defendant's requirement of proof to a reasonable degree of medical certainty also recognizes that rarely if ever can anyone state to an absolute certainty that a medical condition will last a person's lifetime. Defendant's use of the reasonable-degree standard, therefore, distinguishes this case from Sansevera, in which the court found unreasonable DuPont's requirement that the applicant demonstrate "with medical certainty" that the disability would be lifelong. 859 F. Supp. at 114-15.
In addition, I note that courts frequently consider whether a physician is able to make a finding to a reasonable degree of medical certainty in similar contexts, which also suggests that there is nothing unreasonable about that standard. See, e.g., Reid v. Connecticut Gen. Life Ins. Co., 17 F.3d 1092, 1100 (8th Cir. 1994) (district court, in finding that defendant insurance company had been prejudiced by plaintiff's late filing of claim, and accordingly did not owe plaintiff any benefits, did not err in relying on physician's inability to state to reasonable degree of medical certainty that plaintiff was disabled during certain time period); Brogan v. Holland, 908 F. Supp. 363, 371 (S.D.W.Va. 1995) (since doctors who examined plaintiff were not able to say with any degree of certainty the specific time or cause of plaintiff's stroke, defendant plan trustees' finding that stroke was not caused by mining accident was not unreasonable); Bruce v. K-Mart Corp., 568 F. Supp. 378, 384 (W.D.Ark. 1983) (finding that plaintiff first became disabled on earliest date when "it could be said with a reasonable degree of medical certainty that the disability was likely to be permanent").
On the record that was before defendants, I also find that their conclusion that plaintiff had not established the permanence of her condition to a reasonable degree of medical certainty was not arbitrary or capricious. Several of the physicians who had examined Darling expressed uncertainty about how long her condition would last, and some even opined that she might recover relatively soon.
For example, a September 22, 1993 letter from Dr. Jack Chelebian, M.D. to Dr. Carl Auerbach, M.D. (a DuPont physician who had referred Darling to Dr. Chelebian) stated that given the "uncertainty of outcome" of plaintiff's condition, he recommended medication on a trial basis. Plaintiff's Motion Ex. H. An attached note stated that "hopefully, she may have a positive response ..." Id.
A letter addressed "To Whom It May Concern" from Dr. A. R. Brigandi, M.D., one of plaintiff's treating physicians, though stating that Darling suffered from Chronic Fatigue Syndrome, also stated that "it is not known whether or when the disability is likey [sic] to resolve," and that plaintiff was "totally disabled from working in any capicity [sic] for an indefinite period of time." Id.
Dr. Auerbach also examined Darling. Although he stated that the trial drugs recommended by Dr. Chelebian had not been successful and that he "did not see any likelihood of a return to work," he also stated that her prognosis was "uncertain," and that "the course of the problem is such that remissions can occur." Id. Ex. I. Dr. Auerbach also stated that "if indeed it is what has become to be known [sic] as the 'chronic fatigue syndrome', the prognosis is fair. Individuals with this syndrome often recover in six to eight months but some can linger on for many years and there are relapses. We just do not have enough medical information about it to make any better prognosis at this time." Brenner Aff. Ex. B.
Dr. Edward E. Walsh, M.D., a consulting physician, also examined plaintiff after she was referred to him by Dr. Brigandi. He stated that "her symptoms fell into this category of chronic fatigue syndrome," but that he tried to reassure Darling that the symptoms "will wax and wane, that they may disappear completely but there is no guarantee of this." Plaintiff's Motion Ex. M. He also said that he explained to plaintiff "that it may well resolve on its own without specific therapy as is often the case." Id.
In light of these statements, I cannot say that "there has been a clear error of judgment" on defendant's part, Jordan, 46 F.3d at 1271, or that their decision was "without reason, unsupported by substantial evidence or erroneous as a matter of law." Pagan, 52 F.3d at 442. This is not to say, of course, that defendant's determination was the only reasonable one, but it is not the role of this court to substitute its judgment for defendant's.
The court is not insensitive to plaintiff's condition. The medical records clearly indicate that she has suffered considerably since her symptoms first arose. I am also aware that persons who are afflicted with diseases that are not yet well understood may be at a disadvantage when attempting to establish the permanence of their condition. Nevertheless, I cannot decide this case based on whether I think that plaintiff "deserves" benefits. Plaintiff is seeking to enforce her rights under a specific, written plan, the Board's interpretation of which I must accept unless it is arbitrary and capricious. Given the uncertainty of the medical record regarding plaintiff's prognosis, I cannot find that the Board's conclusion that plaintiff had failed to show that she suffered from a permanent disability was arbitrary and capricious.
Plaintiff's motion for summary judgment (Item 7) is denied. Defendant's cross-motion for summary judgment (Item 8) is granted, and the complaint is dismissed.
IT IS SO ORDERED.
DAVID G. LARIMER
UNITED STATES DISTRICT COURT
Dated: Rochester, New York
January 21, 1997.