Ivory McCoy v. Michael Holland

PUBLISHED
UNITED STATES COURT OF APPEALS
FOR THE FOURTH CIRCUIT
 IVORY MCCOY,
Plaintiff-Appellee,
v.
MICHAEL HOLLAND; JOSEPH P. No. 03-1223 
BRENNAN; MARTY D. HUDSON; B.V.
HYLER, Trustees of the 1974
Pension Plan,
Defendants-Appellants. 
Appeal from the United States District Court
for the Western District of Virginia, at Big Stone Gap.
Glen M. Williams, Senior District Judge.
(CA-02-104-2)
Argued: January 22, 2004
Decided: April 9, 2004
Before NIEMEYER, WILLIAMS, and GREGORY, Circuit Judges.
Reversed and remanded with instructions by published opinion. Judge
Williams wrote the opinion, in which Judge Niemeyer and Judge
Gregory joined.
COUNSEL
ARGUED: Carolyn O’Meara Dutrow, Office of the General Counsel,
UNITED MINE WORKERS OF AMERICA, Washington, D.C., for
Appellants. Terry Gene Kilgore, WOLFE, WILLIAMS & RUTHER-

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FORD, Norton, Virginia, for Appellee. ON BRIEF: Glenda S. Finch,
Deputy General Counsel, Michele Schoeppe, Senior Associate Coun-
sel, UMWA Health & Retirement Funds, UNITED MINE WORK-
ERS OF AMERICA, Washington, D.C., for Appellants. Roger W.
Rutherford, WOLFE, WILLIAMS & RUTHERFORD, Norton, Vir-
ginia, for Appellee.
OPINION
WILLIAMS, Circuit Judge:
The Trustees of the United Mine Workers of America 1974 Pen-
sion Plan appeal the district court’s summary reversal of their deci-
sion to deny disability pension benefits to Ivory McCoy. Finding that
the decision of the Trustees was supported by substantial evidence,
we reverse the district court and remand with instructions that sum-
mary judgment be entered in favor of the Trustees.
I.
Ivory McCoy worked as a roof bolter for the Pittston Coal Company.1
In April 1993, McCoy was hit in the head by a falling rock while
working and was treated in the emergency room for a sprained neck.
He was advised to miss three days of work, and a follow-up appoint-
ment was scheduled. In May 1993, his attending physician completed
a report for the workers’ compensation commission in which
McCoy’s diagnosis was listed as cervical muscle spasms. The record
contains no evidence that McCoy sought any further medical treat-
ment relating to pain in his neck or his back until May 1995. McCoy
continued working in the mines until he was laid off in 1994. After
being laid off, McCoy worked as a carpenter until August 1995,
when, he claims, pain and psychological problems forced him to quit.
1It appears that McCoy’s direct employer was the Clinchfield Coal
Company, a subsidiary of Pittston.
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A.
Starting in May 1995, nearly two years after the mine incident,
McCoy began seeking and receiving treatment from a variety of phys-
ical and mental health professionals. McCoy first sought treatment
from Dr. James Gardener for "neck stiffness, soreness, and right
shoulder discomfort." (J.A. at 79.) Dr. Gardener diagnosed McCoy
with scapulothoracic syndrome.2 He prescribed Anaprox DS, an anti-
inflammatory drug, and advised McCoy to apply moist heat and mas-
sage to the problem areas. McCoy visited Dr. Gardener again in Janu-
ary 1996, at which time he complained of headaches and increased
pain in his neck and shoulder. Dr. Gardener gave McCoy a trigger-
point injection of anti-inflammatory and pain medications. He also
recommended that McCoy continue taking Anaprox DS and continue
applying heat and moisture to his neck and shoulder.
In early 1996, Dr. Russell McKnight evaluated McCoy’s psycho-
logical condition. Dr. McKnight reported in February 1996 that
McCoy suffered from "Anxiety Depressive Syndrome with Insomnia
secondary to Chronic Pain and Major Affective Disorder, Depression
of Moderate Severity with Psychomotor Retardation." (J.A. at 87.)
McCoy next visited Dr. Calvin Johnson of Watauga Orthopaedics.
