTHEDISTRICTOFMASSACHUSETTS   [Hon.0 @ MichaelA._Ponsor_,U.S.DistrictJudge] f A') ` dE<` A b @@'Before G @@Torruella,CircuitJudge,   Campbell,SeniorCircuitJudge, y! andLynch,CircuitJudge. O " .A') ` dE<!` A !K$       CharlesLeonardMitchellforAppellant. "0&   JoanO._Vorster_,withwhomElizabethL.B.Greeneand_Mirick_, $( O'Connell,_DeMallie_Ԁ&_Lougee_,_LLP_wereonbrief,forAppellee. b% )   *'ddd Xdd Xdd X(#(#,( dd ,( dd ,( dd +  '4#,'4#  SIH(#- @38456@S_April15,2005 )n$/ _ RHC)D%0" @38456 @ R(H(#1  (  * !    *,X` XX* `   |-(4?L  W#  8EXXdd8    _ XEXX XE8EXXdXXd8&=EXXdXXd= ` LYNCH,CircuitJudge . Thiscaserequiresustoaddress  whatismeantbydenovojudicialreviewunderERISAofadenialof x benefitswhentheERISAplandoesnotpreservediscretioninthe $t planadministrator.Thatraisesconcomitantquestionsofwhether   theclaimantisentitledtotrialinthedistrictcourtandwhat, |  ifany,evidencemaybeadmittedthatisnotintheadministrative ( x  recordbeforetheERISAadministrativedecisionmaker.Our $  conclusionisthatgiventhenatureoftheclaimant'schallenge   herethathedidinfactestablishhiseligibilitytobenefits ,|  beforetheERISAdecisionmakertheclaimantwasnotentitledto ( trialortoadmitdesirednewevidenceoutsidetheadministrative  recordortodiscovery.Havingdefinedthestandards,weapply 0 themtothefacts,andupholdthedenialofbenefits. ,    I.   + ` JacobOrndorfworkedasaperfusionist,apersonwho P operatesaheartlungmachine,forJerseyShoreCardiacAssociates, L Inc.("JerseyShore")fromJanuary1,1992untilMarch29,1995.     DefendantPaulRevereLifeInsuranceCompany("Revere")provides p!" grouplongtermdisabilityinsurancecoveragetoJerseyShore;this #l$ planisanemployeewelfarebenefitplanasdefinedbyERISA.  $ &  ` InJune1995,Orndorfstartedreceivingdisability t&!( benefitsforhisdrugdependency; underthepolicy,thesebenefits  (p#* wouldlastonlyuntilJune26,2000. In1998,Orndorffirst )%, informedReverethatheclaimedacontinuationofthedisability x+&. K 8EXXdXXd8   paymentsbeyondJuneof2000basedonpurportedbackproblems.   Therewasconsiderableexchangeofmedicalinformationbetween \ OrndorfandRevere.ReveredeterminedthatOrndorfwasnot X disabledduetopainfromhisback,neck,ankleorhypertension.   OnJanuary10,2002,Revereissuedafinaldenialofbenefitsand `  informedOrndorfthathehadexhaustedallofhisappellate  \  administrativeremediesandthatReverewouldreviewnofurther   information;theadministrativerecordwasclosed.  d   ` InFebruaryof2002,Orndorf  #  1      # XEXXXE#XEXX XEԀfiledsuitagainstRevere) #  2       `  infederaldistrictcourtpursuantto29U.S.C.1132(a)(1)(B),   allegingthatRevereunlawfullydeniedhisclaimforlongterm h disabilitybenefitsduetophysicallimitations. Bothparties d filedmotionsforsummaryjudgment.    ` Thedistrictcourtextensivelyreviewedtheevidencein l theadministrativerecord,thedutiesofsomeoneinOrndorf's h occupation,Orndorf'sfirstclaim(drugdependency)andsecond  claim(backpain)fordisability,histreatmentforbackpain,his p  capacitytowork,Revere'sconclusion,andOrndorf'sargumentson !l" appeal. ThecourtconcludedthatOrndorfwasnotdisableddueto "$ back,neck,oranklepainorhypertensionunderthetermsofthe  plan;k #  3      ׀"Orndorf'sclaimcollapsedundertheweightoftheRecord."  \ ThecourtgrantedsummaryjudgmenttoRevereonMarch17,2004. X Orndorfv.PaulRevereLifeIns.Co.,No.0230024(D.Mass.Mar.   17,2004).  `    II.   \  J A.ThePolicy $   ` TheReverelongtermdisabilitypolicyatissueprovides   benefitsincertainsituations, includingwhenanindividualis ,|  totallydisabledfromperformingthedutiesofhisorherown ( occupation.TotaldisabilityforthepurposesofOrndorf'spolicy  means: 0 8 ` a.thatbecauseofinjuryorsicknessthe , employeecannotperformtheimportantduties  ofhisownoccupation;andb.theemployeeis  undertheregularcareofadoctor;andc.the ^ employeedoesnotworkatall.4` x` x !" ` ThepolicyalsodefinesRevere'sobligationtopay 0 benefitstotheemployee:   8 ` [Revere]pay[s]monthlytotaldisability 8!" benefitstoanemployeeifhebecomestotally "^# disabledwhileinsuredduetoinjuryor "4$ sickness.Theemployeemustbeunderthecare # % ofadoctorwhiletotallydisabled.... $& Duringanycontinuousperiodofdisability f% ' immediatelyfollowingcompletionofthe <&!( employee'seliminationperiod,butbeforethe 'b") endofhisbenefitperiod,[Revere]pay[s]the '8#* employeeamonthlytotaldisabilitybenefit ($+ foreachwholemonthinwhichheistotally )$, disabledfromhisownoccupation.Ifthe  employeeworksotherthanfulltimeathisown  job,hemayqualifyformonthlyresidual \ disabilitybenefits. $2` x` x B.Orndorf'sFirstClaimforDisability .  ` InMayof1995,Orndorfsubmittedhisfirstclaimto   Reverefordisabilitybenefitsfora"drugrelated"sickness, 6   followinghospitalizationforadrugoverdose.   2   ` RevereevaluatedOrndorf'srecordstodeterminewhether   hewastotallydisabledduetodrugdisabilityundertheplan,and :  onAugust24,1995,RevereinformedOrndorfthatithadapproved 6 hisclaimunderthe"OtherLimitations"provisionofthePolicyand  thathisbenefitsperiodwouldexpireonJune26,2000.l #  4       >   ` AlthoughOrndorfisnolongerreceivingpaymentsforthis : disability,hisdrugandpsychiatricillnessescontinuetopreclude  himfromreturningtohisjobasaperfusionist.m  #  5      ׀ Onemightask B why,ifOrndorfisdisabledanywayfromdoinghisjobasa  perfusionist,thereisanyissueaboutwhetherheisalsodisabled \ byhisbackcondition.Therearetwoanswers.Thefirstisthat X Revere'sstatementofreasonsastowhyitdeniedbenefitsisthat   (1)thebenefitperiodforthedrugdependencydisabilityhad `  expiredand(2)theinformationprovideddidnotsupport  \  eligibilityfordisabilityunderanyotherprovisionoftheplan.   