Reid v. Metropolitan Life Insurance (944 F. Supp. 2d 1279, 2013)

ORDER

AMY TOTENBERG, District Judge.

This case is brought under the Employee Retirement Income . Security Act of 1974 (“ERISA”), 29 U.S.C. § 1001 et seq. Plaintiff Sandra Reid (“Reid”) contends that Defendant Metropolitan Life Insurance Company (“MetLife”) wrongfully terminated her long term disability benefits after 24 months despite substantial medical documentation demonstrating that Plaintiff was disabled due to dementia. Plaintiff further claims that this termination was arbitrary and capricious. This matter is before the Court on Defendant’s Motion for Judgment on the Administrative Record [Doc. 24] and -Plaintiffs Motion for Judgment on the Administrative Record [Doc. 25]. The Court first sets forth below its findings of fact and thereafter the legal standards of review and an analysis of the evidence in the context of applicable standards.

I. FINDINGS OF FACT

Plaintiff filed her Complaint against MetLife on July 25, 2011, under ERISA seeking to recover long term disability benefits under an employee welfare benefit plan offered by her former employer International Business Machines Corporation (“IBM”), plus interest, attorney’s fees, and litigation expenses. (Compl., Doc. 1; AR 1-52, AR 52-88.) On October 6, 2011, Plaintiff filed an Amended Complaint to include a claim for benefits under IBM’s 401(k) disability protection program, which contributes to a participant’s 401(k) account in the event of disability. (Am. Compl., Doc. 12.) MetLife asserted a counterclaim for overpaid benefits in the amount of $50,806.57, relating to Plaintiffs receipt of a retroactive lump sum award of Social Security disability benefits. (Countercl., Doc. 14.) Plaintiff has exhausted her administrative appeal remedies. (Am. Compl. ¶ 25; Answer ¶ 25).

A. Pertinent Plan Provisions

Effective January 1, 2005, IBM offered its employees a long term disability benefits plan (“the LTD Plan”) and 401 (k) disability protection program (“the DDP Plan”) funded by a group policy issued by MetLife. (AR 1-99.) As an eligible employee of IBM, Reid was a participant in the LTD Plan and the DPP Plan. (Affidavit of Timothy D. Suter, Exhibit 1 to Def.’s Mot., ¶ 4, Doc. 24-2.) Benefits under the Plans are insured by MetLife and MetLife is the claim administrator under the Plans. (Id. at ¶ 5.)

The LTD Plan defines “Disabled” or “Disability” to mean that “due to Sickness or as a direct result [sic] accidental injury,” a claimant is (1) receiving “appropriate care and treatment,” and, (2) “during the elimination period and the next 12 months of sickness, unable to perform each of the material duties” of their own occupation, and (3) “after such period unable to perform the duties of any gainful occupation” for which the claimant is reasonably qualified taking into account their training, education and experience. (AR 22.) However, the LTD Plan contains the following limitation provision for “Disability Due to Mental or Nervous Disorders or Diseases”:

If you are Disabled due to a Mental or Nervous Disorder or Disease, We will limit Your Disability benefits to a lifetime maximum equal to the lesser of:

• 24 months; or

• the Maximum Benefit Period

This limitation will not apply to a Disability resulting from:

• schizophrenia;

• dementia; or

• organic brain disease.

Mental or Nervous Disorder or Disease means a medical condition which meets the diagnostic criteria set forth in the most recent edition of the Diagnostic And Statistical Manual of Mental Disorders as of the date of Your Disability. A condition may be classified as a Mental or Nervous Disorder or Disease regardless of its cause.

(AR 39 (hereinafter the “Limitation Provision”).) The DDP Plan contains a virtually identical definition of disability and the same Limitation Provision as the LTD Plan. (AR 77, AR 81.) MetLife determines eligibility for benefits under the LTD Plan and the DDP. (AR 33, AR 39, AR 77, AR 81.)

B. Plaintiffs Pre-Disability Claim Employment and Medical History

Plaintiff worked for IBM and IBM’s predecessor, AT & T, from 1986 to 2006. (AR 1859-61, AR 998.) From 1999 to 2007, Plaintiff was employed by IBM as an Advisory Project Manager. (AR 1859-1861.) Her job duties included: (1) managing and leading a team on a complex small project, medium size project or significant segment of large hardware and software projects; (2) demonstrating working knowledge in business matters, finance, planning, forecasting and personnel in order to manage team staff and business issues; (3) negotiating effectively with team members to define the team’s goals, work content and schedules; (4) communicating team results to immediate management/project manager; (5) establishing and maintaining communication of project status with the project team and other staff; (6) complex problem solving related to various projects or functions; (7) applying creativity and judgment in development of multiple solutions related to project objectives; (8) defining and deciding objectives related to the projects from a cost schedule, technical and quality perspective and providing guidance in these area to others; (9) working with customers/suppliers/IBM staff; (10) identifying estimates and presenting cost, schedule and business and technical risk for projects; and (11) interfacing directly with corresponding levels of customer’s staff in carrying out responsibilities for customers’ financial baseline of projects. (AR 1862-1862.)

In 2001, Plaintiff began complaining to her doctors that she was experiencing trouble sleeping, and problems with memory, that she had noted decreased retrieval time, slow speech and comprehension, • she was mixing words, she found it took a “lot of effort to concentrate,” and that it was difficult t'o make simple decisions. (AR 471-472, AR 930, AR 934, AR 949, AR 952-53, AR 958-59, AR 819.) Plaintiff stated that she had always been an overachiever at work but that she felt humiliated because of these problems and was concerned about her job status. (AR 943, AR 953, AR 958.) Plaintiff was diagnosed with Attention Deficit Hyperactivity Disorder (“ADHD”) and depression and was prescribed numerous medications including Celexa, Wellbutrin, Ritaliln, Buspirone, and Ambien for her symptoms. (AR 825, AR 838.) In 2002 and 2003, her cognitive issues continued with memory and concentration problems, disorganized thoughts, disruptive sleep leading to “inconsistent performance,” and struggles with her work schedule. (AR 838, AR 843, AR 848 — 49, AR 852-853, AR 854, AR855, AR 856-57, AR 861, AR 878-879, AR 808, AR 812.) Plaintiff stated she wanted to improve her memory and concentration so she did not sound like a mentally challenged person. (AR 885-86.) Plaintiff began seeing a psychiatrist, Dr. Rick Stallings, M.D., in June 2002. (AR 836; AR 474.) In 2004, Dr. Stallings referred Plaintiff to Dr. Andrea Carstens, Ph.D. and Clinical Neuropsychologist, for a neuropsychological evaluation. (AR 784.)