Dr. Johnson found that McCoy’s "X-rays of the cervical spine reveal-
[ed] some degenerative cervical dis[c] disease3 . . . [and] mild degen-
2The parties define scapulothoracic syndrome as "a condition which
frequently simulates a herniated cervical invertebral disk. . . [t]he pain
often radiates to the neck and occiput . . . and may be accompanied by
headache." (Appellant’s Br. at 6 (quoting 5 J.E. Schmidt, Attorney’s Dic-
tionary of Medicine Word Finder s-42).)
3Degenerative disc disease is not a medical term of art. Instead, it is
a "convenient label . . . applied carelessly to a variety of distinct [degen-
erative] processes of spinal joints." 3 Donald Resnick M.D., Diagnosis
of Bone & Joint Disorders 1372 (3d ed. 1995). Degenerative diseases of
the spinal joints commonly result from structural changes "in the verte-
bral bone and endplate, which occur with advancing age, [and] interfere
with normal discal nutrition." Id. at 1373. One common degenerative dis-
ease of the spine is intervertebral chondrosis, which occurs when
"[a]ging results in dehydration and loss of tissue resiliency in the inter-
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erative change at [the lumbar spine.]" (J.A. at 92.) He determined that
McCoy suffered from chronic cervical strain and chronic low back
syndrome.
McCoy later visited William Brezinski, a licensed psychologist, for
an evaluation. Brezinski diagnosed McCoy with moderate to moder-
ately severe dysthymic disorder,4 moderate to moderately severe gen-
eralized anxiety disorder, and obsessive compulsive personality
disorder.
vertebral disc." Id. at 1375. Although the cause of intervertebral chondro-
sis is "not defined[,] . . . [t]he opinion that long-standing stress is
important in its development has gained wide acceptance." Id. "Congeni-
tal factors may also be important." Id. Another disease often described
by the catch-all phrase "degenerative disc disease" is spondylosis defor-
mans, which is typified by bone outgrowths, called osteophytes, along
the vertebral column. Id. at 1386. Spondylosis deformans is "extremely
common" with "precipitously rising frequency . . . with advancing age."
Id. at 1386. It is "generally . . . accepted" that spondylosis deformans is
caused by repeated exposure to stress at the site of "abnormalities in the
peripheral fibers" of the spinal column. Id. at 1388. Finally, the term "de-
generative disc disease" is used to denote several varieties of osteoarthri-
tis of the spine. Id. at 1396-1400. Osteoarthritis of the spinal joints is
"similar to degenerative diseases of other synovial joints." Id. at 1396.
Osteoarthritis is "a noninflammatory degenerative joint disease . . . char-
acterized by degeneration of the articular cartilage, hypertrophy of bone
at the margins, and changes in the synovial membrane." Dorland’s Illus-
trated Medical Dictionary 1199 (28th ed. 1994).
Even though these degenerative diseases of the spine are separate,
"some of the processes are related, [and] they frequently coexist at the
same vertebral level." Resnick, supra, at 1404. "Degenerative changes of
the cervical spine are common after the age of 40 years and affect more
than 70 percent of patients older than 70 years." Id. at 1407. Similarly,
"[d]egenerative changes in the lumbar spine . . . [are] detected . . . in 60
to 80 percent of men and women by the sixth decade of life, and in about
100 percent of subjects by the age of 70 years." Id. at 1408.
4Dysthymic disorder, also known as dysthymia, is "a mood disorder
characterized by depressed feeling . . . in which the associated symptoms
. . . are not severe enough to meet the criteria for major depression." Dor-
land’s Illustrated Medical Dictionary 519 (28th ed. 1994).
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In late 1996, Dr. Harry Kennedy performed an MRI of McCoy’s
neck and lumbar region. Kennedy noted degenerative changes in
McCoy’s neck. He also found bulging and protruding discs impinging
on a neural foramen and displacing a nerve in McCoy’s lumbar
region.
In February 1997, McCoy was referred to Dr. Loepoldo Bendigo
by the Social Security Administration for an evaluation in connection
with his application for Social Security Disability Insurance (SSDI)
benefits. Dr. Bendigo diagnosed McCoy as suffering from degenera-
tive disc disease of the cervical spine and severe degenerative disease
of the lumbar spine.
McCoy continued to visit Drs. Gardener and McKnight for the next
several years, reporting pain in his neck and lower back as well as
affective problems. McCoy was treated with a variety of anti-
inflammatory, antidepressant, anti-anxiety and pain medications.
McCoy also consulted an orthopedic surgeon, Dr. Schroering, but
McCoy failed to introduce the results of Schroering’s evaluations into
evidence.
