Hunter v. Aetna Life Insurance Company, No. 7:2012cv00113 - Document 23 (W.D. Va. 2012)

Court Description: MEMORANDUM OPINION. Signed by District Judge Glen E. Conrad on 09/20/2012. (ssm)
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CL SOFFI U. DI COURT ERK' CE S. ST. AT ROANOKE, VA FI LED I THE UNI N TED STATES DI STRI COURT CT FOR THE W ESTERN DI STRI OF VI NI CT RGI A R OAN O KE D I I ON V SI SE 2 2 2 1 02 J C UL BY: 9 ' DEPUW CLERK CLAREN CE HU N TER Pli it antfl Ci lAci No. 1 c 0011 vi ton 7:2-v- 3 M EM O M ND U M O PI I N N O AETNA LI I FE NSUM N CE COM PANY By: Hon. e E.Conr d Gln a ChifUnied St t DititJ e t aes src udge D ef nt enda . ThsERI A c s aie fo ted cso b Aen LieI s r n eCo n (% ta' t i S a e rs s r m h e iin y t a f n u a c mpa y ç n ' o Ae ) tr naeln -e m ds b lyb n tt p i t M r Clrnc Hu tr(: ne '.Hu trcams emi t o g tr ia ii e eis ad o , ae e n e ç tr' n e li t Hu ) t tAe nawr uly t r nae dia lt beneisowedt hi unde agr p polc pln ha t ongf l e mi td s biiy ft o m r ou iy a unde wrte by A e na a ofe e t Ht t ra pa t hi e pl m e w ih t H it Hot l r i tn t nd f r d o m e s r of s m oy nt t he lon es C o por ton. Fort r as s tf r h be ow , he c t ilgr ntA e na sm oton f rs m a y r ai he e ons e o t l t our w l a t ' i o um r j d me ti isfvo . ug n nt a r 1 . Fac ualand Pr edur Backgr t oc al ound Efeci J nua y 1 2007,Aenais d agr polc t Hit Ho el Co por ton f tve a r , t s ue oup iy o lon t s r a i pr di e i bl e oye gr p lf a cde t ld t a l ng-e m dia lt c r . ovi ng lgi e mpl es ou ie, c i n a eah, nd o t r s biiy ove age The l tr dia lt c r ge o f r mont y be ft t e oye who a e (ot l ong-e m s biiy ove a f e s hl neis o mpl es r t aly t dia e 'defne as s bl d,' i d : Yo a edee d t bet al dia e whieeihe oft f lowi a ist you: u r me o ot ly s bl d l t r he o l ng pple o * D urng t pe i w hi h e r g a t r t fr t 24 m ont be t a e i he rod c nds i ht fe he is h ne ks r payabl i a perod oft aldi abiiy: en i ot s lt T Yo a e n ta e s ll be a s o ij r o d sa e t p ro m t u r o bl, o ey c u e f nu y r ie s , o ef r he ma e i ldu i sofyou o oc paton;e e t ti yo sa twor a a t ra te r wn cu i xc pt ha f u tr k t r as bl oc upato you w ilno l nge be de m e t a l di a e e ona e c i n l o r e d ot ly s bl d. * The ea trd i s h perod oft aldiabiiy: r fe urng uc i ot s lt Yo ae n ta l,s ll be a e o ijzy o d sa e t wo k a an u r o be o ey c us f nl r ie s , o r t y r ra e sonabl oc paton. e cu i ( mi itaieRe o d(ç ' a 9 8 (mp ssa d d . Ad nsrtv c r $ ) t 8 ) e hai d e ) AR' Thus t r ar t r l ntpe i f de e mi ng û o a dia lt 't fr tt nt , he e e wo eeva rods or t r ni t t l s biiy': he is we yt f m on h pe i whe ac ama i de meddi a e i una et wor i hi orhe own our t rod n l i nt s e s bld f bl o kn s r occ ton,a t pe i f l ng t fr tt nt f urm on hswhe a cai nti de m e upa i nd he rod olowi he is we p o t n l ma s e d diabld onl i heors i una et pe f m a r as bl oc upai Thepln defnes s e yf he s bl o ror ny e ona e c ton. a i tr a ona eoc pai n'a t ny ga nf a tviy f rwhih you a e;orma r s na y be om e te s bl cu to ' s i a i ul c i t o c r y ea o bl c , fte bye ai tani ore re e. (d.a 999. l a a df dia lt i grntd, itd duc ton; ri ng; xpe inc ' I t ) f n war or s biiy s a e ' t pl n r quiest c ai a t fl a i a i f m one a y be tt unde a ot he a e r he l m nt o ie pplc tons or t r ne i s r ny her potntal a i bl dia lt pr n ,i udi t fde a s i s c iypr n (d. t e ily pplca e s biiy ogrms ncl ng he e r l ocal e urt ogrm. I a 9 2. Aenate ofst t o ea r sa an tp y n sma eu d rtepln.(d. t9 8)Th 9 ) t h n fes h s wa d g is a me t d n e h a I a 8 . e pl n alo no e t tAe nai afd ir t rERI a r s r sf is l: a s t s ha t s i uca y mde SA nd e e ve or te f com pl t a ho iy t r vi w a l de e cl i s f be ft unde t s polc I e e ut r t o e e l ni d a m or ne is r hi i y. n exe c sng s h fduc a y r s nsbiiy,Ae na s l ha dic e i r a hort r ii uc i i r e po i lt t hal ve s r tona y ut iy t de e mi whe he andt wha e e e oyee andbene i a i sa e e il d o: t r ne t r o t xtnt mpl s fcire r ntte t be ft ;a co tu a diput d ordo f tr oft spolc o ne is nd nsr e ny s e ubtul e ms hi iy. (d.983. I ) I 2007 a 2008 H un e w a a e pl e ofHit H o e sCor a i a w a n nd , t r s n m oye lon t l por ton nd s e i bl f rbe ft u rt pln.He frtr quese s r-e m dia lt i M a c 2007afe a lgi e o ne is nde he a is e td ho ttr s biiy n r h tr di nos sofs r oi i by D r M i he e Ba l u, unt r s pul onol gi tf r a lr l van pe i . ag i a c dos s . c l lo H e ' m o s o l e e t rods (d.a 212 615. l M ac of2008,Hu e s te a he s ttr dia lt cai l t -4, ) n rh ntr ubmitd not r hor-em sbiiy l m, c ani ofba kpan,c s pan,a r xi a ey, re i a s roi i.(d.a ompli ng c i he t i no e a, nxit hype tnson, nd ac doss l t 2 8 . Aen a r e Hu trs o ttr be eist o g Oco e 1 2 08 Hu trsls d yo 0) t a wa d d n e h r-em n ft hru h tb r , 0 . ne ' a t a f woka Hit wasM ac 26, 08.(d.a 55. Hune t r a trr se lng-e m dia lt r t lon rh 20 I t ) tr he e fe eque td o tr s biiy be ft f rhi il s ,a i Augus 2008, t c ne is o s lnes es nd n t Ae na onduced ar viw t dee m i ei i lt t e e o tr ne lg biiy. (d a 3 7) Aspa t ft sr ve Aen rc ie a atn i gp ysca ssae n (APS' l. t 8 . r o hi e iw, t a e ev d n te d n h iin' ttme t t ' ç ) fo Dr Bal u, c lse aprma ydi gnossofçs r i i/ r m . lo whi h it d i r a i ta co dosshypere i n, a we lasot r tnso ' s l ' he dig o e o lmb rds d sa ea a xit h a a h s ( za 75 ) Hu trss mpo a n s s f u a ic ie s nd n ey-e d c e . J .t 6. ne ' y t ms # icud dç if s p i i ons mu ce , a k& c et ft u . (d. t757. I af low-p n l e d fu e an nj it, s ls b c h s, ai e' I a ) n ol u d g ' lte on Se embe 1 2008, .Bal u wr t e tr pt r 6, Dr lo o e: El n e)ha ah so yo s rod ssa sv r d f l t c nr lh p re so . lu tr s itr f ac io i nd e ee it t o o to y e tn in ku The pa int wa doi quie wel,wa f toni no mal a hi diea e te s ng t l s unci ng r ly nd s s s wasi c r untl Aprl 2008. At t t tme he ha a dr tc i r as i n ontol i i ha i d nma i nc e e n s mp o t lg wihs v r maas , aiu , if s j itds o o tb c p i , y