Tony Cerentano v. Umwa Health and Retirement Funds

In the
United States Court of Appeals
For the Seventh Circuit
____________________
No. 13‐2037
T ONY C ERENTANO,
Plaintiff‐Appellant,
v.
UMWA HEALTH AND R ETIREMENT FUNDS ,
Defendant‐Appellee.
____________________
Appeal from the United States District Court for the
Southern District of Illinois.
No. 3:12-cv-00153 — Michael J. Reagan, Judge.
____________________
A RGUED NOVEMBER 6, 2013 — D ECIDED N OVEMBER 22, 2013
____________________
Before WOOD, Chief Judge, and FLAUM and T INDER , Circuit
Judges.
FLAUM, Circuit Judge. From 1978 to 2000, Tony Cerentano
worked as a coal miner. He was injured in fifteen mining
incidents and received six separate awards of permanent
partial disability, but he was able to return to work after
each injury. In 2005, Cerentano’s car was rear‐ended,
resulting in more injuries. After this accident, Cerentano
sought and was awarded Social Security disability benefits.

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He then applied for disability pension benefits under the
United Mine Workers of America 1974 Pension Trust Plan.
The plan’s trustees denied Cerentano’s application for
benefits, concluding there was no causal link between his
mine injuries and the award of Social Security benefits.
Cerentano then filed suit, challenging the trustees’ decision
pursuant to the Employee Retirement Income Security Act of
1974 (ERISA), 29 U.S.C. § 1332(a)(1)(b). The district court
granted summary judgment to the defendant plan. We
reverse and remand to the plan’s trustees.
I. Background
This case has three relevant periods: (1) 1978–2000;
(2) 2001–2004; and (3) 2005 and after. Cerentano worked in
the mines in the first period, worked out of the mines in the
second period, and did not work in the third period.
A. Injuries in the coal mines, 1978–2000
From 1978 until 2000, Cerentano worked for Monterey
Coal Company and was involved in various accidents on the
job, resulting in injuries to his elbow, knee, back, neck, and
shoulders. The relevant accidents include (but are not
necessarily limited to) the following.
On January 29, 1986, Cerentano sprained the right side of
his back while lifting a shovelful of slate. He missed work
for ten days. He received temporary total disability benefits
and a 1.25 percent permanent partial disability award.
On May 23, 1989, Cerentano injured his left elbow while
he was throwing a rock dust bag. He ultimately missed 247
days of work, including having surgery to repair a ruptured
biceps tendon. He received a 20 percent permanent partial
disability award. He later reinjured that elbow at work.

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No. 13‐2037 3
On February 10, 1994, Cerentano sprained his left knee
when he slipped while pulling loose cable. Despite popping
and occasional pain in his knee, he did not miss work after
this injury. However, on June 3, 1994, he twisted this knee
when he stepped on a piece of coal while stepping off a
ladder. After an MRI, Cerentano had surgery to repair a
meniscal tear and reconstruct the anterior cruciate ligament
(“ACL”). Seven months later, he returned to work without
restriction. He received a 35 percent permanent disability
award for his left leg.
On February 27, 1999, Cerentano slipped and fell when
he caught his foot on the lip of a coal‐hauling cart, straining
a muscle in his back. A follow‐up examination found no
neurological deficits, and an MRI of his spine was negative
for disc herniation and did not suggest a compression
fracture. Cerentano missed 88 days of work before returning.
He received temporary total disability benefits and a five
percent permanent partial disability award. 1
On July 27, 2000, Cerentano inhaled fumes when he
opened the lid on a battery compartment in a coal car that he
had been operating. After complaining of chest tightness
and dizziness, he was given oxygen and sent home. The next
day, he returned to work, but power was interrupted in the
mine. During the subsequent evacuation of the mine, he fell
ill, became light headed, and fell out of a moving cart. He
was taken to the hospital because of pain in his shoulders,
1 In May 2000, Cerentano’s family doctor (Dr. Cantrell) also began
treating him for dysthymia, a mood disorder whose symptoms are
longer‐lasting but less severe than depression. She prescribed
antidepressants.