Revereislimitedtothegroundsofdenialitarticulatestothe d  claimant.SeeGlistav.UnumLifeIns.Co.,378F.3d113,12829 `  (1stCir.2004).Second,Orndorfcitestoaprovisioninthe   policythatprovidesforcircumstanceswhereanemployeeis h disabledbymorethanoneinjuryorsickness: d 8 ` IfaDisabilityiscausedbymorethanone  InjuryorSickness,orfromboth,Wewillpay  benefitsasiftheDisabilitywascausedby l oneInjuryorSickness....Wewillpaythe B largerbenefit.}0 h` x` x Reverehasnotdisputedtheapplicabilityofthisprovisionto   Orndorf'scase. p   ` ThereisnorealdisputethatOrndorfwaspaidthe   benefitsowedforhisfirstdisabilityclaimduetodrug \ dependency.n #  6      ׀Thequestioniswhetherhewasdisabledwithinthe X meaningofthepolicyforhisallegedbackcondition,hissecond   claimfordisability. `  C.Orndorf'sSecondClaimforDisability  \   ` AlthoughOrndorfsayshishistoryofbackpaindatesback   to1976,Orndorffirstclaimeddisabilityonaccountofhisback d  paininJuneof1998,whenaReverefieldrepresentativemetwith `  Orndorfathishomeonanunannouncedvisit. Duringthisvisit,   Orndorfclaimedthathischiefdisablingconditionwashisbackand h thatthereforethedisabilitypaymentsshouldcontinuebeyondJune d of2000. Soonthereafter,RevereobtainedOrndorfscomplete  SocialSecurityDisabilityInsuranceAppealdecisionandhis l medicalrecords.  h  ` InDecemberof1999,theinsurerissueditsoriginal  decisiononthissecondclaim,andOrndorfwastoldthathis p  benefitsweredenied: !l" 8 ` Intheregularcourseofadministeringyour  claim,weconductedareviewofallofyour  medicalrecords.Asaresultofthisreview, \ itisouropinionthatyouarenotprecluded 2 fromperformingthedutiesofyourjoborone X similarinnature..` x` x 8 ` Youallegedthatyoucouldnotworkdueto   chroniclowbackpainandadvisedyourdoctor `  onJune23,1998thatyouractivitieswere 6   limitedandyouremainedindoorsmostofthe  \  time.However,onJune11,1998,youreported  2  youhadbeenonalongbikeride.Thereseems   tobesomediscrepancybetweenyourrelated   historyandlimitationsandyouractuallevel d  ofactivitiesandyourperformance.: ` x` x 8 ` Wefoundnoevidenceofbackproblemsor 6 hypertensivecareduringtheyear1998.   Consequently,itisouropinionthatyouronly  disablingconditionhasbeendepressionand h substanceabuse.Therefore,yourclaimhas > beenadministeredandpaidundertheOther d Limitationsprovisionofthepolicy.88 :` x` x  ` InOctoberof2000,onthefirstreviewofitsdenial,  theinsureradvisedOrndorf: B 8 ` WehavereceivedyourletterdatedOctober3, > 2000includingaletterfromDr.Gilbert.  Yourentireclaimfilewassenttoourmedical  departmentforreview,thereviewincludedthe p  followingrecords:medicalreviewfromDr. F ! Bianchi,medicalpacketfromyoubackdated !l" 8/31/00,letterfromDr.Runddated11/1/97,a !B# functionalcapacityformcompletedbyDr. "$ Gilbert,CTlumbarspinedated3/8/00andx #% raysofspineandcervicaldated5/12/00.t$&` x` x 8 ` Atthistimeitisouropinionthatinorder  &p!( tofullyevaluateyourphysicallimitations &F") andrestrictionsweneedadditionalobjective '#* information.Thisinformationshouldinclude (#+ reportsofyourlastexaminationfromthe x)$, reporteddateofyourillnessandupdated N*%- physicalexaminations.> $+t&.` x` x  ` OnAugust23,2001,theinsureraffirmeditsdenialof  benefitsonthebasisthat: \ 8 ` Theserecordswerereviewedbyoneofourin X housephysicians.ThisphysicianisBoard . CertifiedinInternalMedicine.Wehave   determinedthatbasedon[]Mr.Orndorf's   medicalrecordsthattherewasnobasisfor `  hypertensiveimpairment,andnoevidenceof 6   persistentimpairmentproducinglimitationsor  \  necessitatingrestrictionsfromMr.Orndorf's  2  maxillarysinusitisandcervicalspine   complaints.C  X  ` x` x  ` Thereafter,atOrdnorf'srequest,theinsurerconsidered :  additionalevidenceandonJanuary10,2002,reaffirmeditsdenial 6 inafinalreview:  8 ` Sinceadditionalinformationwassubmitted, > Mr.Orndorf'sfilewasforwardedtothe d medicaldepartmentforreview.Accordingto : theBoardCertifiedPhysicianinInternal  Medicine,heconcludesthefollowing:` x` x 8 ` a)Primarypsychiatricimpairmentatthedate B ofdisabilitywithpersistencedemonstrated h throughmuchoftheclaimperiodwithout > adequateobjectivedocumentationof  persistencetoorbeyondthe12/21/99  determinationletterp ` x` x 8 ` b)Noobjectivebasisforhypertensive !l" impairmentproducinglimitationsor !B# necessitatingrestrictionsatorbelowahigh "$ levelmediumworkload#%` x` x 8 ` c)Degenerativediscdiseaseofthelumbar J% ' spinewithintermittentsymptomatic  &p!( exacerbationswithoutevidenceofcontinuous &F") orpersistentongoingimpairmentthroughthe '#* lifeoftheclaim,atoraboutthe12/21/99 (#+ determinationletter,orsubsequentlyx)$,` x` x 8 ` d)Posttraumaticanklepathologywithout $+t&. objectivelydemonstratedstandingor +J'/ ambulatoryimpairmentduringthecourseofthe  claimbeyondtransientlyassociatedwiththe  11/99sprainandspecificallywithoutevidence \ ofcontinuedorpersistentimpairmentfromthe 2 12/21/99determinationletteruptothe5/3/00 X ratingexamination.