t maoo y t e ee lie ftg e dfu e on ic mf r, a k an w ei t l s a a e a. H i c ton has b n s o t i pr ve w ih t gh os nd nor xi s ondii ee l w o m o t he pain c n iun t c mpano sveeftg a dj it i t t o tn ig o o li f e r aiue n on pan. e Att pr s nttm ehi pan woul no al hi t f to f ra 8 hotrpe i he e e i s i d t low m o unci n o n l rod o tm e a w or H i pr nos s i g r d. M os patent w ih s r oi i f i t k. s og i s ua de t i s t a c dos s rs e pond t t r py a uli a e y a e a e t go i o r m i son a lve nor al o he a nd tm t l r bl o nt e s i nd i m lf t e . Occ i l pai nt, ho ve , f i t r s nd a iesyl s asonaly te s we r al o e po nd ha ve o ngoi s m pt a ol ng y om t ogy. (d. t753. l a ) Aen as rc ie aj bd srp in fo Hi o lsi Hu trsp sto a Die t ro t a lo e ev d o e cito r m l n it t ng n e ' o i n s rco f i Event . The de c i i n lsed t physc lr quie e soft poston asf l : s s rpto it he i a e r m nt he ii olowsl 1 ej bsesnil u cinsicu e Th o ' se ta fn to n ld d: 40% 25% Diecsev ma me t m i t e cuton ofnegoit gr s l a ee nt.Thi r t ent nage nt ea n he xe i taed oup aes gr me s s i l sdie tng alas t ofpr es i t m deveopm e ti l ngr nlt e ,tai ng, ncude r c i l pecs of sonalea l n ncudi ec im nt r ni r ognii s ce sonplnni c hi / uns i pe f m a ee uaton,goals ti ec ton, uc s i a ng, oac ngco elng, ror nc val i etng, i ntvepln. nce i a M an ansa a it i n nnuala ountl d of6- gr var ngi sz andco plxiy. cc oa 25 oups yi n ie m e t 1% 5 Hep p o iesrtgcdrcinfrteh tl yp riiae gi)o c mmite a di metn s ls r vd tae i ieto o h oe b atcp ts sc n o t s n n eig , e i udi butnotlm ie t De rm e H e Exec i Com m ite,Reve M a m e , ncl ng, i td o pa t nt ad, utve te nue nage nt Gr u P c Up Fo da d Be e a e S ae n, a i , r a d P t n e to M e t gs M a o p ik , o n v r g , tt me t Qu l y P e n os Co v n i n ei . y t n l 5% a s pa tci t i ope a i de rm e ,CVB a s e m ee i . l o r i pa e n r tng pa t nt nd al s tngs Diecsdaiydepa t e ope ai ,c t m e co lctr ol in,i e a ton wih Nai Sals r t l rm nt r tons uso r nfi es uto ntr c i t tonal e , Sal Te hnolgySu r, r ton ofcor at a hotll lrpo s busnes a m aket es c o ppo tgene ai por e nd e eve e rt, i s nd r pl deveo an lpmen sa i plm e ain,a landm ont y f ec ta bud . t nd m e ntto nnua hl or as nd get Ph i a Ac i t ysc l tviv Fr q nc e ue v Sitng ti W al ng ki Clm bi s ais i ng t r St ndi a ng Cr hi Be ng st pi ouc ng/ ndi / oo ng Re chi a ng Gr s ng a pi Fr nt eque Fr equent Occ s ona ai l Frequent Occ s ona ai l Oc a i l c s ona Fr equent Oc a i l c sona Pus ngguli hi lng (d.a 73 ) l t 4. Afe r viwi Hu e ' me c lflsa Dr Balou' APS,on Oc obe 22,2008, tr e e ng nt rs di a ie nd . l s t r Aen a p o e lngtr d s bl yp y n st Hu trefcieS p e e 23 2 8 (d a ta p r v d o -e m ia ii a me t o ne fe tv e tmb r , 00 . L= t t 3 4) Aen ' rv e c n lde t a Ht e ' tp rcu i nfo wo ko af ltmeb ssi 9 . t a s e iw o cu d h t mtrs t qe lso r m r n uli a i s l s ppore duet s c d i .Re or i c t s ve e ftgue, aaie, ghtl s a dif s u td o ar oi oss c ds ndia e e r a i m l s wei os , nd f u e j ita db c p i '(d a 2 4. Aen c n iu dt rc ieAPS fo Dr Balun tn on n a k an. I . t 2 ) t a o tn e o e ev ' S r m . l o ig o Hunt rsi biiy t r t n t wo k duet s r dosst o e ' na lt o eur o r o a coi i hr ughoutt r s of2008. I Fe a y he e t n bnz r of2009,Hunt rwa no ii d byt SocalSec iy Admi sr to t thewoul begi e s tfe he i urt nitai n ha d n rc ii s ca s c rt d sbit b n ft i t a u t f$ ,8 0 p rmo t (d a 7 6. e evng o il e u i ia l y e eis n he mo n o 10 2.0 e nh. l . t 2 ) y i On M a 18 2009,Dr Bal u s ntAe naa APS sai t tHt e coul r tmzt wor y , . lo e t n t tng ha mt r d et o k wihç r titons' May26,20 (#.a 719- ) Asar s toft APS, t de e t ç esrci 'on no 09. J t 20. eul he Aena nid Ht e ' cam f rf rhe b n ft, ndn tfe hm o hi rg tt a p a t d cso .(d a mtrs li o u t r e eis a oiid i f s ih o p e lhe e ii n 1 . t 45 - 0) OnDe e e 9 20 9, ne a p ae a s b te n w rc r sfo Dr Bal u 95 . c mb r , 0 Hu tr p e ld nd u mitd e e o d r m . lo , whi h not c tnued s r oi i,a we la rghtl gpan tlkey r a e t hi L5- 1dik,' c ed on i a c doss s l s i e i si l elt d o s S s ' hypere i mz çll si da i ftg a se pi s . (d. t71 ) Therpor as tnson, d texce sve ytme aiue nd le ne s' 1 a 6. ' e t lo 5% (d.t7 3) l a 3. Tr vel pe i cal f t pum os ofpr e sona d l e ;c t e ori tyeve s a s rodi ly or he e of s i l eveopm nt usom r ndusr nt, evauain ofr nuea l sisoff t em e tngs s l to eve nd ogitc ' ur ei ; uppor ofOwnt Gr M ar t u t he oup ke i ta i r m uliyea ;i e na comm it pa ii to n niitves e: t- r ntr l tee rtcpain; nnualc e e wih dicplne. onfr nce t s i i sa e t tHun e ç red goi ba k t wor bu t da hewe hi BP wa hi Hewa tt d ha tr t i t ng c o k, t he y nt s s gh. s ,2 , ca lmmy,s ay,erbl ftgue a wa una et fnci we t tri y ai d nd s bl o u ton. (.) OnJ r 22,201 J i anuay 0, Aena ove t ned ispr vi de a ofbe ft , i ngt tts fcintdoc t rur t e ous ni l ne is fndi ha tufi e umen a i e ss t ton xit whc s p o t c ni u di ar n. (d a 46 . ih u p rs o tn e mp ime t' 1 . t 0) ' Shorl t e tr Aena s ntHunt a lte r mi ng hi t tt û ty her afe , t e er e tr e ndi m ha he ç oc upa i ' own c ton' pe i f hi dia lt de e m i to woul e on Se e rod or s s biiy t r nai n d nd pt mber2 201 andhewoul 2, 0, d s eque l ha t s hewa t et pe f m ia r a ona e oc upa i ' o c i ubs nty ve o how s mabl o ror iny e s bl c ton't ontnue r cevi be ft . Ae naa s d Ht e t s e i ng ne is t dvie mt r o ubmi me c la vo to lr cor i c tng t di a nd cai na e ds ndia i whyhewa diabldfom pef nga heroc upain.(d.a 488. On Ma 1 201 Dr s s e r ronni not c to 1 t ) y 3, 0, . Ba l s bm itd a APS no i t tHuntrwasS o a l/ r ne ty dia e ' nd i t a ng lou u te n tng ha e s t ly pe ma n l s bld'a s t wi t dr SocalSe trt dia lt ' (d. t695. l t s cinoft APS aki a wor lmiai i cliy s biiy. l a ' ) n he e to he s ng bout k i ttons a dc re ta iiyt p rii t i j btanigp o rms Dr Baluwr t 1 A. (d) Aen n u r n b l o a t pae n o ri n r g a , . lo oe ç ' l . t a t c N/ ' r c ved a t rAPS fom Dr Ba l onAugus 6,201 no i Ht e ' dignos sof e ei no he r . lou t 0, tng mt rs a e hy re i s z oi i,c tpan,a e y,a dicdie s Dr Bal u agan i c t d t t pe tnson, a c doss hes i nxit nd s s a e. . lo i ndia e ha Hl e i çoal/ r n n l d sb e . . a d da ngS ca Se miyds blt, a d mtr s d tl pema e ty ia ld . ln l rwi o il c t ia ii ' n t y y' rs n e ( A't q sin rg r igwok a dtan n lmiain .