According to Dr. Carstens’s September 2004 neuropsychological evaluation, Plaintiff was referred by Dr. Stallings to evaluate her concerns regarding problems with memory and concentration that had not improved over the prior three years. (AR 466-470.) The 2004 evaluation references Plaintiffs diagnoses at that time as including Major Depressive Disorder, Single Episode, Partial Remission, and Attention Deficit Disorder. (AR 466.) Dr. Carstens’s notes indicate that Plaintiff, who was 48 at the time of the evaluation, “completed the 12th grade and went on to establish an impressive career as a computer systems analyst.... [She] is self-taught regarding her computer skills and describes herself as a hands-on learner.” (Id.) Plaintiff reported a history of being extremely well organized but had experienced a change in this area. (Id.) Dr. Carstens reviewed Plaintiffs medical records from 2001 forward summarizing her mental health history following her husband’s stroke problems and performance problems at work. (AR 467.) Dr. Cartsens noted that while Plaintiff was treated for depression and Attention Deficit Disorder, her cognitive difficulties were ongoing. (Id.) Dr. Carstens also noted Plaintiffs family history of Alzheimer’s. (Id.)

Dr. Carstens’s 2004 report reflects Plaintiffs reported problems with job performance:

Ms. [Reid] works from home for IBM, doing consulting regarding the acquisition of computer projects and system support. She works approximately 10 hours a day. Her last performance evaluation in February of 2004 for her work in 2003 had dropped from a highest category to a satisfactory category. She was noted to not be timely in her work completion. She reports this is related to a decline in her organization, and general forgetfulness. She has missed conference calls that she is hosting, despite computer reminders. She gets projects and people assigned to them mixed up. She notes that her job has always been quite stressful and demanding and that there has been an increase in her responsibilities. She reports that at times she approaches quite familiar and routine tasks and forms and draws a blank.

(AR 467.) Plaintiff reported poor concentration and problems with comprehension for both written and verbal communication. (Id.) She indicated feeling that her “conversation is ‘all over the place,’ as though her mouth and mind are out of sync” and a possible decline in spatial processing based on recent experiences getting lost in previously familiar places. (AR 468.) Plaintiff indicated she was “most concerned about her inability to recognize or recall personal experiences when looking at family photographs from less than 10 years ago. Despite a variety of prompts from family members, she has no recollection of herself in these scenes. She has difficulties remembering appointments and deadlines.” (Id.)

Dr. Carstens administered several cognitive testing protocols including Cognistat, the Wechsler memory Scale-Ill, the Rey-Complex Figure Test, the Trail-making Test, the Finger Tapping Test, the Wide Range Achievement Test-3, the HANDS Depression Screening Tool, and the Burns Anxiety Inventory. (AR 469-470.) Dr. Carstens summarized Plaintiffs test results as follows:

The results of this neuropsychological evaluation were abnormal, reflecting mild deficits in attention, working memory, processing speed and written arithmetic. Her speech is disorganized. Normal scores are seen on tests of motor fluency, memory for stories, word list delayed recall, reading recognition and aspects of visual memory. Her deficits are occurring in the context of significant stress and documented Depression and Attention Deficit Disorder. However, her presentation is not fully explained by these factors, and there is concern for the family history of early onset Alzheimer’s. Her cognitive performance is consistent with Cognitive Disorder NOS [Not Otherwise Specified],

(AR 470.) Dr. Carstens’s observations of Plaintiff during testing were that “she presents as having above-average intelligence, based on her speed of processing and conversation. However, her conversation was a little hard to follow at times, being somewhat disorganized.... She did have episodes of ‘blanking out’ on recall tasks, momentarily unable to recall any information.” (AR 468.) Dr. Carstens’s interview notes indicate that Plaintiff had “clear problems with working memory, disorganization of speech not easily explained by depression or ADD.” (AR 776.) Dr. Carstens reported that Plaintiff was cooperative during the evaluation and “there were no concerns about malingering or poor effort. The results of testing are considered accurate.” (AR 468.)

In 2005, Plaintiff was released from counseling for depression. (AR 754-AR 756.) However, she returned to Kaiser Permanente Behavioral Health on October 26, 2006, following a divorce because of problems at work, anxiety, depression, and issues with her memory, concentration, and thinking. (AR 752-53.) Dr. Stallings attributed Plaintiffs problems to her prior diagnoses of ADHD and depression. (AR 747-48.) Plaintiff began taking Adderall, which she reported “helped some but it feels like there is still a ways to go.” (AR 739.)

On June 13, 2007, Plaintiff was diagnosed with Bipolar Disorder after reporting symptoms of memory problems, difficulties in formulating words and thoughts, embarrassment at work due to a decline in skills, behavioral changes in spending too much money on jewelry, and difficulties with processing information and making decisions. (AR 719.) Plaintiff stopped working altogether on June 25, 2007. (AR 693.)

On June 27, 2007, psychiatrist Reed Pitre, M.D., met with Plaintiff for a “medication consultation.” (AR 692-703.) In addition to severe symptoms of depression, anxiety, and mania, Plaintiff reported experiencing “disorganized thoughts with thought blocking.” (AR 693.) Dr. Pitre prescribed Lithium to treat Plaintiffs mixed mania symptoms and racing thoughts and prescribed Risperdal to treat Plaintiffs psychotic symptoms, thought blocking, anxiety and insomnia. (AR 695.) On July 3, 2007, Dr. Pitre followed up with Plaintiff who reported that the she felt “slightly less disorganized than before on Lithium and Risperdal.” (AR 680.) Dr. Pitre also ordered a brain MRI to rule out organic causes of Plaintiffs symptoms. (AR 680-681.) On July 12, 2007, Dr. Paula R. Greenfield, M.D., reviewed the MRI of Plaintiffs brain and noted “moderate to severe cerebral atrophy” and indicated that no masses were identified. (AR 683.) Ms. Reid was then 51 years old. On July 13, 2007, because of the abnormality on the MRI, Dr. Greenfield ordered a CT scan to rule out meningomas/tumors. (AR 1434-1435.) Dr. Greenfield noted “some dense calcification along the falx” but ruled out the presence of meningiomas, therefore indicating a normal impression of the brain. (AR 1434.)

