Lloyd v. Procter & Gamble Disability Benefit Plan

MARK LLOYD, Plaintiff-Appellant, v. PROCTER & GAMBLE DISABILITY BENEFIT PLAN, Plan #501; PROCTER & GAMBLE LONG TERM DISABILITY ALLOWANCE POLICY PLAN; PROCTER & GAMBLE DISABILITY COMMITTEE, Defendants-Appellees.

No. 20-4329

United States Court of Appeals, Sixth Circuit

September 3, 2021

NOT RECOMMENDED FOR PUBLICATION

ON APPEAL FROM THE UNITED STATES DISTRICT COURT FOR THE SOUTHERN DISTRICT OF OHIO

Before: GRIFFIN, LARSEN, and NALBANDIAN, Circuit Judges.

LARSEN, CIRCUIT JUDGE

Mark Lloyd alleges that the Procter &Gamble Disability Benefit Plan and other defendants wrongfully denied him long-term and short-term disability benefits in violation of the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C § 1001 et seq. The district court upheld the denial of long-term disability benefits and held that Lloyd was entitled to short-term benefits for only a brief period. Lloyd appeals. For the reasons that follow, we AFFIRM.

I.

From 2000 to 2017, Lloyd was an "IT Systems/Solutions Manager" at Procter &Gamble (P&G). During his time at the company, Lloyd struggled with a range of gastrointestinal issues and fibromyalgia. He claims that he was denied benefits due to him under the terms of P&G's disability plans (collectively, "the Plan").

A.

The P&G Disability Committee is the Plan's named fiduciary and administrator. After consulting with an outside company that assists with claim administration, a Review Board within P&G rules on each disability claim. An applicant may appeal the Review Board's decision to the Disability Committee, which makes the final determination.

The Disability Committee has "discretionary authority to interpret the terms of th[e] Plan" and to determine an applicant's eligibility for benefits. The applicant bears the burden to show his entitlement to benefits. To do this he must provide objective medical evidence indicating that he meets the Plan's definition of "Total Disability" (for long-term benefits) or "Partial Disability" (for short-term benefits).

"Partial Disability" is defined as

a mental or physical condition resulting from an illness or injury because of which the Participant is receiving medical treatment and cannot perform regular duties of his or her current job but can perform other roles at the same site or other jobs outside of the Company. Thus, a condition of Partial Disability does not necessarily prevent the Participant from performing useful tasks, utilizing public or private transportation, or taking part in social or business activities outside the home.

"Total Disability" is defined as

a mental or physical condition resulting from an illness or injury which is generally considered totally disabling by the medical profession and for which the Participant is receiving regular recognized treatment by a qualified medical professional. Usually, Total Disability involves a condition of such severity as to require care in a hospital or restriction to the immediate confines of the home. The Trustees reserve the right to determine what is considered as "regular" and "recognized treatment."

When a participant's employment at P&G ends, his rights under the Plan immediately end as well.

B.

Lloyd was diagnosed with irritable bowel syndrome with abdominal distention in 2009. He has undergone a variety of tests and treatments due to his abdominal pain and bloating.

In June 2014, Lloyd had his first appointment with Dr. Donald Kirby, a gastroenterologist at the Cleveland Clinic, specializing in intestinal motility disorders and related subjects. Lloyd reported "recurrent episodes of abdominal distention that seem[ed] to appear without reason" and would last from one to seventeen days. (Emphasis omitted.) Tests indicated that Lloyd had "normal gastric emptying," "normal small bowel transit time," and "slightly delayed colon transit time." Dr. Kirby concluded that Lloyd had "no bowel obstruction." (Capitalization omitted.) His initial impression was that Lloyd was suffering from "intermittent episodes of severe intestinal dysmotility," but he did not identify the exact cause.

About two months later, another doctor diagnosed Lloyd with a colon infection. Lloyd applied for disability benefits. The P&G Review Board found Lloyd to be disabled and awarded him benefits from September 8, 2014 to October 19, 2014. After the infection subsided, Lloyd returned to work.

Shortly thereafter, Lloyd again applied for disability benefits, citing generalized gastrointestinal issues with an onset date of January 23, 2015. Lloyd's primary care physician, Dr. Robert Hellman, said that Lloyd lacked the capacity to work "due to fatigue [and] pain." But Dr. Norman Gilinsky, Lloyd's regular gastroenterologist, and Dr. Sri Koneru, Lloyd's rheumatologist (who was treating Lloyd's fibromyalgia), both concluded that Lloyd was able to work. The Review Board credited Drs. Gilinsky and Koneru and denied Lloyd's claim. P&G then placed Lloyd on an unpaid leave of absence because of the amount of work he had been missing.