(d. t6 3) epo d d I 'o ueto s e adn r n rii g i tto s I a 8 . N/ Alo i Aug t201 Hun e ' r c dswe e r viwe a Aena' r que tby Dr De s s n us 0, t rs e or r e e d t t se s . nni M a alt de e mi i Hunt wa dia e fom pe f mi ( ny occ pai n. Dr M az llse z o t r ne f er s s bld r ror ng t a u to ' . a it d ' E hes pan,f tgue, g bl pr s ur de e so .. c z cf tg L5- diche niton t t i a i hi h ood e s e, pr s i n . h oni ai ue, S1 s r a i c w ih ne v r tc pr s i n a r di ul t ditc t w a ki s r oi i a t co r l d t r e oo om e s o nd a c opa hy, fi uly l ng, a c dos s nd m nt ole hypere i ' (Z a 674. Therviw deaisHuntrsme c is a te t ntgoi tnson. J t ) ' e e tl e ' dialsues nd rame ng bac t hi fr tdi a lt d a m i 2007. Dr M a a a s c t c e D r Ba l by phone on , o s i s s biiy i n k . z l l o on a t d . lou 2Ae aas e t t ti wasi m s rs ha t mposi et tHuntrtidt r tln t wor sncehehadbe t m i e 9om hi sbl ha e re o e t o k i r en er natd s poiini Mac 2 0 .Dee datsBre a l) sto n rh 0 8 ( fn n' if t . Augu t8, 0 t dic sHun e ' a lt t wor s 201 o s us t rs biiy o k.Ac di t Dr M a lsnot oft cor ng o . za ' es he c onve s ton,Dr Bal u i c t d t tHt e ' c s x-a a i i sudiss rai . lo ndia e ha mt rs he t r ys nd mag ng t e howe d i ove nti Huntrss roi i.( .a 676. DrBal as not t tHuntrs mpr me n e ' ac doss J , t ) # lou lo ed ha e' hy tnso ha notca e a sg fca t g or n da pere i n d us d ny inii nt ar et ga mage a t hi bl pr s ewa , nd hat s ood es ur s welc r ld durnghos t lz tonsca i he t bei vet contnuedhype tnson wa a l ontole i piai a i usng r o le he i re i s r s lo ( dcn l o c mpl nc . (() Ad iin ly Dr Balusae t a Hu trs e ut f t iia n n o i e' L . dto al, . lo ttd h t ne ' me a ' c ompli sofpai a f tgueha notbee c r aedby physc e m i ton or1b sudis ant n nd a i d n orobor t ial xn na i a t e, a t hehad e bie no s ns r m o ori r e orde m aom a diti ton ofpa n nd hat xhi t d e o y t mpaim nt r t l srbu i i rltn t t eL5 S1d s h r ito .(d) Fial DrBalun tdt a Hu trh dahso yo eaig o h - ic enain 1 . n l . l oe h t n e a itr f y, o c oni pan,a t ts r dossca s ei e c us s pan,butt t r wa no hr c i nd ha a coi i n om tm s a e uch i hat he e s d cl n ai no atrtsj its lig, rd ce s dr n eo moin.(d. o l tto f rh ii,o n wel o e r a e a g f to l ) me n Asar s l o hsr ve Dr Ma a c ncu e ta t ee d n eEale )t s p o t e ut f i e iw, . z l o ld d h t h vie c s ild o u p r f f tona i pa r e f t e ie tm e f n e ' a t tHt t r ç houl be a e t pe f m t unc i l m i m nt or he ntr i r m ,' nd ha m e t s d bl o r or he d i ofa s ntr lght a / me um de nd oc upa i 'a pe ha C ve ahe or utes ede a y, i , nd or di ma c ton' nd r ps t n e avy v r h a de ndo c p to a ln a hi blo p e slei man n d . .' (d. t6 7 7 . ey e vy ma c u ain s o g s s o d r st s itie . . I a 7 - 8) r ' Ae nat n f war d Dr M a a ' r vi t Dr Ba lu, t he ol de . z ls e ew o . lo who wasas d whe he s ag ee wih ke t r he r d t t as e s ntt tHunt rwasa et r t n t wor i açs dentr lgh , he s s me ha e bl o eur o k n de a y, i t medi , avy a um he nd veyh a oc u ain . . nf ltmeb ssef cie92 / 01 . (d a 6 071) Dr Balu r e vy c p to . o ul i a i fe tv / 32 0' l . t 7 - . . l ' o r ple t ts tgl r e t tg-l ejc dpef m sde ay,lg duy.Hi BP c r e id ha he ta geeld) ha l mtr oul rbr e ntr iht t s ontol l h sn t e a q aet p ro m h a yo v r he v wo k. ( a 6 7) a o be n de u t o ef r e v r e y a y r ' J t 6 . ' #. A e na t n co r c e t have a ta f r bl s lsa ys sco uc e i Oc obe 201 t t he nt a t d o r ns e a e kil nal i nd t d n t r 0 o de e m i w he hert r we e s t bl lghtor s de a y oc upa i f rs eo ofHunt r s t r ne t he e r uia e i e nt r c tons o om ne e' experence and educaton. The anal sre ur a s pl ls ofpostons avaiabl w ihi a i i ysi t ned am e i t ii l e t n ffy- ier di ,i l ng: a ge r s r to ,ma ra rm e s s r s rdei r it m l a us ncudi m na r e e vai ns nage pa t nt, upe vio lve y d i r, u e vs r o d rtk r, n s lsp o to rprsn ai e .(d. t 5 ) rves s p r io y r e a e s a d ae r moi n e e e ttv s l a 6 7. On M a c 1 2011 Ae nade e Hunt rsc am f rc tnui lng-e m dia lt r h 8, , t nid e ' l i o on i ng o t r s biiy be isbas d on Dr M a alsr viw,hi c ver ai wih Dr Bal i c tng he opi on neft e . z ' e e s on s ton t . lou ndia i r ni t t mtrc udrtunt wo k a dt evo ain l n lss ( =a 5 - . OnM a 6 2 1 ha Ht e o l et' o r , n h c to a a ay i. J .t 4143) # y , 01 , Hun e a t r ppea e Aena' de son,wrtng t theha f l d up wih a o t dit Dr Clr l d t s cii ii ha d olowe t n rhope s, . a e W ei dman,f c oni pai i bot knee .t#=a 638. Huntrha undego a tr c c or hr c n n h s J .t ) e d r ne rl osopi l s ge y on hi l tkne i e ry 2011, nd he s ur r s ef e n a l a ubmitd not sfom Dr W ei a c onilng t te e r . dm n hr c i he s geya hi f l up a nt ns tdaa 628- ) Dr W ed n' noesi c t vayi ur r nd s olow- ppoi me t. L. t 37. . ima s t ndiae r ng d g e sof i, t fe s a ds meq a arp .