C. Plaintiffs Long Term Disability Benefits Claim

On November 29, 2007, Plaintiff made a claim for long term disability benefits with IBM supported by a Statement of Attending Physician from her psychiatrist, Rick Stallings, M.D. (AR 1295-1298, AR 1871-1874.) The claim was based on a Primary Diagnosis of “Bipolar I Disorder, Mixed, Severe w/ Psychosis” and Secondary Diagnoses of Cognitive Disorder and Monoclonal Gammopathy. (AR 1294-1295.) In support of his diagnosis of Bipolar Disorder, Dr. Stallings listed the following as his “Objective Findings:” “depressed mood, blunted affect; decreased short term memory.” (AR 1295.) In support of his diagnosis of Cognitive Disorder, Dr. Stallings referenced the July 2007 MRI/CT scan under “Objective Findings” and under “Subjective Symptoms” he listed “decreased cognitive functioning.” (AR 1295.) Finally, Dr. Stallings indicated that Plaintiff suffered from a Class 5 Mental/Nervous Impairment with “significant loss of psychological, personal and social adjustments.” (AR 1298.) The November 27, 2007 Statement of Attending Physician provided by Dr. Stallings indicates that he did not advise Plaintiff to return to work and listed her restrictions as “cannot be responsible for activities requiring focus/concentration” and her limitations as “has current [low] ADLs [activities of daily living] — appears intermittently disheveled.” (AR 1297.) Dr. Stallings further declared that Plaintiff was disabled from both her own occupation and any occupation. (AR 1298.)

On December 3, 2007, Mark Womack, LCSW, completed an “IBM Medical Treatment Report-Psychiatric Impairment Rating” documenting Plaintiffs levels of impairment. (AR 1882.) Mr. Womack responded that Plaintiff was severely impaired with respect to social and recreational activities associated with her daily living. (Id.) Under the heading “Thinking, Concentration, Persistent and Pace” he stated that she was severely impaired in her ability to maintain attention, concentrate on a specific task and complete a task in a timely manner, in both her immediate and remote memory, and in her ability to perform daily tasks (including work) that she previously performed at a reasonable pace. (Id.) He noted serious impairments in her problem solving and conceptional reasoning ability and in her ability to initiate decisions and perform planned actions. (Id.)

On December 19, 2007, MetLife acknowledged receipt of Plaintiffs LTD application and requested additional information necessary to evaluate her claim for benefits. (AR 1635.) Specifically, Met-Life requested Plaintiff provide the following information by January 3, 2008:

• Copies of the last 3 office visit notes from all of your current treating physicians including:

• mental status exam and cognitive test results,

• treatment plan and medication list with dosages,

• response to treatment,

• current restrictions and limitations,

• return to work prognosis,

• Completed Psychiatric Questionnaire,

• Completed Personal Profile Evaluation form (enclosed with this letter),

• Proof of filing for Social Security Disability Income (contact SSA).

(Id.) On December 20, 2007, Reid participated in a telephone interview with Met-Life regarding her LTD/401K protection benefits. (AR 107-116.) When asked to describe the symptoms that prevented her from working, Plaintiff stated: she could not concentrate, she had difficulty with writing and her spelling was poor, she felt as if she were hearing voices, she had an impaired memory, she could not comprehend information, she had sleeping problems, and she was agitated easily. (AR 109.) Plaintiff identified her medications at that time as: Lamictal, Bupropion, Pro-vigil, Lithium, Carbonate ER, Risperdal, Benztropine, Mesylate, Zolpidem, and Furosemide. (AR 110.) She stated that the side effects were constant dry mouth, tremors in hands, concentration problems and disorganized thoughts. (AR 111.)

Plaintiff and her doctors submitted the requested information to MetLife in support of her application for LTD benefits. (AR 1636-1864.) On December 28, 2007, Mark Womack, LCSW, provided the requested Psychiatric Questionnaire (along with copies of Plaintiffs progress notes and other testing) stating that Plaintiff exhibited the following symptoms that would impair her from working: impaired cognitive ability, thinking, memory, crying and irritability, anxiety as evidenced by allowing bills/utilities to go unpaid and lost blocks of time. (AR 1648 — 1649.) Mr. Womack described Plaintiffs primary work responsibilities as “project mgr — requires regular interaction w/ co-workers + attention to detail — both are not possible at this time.” (AR 1648.) Mr. Womack indicated that he recommended that Plaintiff stop working on June 26, 2007, participate in daily group therapy, and provided an estimated return to work date of March 31, 2008. (AR 1649.) He also provided copies of Plaintiffs progress notes from September 2007 through January 3, 2008, (AR 1658-1857), and the August 2007 neuropsychological evaluation performed by Andrea Carstens, PhD., providing a primary diagnosis of Cognitive Disorder. (AR 1651-1657.)

In 2007 and at the age of 51, Plaintiff was again referred by her psychiatrist, Dr. Reed Pitre, M.D., to Dr. Carstens for a neuropsychological evaluation to address Plaintiffs concerns regarding memory in the context of her Bipolar Disorder. (AR 1651.) The 2007 report references Plaintiffs prior neuropsychological evaluation in 2004. (Id.) Plaintiff was accompanied by a friend who participated in the interview and who noted “significant cognitive and behavioral decline in the last year, resulting in Intensive outpatient treatment and short term medical leave from her job since June 2007 for treatment of bipolar disorder.” (AR 1655.) The report indicates that Plaintiffs friend completed a Clinical Dementia Rating noting “no problems with personal care, questionable problems with orientation and community affairs, and mild impairment with memory, problem solving and home hobbies.” (Id.)

Dr. Carstens’s report further noted Plaintiffs family medical history of schizophrenia, depression, bipolar disorder, and Alzheimer’s. (AR 1652.) Plaintiff presented with an “ABNORMAL mental status” relating to her (1) speech: “some dysfluencies and word finding problems,” (2) affect: “Decreased Range, Congruent with Mood and Depressed,” and (3) memory: “Fair.” (Id.) During intake, Dr. Carstens noted problems with Plaintiffs executive functioning as reflected by her descriptions of the clutter in her home “due to piles of paperwork, abandoned hobbies and unnecessary purchases.” (AR 1653.) Dr. Carstens’s intake notes further reflect that Plaintiffs speech was tangential and that she had poor remote and recent memory. (Id.) With regard to academics, Dr. Carstens noted that Plaintiff has “difficulty remembering or recalling what she reads. Avoids sustained mental activity, overpays bills; has not completed her taxes in 3 years.” (Id.) Dr. Carstens’s Report refers to Plaintiffs 2007 MRI showing “moderate to severe atrophy, worse for the occipital lobes bilaterally.” (Id.)

Dr. Carstens observed that Plaintiff presented with “apparent average intelligence,” but her test results demonstrated a “Full' Scale IQ of 79, which falls at the upper limit of the Borderline [intellectual functioning/mental retardation] range, at the 8th percentile” and her Verbal (81/10th percentile) and Performance (80/9th percentile) IQ levels both fell in the Low Average range. (AR 1653.) Dr. Carstens noted that Plaintiffs index scores were more informative showing:

average Verbal Comprehension (91) and below average Perceptual organization (88). Working memory and processing speed were 73, both falling in the borderline range. These latter scores are significantly lower than her verbal and perceptual indices. These scores would predict problems with concentration, short term memory and paperwork.