In August 1999, McCoy was examined by Dr. Alain Desy. (J.A. at
130.) Dr. Desy diagnosed McCoy with "Chronic Cervical Pain as the
result of Post-Traumatic injury (Sprain/Strain) over pre-existing Spon-
dylolysis5 and Degenerative Changes, . . . Chronic Low Back Pain
due an aggravation of a pre-existing condition[, and] . . . Mild Reac-
tional Depressive State due to the [other] diagnos[e]s." (J.A. at 132.)
Dr. Desy stated that "it [wa]s believed that all the above-mentioned
diagnoses [we]re in relation to the work injury of 1993." (J.A. at 132.)
B.
McCoy initially applied for disability pension benefits in 1996. The
Trustees denied McCoy’s application because he had not yet been
awarded SSDI benefits. In February 2000, an administrative law
judge (ALJ) determined that McCoy was entitled to SSDI benefits as
5Spondylolysis is "a general term for degenerative changes due to
osteoarthritis." Dorland’s Illustrated Medical Dictionary 1564 (28th ed.
1994).
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of August 15, 1995. The ALJ found that McCoy was disabled primar-
ily because of "severe major affective disorder" with a secondary
diagnosis of "degenerative disc disease of the cervical and lumbar
spine." (J.A. at 61, 70.) The ALJ noted that McCoy was able to per-
form medium exertion but concluded that his affective disorder pre-
vented him from performing substantial gainful activity.
After McCoy was awarded SSDI benefits, the Trustees reconsid-
ered McCoy’s application. The Trustees again denied the application,
this time because they determined that the medical evidence did not
establish a causal link between the 1993 mine accident and McCoy’s
disabling conditions.
McCoy then filed a complaint in the United States District Court
for the Western District of Virginia alleging that the Trustees abused
their discretion when they denied his disability pension application.
Both parties moved for summary judgment, and the district court
granted McCoy’s motion and held that the Trustees had abused their
discretion. Accordingly, the district court ordered the Trustees to
award McCoy a disability pension. The Trustees timely appealed.
II.
A.
When an ERISA disability pension plan commits eligibility deter-
minations to the discretion of the plan administrator or fiduciary, we
review those determinations for abuse of discretion. Firestone Tire &
Rubber Co. v. Bruch, 489 U.S. 101, 115 (1989). "It is well-established
that the abuse of discretion standard under [Firestone] is applicable
to our review of the Trustees’ decisions under the UMWA pension
plans." Hale v. Tr. of United Mine Workers of Am. Health & Ret.
Funds, 23 F.3d 899, 901 (4th Cir. 1994). Under this standard, "we
will not disturb such a decision if it is reasonable." Booth v. Wal-Mart
Stores, Inc. Assoc. Health and Welfare Plan, 201 F.3d 335, 342 (4th
Cir. 2000).
Although we may consider many factors in determining the reason-
ableness of a fiduciary’s discretionary decision, see Booth, 201 F.3d
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at 342-343; Brogan v. Holland, 105 F.3d 158, 161 (4th Cir. 1997);
Lockhart v. United Mine Workers of Am. 1974 Pension Trust, 5 F.3d
74, 77 (4th Cir. 1993), the only factor at issue here is the degree to
which the considered materials support the Trustees’ decision. See
Booth, 201 F.3d at 342 (listing the "adequacy of the materials consid-
ered to make the decision" as a factor). In other words, given the con-
text of this case, the Trustees’ decision is reasonable if it is supported
by substantial evidence. See Bernstein v. CapitalCare, Inc., 70 F.3d
783, 788 (4th Cir. 1995).
B.
A claimant must make three showings to be eligible for a disability
pension under the 1974 UMWA pension plan. See Boyd v. Tr. of
United Mine Workers Health & Retirement Funds, 873 F.2d 57, 59
(4th Cir. 1989). First, the claimant must establish that he was involved
in a mine accident. Id. Second, he must show that he has been
awarded SSDI benefits, thus conclusively establishing that he has a
disability (Qualifying Disability). Roberston v. Connors, 848 F.2d
472, 475 (4th Cir. 1975). Finally, he must prove that the mine acci-
dent proximately caused, or was substantially responsible for, the
Qualifying Disability. Id.; Boyd, 873 F.2d at 59.