( a e r e pan si n s, n o u d to hy J ) f # Aspa toft a a pr e s Aenaha t mor physcins Dr Le r Cos a r he ppe l oc s , t d wo e i a , . ona d mo, pul o ogit a Dr Robe tSwo i ky,as i iti oc upai me cne r viw Ht e ' m nol s , nd . r tns pecals n c tonal dii , e e mt rs m edi alr c ds Dr Cos o c l d t tt r wast l c ofs ppo tve m e c l c e or . . m onc ude ha he e $ ak a u ri di a doc e a i t s um ntton o uppor anys g fc ntf tonali i ntfom 1130 201 t ough t i nii a unc i mpanne r / / 0 hr 8/ 72011 fo apul naypes ci ,ha woul prcl ( mtr fom f nci ngwihi 1 / ,r m mo r rpe tve t t d e ude Ht e) r u toni t n a yo c pain' (d a 6 3) Dr Co mon tdta t ee(sn d c me tto t s g e t n n c u to . l . t 0 . . s o e h t h r i o o u nain o u g s a y ' i e e ba i orwo s ng oft cli a tsc tonr uii asgnii a o feque us ge of xac r ton r eni he am n ' ondii eq rng i fc nt r r nt a ic e s dseo dr q ie n s'a d c n ld dt tHu trc udp rom aj bwi al h n r a e tr i e ur me t, n o cu e ha n e o l ef r o t i t ' h g p y ia d ma dlv l fwo k (4) Dr Cos t c atmpe t c na t . lo t h sc l e n e e o r . L , . mo wie te td o o tc Dr Bal u o dic sHuntrsc tonbyphonebutwa uns e su,(4,a 595. Aenaf wade Dr s us e ' ondii s ucc sf l L t ) t or r d . Cos o' r po tt D r B a l a ki hert r s nd t Dr Cos o' co l i t tHunt rw a m s e r o . lou, s ng o e po o . m s nc us on ha e s ftt pef m s de ayorlg j .Dr Bal r ponde i wrtngt tçllom apul r i o ror e ntr iht obs . lou es d n ii ha ûtr monay sa t ndpoi ,Ido notbe i he i di a e f r lghtdut asnot by youri pe ntr vi w e nt leve s s bl d o i y ed nde nde e e r a d 1 uda r ewi t a c n l in.Th p te tfesta h i u a l t p ro m a yj b n wo l g e t h t o cuso h e ain e l h t e s n be o ef r n o due t deg ne a i diea e i hi kne s Iwoul s s ob ani r c dsfom orhopedis o e r tve s s n s e . d ugge t t i ng e or r t c gi)wh h sb e f lo nghm i ta rg r . (4 a 5 . sc o a e n olwi i n h t e ad' L a t 91) ' D r Swotns y al o e m i d Ht t r s fl s i l ng t not f om Dr W e dm a . i k s xa ne m e ' ie , nc udi he es r . i n r r ng Huntr skne pr blm s Afe no i Huntrshit y ofc oni pan a ega di e' e o e . tr tng e ' sor hr c i nd hype t ns on,D r Sw otns de e mi d t tt r w a i ufi i ntdoc e a i ofil s or re i . i ky t r ne ha he e s ns t c e um nt ton lne s s mpo t l t ne ' a l yt wo kwi r s c t to ec n iin .(d a 61 - 1) y tms o i Hu trs bit o r t epe t o h s o dto s l . t 0 1 . mi i h Re a dn Hu trsk e pan Dr S tn k n td Sth e m fndng a es a tb t g r ig n e ' n e i, . wois y o e ,fj e xn i i s r c n, u g i c td ( mtr c dsilwal a sa una ssed.... ousyhec dno wok fom ndiae Ht el oul tl k nd tnd sit Obvi l oul t r r h ss r eyd t, /8 1 , n r su tl ewa rc v r d' (d a 61 ) Ab e trc r t t i u g r ae 22 / 1 o wad n ih s e o ee . l . t 2. s n e o ds o he ' c r y,Dr Swo i ky putHuntrsr c r pe i fom t s ge y a t ry-i da ,a ontar . tns e ' e ove y rod r he ur r t hit fve ys nd c n ld dta Sth fl d e n toh r s e tb ihl tto p e ldn p ro ma c o o cu e h t l q e ie o s o te wie sa ls i ains r cu ig e fr n e f g mi l h ph sc ld ma wo k. (d. Ba e o hse au to , . woi k c n ld dta i t y ia e nd r ' I ) s d n i v lain Dr S tns y o cu e h t g ' Ht e wo d bea et peror lg wor b wa r ti td fom o upa i r quii mt r ul bl o f m i ht k ut s esrce r cc tons e rng Se ttvebe ng,ci ng,orhe vy lfi ' (d. Dr Swoi kyas atmpe t c tc ç peii ndi lmbi r a it ' l ) . tns lo te td o ona t ng. Dr W ei a t dic sHunt rskne pr e ,bu wa uns c s ul Net rDr Swo i ky . dm n o s us e' e obl ms t s uc es f . ihe . tns no a r nyonea Aenae rs t t ve pokewih orr c i d a doc ntton die ty fom Dr W edm a t e e ve ny ume ai r c l r . i n. By lte da e Ocobe 1 2011 Aenade e Hunt ' a e tr t d t r 9, , t ni d ers ppea ,lsi t nt ne l itng we pni docu e s m osl med c lr porsf o Huntr sphysc a - r vi we a pa toft a al m ntty ia e t r m e' i ins e e d s r he ppe pr s .(d. t558. Thelte i c e t tt o yphyscin-e mmende r srci oce s I a ) etr ndiatd ha he nl i a rco d etitons Dr Swotns slmiai onrpeii be ng,ci ng,orhe vylfi weeno ob . i ky' i ttons e ttve ndi lmbi a itng r tj r uie nt oft s mpl postonslse i t vo to a l i.(d. t560. Thelte eq rme s he a e ii itd n he cainal nayss 1 a ) e tr ac knowl dge t tH t t rha be n a ove f s i ls l iy di a lt be t , no e e d ha m e d e ppr d or oc a ecz t s biiy ne ks but t d r 8 t ti as pa a ede e mi tont tm a beba e on dif r ntc ie i,a t tHuntrha no ha s e z t t r nai ha y sd fe e rtra nd ha e d t p o ie Aenawi a yi fr to r ltn t tes ca s c rt deemiain.(d. Th r vd d t t n n omain eaig o h o il e u i tr n to l ) e h y l te c l d by a sngHuntrofhi rghtt b i a cvi a ton l rERI i he et r oncude dvii e s i o rng i l c i mde SA f dia ee wihAena' decson.(d. sgr d t t s ii 1 ) II. Di scusson i A. St andar ofRe e d vi w $1 r viwi t de alofbe ft t 1n e e ng he ni ne is mdera ERI pln,ad src c t is m us n SA a itit our fr t t c i rdenov whehert r e ntpln doc nt c e dic e i r a ho iy on t pln onsde o t he elva a ume s onfr s r tona y ut rt he a a i sr t t m a a be ft - lgi lt de e mi ton. D upe r v.Lie l tr nce Com na dm ni t a or o ke ne is e i biiy t r na i ' ' ry f nsla ny o No t Ameiq 6 2F.d8 0 8 9( t Ci. 01 ) d he apa b istr c n e s f rh rc , 3 3 6 , 6 4h r 2 1.E n ln y t ems o fr W dic e i on t pln' a i sr t t i e pr tispr son a t a nitaora t s r ton he a s dm nita or o ntr e t ovii nd he dmi sr t c s r as bl wihi t s opeoft tdic e i co t d e t t admi srt ' i e r tton.' e ona y t n he c ha s r ton, urs ef r o he nitaors ntm ea i ' I . q oi Co u c v. f Co p. v rn ePa P a , 31F.d 1 0 1 6(t Ci. 0 5 d ( u tnc l c i Ag a r Se ea c y ln 4 3 7 , 7 4 h r 2 0 :. Unde t a e ofdicr ton s a r a c t t a no di t b a l ng t r di a lt r he bus s e i t nda d, our im y t s ur o e m s biiy d tr nainma eb ( a mi itao )s ln a isd cso i r ao a e' 80 t v. aeemi to d y t d nsrtr o o g s t e iin s e s n bl. 0 h W l he ' M atSo e . n . s c He 1 & W efz P a , 01F.d3 5 3 (t Ci. 0 0 .tA) r tr s I c Aso . at h lae ln 2 3 3 , 41 4h r 2 0 ) ( n ( a i sr t ' d ii i r as na ei i i t r ul ofad i ae, i i e r as ng dm nita ors ecson s e o bl f t s he es t elber t prncpld e oni pr es a i i i s ppore by s t tale de .'Eva v.Ea on Cop .Long Te m oc s nd f t s u td ubsan i vi nce' ns t r Dia lt Pln,51 F. 31 322(t Ci.2008 .Subsn ile de ei evi nc t tç s biiy a 4 3d 5, 4h r ) tnta vi nc s de e ha i a ras ngmi woul a ce ass fce tt s e oni nd d c pt ufiin o uppor apatc a concuson gnd)c it of t riulr l i a onsss m or t n a m e e s i il ofe d nc butm a be s e tl s t n a pr ponder nc ' e ha r c ntla vi e e y om wha e s ha e a e. ' Le br v. etnc eElc. n.747F. 1 208( hCi.1 .Thef tt tapln Fe e W si hous e Cor , 2d 97, 4t r 984) ac ha a a i sr t ,a tng a a fduci r m a ha a c lc i i t r ti s vi a bo h t dm nit a or c i s i a y, y ve onfi t n n e es n er ng s t he rviwe a pa e o camsi t u o efco n n ma yta arv e n j d emus tk e e r nd y r f li s t t n a tr mo g n h t e iwig u g b ta e it a c u t' Mer p l a