Lloyd unsuccessfully appealed the Review Board's decision. The Disability Committee observed that the notes from Lloyd's most recent visit to Dr. Hellman "contain[ed] no objective information to substantiate disabling fatigue or pain." The Disability Committee also obtained an independent review from another gastroenterologist, Dr. Sunil Sheth. Dr. Sheth reviewed Lloyd's medical records and agreed with Dr. Gilinsky's earlier assessment: Lloyd had "no functional impairments from [his] chronic diagnosis of irritable bowel syndrome that has been present since 2009," and "from a [gastrointestinal] standpoint, abdominal distention and bloating by itself does not result in any restrictions or limitations." The Disability Committee credited Dr. Sheth's opinion and upheld the denial of benefits on October 30, 2015.

C.

On December 1, 2015, Lloyd filed another disability claim, which is the first claim in dispute here. Lloyd alleged that he had been disabled since November 3, 2015, ^[1] primarily due to gastrointestinal issues.

On January 19, 2016, the Review Board denied Lloyd's claim. It observed that, in early November, Lloyd's primary care physician, Dr. Anup Kanodia, had "described [him] as appearing well with no acute distress and with no documented clinical abnormalities." Two rheumatologists had also documented normal findings for Lloyd in November and December 2015 and had not recommended taking Lloyd off work. But, in late December, Lloyd visited Dr. Kanodia again, who, this time, concluded that he was unable to work in any capacity. The Review Board concluded that there was no indication that Lloyd "w[as] evaluated or treated by a gastroenterologist" during the claim period and that "there [wa]s a lack of objective medical information to support [a finding] that [Lloyd] w[as] partially or totally disabled as defined by the Plan beginning November 3, 2015."

On January 29, 2016, before he appealed to the Disability Committee, Lloyd had an appointment with Dr. Kirby. According to Dr. Kirby's notes, Lloyd had been to the emergency room with "abdominal distention and pain" four times since their last meeting in May 2015. Dr. Kirby also noted that Lloyd reported "severe difficulty going to work." "While [Lloyd] may have had Irritable Bowel [Syndrome] at some point in the past," Dr. Kirby concluded, Lloyd's "motility disorder ha[d] progressed." Dr. Kirby diagnosed Lloyd with chronic intestinal pseudo-obstruction (CIPO).

CIPO is a rare condition that produces symptoms similar to ordinary bowel obstruction. However, with CIPO, the obstruction does not result from a mechanical blockage inside the intestine. Rather, it results from a failure of intestinal muscles or nerves to move materials through the bowels normally. Dr. Kirby is one of the few experts on this disorder. According to him, it takes a long time to diagnose CIPO because one must test for, and rule out, other causes of the symptoms; for example, a mechanical blockage in the intestine due to an internal lesion could be another cause.

In February 2016, Lloyd filed his appeal with the Disability Committee, citing this new diagnosis.^[2] The Committee returned to Dr. Sheth for an updated opinion. Dr. Sheth was skeptical. First, he disagreed with Dr. Kirby's diagnosis. Dr. Sheth explained that CIPO is an appropriate diagnosis "when there is evidence of obstruction without true mechanical obstruction," but Lloyd, "on multiple occasions during acute flares, has had no evidence of bowel distention, dilated loops, or air-fluid levels"-nor did he have any "evidence of impaired motility." Second, he faulted Dr. Kirby for focusing too much on Lloyd's diagnosis rather than his symptoms when deciding whether Lloyd was disabled. In Dr. Sheth's view, no objective medical evidence indicated a significant change in Lloyd's condition since the previous denials of benefits.

In April 2016, the Disability Committee upheld the denial of benefits. It reiterated Dr. Sheth's conclusion that "there ha[d] been no major change in" Lloyd's symptoms and that tests had "repeatedly resulted in negative findings with no evidence of bowel obstruction." For example, Lloyd's "x-ray and lab results were normal" during his January 2016 appointment with Dr. Kirby.

D.

We now turn to Lloyd's second disputed denial of benefits. Lloyd obtained an additional review from a different gastroenterologist, Dr. Prakash Gyawali. He concluded that Lloyd's history "could be consistent with intermittent pseudoobstruction [CIPO], but there is likely a component of constipation predominant irritable bowel syndrome as well." Dr. Gyawali did not opine on whether Lloyd's condition was disabling.

In 2016, Lloyd began taking a new prescription medication domperidone. ...