` x` x 8 ` e)Noobjectiveevidenceofcontinuedor   persistentimpairmentproducinglimitations `  necessitatingrestrictionsfromtheclaimant's 6   maxillarysinusitisandcervicalspine  \  complaints.3G  2 ` x` x 8 ` Basedontheinformationintheclaimfile,   thedenialofbenefitsinMr.Orndorf'scase d  isappropriate.O  : ` x` x  ` Orndorfthenfiledsuitinthedistrictcourt. 6   III.   Q   ` Onappeal,Orndorfraisesseveralchallengestothe Z districtcourt'sdecision,arguingthedistrictcourterredby(1) V failingtousedenovoreviewinrulingonthecrossmotionsfor  summaryjudgment;(2)denyingOrndorf'srequestfordiscoveryand ^ leavetosubmitadditionalevidence;(3)denyingOrndorf'smotion  Z forsummaryjudgmentor,inthealternative,infailingtofinda  materialdisputeoffactwhichwouldhavedefeatedRevere'smotion; b ! and(4)notawardingOrndorfinterest,attorney'sfees,andcosts. "^#  IfOrndorfiswrongaboutthefirstthreeclaims,thefourth # % necessarilyfails. f% '  ` Bothpartiesagreethatdenovoreviewbythedistrict 'b") courtofaplanadministrator'sdecisiontodenybenefitsunderan ($+ ERISAplanisproperunderFirestonev.Bruch,489U.S.101,115 j*%- (1989),wheretheplandoesnotgrantdiscretiontothe ,f'/ administrator.o #  7      ׀ Theoverarchingquestioniswhatexactlyis  entailedindenovoreview. \ A.AppellateStandardofReview X  ` Wequicklyputasideoneissueaboutthescopeofour   appellatereview.Becausethecasewasdecidedonsummaryjudgment `  inthedistrictcourt,thestandardofreviewusedbythiscourtto  \  reviewthedistrictcourt'sdecisionisdenovo.SeeFentonv.   JohnHancockMut.LifeIns.Co.,400F.3d83,87(1stCir.2005). d  Thisincludesourengaginginnondeferentialreviewofthelegal `  questionofthepropercontentofthedistrictcourt'sdenovo   reviewofaplanadministrator'sdetermination,asthattermis h usedinFirestonev.Bruch,489U.S.at115. d  ` Thereviewutilizedbothbythiscourtandthedistrict  courtinthisERISAcasediffersinoneimportantaspectfromthe l reviewinanordinarysummaryjudgmentcase.AswenotedinListon h v.UnumCorp.OfficerSeverancePlan,330F.3d19(1stCir.2003),  inanERISAcasewherereviewisbasedonlyontheadministrative p  recordbeforetheplanadministratorandisanultimateconclusion !l" astodisabilitytobedrawnfromthefacts,summaryjudgmentis "$ simplyavehiclefordecidingtheissue.Id.at24.Thismeans t$& thenonmovingpartyisnotentitledtotheusualinferencesinits  &p!( favor.Id.Whenthereisnodisputeoverplaninterpretation,# XEXXXEԂ#XEXX XEthe  useofsummaryjudgmentinthiswayisproperregardlessofwhether \ ourreviewoftheERISAdecisionmaker'sdecisionisdenovoor X deferential.# XEXXXEԢ]#ԚXEXX XE #  8      ך# XEXXXEԵ^#XEXX XE   # XEXXXEK_#XEXX XEB.ContentofDeNovoStandardofReview `   ` Plaintiff'sargumentastothepropercontentofthe  \  districtcourt'sdenovoreviewisbasedonthesecondparagraphof   Firestone'sholding,setforthbelow: d  Ӏ8 ` Asthiscaseaptlydemonstrates,thevalidity `  ofaclaimtobenefitsunderanERISAplanis 6 likelytoturnontheinterpretationofterms   intheplanatissue.` x` x 8 ` Consistentwithestablishedprinciplesof h trustlaw,weholdthatadenialofbenefits > challengedunder1132(a)(1)(B)istobe d reviewedunderadenovostandardunlessthe : benefitplangivestheadministratoror  fiduciarydiscretionaryauthoritytodetermine  eligibilityforbenefitsortoconstruethe l termsoftheplan.B` x` x `Firestone,489U.S.at115(emphasisadded). >  ` Firestonemakesitclearthatinsuchsituationsof  disputeoverthemeaningofplanlanguage,nodeferenceisgivento F ! theadministrator'sinterpretationoftheplanlanguage.Rather, !B# thecourtinterpretstheplandenovo,andappliesthenormalrules  forcontractinterpretation.SeeHughesv.BostonMut.LifeIns. \ Co.,26F.3d264,26768(1stCir.1994).Inthiscase,thereis X nodisputeaboutinterpretationoftheplantermspresentedon   appeal.q #  9      ׀Thusthereisnooccasiontoconsidertheuseofoutside `  evidencetoassistthecourtininterpretingplanlanguage.# XEXXXEԥ_#XEXX XEԀThere  \  isalsonodisputeoverwhattheplandocumentsare.Cf.Fenton,   400F.3dat8789.Butliterallyread,Firestone'sdenovoreview d  languageisbroader,andalsoincludesaconclusiontodeny `  benefitsbasedonasetoffacts,suchasRevere'sconclusionhere.    ` FromFirestone'sdenovoreviewlanguage,Orndorfmakes h severalarguments. d  ` Orndorfarguesthatthedistrictcourterredbygiving  deferencetotheadministrator'sdecision.Thecorrectstandard, l heargues,is"whether,uponafullreviewoftheadministrative h record,thedecisionoftheadministratorwascorrect." Weagree  withthisstandardanddisagreethatthedistrictcourtusedany \ otherstandard. X  ` Orndorfnextarguesthatiftheadministrativerecord   showsanyconflictinviewsamongthedoctors,thensummary `  judgmentmustbedenied. Orndorfmaybearguingthatonreviewof  \  anadministrativerecordthroughsummaryjudgmentthecourtmust   relievehimofhisburdenofprovingheisdisabledbecauseunder d  summaryjudgmentallinferencesaredrawnagainstthemovant.We `  havealreadyrejectedthisargumentinListon,330F.3dat24,and   weapplyListontodenovoreview,asnotedabove.Alternatively, h Orndorfmaybearguingthatacourtfacedwithanadministrative d recordwithconflictingmedicalopinionsshouldthenholdatrial  withwitnessestoresolvethedisputes.Hefiledamotiontothat l effect,whichwasdeniedbythedistrictcourt. Thecourtwas h correcttodenythemotion.Trialisnotwarrantedbecausethe  recordshowsonedoctor'sdiagnosisdisagreeswithanother's,and p  # XEXXXEg#XEXX XEthefactthatjudicialreviewisdenovodoesnotitselfentitlea !l"  claimanttoatrialortoputonnewevidence.