Sharp v. Trs. of the Umwa 1974 Pension Trust, Case No. 18-cv-03056

441 F.Supp.3d 680

William R. SHARP, Plaintiff,

v.TRUSTEES OF the UMWA 1974 PENSION TRUST, Defendants.

Case No. 18-cv-03056

United States District Court, C.D. Illinois, Springfield Division.

Signed February 27, 2020

Filed February 28, 2020

Grady E. Holley, Holley, Rosen & Beard, LLC, Springfield, IL, for Plaintiff.

Emily Rebecca Perez, Greg A. Campbell, Hammond and Shinners PC, St Louis, MO, for Defendants.

OPINION

SUE E. MYERSCOUGH, U.S. District Judge:

Now before the Court are Defendants' Motion for Summary Judgment (d/e 19) and Plaintiff's Motion for Summary Judgment (d/e 21). For the reasons set forth below, Plaintiff's summary judgment motion is GRANTED. Accordingly, Defendants' summary judgment motion is DENIED.

I. INTRODUCTION

On March 23, 2018, Plaintiff William R. Sharp filed a Complaint against the United Mine Workers of America Health and Retirement Funds. On August 3, 2018, Plaintiff, with leave of Court, filed an Amended Complaint against Defendants, Trustees of the UMWA 1974 Pension Trust. Plaintiff's Amended Complaint, pursuant to provisions of the Employee Retirement Income Security Act (ERISA), requests an award of pension disability benefits under the United Mine Workers of America 1974 Pension Plan (Pension Plan), prejudgment interest, costs, and attorney's fees.

Both parties now move for summary judgment. The material facts are undisputed.¹ Plaintiff claims that the undisputed material facts establish that he is entitled to pension disability benefits under the Pension Plan. In contrast, Defendants assert that the undisputed material facts establish that Defendants' decision to deny Plaintiff pension disability benefits was not arbitrary or capricious and must be affirmed.

II. JURISDICTION AND VENUE

The Court has subject matter jurisdiction over Plaintiff's claim for pension disability benefits because that claim is brought under 29 U.S.C. § 1132(a)(1)(B). See 28 U.S.C. § 1331 ("The district courts shall have original jurisdiction of all civil actions arising under the Constitution, laws, or treaties of the United States.").

Because a substantial part of the events giving rise to Plaintiff's claim occurred in the Central District of Illinois, this district is a proper venue for Plaintiff's claim. See 28 U.S.C. § 1391(b)(2) (stating that a civil action may be brought in "a judicial district in which a substantial part of the events or omissions giving rise to the claim occurred").

III. FACTS

Since the 1980s, Plaintiff has been evaluated for "numerous problems including his low back." R. 346.² Plaintiff had chronic low back pain complaints prior to December 16, 2003. Id. In testimony provided in connection with a workers' compensation claim, Plaintiff stated that he had low back pain and left-leg numbness prior to December 16, 2003 and that he filed a previous workers' compensation claim after an accident in October 1999 involving his low back. R. 352-53.

In 1999, Plaintiff had radiculopathy and, possibly, a lumbar disk rupture. R. 349. Vittal Chapa, M.D., ordered a lumbar MRI. Id. Plaintiff underwent an MRI in November 1999. R. 355. The MRI results, when compared to the results of an MRI conducted in June 1997, noted a significant change at the L2-3 and L4-5 levels. Id. At L3-4, Plaintiff had developed a posterolateral herniation of the disk with encroachment upon the L3 nerve root. Id. On January 19, 2000, Plaintiff underwent a CT myelogram, which showed a diffuse disk bulge at L3-4 with bilateral inferior foraminal stenosis. Id.

In 2000, Dr. Chapa diagnosed Plaintiff with lumbar disk radiculopathy, and Plaintiff was admitted to the hospital for intractable low back pain. R. 349. An MRI from September 2000 showed a diffuse bulging of the disk at L3-4. R. 69. On October 17, 2000, Dr. Chapa diagnosed Plaintiff with chronic low back pain and lumbar disk disease. R. 349. On July 21, 2003, Dr. Chapa noted Plaintiff's history of chronic back pain and osteoarthritis. R. 352.

Plaintiff was employed by Freeman United Coal Mining Company (Freeman), a signatory company to the Pension Plan, which was administered by Defendants. On December 17, 2003, Freeman completed an accident report stating that Plaintiff had stepped in a hole and twisted his back, resulting in a sprain. R. 116.

Two days later, Dr. Chapa met with Plaintiff, who reported that he had stepped in a hole and twisted his back and was experiencing pain in his low back that radiated down his right leg. R. 93. Plaintiff also reported that his pain was somewhat better than it had been two days prior and that he was experiencing some intermittent numbness in his right leg. Id. Dr. Chapa found that Plaintiff had a "positive straight leg raising test on both sides at 70 degrees." Id. Dr. Chapa's impression was "[l]umbosacral sprain," "[r]ule out lumbar radiculopathy," and "[p]revious history of lumbar disk disease." Id. Dr. Chapa noted that Plaintiff could return to restricted work not involving physical activity on December 20, 2003. R. 93-94.