(AR 1653-1654.) In addition, Plaintiffs verbal subtest scores generally fell below average, with the exception of her Information and Vocabulary scores that were both average. (AR 1654.) Dr. Carstens stated that Plaintiffs “scores certainly suggest some decline in working memory and processing speed relative to previous functioning, based on her achievement testing and occupational attainment. As this test was not given previously, it is not possible to calculate a course of decline.” m

Plaintiff scored within the average range on the cognitive screening test “Cognistat,” a neurobehavioral cognitive status examination screening tool to sample skills in the areas of orientation, attention, language, construction, memory, calculation and reasoning. Dr. Carstens noted that Plaintiff “improved on the attention subset, which formerly fell in the range of mild impairment. Memory was strong.” (AR 1653.) On the WSM-III Logical memory and word list subtests, Plaintiff was mildly impaired for both verbal memory at immediate recall and verbal learning, average for verbal memory and verbal learning at delayed recall, and below average for recognition. (AR 1654.) Plaintiff showed improvement from the 2004 neuropsychological evaluation on her visual memory from mild impairment to average or below average. (Id.) Plaintiff scored below average on Trail Making Tests administered to assess processing speed. (Id.) However, on Part B of the test that measures processing speed and divided attention, Plaintiff completed the test in 102 seconds, faster than her previous score of 114 in 2004. (Id.) Plaintiff obtained an average score of 107 for reading recognition on the WRAT-3, but showed significant improvement relative to her previous spore of 94. (Id.) Her score for written math achievement of 81 was below average and did not significantly differ from her previous score of 84. Plaintiff showed significantly more depression and anxiety on the HANDS depression screening tool relative to her previous scores. (Id.) On the MMPI-2, Plaintiff produced a profile of marginal validity “because she presented herself in an overly positive light, which may [have] resulted] in an underestimate of her problems.” (Id.)

Dr. Carstens observed that Plaintiffs “concentration during testing was variable” and that she “worked slowly on the MMPI-2, appearing to have difficulty deciding on her response” and at times would get distracted by noises outside the room. (AR 1653.) However, Plaintiff evidenced good effort during testing and the results were considered accurate. (AR 1653.) In summary, Dr. Carstens stated:

Ms. Reid presents with cognitive concerns which are almost identical to those voiced in her previous evaluation in 2004. Her friend notes significant cognitive and behavioral decline in the last year, resulting in Intensive outpatient treatment and short term medical leave from her job since June 2007 for treatment of bipolar disorder. Testing shows some improvement since 2004 in the areas of attention (digit span repetition), visual-spatial processing and visual memory, left hand motor speed and reading recognition. There is a slight decline in word list learning and recall of concern, given the family history for Alzheimer’s, and her CT showing moderate to severe cerebral atrophy. New testing (WAIS-III) indicates likely declines relative to remote functioning, in the areas of working memory and processing speed. She is still evidencing some symptoms of bipolar disorder and her self report shows increase in depression and anxiety relative to 2004. Personality testing is consistent with somatoform disorder, with significant depression and tension. Thus, she is still showing signs of cognitive disorder which has not clearly worsened, but the question of etiology (bipolar disorder vs. early dementia) remains.

(AR 1655.)

On January 3 and 4, 2008, Plaintiff filled out a Personal Profile form for MetLife describing her current condition. (AR 1637-1638, AR 1642-1645.) Plaintiff responded that she had a loss of interest and motivation with regard to most activities, she found it very difficult to complete tasks such as filling out this form, she had suffered a loss of concentration and focus, she had problems with typing, managing her checkbook, paying bills in a timely manner, handwriting and spelling, she was easily agitated, and she had auditory hallucinations. (AR 1637.) Plaintiff further stated that she had experienced changes in her ability to care for her personal needs and grooming: “No daily showers. Now shower once every 4-5 days. Do not care about my appearance as I did in the past. No interest in putting on makeup and /or lipstick or collone [sic] everything takes so long to do.” (AR 1638.) Plaintiff also responded that she had difficulty performing daily household tasks such as cleaning and grocery shopping. (AR 1645.) As a result of her “inability to stay focused/coneentrate,” Plaintiff stated that she no longer had interests, hobbies, or participated in social activities such as going for walks, seeing movies, sewing, fishing, watching television, and playing billiards. (AR 1645.)

D. MetLife’s LTD Coverage Determinations

On January 11, 2008, MetLife notified Plaintiff that her claims for benefits under the LTD Plan and the DDP 401 (k) Plan had been approved effective December 22, 2007. (AR 1620-1623.) MetLife further notified Plaintiff that because their records showed her disability was due to a mental and nervous condition, her benefits would be limited to 24 months and that benefits would end on December 21, 2009. (AR 1620-1621.) MetLife’s Claims Activity Log indicates that its decision was based on a primary diagnosis of Bipolar Disorder with a co-morbid diagnosis of Cognitive Disorder and notes her symptoms of depressed mood, blunted affect, decreased short-term memory, decreased organization, decreased ADL’s (activities of daily living), irritability, auditory hallucinations, and decreased cognitive functioning. (AR 147-48.)

On April 11, 2008, MetLife informed Plaintiff that “[y]our current claim for long term disability benefits is currently approved because you are totally disabled from performing your own job. For benefits to continue beyond 12/22/2008, you must be totally disabled from performing any occupation.” (AR 1981-1982.) As Plaintiffs estimated return to work prognosis was listed by her doctors as July 1, 2008, MetLife consulted with Plaintiffs medical providers, Dr. Stallings and Mr. Womack who provided additional medical documentation to support a continuation of her benefits for disability for any occupation. (AR 171-77.) MetLife’s Claims Activity Log in April 2008, indicates Met-Life’s concern that if Plaintiffs doctors did not advise her to return to work, it would be necessary to determine if Plaintiff was disabled due to any other medical conditions and notes: “Organic psychosis was given as a DX [diagnosis] previously. CM will make sure PCS follows up on that to determine if there is medical to support and this would be an exclusion to the claim” (meaning the benefits would not be subject to the Limitation Provision). (AR 181-82.) The June 2008 Activity Log summary further acknowledges that Plaintiffs medical records demonstrated the potential presence of a covered disability in addition to her Bipolar diagnosis:

when obtaining medical update from APS [attending physicians], please inquire whether [employee’s] condition is the result of something organic going [on]. We have medical info from Dr. Carstens that continues to state [employee’s] primary diagnosis is organic psychosis. We are reviewing claim for transition at this time, we need to investigate this as organic brain disease is an exclusion to the LDB [limited disability benefits].