% #  10      # XEXXXEp#XEXX XEԀ# XEXXXEq#XEXX XE "$  ` Somecourtshavestatedthat"factualfindings"madeby   theadministrativedecisionmakerarerevieweddenovoandhave \ suggestedthatthiswarrantstheintroductionofnewevidenceto X thetrialcourt,perhapsintheformofanevidentiaryhearingor   atrialdenovo.SeeLubyv.TeamstersHealth,Welfare,&Pension `  TrustFunds,944F.2d1176,118485(3dCir.1991).# XEXXXE specialist,whoexaminedOrndorfandhis  recordsandopinedthathewasdisabledon  January10,2002,thedateofRevere'sdenial p  andatthetimeoftheexaminationoneyear F ! later. !l"` x` x NotonlydowerejectOrndorf'sclaimthatitwaserrorforthe "$ courttoexcludesuchextrarecordmedicalevidence,butweholdit t$& wouldhavebeenerrorforthecourttohaveadmittedsuchevidence.  &p!(  ` Thedecisiontowhichjudicialreviewisaddressedisthe '#* finalERISAadministrativedecision.Itwouldoffendinterestsin x)$, finalityandexhaustionofadministrativeproceduresrequiredby $+t&. ERISAtoshiftthefocusfromthatdecisiontoamovingtargetby  presentingextraadministrativerecordevidencegoingtothe \ substanceofthedecision.Liston,330F.3dat24.Thereisno X claimOrndorfwasdeniedanopportunitytopresentevidencetothe   administrator.Here,theplaintiffhadampletimetocollect `  recordsandhadtwoadministrativeappealsreviewsofhisclaimsby  \  Revere.Evenifthenewevidencedirectlyconcernedthequestion   ofhisdisabilitybeforethefinaladministrativedecision,itwas d  inadmissible. `   ` Furthermore,thefinaladministrativedecisionactsasa   temporalcutoffpoint.Theclaimantmaynotcometoacourtand h askittoconsiderpostdenialmedicalevidenceinaneffortto d reopentheadministrativedecision.TheevidenceOrndorfsoughtto  introduceisofthischaracter. l  ` AsthiscourtnotedinListon,thefocusofjudicial h review,underthearbitraryandcapriciousstandard,isordinarily  ontherecordmadebeforetheadministratorandatleastsomevery p  goodreasonisneededtoovercomethatpreference.Id.Listondid !l" notresolvethequestionofwhetherthesameruleapplieswhen "$ thereisdenovoreview,butdidnotethatevenindenovoreview t$& casesitwas:  &p!( 8 ` atleastdoubtfulthatcourtsshouldbeinany '#* hurrytoconsiderevidenceorclaimsnot (#+ presentedtotheplanadministrator.... x)$, Exhaustionofremediesprinciplespointin N*%- thisdirectionevenifnodeferenceweredue $+t&. totheadministrator'sdetermination,assuming +J'/ alwaysthattheplanempoweredthe  administratortomakeaninitialdecision.` x` x Id.(citationomitted). 2  ` WeholdthattheListonruleaboutadmissibilityof . evidenceoutsidetheadministrativerecordappliesevenwhenthe   denialofbenefitsissubjecttodenovoreview.# XEXXXEiy#XEXX XEWhetherevidence 6   isadmissibleturnsonthenatureofthechallengetothedecision;  2  theanswertothequestionisnotlikelytoturnonwhetherthe   standardofjudicialreviewisdenovoorarbitraryandcapricious. :  Thefocusofthereviewunderdenovoreviewisstillthe 6 administrator'sdecisionandmustordinarilybebasedonthe  administrativerecord. >  ` Theremaybetimeswhenitisappropriateforcourtsto : hearnewevidence.# XEXXXE#XEXX XEWherethechallengeisnottothemeritsofthe  decisiontodenybenefits,buttotheprocedureusedtoreachthe B decision,outsideevidencemaybeofrelevance.Forexample, > evidenceoutsidetheadministrativerecordmightberelevanttoa  claimofpersonalbiasbyaplanadministratororofprejudicial F ! proceduralirregularityintheERISAadministrativereview !B# procedure.Seeid.at23.Weneednotcataloguethesituationsin #% whichnewevidenceisadmissible,otherthantonoteitismore J% ' obviouslyrelevantwhentheattackisontheprocessofdecision &F") makingasbeingcontrarytothestatutethanonthesubstanceof (#+ theadministrator'sdecision.Also,evidencemayberelevantto N*%- explainakeyitem,suchasthedutiesoftheclaimant'sposition, +J'/ ifthatwasomittedfromtheadministrativerecord.Such  explanatoryextrinsicevidencewasadmittedbythedistrictcourt \ inthiscase;Reverehasnotdisputedthisadmission. X  ` Othercourtshavesuggestedvariousmeasuresfor   evaluatingtheadmissibilityofsuchextraadministrativerecord `  evidence.See,e.g.,Quesinberryv.LifeIns.Co.ofN.Am.,987  \  F.2d1017,102325(4thCir.1993)(enbanc).Butweneedonly   note,notdecidetheissue.Theevidenceherewasinadmissible, d  interalia,becausetheotherevidenceplaintiffadvancesis `  largelyevidencecollectedafterorevidenceofhisconditionafter   Revere'sfinaldecisiononJanuary10,2002.# XEXXXEԹ#XEXX XE h D.Discovery d  ` Orndorfalsoarguesthedistrictcourtshouldhave  providedhimwithdiscovery"todeterminewhethertheRevereclaim l staffandmedicalreviewersfollowedprocedureandwereproperly h educated,trainedandqualified."    ` ThedistrictcourtinvitedOrndorftomakeamore p  specificshowingofthepertinenceoftherequest,buthedidnot. !l" Thecourtwascorrecttodenydiscovery.Therewasnoserious "$ claimofbiasorproceduralmisconducttowardOrndorf.Aswesaid t$& inListon,"atleastsomeverygoodreasonisneededtoovercome  &p!( thestrongpresumptionthattherecordonreviewislimitedtothe '#*  recordbeforetheadministrator."Liston,330F.3dat23.Thisis x)$, trueastodiscoveryaswell,regardlessofwhetherthestandardof  reviewisdenovoordeferential. \    III.  