Liel s Co. Gln 5 4U. 1 5 1 6( 0 8 ; e as W iims no c o n . to oi n f n . v. e n, 5 S. 0 , 1 2 0 ) s e lo l a ' t l v. to oia LieI s Co, 0 F.d6 2 6 031( t Ci. 1 )( odngt a a rt Mer p l n f n . .6 9 3 2 , 3 - 4h r 20 0 h li h t he he t Supr m eCour' de son i Glz t Fourh Cicu tspr vi ç odii d a eofdic e i e ts cii n em, he t r i' e ous ç fe bus m s r ton sa r 'whi hha be a i a ei c s swhe et a nitaorbot r viwe a pad t nda dr' c d en pplc bl n a e r he dmi sr t h e e d nd i cai ,wa nol ra oprae a c t s d smpl a y a unat r d a eof l ms s onge ppr it , nd ours houl i y ppl n le e bus ds rto sa d r o rviw) icein tn ad f e e . B. A nal s vsi TheFourh Cic thasç de ii d eghtnone l i f c or t ta c r m a c i r' t r ui G ntfe i i xcusve a t s ha ou t y onsde ' i de e ni whe he apln a i sr t a e isdic ei i d nyi abe isc am . n t nni ng t r a dm nitaor bus d t s r ton n e ng neft l i Thos f c o sa e: e a tr r ( )Th ln u g o t e pa ( )Th p po e a d g aso t e pa ;( )Th 1 e a g a e f h ln; 2 e u s n o l f h ln 3 e ade cy of t m a e i s c i r d t m a t de ii n a t de e t qua he t ral onsde e o ke he c so nd he gr e o whih t y s c he uppor i;( W hehe t de ii ma ng pr es wa ras d t t 4) t r he cson- ki oc s s e one a p icpe ; () W h te t e d cso c mp rs wih oh r p o iin i nd rn ild 5 eh r h e iin o o t t t e r vso s n t e p a a wi e rir itprtto s o te pln; ( ) W heh r t e h ln nd t ale n e eain f h a 6 h te h decson was c it nt wih t pr e a a s tntve r quie e s of ii onsse t he oc dur l nd ubsa i e r m nt ERI A;( ) An e tr a sa d r rlv n t te e rie o ds rto ;a d S 7 y x en l tn ad ee a t o h xecs f icein n ( )Th Ad n srt r moie o a yc nlcso itr s ima ha e 8 e miitao ' t s r n o tit f nee t t y v . s v Cha inv. a k& De ke ( S. I c, 5 F.d3 3 3 8(t Ci. 0 8 (uoi:80 t 2 mno Blc c r U. ) n .5 0 3 5 , 5 4 h r 2 0 ) Q tn 0h, 01 , F. a 3 43 . 3d t 42- ) Somecoursha a id t s f t spice me ,s eW as o v.M edi Ge r sl , t ve pple he e acor e - al e sn a ne al nc. 4 6F. u p. d 5 ( D. . 0 6 ( tn i whc p ry sfv re c fco weg e ) a 4 S p 2 79 E. Va 2 0 ) noig n ih a t' a o a h a t r ih d , nd ot r ha e i t f c or colec i y t de e m i w he he t pl n a i s r t ' he s ve xnm ned he a t s l tvel o t r ne t r he a dm ni ta or s de sonwast r s tofar a one a prnc pld pr es s cii he e ul e s d nd i i e oc s upporedby s tntale de t ubsa i vi nce. Se Duper v.Liel trnceCompmw ofNo t Ameia,63 F. 860,869( hCi. 1 . e rv f nsla rh rc 2 3d 4t r 201 ) 10 Hu trsag me t f c so t e o te80 t fco s t3 tea e u c o t e ne ' r u ns o u n hre f h 0h a tr:ç ) h d q a y f h ( maerasconsdee t ma t de so andt de e t whi t ys t il i rd o ke he ciin he gre o ch he uppor i;( ( hehe tt 4) wl t r t ed cso - kn p o e swa ra o e a dp icpe ' . gn q( )(l eAd n sr trs h e iin ma ig r c s s e s n d n rn ild . . a d 8 th miitao ' , m otve ora c l c s ofi e e ti m a ha ' I e ua i t s f c or ,c t ha i s ny onti t nt r s t y ve. n val tng he e a t s ours ve ' co i r d t a o a s c ofi or ton r le onby pln a i sr t si de ng nsde e he m unt nd our e nf ma i e id a dm nita or n nyi cli . Decsonsba e on t r po t ofmuli e i pe ntphysca who t oughl a ms ii s d he e rs tpl , nde nde i ins hor y e l t d al s vaua e 1 ubmit m e ca r o dsha bee de medt r ul oftde i r t a ted di l ec r ve n e he es t ç lbe a e nd prncpl d'pr ed e . W as o 446 F.Supp. a 5 i i e ' oc ur s s n, 2d t 97.Se 800t 201F. a 344e h, 3d t 45 ( odigta c n ieaino t c mpeeme ia rc r s rla c o id pe d n me ia h l n h t o sd rto f he o lt dc l e o d ,ein e n n e n e t dc l e uai ,a avocai la yssco tt e aprncpl r a one pr esl Eli v. val tons nd tona nal i nsiutd i i ed e s d oc s; ls M er ia LieI . ,1 F.d228, 34(t Ci.1 ( di t tade sonba e topoltn f ns Co. 26 3 233- 4h r 997) hol ng ha cii s d on i pe nta c am a - u it d me c lr o dsa r s tng fom atlngt and nde nde nd l i nts bm te di a ec r nd e uli r te hy to o g 'e au t nwa tep o u to ad l rt r a o n pr c s) Domel M er p ltn h r u h' v lai o s h r d c f ei ae e s nig o e s; r lv. to o i be a LieI s Co,1 5F. p' . 8 , 9 - 5( t Ci. 0 6 ( ligta c n ieaino te f n . . 6 Ap x 2 8 2 4 9 4h r 2 0 ) hodn h t o sd rto f h c omplt r c d,r la eon i pe n media e l tons a a s s ntoft cli a ' e e e or einc nde nde t c l vaua i , nd s es me he am nts voc tonalc pa iy a ai a ct mount t aprnci e r s ngpr es) l Donnel,hec t lne ed o i pld eaoni oc s. n lt our outi d t se t ke by t pln a nitaor he t ps a n he a dmi srt : M eLie' de son t t r nae Donne ls diabiiy be is r s t d fom a t f s cii o e mi t l' s lt neft e ule r pr es t t wa de i r t a prnci e The co pa s decsonmaki oc s ha s lbe a e nd i pld. m ny' ii ng pr es i l ed age nea t oughconsd ai ofa1 t e de e be or oc s ncud nui nd hor i er ton l he vi nc f e i. I r e e a 1 m e c l e de e t t D o l s it d, m ea ur d t t evi w d l di a vi nc ha nnel ubm te s e Dor lsvoc tona abiii s pr ur d a i pe mel' a i l lte , oc e n nde ndent evaua i l ton of t he m e c le de ,a c i r alo t c to t t Dor l di a vi nce nd onsde ed 1 f he ondii ns ha mel c amed li conti e t herdiabiiy. Fur he m or ,M e li e ke D or e l i or rbut d o s lt t r e tvf pt m l nf med of t s a usofhe cl m t oughou t r vi w .... he t t r ai hr t he e e l Thec tdee m i d t ts h se c tt e at lbe a ea prnci ed de ii nm a ng d. our tr ne ha uc t ps onsiut d i i r t nd i pl de c so ki pr e s' l a 295. oc s . d. t ' Aspa t t r viw pr es ,a i sr t sma alo ber quiedt c i rwhehe r of he e e oc s dm nitaor y s e r o onsde t r t ecama t a be nd e dttl d sbldb teS ca S c rt Ad nsrto (ç A' . h li n h s e e me o al ia e y h o il e u i mi itain t ' y y SS ) Eli tv.SaaLeeCo . 1 F. 601 607( hCi.1 ) SSA deemi tonsaenotbi ng lot r m , 90 3d , 4t r 999 . tr nai r ndi o pl n a i sr t s butt y ar e il d t s e w e g . l A tl as one cour i t Four h n a dm ni ta or , he e ntte o om i ht d. e t t n he t Cic tha s d t twhen t di abiiy defnii t rt pl n i consder bl s m ia t t r ui s ai ha he s lt i ton mde he a s i a y i l r o he s a s curt de i ton,t pln a nitaori r quie t gi t SSA dee m i ton ocil e iy fnii he a dmi sr t s e r d o ve he t r nai t iniia t ih . Hie v Un m Liel s Co o Am.1 0F. u p. d4 8 4 8( . Va t g fc n weg t' n s . u f n . . f , 1 S p 2 5 , 6 W D. . s ' 200 . 