(AR 187.)

Based on its investigation in April and July 2008, and due to the severity and extent of her symptoms of Bipolar and Cognitive Disorder, MetLife concluded that Plaintiff was unable to perform the functional requirements as an advisory project manager on an ongoing basis which requires the ability to focus and concentrate on work procedures, have energy and stamina to perform work tasks, interact appropriately with co-workers, and control emotions in the workplace. (AR 178-182, AR 191-194.) On November 13, 2008, MetLife received updated medical records from Plaintiffs therapist Mr. Womack noting that her Bipolar disorder was in partial remission but that her Cognitive Disorder diagnosis remained and prevented her from returning to work before February 2, 2009. (AR 205-206.)

On November 11, 2008, Reid was evaluated for double vision. (AR 1529.) Plaintiff reported her neurological symptoms at the time included gait disturbance, impaired coordination, imbalance, memory loss and tremors. (Id.) Plaintiffs ophthalmologist referred her for these additional scans as a result of Plaintiffs complaints regarding her double vision. On December 4, 2008, as a result of her diplopia (double vision), Plaintiff underwent an MRA of the head and neck and an MRI of the pituitary, brain, and brain stem to determine neurologic causes of her double vision. (AR 1424-28.) The results from the 2008 scan were noted as follows:

The pituitary gland demonstrates normal size and contour. No displacement of the pituitary stalk is seen. The pituitary shows normal signal without contrast, without evidence of hemorrhage. It demonstrates normal homogeneous enhancement. The suprasellar cistern is clear. Both cavernous sinuses appear intact.

T2 images of the entire brain demonstrate no signal abnormality. The ventricles are normal in size. No abnormal brain enhancement is seen.

Impression:

No evidence of pituitary adenoma.

Otherwise unremarkable brain.

MRA brain:

Technique:

Thin section axial images were obtained, and multiple projection reconstructions performed.

Examination shows no evidence of stenosis or occlusion.

No aneurysm is identified. No arterial malformation is seen. Impression: Normal.

(AR 1424-25.)

On December 10, 2008, MetLife notified Plaintiff that it had completed its review of her claim for continued long-term disability benefits (beyond the first 12 months of disability for her own occupation) and found that the information on file supported continued approval of her claim for disability benefits. (AR 1555.) MetLife further stated that it would periodically require Plaintiff to provide updated information concerning her disability and asked that Plaintiff advise MetLife “of any changes that might affect [her] benefits, such as a change or improvement in [her] medical condition(s), a return to work, or receipt of other income.” (Id.) MetLife’s Claim Activity Log indicates that its determination was based on Primary diagnosis of Bipolar and a comorbid diagnosis of Cognitive Dysfunction/Disorder. (AR 214-217.)

Plaintiff kept MetLife informed of changes in her medical history, including problems with her vision, a second round of brain scans, and a second neuropsychological evaluation. (AR 216-252.) Met-Life continued to solicit and receive updated medical information regarding each of the Plaintiffs conditions. (Id.) On March 18, 2009, the Claim Activity Log states:

Per recent review of updated medical info, PCS recommends medical supports a severity of impairment due to severity of symptoms noted.... There is no information to indicate a significant positive change or improvement in [employee’s] condition since the last clinical review. All diagnoses include bipolar I disorder, cognitive disorder, neuropathy, hearing loss, TMJ, sleep apnea, and MonoclonParaproteinemia. Bipolar disorder is an LDB [limited disability benefits].... Based on [employee’s] clinical history, continued symptomology such as mania, cognitive deficits especially with poor short term memory, impulsive spending and isolative behavior, PCS recommends that medical supports a severity of impairment. Information from Dr. Stallings and L.M. Womack, LCWS dated 2/16/09. Diagnosis is bipolar I disorder.... Based on the info above, ltd. benefits will continue. ...

(AR 230-32.) In late April and early May of 2009, the MetLife claim manager assigned to Plaintiffs file conducted a clinical consult with Sheila Donoghue, a MetLife “Psych. Clin. Spec.” and the notes state as follow:

See diary dated 4/18/09 for summary of updated medical info received from [employee’s] psychiatrist. Ap [attending physician] notes organic psychosis and has referred [employee] for revised neuropsych testing. PCS to review [the] information and fiu [follow up] for neuropsych test results and other info needed to prove [employee] has organic psychosis. This may support there is an exclusion and benefits could possibly continue beyond ldb [limited disability benefits] end date of 12/21/09.

(AR 248.) However, on May 13, 2009, MetLife completed a “subsequent claim decision” stating “[t]he clinical information from Dr. Stallings and Mark Womack indicate the primary diagnosis that impairs functionality is bipolar disorder. This is not an exclusion to the ldb. While employee is reporting cognitive limitations, particularly problems with memory, there are no clinical findings to evidence a cognitive disorder or an organic brain disorder. If there is any new or additional clinical information received to indicate a change in the primary diagnosis or [employee’s] return to work ability cms may refer to pcs for review.” (AR 253-54.)

On June 10, 2009, Plaintiff (age 53) underwent a third neuropsychological evaluation performed by Teresa Whitehurst, PhD, Clinical Psychologist. (AR 1448-57.) Dr. Whitehurst’s report was finalized on September 11, 2009. (AR 1451-1457.) Plaintiff was again escorted by a friend who stays with her 4 to 5 months at a time who also participated in the interview. (Id.) Dr. Whitehurst stated that Plaintiffs illness was chronic and that the onset was gradual, “especially last year and a half.” (AR 1448.) During intake, Dr. Whitehurst reported that Plaintiff had problems with her speech, executive functioning, concentration, and memory. (Id.) Plaintiff also reported blank periods, “especially in the Fall of 2008 when she apparently ordered a lot of expensive diamond jewelry,” and episodes of disorientation while driving. (Id.) Plaintiff reported that she felt flat and that she just did not care about things anymore and her friend reported that “this has been a 180-degree change over last year: ‘very very very flat affect.’ ” (Id.) Plaintiffs friend also indicated that Plaintiff “used to be an excellent housekeeper and ‘the consummate entertainer’ ” but that now her house was a mess with piles of laundry. (Id.) Plaintiff still suffered from manic episodes, auditory hallucinations, and excessive worry and anxiety resulting from her financial problems. (Id.)