X & ` Turningtoreviewoftherecord,wesummarizethe   evidence. |  A.TheDutiesandJobRequirementsofaPerfusionist ( x   ` In1995,inconnectionwithhisfirstdisabilityclaim, $  OrndorffiledanoccupationalreportwithReveredetailingthe   physicaldemandsofhisjob. Henotedthathefrequentlyhadto ,|  stoopandbend;occasionallyhadtoreachabovehisshoulderlevel; ( continuouslyneededmanualdexterity;occasionallyhadtolift50  pounds;neverhadtocarry;andhadtobothsitandstandfor5 0 hours. Hedescribedhismostimportantoressentialfunctionas , "operatingaheartlungmachineduringopenheartsurgery,"andhe  leftblankthespacefor"additionalcommentsonphysical 4 requirements." ReveredoesnotdisputethatOrndorf's"own 0 occupation"wasthatofaperfusionist,anddoesnotdisputehis   characterizationofthephysicalrequirementsofhisjob. 8!"  ` AnEmployabilityandEarningCapacityEvaluationt #  11      ׀which "4$ wasadmittedintoevidencebythedistrictcourtdescribesthejob $&  ofaperfusionist: <&!( 8 ` Setsupandoperatesheartlungmachinein   hospitaltotakeoverfunctionsofpatient's  heartandlungsduringsurgeryorrespiratory \ failure.Reviewspatientmedicalhistoryand 2 chart,andconsultswithsurgeonorphysician X toobtainpatientinformationneededtosetup . heartlungmachineandassociatedequipment.   Selects,assembles,setsup,andtestsheart   lungmachinetoensurethatmachineand `  associatedequipmentfunctionaccordingto 6   specifications.Operatesheartlungmachine  \  toregulatebloodcirculationandcomposition,  2  toadministerdrugsandanestheticagents,and   tocontrolbodytemperatureduringsurgeryor   respiratoryfailureofpatient.Monitorsand d  observesoperationofheartlungmachineand :  patient'sphysiologicvariablessuchasblood `  temperature,bloodcomposition,andflowrate, 6 andadjustsequipmenttomaintainnormalbody   functions.Cleansandadjustspartsofheart  lungmachine.V h` x` x  ` Thereportclassifiestheperfusionist'sjobas"medium d work"accordingtotheDepartmentofLabor,meaningthatit  involvesexerting20to50poundsofforceoccasionally,and/or10 l to25poundsofforcefrequently.Thereportnotesthatthejob h involvesliftingfilledbloodlinesandbucketsoficeweighingup  to50pounds.Theotherphysicaldemandsincludestooping, p  occasionally;crouching,occasionally;reaching,constantly; !l" handling,constantly;fingering,constantly;feeling,occasionally; "$ andtalking,frequently.  t$& B.EvidenceintheRecordofOrndorf'sBack,Neck,andAnklePain  &p!( 󀀀andTreatment: &F")  ` Orndorffirstsoughttreatmentforbackpainin1976. (#+  WhileservingintheAirForce,hesoughttreatmentinSeptemberof N*%- 1978attheAndrewsAirForceBaseSpineClinicand inJulyof +J'/ 1979,afterinjuringhimselfwhilejumpingoutofamovingcar. X  raystakeninJulyof1979indicatedthathehad50percentlossof \ discspacebetweenL4L5inhisspine. Thenextrecordof X treatmentforbackproblemswasonOctober23,1992,approximately   tenmonthsafterOrndorfstartedasaperfusionistatJerseyShore. `  Atthisvisit,hecomplainedof"recentlowbackpain"afterhe  \  weightlifted350400pounds.    ` InDecember1993,OrndorfhadanMRIofhislumbarspine. d  Theradiologistreportnotedthat"[t]hereisacentralandleft `  sideddischerniationattheL4L5level.Therearedegenerative   discchangesofthisdiscwithadecreaseinthediscspaceheight h andsomelossofsignalintensityofthedisc."Theimpressionof d theradiologistwas"centralandleftsideddischerniationwith  prominentdegenerativechangesattheL4L5level.Noevidenceof l lumbarspinalstenosis."  h  ` InJanuaryof1994,Orndorfsoughtmedicalattentionfor  lowbackpain.ThetreatingphysiciannotedthatOrndorfhad p  "[a]dvanceddegenerativechangeswithsmalldiscfragmentat45 !l" intervalwithsecondarychangesatthe34interval."He "$ recommended"strongrehabilitativeprogram"andaseriesof t$& epiduralinjections.Orndorfclaimstohavereceivedaseriesof  &p!( threeepiduralsatJerseyShoreMedicalCenter,althoughthereare '#* nomedicalrecordsofthesetreatments. OnMarch8,1995,Orndorf x)$, wenttoacliniccomplainingofchroniclowbackpain,whichhe $+t&. claimedwasaggravatedfromstandingandwalking.Hewasoffered  anorthopedicevaluationandarehabilitation/medicalevaluation, \ bothofwhichhedeclined;heacceptedaprescriptionforpercocet. X   ` FromMarch29,1995toApril3,1995,Orndorfagain   complainedofbackpainduringhisstayattheCooleyDickson `  HospitalPsychiatricProgram,wherehewashospitalizedaftera  \  drugoverdose. Thedischargesummarynotedthatduringhis   hospitalization,Orndorfcomplainedofbackpain,butthispainwas d  "foundtobecontrollablewithTylenolandstretchingexercises." `    ` ThereisnoevidencethatOrndorfwastreatedforor   experiencedlowbackpainafterhisreleasefromthehospitalin h Aprilof1995toJuneof1996.  d  ` InJune1996,Orndorfwasinvolvedinaslowspeedcar  accidentandcomplainedoflowbackstrain. WhileaLumbosacral l SpineexamshowednarrowingoftheL4L5disc,possiblywith h associatedspinalstenosisordischerniation,theradiologist  thoughtit"veryunlikely"toberelatedtothecaraccident.  p   ` InSeptember1996,Orndorfwasagaintreatedforback !l" pain,attheVeteransAdministration("VA")MedicalCenter "$ complainingthathecouldnotstandformorethanhalfanhour. t$& TheimpressionsofthephysicianseeingOrndorfincluded"chronic  &p!( lowbackpain"andherniateddiscsbetweenL4andL5. Orndorfwas '#*  referredtophysicaltherapyandrehabilitation;therecommended x)$, planincludedweightreductionanduseofaTEN'sunit(aportable  physicaltherapydevice)foraperiodoffourweeks.  \   ` Orndorfthenstartedacourseofphysicaltherapyand X paintreatments.DuringtheSeptember30,1996session,he   reportedthattheTEN'sUnitworked"great."OnOctober31,1996, `  Orndorfwastreatedwithanepiduralblock.Hereportedhe  \  obtained23monthsreliefwithpastepiduralblocks. OnNovember   5,1996,heagainreportedgoodresultsfromtheepiduralblock, d  and onDecember6,1996,hisphysiciannotedthathislowbackpain `  wasstable.     ` Thereisnoevidencethathewastreatedforor h experiencedlowbackpainfromNovember1996toDecember1997,with d theexceptionofaletterfromaphysicianstatingthatOrndorfwas  unabletoperformastresstestbecauseoflowbackpain.  l  ` OnDecember4,1997,Orndorfwastreatedagainfor h complaintsoflowbackpain.Hewastoreceiveanepiduralblock  andhavephysicaltherapyforafewweeks. Hewentforphysical p  therapyonDecember5,8,11,and15,1997,butdidnotshowupfor !l" hisappointmentsonDecember17,19,and22.Thetreatmentplan "$ wasterminatedonDecember22duetohisfailuretokeephis t$& appointments.  &p!(  ` OnJanuary9,1998,Orndorfsawanorthopedist.Onthe '#* questionnaireform,heindicatedthathehadexperiencedbackpain x)$, "offandon"since1976.Henotedthathecouldnotstandfora $+t&. longtimeandthatthepainwassevere.However,healsoindicated  thatpainmedicines,arthritismedicines,physicaltherapy,heating \ pads,nervestimulation,andcortisoneinjectionsall"improved" X hisbackpain. Theorthopedist'sformindicatedthatingeneral,   Orndorfappearedhealthy,andthatepiduralsgavehim"2monthsto `  ayear'sreliefpaincomesbackgradually."Theorthopedist  \  notedthe"goodresultsofepiduralinjections."     ` OnJune23,1998,OrndorfinformedaReverefield d  representativethathisaddictionandhisbipolardisorderwere `  wellcontrolled.Henotedthathewasawarehisbenefitsforthis   disabilitywouldend,butthathischiefdisablingconditionwas h hisbackandthathisclaimforlongtermbenefitswouldextend d beyondthe60months.   ` OnJuly27,1998,Orndorfagainvisitedadoctorwith l complaintsoflowbackpain.Thetreatmentincludedcontinuing h physicaltherapyandreferraltoapainclinicforanepidural  block. Orndorfreportsthatinthesummerandfallof1998,he p  wenttotheVApainclinicforthreeepidurals. !l"  ` FromAugust1998toJune1999,thereisnorecordof "$ Orndorfbeingseenbyaphysicianorreceivinganytreatmentfor t$& lowbackpain.AttheendofJune1999,heonceagainwenttoa  &p!( physicianwithachiefcomplaintoflowbackpain. Dr.Richard '#* Norrisnotedthatthemostlikelyoriginofthelowbackpainwas x)$, anaccidentin1976.Dr.Norrisnotedseverenarrowingindisc $+t&. spaceanddischerniation.ThedoctorobservedthatOrndorf's  "gaitisminimallyantalgicontheleft.Hehasmoderate \ restrictionofrangeofmotionofthelumbarspine."Dr.Norris X notedthatOrndorfhada"severediscogenicdiseaseatL45."     ` OrndorfclaimsthatinNovemberof1999,hisbackpain `  causedhimtofalldownthestairsandthathewasseenattheVA  \  clinic. Therearenodocumentsverifyingthisevent.    ` OnJanuary23,2000,OrndorfwenttotheVAclinicafter d  regularofficehourswithacomplaintofbackpainexacerbation `  fromstandingtoolong.Thephysicalexaminationrevealedthathe   hadmildtendernessinthemidlumbararea,nofluctuance,no h radiation,andnormalgait.Theexaminernotednoevidenceofback d muscularspasms.TheexaminerofferedMotrintothepatient,which  wasrefused.TheexaminertoldOrndorfthathecouldnotschedule l aCTScanandinformedOrndorfthatduetothechronicnatureof h thisproblem,heshouldcontacthisprimarycarephysicianthenext  morning,whomightbetterbeabletoservehim.Theexaminernoted p  thatOrndorfwasupsetwhenhecouldnotreceivenarcoticsafter !l" hours.  "$  ` OrndorfdidscheduleaCTScanwiththeVA# XEXXXEԃ#XEXX XEMedical t$& Center,whichwasperformedonMarch8,2000.Theradiologist's  &p!( impressionsfromthescanwere"[m]oderatedegenerativedisc '#*  disease[at]L45causingmildcentralspinalstenosis."  x)$,  ` IncontrasttotheextensivemedicalrecordsofOrndorf's   treatmentforbackproblems,therecordcontainslittleevidenceof \ Orndorf'sneckorankleproblems.Orndorfbrokehisanklein1974 X whileservingintheAirForce.In1999,hesprainedthesame   ankle,butwasphysicallyimpairedonlybriefly.ACTscanreport `  ofOrdnorf'sankledatedMay4,2000notes,"markednarrowingof  \  thetalotibialjoint...degenerativechangeswithspurringand   sclerosisinvolvingthedistaltibia[,]...themedialand d  lateralmalleolus...andplantarclacanealspurring." `  Ѐ  ` Asforhisneckpain,Orndorfsufferedacervical   fracturein1978,andacervicalstrainassociatedwithan h automobileaccidentinJune1996.AreportofanXraytakenon d Orndorf'sneckonMay12,2000states"cervicalspondylosisatthe  C5C6levelwithmildencroachmentoftheintervertebralformina l [and]lossofnormalcerivalcurvaturecompatiblewithmuscle h spasm."    ` Thereisnoadditionalevidencefortreatmentofback, p  neck,orankleproblems.   !l" C.EvidenceintheRecordofOrndorf'sPhysicalLimitationsand "$ 󀀀CapacitytoWork #%  ` InMayof1995,whenOrndorfsubmittedhisfirstclaim J% ' fordisability,hedidnotreportbackpainoranyotherphysical &F") limitationthataffectedhisabilitytoperformhisjobasa (#+ perfusionist.Henotedthathisonlysicknesswas"drugrelated," N*%-  and inresponsetothequestionofhowthe"disability[has] +J'/ interferedwiththeperformanceofthejob?...Pleasedescribe  sitting,standingandwalkingrequirementsandlimitations," \ Orndorfwroteonly,"judgment." Thephysicianwhocompletedthe X AttendingPhysician'sStatement("APS") forthefirstclaimalso   didnotidentifyanyphysicallimitationsonOrndorf'scapacityto |  work.  ( x   ` InhisevaluationforvocationalrehabilitationonJune $  26,1995,Orndorfreportedthathehadnophysicaldisabilities,   butdidsufferfromhypertension. Also,inDecemberof1995, ,|  OrndorftoldaRevereclaimsdepartmentagentthathewas ( interestedinworkingandthathewoulddolaborerwork,butnot  forever. OnMarch12,1998,Orndorfwas"think[ing]about" 0 returningtoworkasaperfusionist,andinanApril1998 , psychotherapysessionhewas"strugglingwithworki ssues...as  hestartstocopewiththeideaofhisinsurancegettingcutoff 4 eventually." 0  ` Orndorf'spsychotherapynotesofJune11,1998reference   hisrecentlongbicyclerideandsweatlodgeceremonyandnotethat 8!" hewasengaginginphysicalactivities. OnJune23,1998,aRevere "4$ fieldrepresentative observedthatOrndorfhadabikeorskirack $& onthetopofhiscarandlivedinasecondfloorwalkup <&!( apartment;however,theonlyoutdooractivitythatMr.Orndorf '8#* admittedtowastakingshortwalks. Orndorf'spsychotherapynotes )$, onJuly2,1998indicatethathehadbeenon"somebicycletrips."  @+&.  ` OnSeptember22,1998,aSocialSecurityAdministrative  LawJudge("ALJ")foundthatOrndorfwas"entitledtoaPeriodof \ DisabilitycommencingMarch28,1995,andtoDisabilityInsurance X BenefitsunderSection216(i)and223,respectively,oftheSocial   SecurityAct." TheALJreliedonthefindingsoftheApril1996 `  andNovember1997physicalexaminationsofOrndorfbyDr.Tonelli,  \  aDisabilityDeterminationServicesstaffphysician.Dr.Tonelli   foundthatOrndorf'slowbackpainwassevere.Heassessedthat d  Orndorfretainedtheabilitytoliftandcarryupto10pounds `  frequentlyand20poundsoccasionally;sit,stand,andwalkwithout   restriction;andperformunlimitedpushingandpulling.Dr. h TonellibelievedthatOrndorfcouldperformoccasionalclimbing, d balancing,stooping,kneeling,crouching,andcrawling.Another  DisabilityDeterminationServicesstaffphysician,Dr.Oscar l Cartaya,concurredwiththeopinionofDr.Tonelliexcepthefound h theclaimantcouldperformfrequentbalancing,kneeling,crouching,  andcrawling.  p   ` TheALJdeterminedthatduetoacombinationofback !l" impairment,hypertension,cardiacimpairment,bipolardisorder,and "$ amixedpersonalitydisorder,Orndorfhadimpairmentswhichmadeit t$& impossibleforhimtoreturntohisformeremploymentormakean  &p!( adjustmenttootherwork,asofMarchof1995.  '#*  ` TheALJfoundthat"asaresultofhismental x)$, impairments,[Orndorf]wouldbemarkedlylimitedinhisabilityto $+t&. completeanormalworkdayandworkweekwithoutinterruptionsfrom  psychologicallybasedsymptomsandmoderatelylimitedinhis \ abilitytomaintainattentionandconcentrationforextended X periodsandtoperformataconsistentpacewithoutanunreasonable   numberandlengthofrestperiods."Shealsofoundphysical `  limitationsconsistentwithDr.Tonelli'sanalysis.TheALJnoted  \  thatOrndorf'sdrugaddictionwas"notacontributingfactor   materialtothedeterminationofdisability."  d   ` Orndorf'sAPSofAugust1998,whichwassignedbyDr. `  Hashimi,Orndorf'spsychiatrist, statesthatOrndorfistotally   disabledfromhisjobandhasbeentotallydisabledfromJuly13, h 1979tothepresent.Thediagnosislistedisbipolardisorder.On d November18,1998ReverereceivedthelastAPSregardingOrndorf,  alsofromDr.Hashimi.Thespacefordiagnosiswasleftblank. l  Orndorf'sNovember24,1998psychotherapynoteindicatesthatone h ofhishobbieswasexercising.    ` InJune1999, OrndorfreportedtoDr.Norristhathe p  ridesabicycleonetotwotimesaweekfortwotothreehours,and !l" thatduringthepastseveralyearshehadreceivedsixtoseven "$ epiduralswithvariedresults.Thesewouldbringhimreliefupto t$& threetofourmonths.  &p!(  ` OnOctober3,2000,OrndorfsubmittedtoReverealetter '#* fromDr.MarkGilbertdatedSeptember12,2000.Theletterwas x)$, addressed"ToWhomItMayConcern"andreadasfollows: $+t&. 8 ` JacobOrndorfisa45yearoldmandisabled  becauseofbackpain.Hefirstinjuredhis  backin1976.Sincethen,hehasseena \ varietyofspecialistsandhashadavariety 2 oftreatmentsforprogressiveincapacitating X backpain.Atthistime,hesaysthathe . cannotstandmorethanafewminutes,cannot   sitforoverhalfanhour,andhastoliedown   severaltimesduringthedaybecauseofpain. `  MRIdonein1993showscentralandleftsided 6   discherniationwithprominentdegenerative  \  changesattheL4L5level.Hecurrentlyis  2  40%serviceconnectedforbackpainandsays   thatheisreceivingSocialSecurity   disability.Becauseofthis,Iconsiderhim d  disabledforsustainedwork. : ` x` x  OrndorfalsosubmittedafunctionalcapacityformfilledoutbyDr. 6 Gilbert. ItisnotclearwhetherDr.Gilbertcompletedtheform  fromaphysicalexaminationoronlyfromOrndorf'sverbalanswers Z tothequestions.Althoughtheformisnotdated,Orndorfclaims V itisfromSeptemberof2000.Itstatesthatinaneighthourday,  Orndorfcansitforonehouratatimeandstandorwalkforone ^ quarterofanhouratatime.ItindicatesthatOrndorfcan  Z occasionallyliftorcarryupto20poundsbutcanneverliftor  carryover20pounds.TheformsaysthatOrndorfcanneversquat, b ! crawl,orclimb.  "^#  ` OnNovember21,2000,Orndorfwasdetermineddisabled # % fromanyemploymentbytheDepartmentofVeterans'Affairsasa f% ' resultofonanklefractureandhypertensioneffectiveOctober22, 'b") 1997.Thereportfoundthathisanklewas20%disablingthe ($+ highestevaluationassignedforlimitationsofmotionforanankle j*%- Єandthathehadlimitedmotionoftheankle.  ,f'/   IV.    ` Inlightofthisevidenceandtheburdenbeingonthe x claimanttoestablishdisability,weconsiderOrndorf'sprimary $t argumentsthatthedecisiontodenybenefitswaswrong# XEXXXE#XEXX XE.    ` First,Orndorfarguesthatthereasonsreliedonby |  Reverearesimplyuntrue,includingthestatementthatOrndorf's ( x  lumbardiscdiseasewas"withintermittentsymptomaticexacerbation $  withoutevidenceofcontinuousorpersistentongoingorpersistent   impairmentthroughthelifeoftheclaim,atoraboutthe12/21/99 ,|  determinationletterorsubsequently"and thestatementthat"we ( foundnoevidenceofbackproblems...duringtheyear1998."   ` Second,hearguesRevere'sreasonsfordenyinghisclaim 0 arewithoutsupportintherecordandfailtotakeintoaccount , certainevidenceaboutthedurationandconstancyofhisbackpain.  Specifically,hearguesReveredidnotcreditthedisability 4 determinationoftheSocialSecurityAdministration,theVeteran's 0 Administration,orOrndorf'sphysician,andthatReveredidnot   performitsownmedicalexamination.u #  12       8!"  ` Wedonotreadthedenialofbenefitstohaveignored  significantmaterialevidencesubmittedbyOrndorf.Thedenial \ letterneednotdetaileverybitofinformationintherecord;it X musthaveenoughinformationtorenderthedecisiontodeny   benefitssusceptibletojudicialreview.Whenthestandardof `  judicialreviewisdenovo,thentheadministrator,ofcourse,runs  \  agreaterriskofreversalifthereislittlediscussionofthe   evidenceaboutdisability.Thediscussionhereofthereasonsto d  denybenefits,asrecountedabove,wasconsiderable.Theopinion `  oftheclaimant'streatingphysician,whichwasconsidered,isnot   entitledtospecialdeference.SeeBlack&DeckerDisabilityPlan h v.Nord,538U.S.822,831(2003). d  ` Orndorf'sclaimthatReveredidnothaveitsown  physicianexamineOrndorf,asopposedtoreviewingrecords,does l notestablishhiscase.Denialsofbenefitsmaybebasedonreview h ofmedicalrecordssubmittedbytheclaimant.Orndorf'sclaimwas  thoroughlyreviewedbyaboardcertifiedinternalmedicine p  physician.Andthisissimplynotacasewheretheonlymedical !l" evidenceraninOrndorf'sfavor,thuscastingintodoubtadenial "$  ofbenefits. t$&  ` Tothecontrary,theevidencerunsagainstOrndorf's   claimofphysicaldisability.Thiscaseturnsnotonthequestion \ whetherplaintiffsufferedback,ankle,orneckpain.Theevidence X isthathedidsufferatleastbackpain.Themedicalreports   clearlyshowbackproblemsandthepatient'sreportsofbackpain `  overtime.Thiscaseturnsonwhetherhemethisburdenofshowing  \  thatthisbackpaindisabledhimfromperforminghisjobasa   perfusionist.Theserecordsdonotestablishthattheseproblems d  disabledOrndorffromperformingthedutiesofaperfusionist.# XEXXXE?#XEXX XEԀOn `  denovoreview,weconcludethatOrndorfdidnotmeethisburden.   Indeed,fromtheevidence,severaldominantthemesemerge. h  ` First,Orndorfactuallyworkedasaperfusionistwithout d anyphysicallimitationsdespitetwentyyearsofbackpainand  treatment.EvenaslateasJanuary1994,Ordnorfcomplainedtoa l doctorof"longstanding"lowbackpain ,yethecontinuedto h performhisjobforanother14monthswithoutanyphysical  limitationsorclaimsofdisability. p   ` Second,whenOrndorfstoppedworkingin1995,itwasnot !l" becauseofbackpain,butbecauseofhisdrugdependency.Indeed "$ hedidnotatthistimeattributehisdisabilitytobackpain. t$& Orndorfhimselfnotedontheclaimsformthathefilledoutforhis  &p!( firstclaimofdisabilitythathehadnophysicallimitationsand '#*  hisonlydisabilitywasdrugdependency. x)$,  ` Third,evenafterhestoppedworkingin1995,thisback   painwascontrollableanditdidnotpreventhimfromworking. \ DuringhisstayattheCooleyDicksonHospitalin1995,thedoctor X notedthatOrndorfcomplainedofbackpain,butthatthepainwas   controllablewithacommonpainrelieverandstretchingexercises. `  InOrndorf'svocationalrehabilitationevaluation,hereportedno  \  physicaldisabilities,andinDecemberof1995,Orndorftolda   Revererepresentativethathewouldperformlaborerwork.InMarch d  of1998,Orndorfbecameconcernedabouthisabilitytosurviveon `  disability,andhewasconsideringreturningtoworkasa   perfusionist.Indeed,hereportedin1996and1997thatvarious h paintherapiesforhisbackwereworking. d  ` Fourth,Orndorfengagedinrecreationalandlifeactivity  inconsistentwithhisclaimofdisability.ThenotesofOrndorf's l psychotherapistsuggestthatOrndorfwastakingbicycleridesand h engaginginphysicalactivity.In1998,helivedonthesecond  floorandhadabicyclerackonhiscar. p   ` Fifth,eventhe1998SocialSecurityAdministration !l" determinationofdisabilitydidnotestablishdisabilityfromhis "$ jobasaperfusionistduetohisbackproblems.Rather,the t$& disabilityfindingwasbasedonacombinationoffactorsincluding  &p!( hypertension,cardiacimpairment,bipolardisorder,andmixed '#* personalitydisorder.ThesameistrueoftheVeteran's x)$, Administrationreport. $+t&.  ` Sixth,thebackdisabilityclaimwasnotmadeatall  untilOrndorfhadonlytwoyearsofdisabilitypaymentsremaining \ fromhisdrugdependencyclaim.Orndorf'sclaimforback X disabilityfollowedhisexpressedconcernswithworkissues"ashe   start[ed]tocopewiththeideaofhisinsurancegettingcutoff `  eventually."   \  Ѐ ` Inlightofthis,themostreasonableviewofthe   evidenceisthatOrndorfdoesnotmeetthedefinitionofdisability d  byaphysicalcondition. `   ` Theawardofjudgmenttothedefendantis affirmed .No   costsareawarded.    # XEXXXE #XEXX XE# XEXXXE#