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left ankle, and left knee. Various x‐rays were negative, but
he was diagnosed with an injury to his left medial meniscus.
After an MRI, a doctor surgically repaired this knee, and also
found that the ACL was lax but not torn. In the aftermath of
the accident, another doctor examined Cerentano for neck
and back pain. He diagnosed contusions of the cervical,
dorsal, and lumbar spines with a possible tear in the cervical
area and degenerative changes in one location. He
recommended weight loss, but no orthopedic treatment.
Another physician, Dr. Dusek, treated Cerentano for pain in
both shoulders, and performed an arthroscopy of the right
shoulder. Cerentano recovered full range of motion.
Cerentano received workers’ compensation benefits for
the July 28th accident, and was awarded an additional 20
percent permanent partial disability for his left leg and 28.7
percent for his right arm. His shoulder pain continued, so he
had more testing. An MRI suggested a partial tendon tear in
the right shoulder but was negative for the left shoulder.
B. Events from 2001–2004
Although he was ultimately released to return to work
without restriction, Cerentano last worked in the mines on
July 28, 2000, because he was wrongfully discharged after a
false positive drug test. A few months later, Dr. Cantrell
diagnosed Cerentano with depression due to his firing and
prescribed antidepressants. Based on various symptoms, a
psychologist also diagnosed and treated Cerentano for
dysthymia and anxiety. Ultimately, Cerentano found work
as a real estate agent and a recreational vehicle transporter.

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No. 13‐2037 5
C. Car accident and aftermath, 2005 and after
On February 16, 2005, Cerentano interviewed for a job as
a laborer in a warehouse. On his way back from the
(successful) interview, his car was rear‐ended. Dr. Cantrell
diagnosed Cerentano with cervicalgia (neck pain) and
lumbar pain. X‐rays showed a loss of normal cervical
curvature and mild scoliosis with mild disc space narrowing
in his lumbar spine. One month later, an MRI showed slight
disc bulging with an annular tear. Cerentano soon returned
to Dr. Cantrell complaining of left knee pain. X‐rays revealed
a small fracture, which was attributed to the car accident.
Dr. Scherer evaluated Cerentano’s left knee for popping
and crunching. He noted Cerentano’s prior ACL surgery and
said that Cerentano “did not have pain in his knee before the
accident.” Dr. Scherer’s impression was a knee injury from
the car accident, either from a blow to the dashboard or a
violent contraction of the quadriceps. Cerentano requested
permission to start his new job; the doctor said that it might
be problematic but that Cerentano could work if he felt well
enough to do so.
In September 2005, Dr. Cantrell diagnosed Cerentano
with diabetes, left arm neuropathy, lumbar pain with
radiculopathy, depression, and left knee pain. In December
2005, Dr. Gornet examined Cerentano for headaches with
neck pain, pain between the shoulder blades, pain into his
left arm, occasional pain in his right arm, back pain, and left
leg pain. Dr. Gornet said that the problems were attributable
to the car accident on February 16, 2005.
Dr. Miller examined Cerentano in 2006 for left shoulder
pain, and noted that the pain began with the 2005 car

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6 No. 13‐2037
accident. After an MRI showed inflammatory changes in the
left rotator cuff, Dr. Miller diagnosed rotator cuff tendonitis
and acromioclavicular (shoulder‐clavicle) degenerative joint
disease. He later injected Cerentano with cortisone, but the
results were disappointing. Dr. Miller’s impression was that
the pain actually emanated from Cerentano’s neck.
Cerentano continued having neck and back pain thereafter.
After the car accident, Cerentano applied for Social
Security Disability Insurance (SSDI) benefits. He sought
benefits beginning on February 16, 2005, the date of the car
accident. In a February 2008 opinion, an Administrative Law
Judge (ALJ) in the Social Security Administration (SSA)
applied the SSA’s five‐step sequential test. See 20 C.F.R.
§ 404.1520(a). The steps ask whether the claimant
(Cerentano) is engaged in substantial gainful activity;
whether he has a severe impairment (or a combination of
severe impairments); whether he is automatically disabled
because his severe impairment is referenced in 20 C.F.R.
§ 404.1520(d); if not, whether he can perform his past work
given his “residual functioning capacity,” which is based on
all of his impairments (not just his severe ones); and if he
cannot do his past work, whether he can do any other work,
given his residual functioning capacity, age, education, and
work experience. See 20 C.F.R. § 404.1520. Thus, under this
test, an individual can be found disabled either under 20
C.F.R. § 404.1520(d), or because he cannot do any work.
Applying this test, the ALJ found that Cerentano could
not do any work, and therefore was disabled and entitled to
benefits. Specifically, Cerentano was not employed, and he
had nine severe impairments: “asthma, diabetes mellitus,
morbid obesity, degenerative disc disease of the lumbar and

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No. 13‐2037 7
cervical spine, status post cervical fusion, degenerative joint
disease of the acromioclavicular joint, rotator cuff tendonitis,
depression, and anxiety.” Despite these impairments, he
could not be found disabled under 20 C.F.R. § 404.1520(d).
However, he could not perform his past work because of his
residual functioning capacity, which was limited due to
asthma; diabetes; obesity; back and neck pain due to his 2005
car accident; degenerative disc disease of the lumbar,
thoracic, and cervical spine; degenerative joint disease of the
acromioclavicular joint; rotator cuff/subacromial bursitis;
chronic back strain; “flexion contracture of the left elbow”;
“internal derangement of the left knee”; anxiety, depression,
and mood swings; severe headaches and pain running down
the neck into the arms and hands; and “knee pain
attributable to a prior knee injury.” The ALJ then found that
there were no jobs that Cerentano could perform given his
age, education, work experience, and residual functioning
capacity. The ALJ therefore found Cerentano disabled as of
February 16, 2005.
Cerentano then applied for disability pension benefits
from the United Mine Workers of America 1974 Pension
Trust Plan (“the Plan”). The Plan trustees denied both his
application for benefits and his appeal. Cerentano then filed
suit in federal district court, challenging the trustees’
determination. The parties stipulated to a remand to the
trustees to take another look, including analyzing additional
documentation. The trustees then issued another denial.
In the district court, both parties moved for summary
judgment, and the Plan’s motion was granted. The district
court first determined that arbitrary and capricious review
applied, because the Plan gives the trustees full discretion to

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8 No. 13‐2037
determine eligibility for benefits. The district court then
noted that the trustees had reviewed Cerentano’s file three
times and concluded that “none of his mine accidents alone
or in combination substantially contributed to his total
disability.” The court found this determination reasonable.
II. Discussion
We review a district court’s grant of summary judgment
de novo. Holmstrom v. Metro. Life Ins. Co., 615 F.3d 758, 766
(7th Cir. 2010). “Judicial review of an ERISA administrator’s
benefits determination is de novo unless the plan grants the
administrator discretionary authority to determine eligibility
for benefits or to construe the terms of the plan.” Id. (citing
Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 115 (1989)).
When, as here, the trustees possess such discretionary
authority, we ask only whether their decision was arbitrary
and capricious. Tompkins v. Cent. Laborers’ Pension Fund, 712
F.3d 995, 999 (7th Cir. 2013). Under arbitrary and capricious
review, we will uphold the trustees’ decision “as long as (1)
it is possible to offer a reasoned explanation, based on the
evidence, for a particular outcome, (2) the decision is based
on a reasonable explanation of relevant plan documents, or
(3) the administrator has based its decision on a
consideration of the relevant factors that encompass the
important aspects of the problem.” Id. at 999 (citation
omitted). Although our review is highly deferential, it “is
not a rubber stamp.” Holmstrom, 615 F.3d at 766. We will not
uphold a denial of benefits “when there is an absence of
reasoning in the record to support it.” Williams v. Aetna Life
Ins. Co., 509 F.3d 317, 321 (7th Cir. 2007) (citation omitted).
In this case, the Plan’s text states that a participant who
“becomes totally disabled as a result of a mine accident …