Dr. Whitehurst reviewed the medical reports of Plaintiffs brain imaging including the 2008 MRI of the pituitary and the July 2007 MRI showing moderate to severe atrophy of the brain. (AR 1452.) Dr. Whitehurst conducted many of the same tests as those performed by Dr. Carstens in 2007. Dr. Whitehurst summarized the results as follows:

Testing revealed severe impairment across domains and tasks in both verbal and visual memory, as well as cognitive processing speed, simple and divided attention and cognitive flexibility.... Reading and arithmetic computation skills were average and low average respectively. ... Reid reported severe anxiety and depression symptoms. The primary diagnosis based on test profile is dementia with the flavor of frontotemporal dementia with regards to patient’s and friend’s emphasis on “flat affect.” It should be noted that personality/emotional factors may be playing a significant albeit undetermined role, contributory and/or consequential with regards to attention, cognitive acuity and concentration. In addition, financial stressors from quite expensive recent purchases ... are contributing to anxiety about money management.... Finally, dissociative processes cannot be ruled out and may be related to organicity and/or to emotional factors. Further exploration of the nature of dissociative symptoms ... is recommended. If cognitive symptoms continue to worsen, repeat brain imaging is recommended. Assessment: (DSM IV-Tr)

Axis I Dementia Bipolar I Disorder r/o Alzheimer’s disease early onset, r/o dissociative disorder

Axis II deferred

Axis III Bipolar I Disorder, Mixed, Partial Remission, Sleep Disorder, Sleep Apnea, Cognitive Disorder, Monoclonal Gammopathy, Undetermined Significance, Hearing Loss, Mixed Conductive Sensorineural Neuropathy, Peripheral TMJ Disorder

(AR 1456 (emphasis added).)

On October 7, 2009, Plaintiff spoke with a MetLife claims representative and advised that she had additional medical information regarding another diagnosis of a brain disorder and she would fax the information to MetLife. (AR 268). MetLife’s Activity Log indicates that it had not received any updated medical information regarding Plaintiffs new diagnosis of a brain disorder as of October 21, 2009; but noted that MetLife would conduct a review to determine whether benefits should continue beyond the limitation period upon receiving a supporting Attending Physician Statement. (AR 269-270.)

On October 21, 2009, and without reviewing Dr. Whitehurst’s neuropsychological evaluation, MetLife notified Plaintiff that her disability benefits would end on December 21, 2009, as their records showed that her disability was due to a mental and nervous diagnosis for which benefits are limited. (AR 1437.) MetLife explained that Plaintiff could qualify for disability benefits beyond December 21, 2009, if she were able to demonstrate that her disability was due to other non-limited medical conditions and advised Plaintiff to submit certain information regarding any other medical conditions she suffered from, including office visit notes, diagnostic test results, lab results, treatment plans, etc. (Id.) MetLife also informed Plaintiff of her right to appeal the determination to limit her benefits to 24 months. (AR 1435.)

On November 3, 2009, Plaintiff contacted MetLife to inquire “about the medical info, on file and the exclusions as noted in the plan” and MetLife explained that if Plaintiffs health care providers submit medical records showing that Plaintiffs disabling condition was the result of schizophrenia, dementia, or organic brain disease, there would be no limitation on benefits for long term disability.” (AR 271.) Plaintiff informed MetLife that her attending physician had sent information stating that she has cognitive dysfunction and dementia and the claims representative advised that MetLife would take another look at the claim to determine whether the medical records supported a disability diagnosis of dementia. (AR 271-72.) The Claim Activity Log reflects that the MetLife claims representative requested another clinical consult after speaking with Plaintiff: “please re-review information received from Mark Womack LCSW. Plaintiff had neuropsych testing on 9/11/09 and it was determined she had dementia, bipolar, r/o early onset of Alzheimer’s and r/o dissociative do. See den 090914F10090 p. 18.... Per the plan, dementia is an exclusion. CM feels this claim should remain open and benefits continue as Idb no longer applies as of 9/11/009. Please advise if you agree or not.” (AR 272-3.)

On November 6, 2009, MetLife conducted an interview with Plaintiff to discuss her most current symptomatology and course of treatment. (AR 273-276.) Plaintiff stated that the symptoms she felt were the most predominant were those resulting from her dementia based on her two neuropsychological evaluations in 2007 and 2009 and the MRI showing moderate to severe cerebral atrophy. Plaintiff explained that she gets lost while driving, cannot recollect recent conversations with others, she gets confused and that when she talks “it is like a blank screen,” and feels flat. (AR 274-75.) She also explained that depression kept her from doing a lot of things. (AR 274-75.) That same day, MetLife referred Plaintiffs file to an Independent Physician Consultant Keven Murphy, Licensed Psychologist, for review of her medical records in order to verify Plaintiffs dementia diagnosis based on her psychological testing. (AR 276-277.) The Claim Activity Log states “Pcs and ipc discussed test results and the possibility of dementia type symptoms related to bipolar disorder. Testing does have suspicious concerns but not exactly clear of convinced dementia dx: Dr. Murphy feels a call to provider who conducted testing would be beneficial for firm dx.” (Id.)

On November 9, 2009, Dr. Murphy spoke with Dr. Whitehurst who “seemed fairly sure that the claimant had a dementia.” (AR 276-77.) According to Dr. Murphy, Dr. Whitehurst thought that Plaintiff did not give her best effort on one of the measures and said that Plaintiffs affect was so flat that it was hard to tell if severe apathy was affecting effort. (AR 277-78). Dr. Whitehurst’s report indicates that Plaintiff related well and was alert during the interview and testing. (AR 1454.) Dr. Whitehurst’s only noted concern evidenced in her report was to the validity of Plaintiffs executive function testing due to Plaintiffs “response patterns.” (AR 1456.) On November 10, 2009, MetLife’s “Psye. Clin. Spec.” Donoghue reviewed Plaintiffs case with Dr. Murphy:

per [Dr. Murphy’s] discussion with Dr. Whitehurst for reasons MRI being read as normal while the CT scan was read as abnormal and demonstrating significant atrophy. If one or the other demonstrated atrophy Dr. Murphy felt that would be enough evidence given the other information. The claimant demonstrated some improvement in 2007 when compared to 2004 according to Dr. Car-tens’s report of 2007 (2004 not in file only referenced). She did much worse this time (2009) but also seemed more depressed and lacking effort on one measure with no formal effort measures administered. Still can not differentiate between a dementia and depressive pseudodementia with full confidence based on information in file. Her performance remains suspicious for dementia but it is difficult to tell given her current level of depression which may account for her flat affect and apathy. Possible directions obtain all imaging studies and 2004 neuropsych report.

(AR 279-280.) MetLife requested copies of Plaintiffs brain imaging scans and the 2004 neuropsychological evaluation performed by Dr. Carstens. (AR 280-286.) On November 17, 2009, Plaintiffs psychiatrist Dr. Stallings completed and returned to MetLife an Attending Physician Statement and Psychiatric Questionnaire indicating diagnoses of bipolar I disorder and a cognitive disorder/dementia and stating that because Plaintiff “has had a significant decline in function: she would be unable to perform the tasks required for any job.” (AR 1003-07.)

The Claim Activity Log indicates that MetLife conducted a “subsequent claim decision” on November 23, 2009, and determined:

claim is reaching ldb max date on 12/21/09. [Employee] suffers from bipolar affective do, mixed and ap [attending physician] noted organic psychoses but there was no medical information provided to support this diagnosis. [Employee] is gathering the medical info to support and show she has dementia, which could allow her benefits to be extended. To date, we have not received this info and will continue with the claim closure. Once the medical is received, it will be reviewed to see if benefits can be extended beyond the ldb end date. Therefore, claim is closed due to claim has reached max duration and benefits are longer payable.

(AR 286-87.) A subsequent log entry from that same date indicated that upon receipt of the requested medical information from Plaintiff, MetLife would determine if the claim would be reinstated and benefits extended beyond the limited disability end date of December 21, 2009. (AR 287.) On November 24 and 25 of 2009, MetLife reviewed the updated medical records received from Dr. Stallings referencing Plaintiffs 2009 neuropsychological evaluation results showing an Axis 1 diagnosis of dementia and noting that Plaintiffs cognitive symptoms as chronic and the degree of her impairment as continuing to be quite significant. (AR 289-290.)

On November 30, 2009, MetLife again notified Plaintiff of its determination that her benefits were subject to the Limitation Provision for mental and nervous disorders. (AR 1979-1980.) Specifically, Met-Life stated,

In reviewing your file, the medical documentation indicates that you are disabled due to bipolar affective disorder, mixed and organic psychoses. We have not received any medical information to support the presence of organic psychoses. These diagnoses falls [sic] under the limited benefit provision of your Plan, and has a limitation of 24 months.

Based on a review of your entire file, we have determined you will have received the maximum benefit period payable under your Plan for this condition on December 21, 2009. No additional benefits will be payable after December 21, 2009 and your disability claim will have been paid in full in accordance with the terms of our employer’s disability plan.

(AR 1979.) MetLife notified Plaintiff that she had 180 days to submit an appeal and suggested that if she intended to appeal that she provide a written statement requesting an appeal, copies of the last 3 office visit notes, current treatment plan with medication list and dosages, current restrictions and limitations, most recent test results, and return to work prognosis for any other non-limiting disabling medical conditions. (AR 1980.)

MetLife’s Activity Log indicates that after it notified Plaintiff on November 30, 2009, of its decision to limit her benefits, MetLife completed its consultation with its Independent Physician Consultant (“IPC”) Dr. Murphy in early to mid-December. Dr. Murphy provided a report of his opinions dated December 14, 2009, summarizing certain of Plaintiff’s medical records and the 2007 and 2009 neuropsychological evaluations. (AR 1378-87.) Dr. Murphy concluded that “from a psychiatric standpoint, the medical information in file supports a diagnosis of Bipolar Disorder I.... [T]he claimant has cognitive deficits associated with her Bipolar Disorder [and] [h]er longstanding memory complaints appear to be due to a pseudodementia associated with depression.” (AR 1386-1387.) Dr. Murphy provides the following explanation of his conclusion:

She has had cognitive complaints for the last 5 years with fluctuating findings on the 3 neuropsychological evaluations. Functionally, she has had significant problems with concentration, pace and task completion that would affect her ability to perform job duties---The results of a single neuropsychological examination are difficult to use in determining whether areas of cognitive difficulty are attributable to Bipolar Disorder or represent the early signs of dementia. Repeated neuropsychological assessment is the best method for documenting a progressive decline in cognition that would be found in a condition such as dementia, Alzheimer’s type. Fluctuation in cognitive functioning, where some areas improve and other worsen with no clear neurologically based pattern is more consistent with a history of depression than dementia. The claimant demonstrated more areas of improvement than decline when the results of 2007 were compared to those of 2004. In most diagnosable dementias scores on memory testing are significantly lower than the results of intelligence testing: This was not true for the claimant as of the assessment in 2007. The claimant was seen by a neurologist, Dr. Clairborne [Plaintiffs ophthalmologist], on November 11, 2008. The only abnormal finding was of a mild tremor. The MRA and MRI of December 2008 were within normal limits; laboratory results were also reported. Although there was the report of a CT scan demonstrating atrophy in a neuropsychological report, the CT scan of July 17, 2007 was normal. The chart was thoroughly reviewed for other indications of dementia aside from the neuropsychological report of June 10, 2009 including the CT scan documenting atrophy and neurologist visits but there was no support for this in file. Due to her concerns about her finances, she appears to have exaggerated her functional difficulties on the examination of June 10, 2009.... Of note, memory complaints of losing time for 2 to 3 hours or for half a day are not suggestive of dementia. Reports of buying things from the shopping channel and not remembering having done that are also atypical. These complaints would be more consistent with a fugue [dissociative] state. Dr. Whitehurst did include the Dissociative Experiences Scale during her examination and the claimant did endorse symptoms of this disorder.

(AR 544.)

On December 21, 2009, Dr. Stallings completed a detailed “Psychiatric Assessment” form stating that Plaintiffs primary diagnoses included Dementia and Bipolar I, Mixed. (AR 997-1002.) Dr. Stallings described Plaintiffs medical history as follows:

Patient has been a member of Kaiser Permanente for about 16 years. She was employed by AT & T, then merged with IBM, for more than 20 years total. She was treated here in Behavioral starting in 2004 for depression and anxiety. Patient also had problems with memory and cognition but in general was quite functional when improved. Over time she had increasing memory and cognition problems which resulted in inability to work by 2007. She has also been treated in individual and group psychotherapy with Mark Womack, LCSW and Deborah Scopp, LCSW and has had several courses of intensive outpatient treatment. She has had neuropsychiatric testing which concluded a diagnosis of Dementia (6/10/09). Patient has had extensive impairment in functioning due to these symptoms which have been progressive. Also MRI of brain 7/07 notes “moderate cerebral atrophy”. (Family history significant her sister with schizophrenia, father has Alzheimer’s, mother possible history of Bipolar disorder).

(AR 998). Dr. Stallings concluded that Plaintiff would never be able to return to work and that vocational rehabilitation was not practical due to the severity of symptoms and impairment and that her “mental problems were secondary to or caused by ... dementia or brain disease.” (AR 1000-1001.) On December 31, 2009, after Plaintiffs limited benefits end date had passed, MetLife sent a copy of Dr. Murphy’s report to Dr. Stallings and Mark Womack for review and comment. (AR 304-305.)