0) Huntr smai a gum e ti t tAenaa e isdic e i by ove l oki anumbe o e' n r n s ha t bus d t s r ton ro ng r f hi il s e a s m pt s a r l ng t he viy ont opi onsofisr viwi doc or s lne s s nd y om , nd eyi oo a l he ni t e e ng t s i t a ofHt e ' e m i ngphysc a .Aena s ist tisde ii n wasno a a e of nse d mtr s xn ni ii ns t ubm t ha t c so t n bus dic eton bec us i wast r s tofa ( lbe ae, i i edr a o ngpr es 't twa sr i a et he e ul l i r t prncpl e s ni de oc s'ha s ç u p re b s b tn il vd n e'Elit S r Le Co o 1 0F.d6 , 05( t Ci,1 9 ) ç p o td y u sa ta e ie c , lo v. aa e r . 9 3 01 6 4h r 9 9 , s ' i udi muli esa e nt by Ht e ' o doc o t theco dr t n t wor ncl ng tpl t t me s mt rs wn t r ha ul eur o k. Hunt ra guest tAe sr vi ngdoc or ove l dhi myra heat is a e r ha ma' e ewi t s rooke s id lh s ues nd i r c l f us d on hi s r oi i a t onl die e lmii hi a lt t wor ncore ty oc e s a c doss s he y s as i tng s biiy o k. Spe iialy, t rpoi so t tDr Bal a Dr Cos o bo h c hedt i sae e st t c fc l Hun e nt ut ha . lou nd . m t ouc her tt m nt ha Hunt rc d r t n t w or asc i f o a m er y t m o r pe s tve ' w hi h e oul e ur o k om ng r m el t pul na y r pec i ,' c i srmi t y o rooke hi ma y ohe di nosdc tons ( a 591 603. Howe r ndic i nael vel d s n t r ag e ondii . AR t , ) ve, Hunt rsa gume ei st f c t tDr Balou ha l be n awa eoft br dt ofHun e ' e' r nt lde he a t ha . l d ong e r he ea h t rs cl i e condii ns s w a ,i f c , he doc o w ho di nos d t m . Apa tf o Dr W e d a am d to - he s n a t t tr ag e he r r m . i m n, w ho tea ed Hunt rf kne pr e s D r Ba l i t onl phys c a w ho s it an r t e or e obl m , . lou s he y ii n ubm ted y s a e e sordoc e t ton on Hunt r sbe l r a di hi he t D r Ba l i ta l t e t d t t m nt um n a i e ' ha f eg r ng s alh. . lou nii ly r a e 12 Hunt rf apul ona y c ton,s r oi i,a monio edhi f hype tnso c s pan, e or m r ondii a c doss nd tr m or re i n, he t i l ba di c di e s a e y, nd o he c tons H e m uli e A PSSe ua e Hunt r s um r s s a e, nxi t a t r ondii . r tpl val t d e' o alhe t a s r e a t e usveba i f rgr ntng Ht e s t and l tr ver l alh nd e v d s he xcl i ss o a i mt r horong-e m be f . On t s pa a eocc sonsd i t a al pr s ,Dr Bal u i or e Aena of ne hs wo e r t ai urng he ppe s oce s . lo nf m d t h ro no t a Ht e c udp ro m lg to s d naywok.( aa 6 8 (t ret a h c ud e piin h t mtr o l ef r ih r e e tr r J .t 7 ) t e h t e o l # Ag p ro m s d n ay lg td t ' ; i. t5 )($ y uaea r If l w ( nelf rs ro d i e f r e e tr ,ih uy.) (d a 91 ç o r wa e ol Hu tr o ac ioss ' As o and s ve ehypere i Fr apul e r tnson. om monar san nt ldo no bei vehe i dia e f lg y t dpoi , t le s s bld or iht dut a notdbyyouri pe ntrviwera lwoul ag e wiht tc uson.). ys e nde nde e e nd d r e t ha oncl i ' Addii ly,durng aphone c l wih Dr M a al Dr Ba l r ma ke upon Hunt ' ove al tona l i a l t , z , . lou e r d ers r l heat a a lt t r t n t wor lh nd biiy o eur o k.Thedef nda sc r c l s e nt ore ty umm a i Dr M az lsr por,i rze . a ' e t n w hi h he no esD r Ba l s sa e e st tHt t r c t . lou' t t m nt ha m e : s f r d no c i c ly s gnii n t r tor n da a as a r ul of unc r l d uf e e lni a l i fca t a ge ga m ge es t ont ole h p re so ta panifss be tv c mplit o pan a d ftg e h d n t y e tn in; h t litf u jcie o an s f i n aiu a o bee co r ae by a ph i a e m i to fndi , l bor t y da a or n robor td ny ysc l xn nai n i ngs a aor t, i gi sudi s t t t r wa no s ns r mot r i par e or a ma ng t e ; ha he e s e oy o m im nt ny de m a om a di ti i n ofpai t tt r w a no m us e w e knes , abno m a r t l sl buto n; ha he e s cl n s r l gai,l sofmus l t ,ormus l a r t os ce one ce tophy;t t t che t x-a had s ha he s r ys hown i pr me w11 r pe tt t pul m ove nt t es c o he mona y s r doss a t t t r wa no 4 r a coi i ; nd ha he e s doc l e a i ofa c i c ly t c lm nt ton ny lni a l a hypnea t c , a hyca di r a, hy poxe i , m a o r de a m e tofpul r nge n monar f ton mec ni t twoul pr c ude y unc i ha cs ha d el pli if antf f om pe f r i t du i sofa oc upa i r r o m ng he t e ny c ton. ( fn a tsBre p. 0 1 )(iigAR a 6 6)Dr Balu' sae n sce ryidc t t a he Dee d n ' if 1 - 1 ctn t 7 . . lo s ttme t la l n iae h t r opi o t tHunt rwasca bl ofr t ni t wor wa no lm ie t a sngl die s ors tof ni n ha e pa e e ur ng o k s t i t d o i e s a e e s ympt s Ra he ,s s r e asHunt rsprma y teai physcan dt i t r e nttm e om . t r he e v d e ' i r r tng ii l ng he elva i r pe i ds a he sat m e sr ga di hi he t r l c t br d s ope oft ttea m ent' ro nd r t e nt e r ng s alh ete t he oa c ha r t . 3Hunt ' agum e i f rherw e ne b hi own dicl m e ofa la ts eofhi alge c to . D urng a ers r nt s u t ake d y s s ai r t e s om s le d ondiins i phonecalwihanAet rpr s nttvedl i t rviw pr e s Hun e s edt thi cai wasnotbas d o l t na e e e ai z ng he e e oc s , t r Gt ha s l m r e n i n it, te s CP (h s pan)o a oe a' (d.t3 6) t xey srs, c et i , r n rxi. l a 5 . a ' I a ton t Dr Bal u,Ae naha t e i pe ntd t sr viw Hun e ' medial n ddii o . lo t d hr e nde nde ocor e e trs c flsf ro j ci e i e c o d sbit .Dr M a a is e asx-a erp r clo cigHu trs ie o b e t v d n e f ia l y . z lsu d i p g e o t l niln n e' ve i r c tons a te t e s nc ea l 2007. Hi r po tdi c s s a ong ot rt ngs H unt r s ondii nd r a m nt i e ry s e r s us e , m he hi , e' bl pr s er a ngs m e c i ,M RIa x-a r uls sr i ht1 r sng t tr uls ood esur e di , diatons nd r y es t, ta g eg aii es es t , c mpan so p i a dftg , n a1o Dr Balu se au to s I a 6 3 7 . l r a hng o lit f an n aiue a d 1 f . lo ' v lai n .(d. t 7 - 8) n e c i t de s on t tHunt rw a c pa e ofpe f r i lg ors e a y dut Dr M a alr le on he ci i ha e s a bl r o m ng i ht ed nt r y, . z e i d hi r viw ofa 1t a ia eme c lr o ds aswela hi c se e l he va lbl di a ec r l s s onve s ton wih Dr Bal u, rai t . lo who i c t d s be ived hewa c pa eofwor ng- a i no wa lmie hi s ft apa tc a ndia e he le s a bl ki nd n y i t d m el o riulr diea eors tofs s s e ympt s om . Dr Cos o' r viw c r aed Dr M a alsa Dr Ba lu' opi onswih r pec t . m s e e orobor t . z ' nd . lo s ni t es t o Hu trsp l n r ds r e .td a 6 4. Hewr t ta t eea pe rdt b (aci c ly ne ' umo ay io d r L= t 0 ) o e h t h r p ae o e < l al ni sa ebe gn c s ofc oni pul tbl ni our e hr c mona y s r oi i,whi h ha be n pr e f s ve a r a c dos s c s e es nt or e r l y a s' (4. t 0 ) Aspat fhse auain, . s atmp e t s e kwihDr Baluo e r. Lza 6 3. ' r o i v l to Dr Co mo te td o p a t . l n o t s pa aeocc sonsbutwa u bl t r c he .Hi r r yil d t s m ec uson a wo e r t ai s na e o ea h r s epo t e de he a oncl i s t toft ot rdocor- t tHune wa a et r t nt wok.Hewr e,çt r iqal kof ha he he t s ha tr s bl o eur o r ot çghee s ac s uppori m e c ldoc e a i t s t ve di a um nt ton o uppor a sgnii a f nc i li paim e f o t ny i fc nt ' tona m r nt r m u 1130201 t ough08 1 2011 fom apul r pes ci ,t twoul pr cude( e l / / 0 hr / 7/ ,r monay rpe tve ha d e l Huntr fo f n to i wihna yo c pai n' (d, r m ' cinng t i n c u to . I ) u ' Hun e a s a gue t tAe nadi notgi s fcintc i r tont Ht e ' kne pa n. t r lo r s ha t d ve ufi e onsde ai o mt rs e i Howe ,Dr Swotns s i al addr s e Ht e ' ca m on a ver . i ky pecûc ly e s d mt rs li ppea ofc oni kne pai l hr c e n r l tng t de ne a i kne di or ra hi r co r f om arhr copi slge y on hi l t e a i o ge r tve e s de nd s e ve y r t os c tr r s ef kne H i r por no e t ûs an ' e m r s t f om Hunt r svi ist Dr W e dm a a e. s e t t s he éc t' xa e uls ' r e ' st o . i n, nd conc ude t tt r w asi ufi i nti or aton i t r porst i c t Hunt rc d not l s ha he e ns tc e nf m i n he e t o ndi a e e oul 14 pe f m s de a y wor Dr W eim a se m r po t c itofbrefno e f l ng ea h of ror e ntr k. . d n' xa e rs onss i t s olowi c H unt r svi is a t y r c e ' st , nd he e ountva y ng deg e s ofpa n a m obiiy. The r por si ude re i nd lt 4 e t ncl ri s uggesed se f Hunt rsr ha bu ne rme i a hi i c i t Hun e ' kne t t ps or e ' e b, t ve nton nyt ng ndiatng hat t rs e pr blm sr nder hi t a l dia e Uli t l Dr Swo i ky c l d t tHunt rsknee o e e ed m otly s bld. tma ey, . tns oncude ha e' pai woul lmi hi fom posto r quii r peii be ng,ci bi orhe vylfi bu n di t m r iins e rng e ttve ndi lm ng, a itng, t d dn t e uti ttl ia l y (d a 61 . i o r s l n oa d sbit . 1 . t 2) i Fi ly,Hu e ar est tAenadi no gi s fce weghtt Hunt ' cli t t na l nt r gu ha t d t ve ufiint i o ers a ms ha c o cpai a f tguer nder d hi unabl t wo k.I Dupe y, heFou t Cic tr ve s d a hr ni n nd a i e e m eo r n n' t rh r ui e r e pl n a i sr t ' de ii d ngbe ft be us i c ude t a nitaorhad a dm nitaors c son enyi ne is ca e t oncl d he dmi sr t u j siibyd se a d dtecama tsfb o agaa da s cae p i a dftg e Dup rv n u tfa l ir g r e h li n ' ir my li n so itd an n aiu . er , 632 F. a 873. l t tc s ,howe r t r wasc e ri ca in fom t cli a ' doc o t t 3d t n ha a e ve , he e l a ndi to r he am nts t r ha s w ast a e t r t t w or a ar s tofhe c ton. The Cour no e t the m ai he m bl o e mm o k s e ul r ondii t t d ha r n t e tng phys c a t i e e es l i ca e t t a i s r t t i hi opi on t cl i a rai i i n w c xpr s y ndi t d o he dm nit a or hat n s ni he a m nt wa d sb e fo wo k:ç per i)n ta l t wo k (u t pana dftg J ' a d( h i s ia ld r m r çDu ry s o be o r d e o1 i n aiug e' n d e s g ; s nota et r tun t a pr vi wo k d i .'l a 871 72. TheCour f ndt tt bl o et ' o ny e ous r utes' d. t t ou ha he ad nitaorsdocor ha f ldt c ntrt tubsa tale de fom g ry'l mi srt ' t s d aie o ou e he t tni vi nce r Duper s s p y iinsta (e)d s ae d ,nf c, rv n he fo wo kng' 1 a 8 3 h sca h t h r ie s s o i a t p e e t r r m r i . d. t 7 . ' He e, ntmbe oft doc o swho e r a l r he t r xami d Huntrorr vi wed hi fl di no ehi ne e e e s ies d t s c pl nt ofge r pa n a f tgue Fore m pl on J y 11 2008, r Ba l r pored t t om ai s ne al i nd a i . xa e, ul , D . lou e t ha Huntrs fr dfom t fus pai i muli eplc ,ba k, bdo n,l .... ( a 792. e ufe e r t f e n n tpl a es c a me egs ' AR t ) di ' l Sept berof2008,D r.Balou repored t Hl t contnued t com pl n ofts e f i n em l t hat m er i o ai çever atgue 4Ther rsi l t f l i s t e s ( hepaintw akswih am id lm p, usng noas itvede c epo t ncude he olow ng G em nt:T te l t l i i ssi vie. Th r i tn en s a teme ilon l e'(d.t6 1)( eh sami l td y,malef so . . Heha ee s e d res th daj iti . l a 3 . ; a n ' H l i o a s l fuin . . d mp s q a arp ya c mp rdt t n n-peaielg.(d.t6 3)tf ek e lo sg dtd y h sn efso o u d to h s o ae o he o o rt e ' l a 3 . ç' n e o k oo o a , a o fuin r v ' h a ysgntc n eyte . (d a 6 2. t ealh k e lo sg o .Th r i n ef so Th r imii l n i i a t r h ma' l . t 3 ) < rlte n e o k o d ee s o fu in. ee s nma i ' ov ce i a s metn en s a o tt me ilon l ea dsmeq dar p yi n td' (d.t6 9) rpms nd o e d re s b u he daj iti n o ua to h s oe . I a 2 . n ' 15 a dj it an' (d a 7 7) OnJ l 6 20 9, ne c mplie t Dr Baluof ana d n on p i. I . t 4 . ' uy , 0 Hu tr o an d o . lo p i n e esi ftg (d.a 71 ) Addii ly,nDr Maz lsrpor, noe t tçg- ejdoe xc sve aiue. I t 6. tonal i . a' e the td ha tluntr s l h v ahso yo c r ncp i t t sg n rlz da das iv le mu t ej it . .' (d. t a e it r f h o i an ha i e eaie n lo n ov s li on s . . l a pl ' 6 6) Ho v r no e ei t r c r d a yo Hu trsd co ss yhsp i h sd s be hm 7 . we e , wh r n he e o d o n f ne ' o tr a i an a ia ld i f om wor ng. Dur ng he c r ki i r onve s to wih Dr M a al i whi h s i ca ed t tH unt r r a in t . z , n c he ndi t ha e c udrt r t wo k Dr Balusae t a Hu trss b e tv c mplit of i h dn t e o l eu n o r , . l ttd h t ne ' u j cie o an s pan a o be n o c ro o ae b e n n to fn i g .( )Smi ry Dr W ed nn ve sae t a Hu trs o r b rtd y x miain d n s J i l l, . ima e r ttd h t n e' A a pai eihe fom hi kne ormor ge r ly, n, t r r s e e ne a l woul r nde hi dia ed. Hunt rha sm pl put d e r m s bl e si y f rh i ufk i ntm e ca e de e, tc a l fom hi own doc or ,i c tng t ta ofhi o t ns t e di l vi nc pariul ry r s t s ndia i ha ny s c tons i l ng c oni pai a f tgue lf hi t bl t pe f a o upa i ondii , ncudi hr c n nd ai , e t m ma e o ronn ny cc ton. l a tont r l ng o t opi onsofmuli emedia pr e sonas Ae nabas d is n ddii o eyi n he ni tpl c l of s i l, t e t de son on t r s t ofa voca i nala l i i ha c m i sone t de e m i H unt r s ci i he e uls to na ys s t d om s i d o t r ne e' s ia ii a c r igt hsh at a de p re c ,o j b i ten to a e o my Th rp r utblt c o dn o i e lh n x ein e f r o s n h ain l c no . e e o t y, co l ncudedt tt r we et n diecl ta f r bl o upai nsr quii onl lg ors ntr ha he e r e r ty r ns e a e cc to e rng y iht ede a y physca aci t f whih s i l tviy or c omeo ofHun e ' e a i a e re lvelc d q iy. ne t r s duc ton nd xpe ince e oul ualf (d. t656. Afe Dr Swotns deemi t tHt e woul ha s r titonsduet hi 1 a ) tr . i ky tr ned ha mtr d ve ome esrci o s kne pa n, e na r s it H unt r s fl t isvoc tona c ns t ntw ho de e m i t tt e i A t e ubm ted e ' ie o t a i l o ula t r ned ha he physc rquieme soft ta frbl oc upainsdi notc lc wiht ersrci .(d. ial e r nt he r nsea e c to d onfit t hos e titons I a 5 0) Hu trag e t t n o tepo iin r q ies c n aye u ainh d e n t t 6 . n e r u s ha ma y f h sto s e ur e o d r d c to e o s o pos es ;how e r i f c , hos pos tons m e el ls co l ge deg ee a o t ofr l va s s ve , n a t t e ii r y i t le r s s ne ype e e nt qualfcaton. Forexam pl t lM anagerRes ii i e, he ç ervatons' pos ton as t çM anagem ent i ' ii ks hat s t a ne s f l r rups l ho e c i a m os al a nee aba hel ' orm a t r s de e r i e or a ge ca e t l ha ns l t w ys d c or s s e ' gr e pr f r bl i hos t lt orhot lm a e e .l notc i f o s h a c l ge bac ound, e e a y n pia iy e nag m nt f om ng r m uc ole kgr 16 e pein ewo kn a ah tl sg n rlyrq ie t g t p sto a ald i ma a e . (d x re c r ig t oe i e eal e ur d o e a o i n s o gng n g r' I . i ' a 651) Huntrsfr rpostonwihHitnwoul quaiyast st ofe re e. t . e ' ome ii t lo d lf hi ype xpe inc l s t t s i no a ca e whe e t c t sas d t dec de be w e n r yi on t n hor, hi s t s r he our i ke o i t e el ng he cli a ' doc or , am nts t s who pe s lyte t d apa inta m a c e rsa e t r ga di hi or r ona l r a e te nd de l a tt men s e r ng s he i biiyt r tu' t wor a t o ni ofd t shiedbyt pl n a nita o who r na lt o et n o k, nd he pi ons oc or r he a dmi sr t r e l t d heat r c dsa mader c vaua e lh e or nd e omm e to c r ci t c am a ' teai ndai ns ontaditng he l i nts r tng p y iin .S eStpv. m Lie I s Co o Ame ia 3 0F.d 3 , 0 ( t Ci. 0 4 h sca s e u Unu f .n . . f rc , 9 3 01 3 8 4h r 2 0 ) (e e sn ad n a o b neiswh nfc dwihc nlcige ie eo d sb ly .I t sc s , rv r ig e il f e ft e a e t o fitn vd nc f ia ii ) n hi a e t Huntr sown physca t s c oft dignos upon whi h Ht e r le f t i ta e' i in, he our e he a es c mt r e id or he niil c e r lo bene is hasr peaedl saedt ts be ive Hunt ri c pa eofr t m i t onf ra f ft , e t y t t ha he le s e s a bl e u ng o wor Li w ie, k. ke s Hunt rha f ie t s i e de efom Dr W ei n i c tng a hi e s a ld o ubm t vi nc r . dma ndia i nyt ng a bouthi a lt t pe f m lghtors de a y wor Ae nahie tte i pe ntdocor t s biiy o ror i e ntr k. t r d lr e nde nde t so c onductt row n r vi w , c ofwhom a tm p e t g n m or i onna i f o Hunt r s hei e e ea h te t d o ai e nf ton r m e' physc a r ga di hi condii ns a ea h ofwhom de e m i d Ht e c d pe f m a las ii ns e r ng s to , nd c t r ne mt r oul ror t e t lgh ors de a y wor i t e nt r k. Aena' r viw c itd ofa e ua i oft e ieme c lr or a lofHunt rs t s e e onsse n val ton he ntr di a ec d, l e' c to ,t o ni ofbo h t cam a tsdocor a i pe ondii ns he pi ons t he li n ' t s nd nde nden physca , ndt t i ins a he e itn eo j b s ie t hi h at a lv l fe p re c .Aenaiiil p i ln -em x se c f o s utd o s e l nd e e o x e in e t ntal ad o gtr h y di a lt f rt o yea sbe or r ce vi i o ton f om H unt r sdoc o t the wasno l e s biiy o w r f e e i ng nf nna i r e' t r ha ong r d sb e Se 80 t 2 F.da 3 4(idngapln' rv ra o iso d cso d n ig ia ld. e 0h 01 3 t 4 fn i a s e es l f t wn e iin e yn be isatli sg ofat ughtu d ii neft elng in ho f l ecsonmaki pr e s;Champi 5 F. a 3 ng oc s) on, 50 3d t 62 (i ngt tt nt Pln o ruldt i ta de a ofs r-em ds biiybe tt ...i fndi ha é whe he a ve r e he niil nil ho ttr ia lt neis t ma fseda a oa h de tai a unbis di eett tfvord (hecai nt' .Aena niet n ppr c monsrtng n a e ntrs ha a e t l ma l' t ) a s ke tHt e we li or t oug utt pr es ,a sng hi oft ne d t s i lo p mt r l nf med hr ho he oc s dvii m he e o ubm t a tona m e ca r cor a hi rghtt a pe . SeeBr n v.Hola 1 F. 1 1 66 ddii l di l e ds nd s i o p al oga lnd 05 3d 58, 65- ( h Ci.1 (tpjantf wa gve af l a fi rviw ofhi cli be a ehewasnotfed 4t r 997) tg li if s i n ul nd ar e e s am c us ii o s cfcr a o f rt eb n ftd n a a do ter lv n pa p o iin . .I lg to a1 f pe ii e s ns o h e ei e il n f h ee a t ln r vso s' n ih f 1 ) t s i ca tbe s i t tAe naa e isdic e i whe i t m i t d Hun e ' be ft . hi , t nno ad ha t bus d t s r ton n t er na e t rs ne is Ha ng de e mi d t tAenapr ry c i e a e l t t r e ntme c l vi t r ne ha t ope l onsder d nd va uaed he elva dia e de e, he c t w co i r w he he A e na ga a opra e s g fc nce t t SSA ' vi nc t our no ns de s t r t ve ppr i t i nii a o he S de e mi ton t tHuntrwast al dia e l islte notf ng Hunt rt ti was t r nai ha e ot ly s bld. n t e tr iyi e ha t dic i ng hi l ng-er dia lt awa ds Aet a knowl dt tHunt rwasr evi s ontnui s o t m s biiy r , na c edge ha e ec i ng s ils urt be ft butsa e t t oca ec iy ne is t t d ha : (tldia lt dee mi ton mz t SSD deemi ton aema i pe nty is sbiiy tr nai d he tr nai r de nde nde l a a e nota w a t s m e. dif e e be wee otrde e m i ton nd r l ys he n The fer nc t n l t r na i a t nd he SSD dee mi to ma be drve b t So a Se urt Admi sr ton ( tr nain y i n y he cil c iy nitai SSA) r gul tons For e m pl SSA r g a i ns r quie t t c r a n di e e di gnos e ai . xa e, e ul to e r ha e t i s as / a es o c ran e r e t i duca i o a l ve s be gi n he vi r or e n c nt oli w e g i ton r ge e l ve a e ve o r lng i ht n dee m i ng whet r a i vi l i e ild t SSD be ft . