Petroske v. Kohler Co.

854 F.Supp.2d 669

Richard E. PETROSKE, Plaintiff,

v.KOHLER CO., Defendant.

Civil No. 11–125 (JNE/FLN).

United States District Court, D. Minnesota.

Feb. 24, 2012.

Andrew J. Hippert, Midwest Disability, PA, Coon Rapids, MN, for Plaintiff.

Jacqueline A. Mrachek, Nilan Johnson Lewis PA, Minneapolis, MN, Kevin J. Kinney, Mark A. Johnson, Krukowski & Costello, SC, Milwaukee, WI, for Defendant.

ORDER

JOAN N. ERICKSEN, District Judge.

Plaintiff Richard E. Petroske (“Petroske”) brought this action against Defendant Kohler Co. (“Kohler”), his former employer, seeking recovery of long-term disability benefits under an employee benefit plan. Petroske commenced this action in the Anoka County District Court in December 2010, alleging breach of contract. Kohler removed the case to federal court because the claim was preempted by Section 502(a) of the Employee Retirement Income Security Act (“ERISA”), 29 U.S.C. § 1132(a) (2006); see Metro. Life Ins. Co. v. Taylor, 481 U.S. 58, 107 S.Ct. 1542, 95 L.Ed.2d 55 (1987); Estes v. Fed. Express Corp., 417 F.3d 870, 872–73 (8th Cir.2005). Both parties have now moved for Summary Judgment. For the reasons stated below, the Court grants Kohler's motion and denies Petroske's motion.

I. BACKGROUND ¹

A. The Disability Plan

Petroske began working for Kohler on a full-time basis as a cabinet installer on September 13, 1998. He stopped working for Kohler in 2003. During his employment and at all times relevant to this litigation, Kohler has maintained a “Pay Protection Plan” (“Plan”). Kohler both administers and pays benefits under the Plan. The Plan states:

After you have been totally disabled for a period of 26 weeks and received your Short–Term Disability or Salary Continuation benefit payments, you will be paid 60% of your base salary under the Long–Term Disability Plan.

Under the Plan, “Long–Term Disability benefits will begin after you have been totally disabled for 26 weeks.” The Plan defines “total disability” as:

• During the first 24 months of disability, you must be totally disabled from performing any and every duty of your occupation or similar job.

• After 24 months, you must be totally disabled from performing any occupation or employment.

You must always be under the care of a licensed physician during your disability. In addition, your disability must be medically verified and satisfactory to the Company before your Long–Term Disability benefits will begin.

The Plan also states:

Payments and final decisions on all claims are the sole responsibility of the Company. If Kohler Co. requests proof of disability, it must be satisfactory to the Company in order for benefits to be paid.

B. Petroske's Medical History

Petroske stopped working for Kohler as a result of his undergoing surgery to repair a torn meniscus. In the following months, he began experiencing symptoms including lightheadedness, dizziness, fatigue, headaches, shortness of breath, double vision (diplopia), droopy eyelids, and facial numbness. In late 2003, Petroske saw Dr. Neil Henry, who assessed Petroske as suffering from weakness and diplopia. In December 2003, Petroske told Dr. Henry that he was too fatigued to be able to work. Petroske was sleeping three to four hours during the day, became tired from walking to his mailbox, and had trouble keeping his eyelids open. Dr. Henry assessed Petroske as suffering from “syndrome of tiredness and diplopia” with “poss[ible] myasthenia gravis.” On this date, Dr. Henry also completed a Kohler “Disability Claim Form,” explaining that Petroske was unable to work due to generalized weakness and fatigue.

On February 10, 2004, Petroske saw ophthalmologist Dr. Howard Pomeranz for an evaluation of his headaches and visual disturbances. Dr. Pomeranz did not find any objective abnormalities and noted that Petroske suffered from a “[s]ubjective visual disturbance of unclear etiology possibly due to diabetic maculopathy.” Petroske also saw ophthalmologist Dr. Eric Steuer, who did not find any evidence of macular disease and did not believe Petroske's visual problems and headaches were related to his retinas. Dr. Steuer opined that Petroske's symptoms could possibly be due to either a connective tissue disorder or some other undefined neurological problem.

On April 19, 2004, Petroske saw neurologist Dr. David Walk, who noted that Petroske's headache was only present when Petroske was seated. Dr. Walk remarked that Petroske “has subjective diplopia with no objective findings” that was “associated with a postural headache syndrome.” He arranged for an MRI to determine the etiology of Petroske's symptoms.

Over the next few months, Petroske underwent an extensive evaluation at the Mayo Clinic. On July 23, 2004, Petroske saw neurologist Dr. Charles Hall, who believed Petroske likely had some variant of postural orthostatic tachycardia syndrome (POTS).² At that time, Dr. Hall noted abnormalities in Petroske's blood pressure readings, specifically noting several instances of blood pressure changes accompanied by increases in heart rate to above 120 beats per minute. Dr. Hall diagnosed Petroske with “orthostatic headache without CSF leak and postural tachycardia syndrome” and recommended that Petroske discontinue his Lasix and wear support hose. Dr. Hall also recommended that Petroske could wear an abdominal binder, tip the head of his bed up, and increase the salt and protein intake in his diet. On August 13, 2004, at Petroske's request, Dr. William Evans from the Mayo Clinic submitted physician reports and documentation of Petroske's “various illnesses and our opinion that he is permanently disabled.”

On August 16, 2004, Petroske saw neurologist Dr. Eduardo Benarroch at the Mayo Clinic, who noted that Petroske's headaches were associated with sitting or standing and were relieved relatively quickly by lying down. Dr. Benarroch noted that Petroske's test results “revealed normal post-ganglionic sudomotor and cardiovagal function” and that Petroske's “orthostatic intolerance with excessive tachycardia upon standing ... could be consistent with deconditioning, hypovolemia, hyperadrenergic state such as anxiety, or less likely limited adrenergic neuropathies.” Dr. Benarroch did not believe that orthostatic intolerance was the cause of the postural headaches, and recommended that Petroske perform resistance exercises in the lower extremities, increase the amount of sodium in his diet, discontinue his Lisinopril, and wear support stockings.

On August 30, 2004, neurologist Dr. Bahram Mokri, a specialist in postural headaches at the Mayo Clinic, examined Petroske. He noted that Petroske's imaging studies had revealed normal results and diagnosed Petroske with orthostatic headaches. He noted that POTS is a possibility, but that “[t]he question may remain as to whether this orthostatic intolerance is a function of deconditioning or is the cause of the headache.” Dr. Mokri recommended symptomatic treatment, a medication adjustment, and use of an abdominal binder.

On September 21, 2004, Dr. Hall again saw Petroske and noted that Petroske “currently still has headaches on attaining an upright position. He is able to hunt and fish and move about quite easily without having headaches, but it is shortly after he rests that his headaches recur in the upright position. This is not likely postural orthostatic tachycardia syndrome. This is not likely a manifestation of autonomic failure.... He will most likely benefit with exercises to improve his conditioning and orthostatic tolerance.”

On October 1, 2004, Dr. William Evans completed the summary of Petroske's evaluation at the Mayo Clinic. He summarized Petroske's final diagnoses as: postural headache, postural intolerance, cervical spondylosis with mechanical neck pain, Type II diabetes, fatigue, and dependent edema. With respect to the headaches, the recommendations were that Petroske wear a waist-high compression garment and decrease his coffee consumption.

Dr. Scott Moses saw Petroske on April 4, 2005. The notes from that visit indicate that Dr. Moses saw Petroske for his orthostatic headaches in March 2005, at which time Dr. Moses recommended exercise and weight loss. On the April 4th visit, Dr. Moses noted that Petroske's blood pressure rose from 135/95 when lying down to 152/100 when standing, and his pulse increased from 76 to 92. Petroske's “active problem list” as of April 2005 was: orthostatic headache, POTS, Type II diabetes, Obesity, Anemia NOS, sleep apnea, high blood pressure, and hyperlipidemia.

On July 12, 2005, Petroske returned to see neurologist Dr. Hall after coming back from a fishing trip in Canada. Dr. Hall noted that Petroske's blood pressure “has been very stable” and that the orthostatic hypotension had resolved. Dr. Hall had “not recorded a low blood pressure on [Petroske] in some time” and “[n]o primary disorder of blood pressure regulation was discovered.” “With adjustment of his medications, Mr. Petroske has actually done very well.” Dr. Hall also noted that Petroske continued to complain of postural headaches upon standing or sitting upright for prolonged periods of time, which was most likely a primary headache disorder. Dr. Hall encouraged Petroske to go back to work and “become as active as he possibly can.” The only restriction Dr. Hall noted was that Petroske “might need to recline for periods of about 15 minutes every two hours while at work.” As of July 2005, Petroske's double vision had apparently improved as well.³

On July 28, 2005, Petroske saw neurologist Dr. Gerald Dove for evaluation of his postural headaches. Dr. Dove's notes state that “[t]he headache is more of a nuisance type headache. It is not very severe. It tends to be a 4/10.” Petroske also reported symptoms of double vision, photophobia, phonophobia, difficulty swallowing, droopy eyelids, and shortness of breath. Dr. Dove reviewed Petroske's previous medical evaluations and noted that Petroske's postural hypotension has resolved. His...