The Trustees use a set of inquiries, called "Q&As," to help them
interpret the terms of the 1974 pension plan. See Brogan, 105 F.3d at
162. The Trustees promulgate these Q&As pursuant to their authority
under the Plan to issue rules and regulations implementing the Plan.
See Lockhart v. United Mine Workers of Am. Health & Ret. Fund, 5
F.3d 74, 77, 78 (4th Cir. 1993). We "afford the Trustees’ interpreta-
tion of these rules the same deference that we give the Trustees’ inter-
pretation of the language of the Plan itself." Brogan, 105 F.3d at 162.
According to Q&A 252, "miners who become disabled by progressive
diseases or conditions such as black lung, silicosis, tuberculosis,
arthritis, rheumatism, etc., cannot be considered ‘disabled as the result
of a mine accident.’" (J.A. at 323.) When a progressive disease com-
bines with a mine accident to proximately cause a claimant’s Qualify-
ing Disability, however, the claimant is eligible for a disability
pension. See Richards v. United Mine Workers of Am. Health & Ret.
Fund, 895 F.2d 133, 136-137 (4th Cir. 1990) (explaining that Q & A
252(k) requires benefits when a mine worker "suffers a heart attack
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while pushing a heavy object in the normal course of his job"); Chica-
relli v. United Mine Workers of Am. Health & Ret. Funds, 943 F.2d
457, 462 (4th Cir. 1991) (same).
In this case, the Trustees determined that McCoy’s disability was
substantially caused by a combination of his degenerative disc disease
and his affective disorder and that neither was caused by a mine acci-
dent.6 Because degenerative disc disease is a progressive condition,
they reasoned, it could not have been caused by a mine accident. In
addition, the Trustees concluded that the mine accident did not "ag-
gravate[ ] or exacerbate[ ]" McCoy’s degenerative disc disease. (J.A.
at 28.) The Trustees also found that McCoy’s affective problems were
aggravated by pain from his degenerative disc disease, but not by pain
arising from his mine accident.
The Trustees’ conclusions are supported by the following undis-
puted facts, several of which show that there was a substantial lapse
of time between the mine accident and McCoy’s initial complaints of
debilitating pain:
• The ALJ determined that McCoy became disabled on
August 15, 1995, more than two years after the mine acci-
dent;
• The ALJ found that McCoy was disabled primarily
because of "severe major affective disorder" with a second-
ary diagnosis of "degenerative disc disease of the cervical
and lumbar spine," (J.A. at 61, 70);
• McCoy was given only three days of leave following the
mine accident;
• McCoy continued working in the mine after the accident
until he was laid off one year later;
6McCoy did not complain of a psychological or psychiatric problem
until January 30, 1996. The Trustees found that the "first evidence of
back pain" was on August 15, 1996. (J.A. at 35.) The Trustees did not
conclude that these conditions were pre-existing.
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• After being laid off, McCoy worked as a carpenter for
approximately sixteen months, (J.A. at 130);
• No evidence in the record indicates that McCoy sought
any medical treatment relating to the mine accident between
May 1993, shortly after the mine accident, and May 1995;
• No evidence in the record indicates that McCoy was
experiencing neck, back or shoulder pain between May
1993 and April 1995;
• McCoy was diagnosed with several psychological disor-
ders in 1996 and 1999, more than two years after the mine
accident;
• McCoy has been diagnosed with degenerative disc dis-
ease on numerous occasions by several different physicians;
and
• The only doctor to opine that McCoy’s disability was
related to the mine accident did not examine McCoy until
August 1999, more than six years after the accident.
This evidence supporting the Trustees’ decision is substantial, and it
was reasonable for the Trustees to conclude that McCoy’s disability
was proximately caused by a combination of his psychological prob-
lems and his degenerative disc disease, not by the mine accident.
Instead of noting the abundance of evidence supporting the Trust-
ees’ determination, the district court improperly engaged in a de novo
review of the record. The district court believed that "[i]t [wa]s only
logical that when a person is hit on the head, that parts of the body,
like the spine, the shoulders, and the neck, which are all in direct lin-
eage would also suffer trauma from such an injury." (J.A. at 268.)