On January 26, 2010, MetLife sent Plaintiff another letter acknowledging receipt of additional medical information relating to her claim and notifying Plaintiff of its determination to uphold the November 30, 2009 decision to terminate long term disability benefits. (AR 1338-1341.) The January 26, 2010, letter provides:

Based on the review of all clinical information on file, including a file review, a discussion with your neuropsychologist, neuropsychiatric testing, MRI/MRA of the brain reports, psychiatrist and therapist treatment notes for the period August 30, 2007 through November 9, 2009. The diagnosis is bipolar disorder with symptoms of cognitive deficits which are pseudodementia to a mood disorder. The diagnosis of dementia has not been evidenced.

(AR 1338.) The remainder of the letter summarizes the findings of Dr. Murphy’s December 14, 2009 report and indicates that because Dr. Stallings and Mr. Womack did not respond and dispute the results of MetLife’s file review the claim would remain closed. (AR 1340.) MetLife again advised Plaintiff of her right to appeal the determination within 180 days. (Id.)

E. Plaintiffs Appeals

On January 28, 2010, Plaintiff appealed MetLife’s November 30, 2009 decision to limit her benefits challenging MetLife’s determination that it had not received any medical information to support the presence of organic psychosis or dementia. (AR 562-64.) In her appeal, Plaintiff pointed to the July 12, 2007 MRI showing “moderate to severe cerebral atrophy” and the 2009 Neuropsychological Evaluation performed by Dr. Whitehurst providing an Axis I diagnosis of dementia as evidence in MetLife’s possession supporting an extension of benefits beyond the 24 month limitation. (AR 562-563.) In addition, Plaintiff provided the detailed psychiatric questionnaire completed by Dr. Stallings on December 21, 2009. (Id.) By letter dated February 1, 2010, Plaintiff indicated her intent to appeal MetLife’s January 26, 2010 determination confirming the limitation of benefits. (AR 315.) In conjunction with the appeals, Plaintiff provided a complete set of her medical records from 2001 to 2007. (AR 314-322.)

On February 2, 2010, MetLife reviewed the additional medical records received from Plaintiffs attorney related to the appeal. According to the Activity Log,

the information provided gives a clearer picture of the history of [employee’s] condition(s) and what is going on. However, the information is dated 2001-2007 and offers no new or more current information that evidences an exclusion. There are no other MRIs on file to compare with the 2007. We have the results of all the neuropsych tests. This information does not offer anything new that would cause us to change the previous decision made on the claim.

(AR 316.) On February 15, 2010, in response to Plaintiffs appeal and apparently after making a determination that the additional information made no difference to its decision to terminate benefits, MetLife requested a second IPC review of Plaintiffs file. (AR 554-57.) Carol Walker, Ph.D., an IPC board certified neuropsychologist, provided a report on February 26, 2010. (Id.) According to the report, Dr. Walker attempted to reach Dr. Stallings on February 24 and 25, without success. (AR 546.) Dr. Walker summarized some of Plaintiffs medical records and noted that “[f]rom a neuropsychological perspective, according to the medical records reviewed, Ms. Reid’s primary diagnosis is bipolar affective disorder” and that “there is no valid or reliable data to support the diagnoses of schizophrenia, dementia, or organic brain disease.” (AR 555-556.)

On July 23, 2010, Plaintiff appealed Met-Life’s January 26, 2010 determination letter, (AR 457-60), and enclosed: (1) a questionnaire signed by Dr. Stallings on the same date (AR 462-65); (2) a copy of Dr. Carstens’s September 2004 neuropsychological evaluation (AR 466-70); (3) a chart prepared by Plaintiff and her attorney summarizing Plaintiffs medical records from November 2001 through February 2005 (AR 471-77); and (4) part of a booklet regarding management of dementia (AR 478-505). Plaintiffs attorney also sent an Addendum to the July 23, 2010 appeal letter advising MetLife that Plaintiff had been prescribed Aricept (Donepezil) for the treatment of dementia (for symptoms including mild to moderate' confusion, impairment of memory, judgment, and abstract thinking, and changes in personality). (AR 520.)

In the July 23, 2010 questionnaire, Dr. Stallings explained the basis for Plaintiffs dementia diagnosis and provided comments on the IPC reports of Dr. Murphy and Dr. Walker each concluding that there was no evidence to support dementia. (AR 461-65.) When asked why he believed that Plaintiff suffers from dementia, Dr. Stallings stated:

I have known Ms. Sandra Reid since her first visit with me here at Behavioral health in June 2002. Even in the first several years of treatment, she had frequent complaints of memory and cognitive problems, which in retrospect were probably early signs of dementia. Despite improvement with treatment for depression and probably long standing Attention Deficit Disorder, the memory and cognitive problems persisted. By 2004 a neuropsychological evaluation revealed deficits in these areas, and the possibility of early onset dementia was raised.... Reid continued to work but never regained her previous level of function and continued to experience memory and cognitive impairments. By 2007, she presented with an acute episode of mania and psychosis, which required extensive treatment per stabilization. Despite some improvement, the extent of memory and cognitive concerns led to a second neuropsychological evaluation in 2007, again showing deficits in a number of areas. During the next 2 years of treatment, her degree of impairment worsened and a third neuropsychological evaluation was done in 2009, which showed “severe impairment across domains and tasks in both verbal and visual memory, as well as cognitive processing speed, simple and divided attention, and cognitive flexibility. The results were so profound that the primary diagnosis was now “Dementia”. In summary, during the more than 8 years I have known Ms. Reid. I and multiple other mental health clinicians have observed and experienced this decline in her memory and cognition. I believe it is quite possible that in the past her primary diagnosis has been early onset dementia, and the other symptomatology of depression, anxiety and mania were manifestations of this primary dementia disease process. Clearly, this is a very complicated case, but it is evident that despite the exacerbations and improvements of the psychiatric symptoms, the common thread of memory and cognitive decline has persisted.

(AR 464-65.) Dr. Stallings disagreed with Dr. Murphy’s statement that Plaintiffs cognitive deficits, unorganized thinking, slow responses and hearing of muffled voices were associated with Bi-polar Disorder. (AR 462.) He reiterated that all of these symptoms can be attributed to Dementia. (Id.) In response to whether he believed that Plaintiff exaggerated her functional difficulties on the neuropsychological examination on June 10, 2009 due to her concerns about finances as stated by Dr. Murphy, Dr. Stallings emphatically stated “[absolutely not, the testing results were consistent with the decline in function which had been observed. Note, her excessive spending was a likely result of the diminished judgment and poor impulse control resulting from the cognitive decline.” (Id.) Dr. Stallings further disagreed with Dr. Murphy’s statement that Plaintiffs longstanding memory comp