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No. 13‐2037 9
shall … be eligible for a pension while so disabled. A
Participant shall be considered to be totally disabled only if
by reason of such accident such Participant is subsequently
determined to be eligible for Social Security Disability
Insurance benefits … .” The phrases “as a result of” and “by
reason of” do not establish how closely connected the mine
accident(s) must be to the disability. When a plan’s language
is “ambiguous,” the trustees’ “interpretation … is entitled to
deference.” Tompkins, 712 F.3d at 1002. The trustees provide
an interpretation here, stating in their denial that
Cerentano’s SSDI benefits were not “causally related” to his
mine injuries, and that he did not establish “a causal link”
between his mine accidents and his award of SSDI benefits.
Moreover, “[t]he Trustees recognize that a combination of
injuries can cause a disability under the Plan.” At oral
argument, counsel for the trustees reiterated that a
combination of injuries from mine accidents and non‐mine
accidents can suffice. Thus, under the trustees’
interpretation, the crucial question is whether there is “a
causal link” between Cerentano’s injuries from mine
accidents and the ALJ’s decision to award benefits.
The trustees’ denial decision does not directly address
this key question, however. Instead, it incorrectly states that
the ALJ awarded benefits “based on” Cerentano’s nine severe
impairments. The trustees’ denial addresses each of these
severe impairments, concluding that none resulted from a
mine accident. The denial also determined that none of
Cerentano’s many accidents, from 1978–2000, was itself a
disabling injury. After all, he returned to work after each
injury, the denial notes. At this point, the analysis ends.

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Even under arbitrary and capricious review, this analysis
is insufficient. By their own interpretation, the trustees
needed to assess whether Cerentano’s mine injuries were “a
causal link” in the ALJ’s decision to award benefits. There
are two ways that an individual can be awarded SSDI
benefits: the first relies only on severe impairments, while
the second considers all impairments. Cerentano was
deemed disabled through this second path, after the ALJ
considered non‐severe injuries, several of which are or may
be from mine accidents (for instance, “flexion contracture of
the left elbow,” “internal derangement of the left knee,” and
“knee pain attributable to a prior knee injury”). Non‐mine‐
related injuries certainly contributed to Cerentano’s
disability, but the Plan states that it is appropriate to award
benefits in certain cases based on a combination of injuries,
only some of which were caused by mine accidents. On that
sensible interpretation, Cerentano’s elbow (and perhaps
several other) injuries could comprise “a causal link” in the
ALJ’s decision. 2 Thus, it was insufficient for the trustees to
conclude that each individual injury was not itself totally
disabling, because that is not the question in this case.
2 Our interpretation is consistent with—and therefore buttressed by—
our sister circuits’ interpretations of this particular defendant’s Plan.
Specifically, the Fourth Circuit said, “if the plaintiff was injured in a
mine accident and that injury, whether in combination with a previous
or subsequent condition, is substantially responsible for plaintiff’s
inability to perform his job and for whatever medical and vocational
reasons he is unable to perform an alternative job, then his total
disability results from a mine accident.” Boyd v. Trs. of UMW Health &
Ret. Funds, 873 F.2d 57, 59 (4th Cir. 1989) (citation omitted). To similar
effect the Sixth Circuit noted that “[t]he question is whether the accident
contributed in some part to the disability of [the applicant].” Odom v.
UMWA Health & Ret. Funds, 687 F.2d 843, 847 (6th Cir. 1982).

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No. 13‐2037 11
The Plan also argues that its denial is strongly supported
by the date of onset for Cerentano’s SSDI benefits—the date
of his car accident, which is more than four years after he
last worked in the mines. Yet the date of onset does not cure
the trustees’ incomplete analysis, nor preclude the
possibility that injuries from mine accidents were a causal
link in the ALJ’s decision.
In sum, the trustees should have examined all of the
injuries—both severe and non‐severe—that the ALJ relied on
in finding Cerentano disabled. The trustees also should have
determined which of those injuries were caused by mine
accidents and whether, in combination, those mine‐related
injuries comprised “a causal link” in the ALJ’s award of
disability benefits. Of course, we do not answer these
questions here. We merely remand to the trustees to address
these issues in a new round of review. See Holmstrom, 615
F.3d at 778 (“When an ERISA plan administrator’s benefits
decision has been arbitrary, the most common remedy is a
remand for a fresh administrative decision rather than an
outright award of benefits … .”).
III. Conclusion
For the foregoing reasons, we REVERSE and R EMAND to
the Plan trustees.

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