Starting from this proposition, the district court concluded that
"McCoy’s diagnosis of degenerative disc disease cannot rightfully be
labeled as a ‘progressive disease."’ (J.A. at 268-69.) First, we believe
that the "logical truth" relied upon by the district court is essentially
a factual medical judgment that should be made by trained medical
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professionals. If the medical evidence is unclear, the Plan grants the
Trustees, not the court, the discretion to resolve any conflicts and
draw reasonable inferences from the record. See Lockhart, 5 F.3d at
77. Second, even if the district court’s premise were correct, the con-
clusion that it drew from that premise was not. The Trustees have
decided that degenerative disc disease is a "part of the normal aging
process[ ] and [that] it is a progressive disease."7 (J.A. at 28.) See also
Q&A 252 ("[M]iners who become disabled by progressive diseases
or conditions such as black lung, silicosis, tuberculosis, arthritis,
rheumatism, etc., cannot be considered ‘disabled as the result of a
mine accident’ under the test stated above.") (emphases added) repro-
duced at (J.A. 323). As such, degenerative disc disease cannot be
proximately caused by a mine injury for purposes of the UMWA
1974 Pension Plan.8 Accordingly, a mine worker whose SSDI award
7We note that all of the diseases commonly referred to as "degenera-
tive disc disease" are progressive conditions that develop slowly with
advancing age. See supra note 3. Because, in both technical and general
usage, the term "degenerative disc disease" denotes progressive condi-
tions, the Trustees’ determination that degenerative disc disease is a
"progressive disease" within the meaning of Q&A 252 is a reasonable
one. See Brogan v. Holland, 105 F.3d 158, 162 (4th Cir. 1997) ("[We]
afford the Trustees’ interpretation of the[ Q&As] the same deference that
we give the Trustees’ interpretation of the language of the Plan itself.").
We further note that McCoy has offered no evidence suggesting that "de-
generative disc disease" is anything other than one of the progressive
conditions described in note 3, supra. Without such evidence, we have
no reason to doubt the Trustees’ reasonable interpretation of the progres-
sive disease exclusion in Q&A 252.
8In his brief, McCoy relies on Lester v. United Mine Workers of Am.
Health & Ret. Fund, 40 F. Supp. 2d 800 (S.D. W. Va. 1999). We note
that district court opinions, whether appealed or not, are not binding on
this court, unless they are adopted by or incorporated into one of our
published opinions. See, e.g., Ashley River Industries, Inc. v. Mobil Oil
Corp., 245 F.3d 849 (4th Cir. 2001). To the extent that McCoy’s brief
can be read to assert that Lester collaterally estops the trustees from argu-
ing that degenerative disc disease is a progressive disease, we note that
McCoy did not raise collateral estoppel before the district court, and he
is thus precluded from raising it for the first time on appeal. See Am.
Canoe Ass’n v. Murphy Farms, 326 F.3d 505 (4th Cir. 2003). Moreover,
even assuming arguendo that the issue of collateral estoppel is properly
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states that he is disabled as a result of degenerative disc disease must
prove to the Trustees that a mine accident combined with or exacer-
bated his disc disease to proximately cause his disability. See
Chicarelli, 943 F.2d at 462. The Trustees did not abuse their discre-
tion by determining that McCoy had not made such a showing in this
case.
III.
For the foregoing reasons, we reverse the judgment of the district
court and remand with instructions to enter summary judgment in
favor of the Trustees.
REVERSED AND REMANDED WITH INSTRUCTIONS
before us, we do not believe that the Trustees are estopped from arguing
that degenerative disc disease is a progressive disease. Importantly, the
court in Lester did not hold that degenerative disc disease is not a pro-
gressive disease. See Lester, 40 F. Supp. 2d at 809. The court merely
held that Lester’s cervical sprain, which an ALJ had determined was the
cause of Lester’s disability, was caused by a mine accident. Id. at 807.
Although in the course of that determination the court rejected the Trust-
ees’ assertion that Lester’s disability was caused by degenerative disc
disease, see id. at 809, the court in no way implied that degenerative disc
disease is not a progressive disease. Id. Accordingly, it would be inap-
propriate to collaterally estop the Trustees from arguing that degenera-
tive disc disease is a progressive disease, because that issue was not
actually litigated or decided in Lester. See Orca Yachts, L.L.C. v. Molli-
cam, Inc., 287 F.3d 316, 318 (4th Cir. 2002) ("Issue preclusion operates
to bar subsequent litigation of those legal and factual issues common to
both actions that were ‘actually and necessarily determined by a court of
competent jurisdiction in the first litigation.’") (quoting In re Varat
Enters., Inc., 81 F.3d 1310, 1315 (4th Cir. 1996)).
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