On December 23, 2003, Dr. Chapa again saw Plaintiff, who reported that his pain was still present and that he was experiencing numbness radiating down his right leg. R. 95. Plaintiff also reported that he was back at work but not doing any bending, lifting, or stooping. Id. Dr. Chapa found that Plaintiff had a "positive straight leg raising test on the right at 70 degrees" and mild paravertebral muscle spasms. Id. Dr. Chapa's impression was "[l]umbar disk with radiculopathy," and he ordered an MRI of the lumbar spine. Id.

On January 5, 2004, Plaintiff underwent an MRI of his lumbar spine. R. 363. The findings were as follows: (1) "mild degenerative change without significant canal or foraminal stenosis" at the L1-2 and L2-3 interspaces; (2) "mild degenerative change without significant canal or foraminal stenosis" at L3-4; (3) "moderate canal and bilateral foraminal stenosis secondary to a combination of disk bulge, ligamentous hypertrophy and facet arthropathy" at L4-5; (4) "minimal degenerative change in the disc with small central disc bulge" and "[n]o significant canal or foraminal stenosis" at L5-S1; and (5) "a rudimentary disc at S1-S2." Id. The MRI findings were summarized as follows: "Significant canal and foraminal stenosis at L4-5. Very small disc at S1-2." Id. During a deposition, David W. Mack, M.D., an orthopedic surgeon who treated Plaintiff, "opined that all the things seen on the [January 5, 2004,] MRI were present prior to the December 16, 2003 accident and were present and growing for years." R. 346-47, 368.

On January 12, 2004, Plaintiff saw Dr. Chapa and reported significant back pain that required Plaintiff to lay with a heating pad for two hours after work. R. 96. Dr. Chapa, whose impression was "[s]pinal stenosis," planned to refer Plaintiff to Dr. Mack. Id. Dr. Chapa advised that Plaintiff should not bend, stoop, lift over 20 pounds, or ride on rough equipment. R. 97.

On January 20, 2004, Plaintiff visited Dr. Mack and reported back pain that went into his legs and "a long history of difficulty with his back." R. 342, 368. However, Plaintiff felt that his back was doing "fairly well" until he stepped in a hole and twisted his back in December 2003. R. 368. Dr. Mack diagnosed "degenerative disc at L3-4 and L4 nerve root irritation" involving the lower legs and thighs. R. 343. Ten days later, Dr. Mack diagnosed "degenerative disc with lumbar spinal stenosis and foraminal stenosis." Id. On January 28, 2004, a return-to-work slip diagnosed Plaintiff with a lumbar strain. Id.

On February 11, 2004, Plaintiff was seen by Paul A. Smucker, M.D., who performed electromyography (EMG) testing on Plaintiff. R. 268. Plaintiff reported "longstanding pain in his low back, with an exacerbation this past December when he stepped into a hole," a "sharp pain radiating into his right leg" when he stepped into the hole, a history of "episodic back problems," and a "tendency to experience numbness and tingling" in his thighs and legs. Id. Plaintiff also reported that his low back pain was more problematic than his "lower extremity symptoms." Id.

Dr. Smucker's conclusions were "[m]ild right L5 and S1 radiculopathy" with no "electrodiagnostic evidence of definable radiculopathy on the left" and "[n]o electrophysiological evidence of diffuse peripheral neuropathy." R. 269. Dr. Smucker's impression was "[l]ow back pain, suggesting possible discogenic/degenerative disc pain, with history of exacerbation this past December." Id.

On February 19, 2004, Plaintiff saw Dr. Chapa, who noted that Plaintiff was performing restricted work and reporting back pain. R. 99. Dr. Chapa's impression was "[l]umbar disc with radiculopathy." Id.

On March 19, 2004, Plaintiff informed Dr. Mack that Plaintiff's pain was worse on the left. R. 344. Dr. Mack diagnosed "spinal stenosis L4-5 with radicular pain." Id. Three days later, Plaintiff was seen by Dr. Chapa, who noted that Plaintiff was seeing Dr. Mack for his back pain and had received epidural injections. R. 100. Dr. Chapa's impression was "[l]umbar disc with back pain." Id.

On April 7, 2004, Plaintiff visited Dr. Mack. R. 344. At this visit, according to an August 2007 decision by the Illinois Workers' Compensation Commission (Commission), Plaintiff complained of low back pain that went into the left hip and, according to Dr. Mack, voiced a desire to "have something done" because Plaintiff's level of activity had markedly decreased. R. 340, 344, 358. According to the Commission decision, Dr. Mack diagnosed L4-5 spinal stenosis with radicular pain and "degenerative changes with foraminal stenosis" and felt that Plaintiff needed "a bilateral decompression and possibly a posterolateral fusion." R. 344.

The same Commission decision also summarized a report by Timothy Van Fleet, M.D., to Dr. Mack on April 23, 2004, as follows:

[Plaintiff] was seen this day and reported he had been experiencing low back pain and lower extremity pain for some time. Dr. Van Fleet noted that he had previously

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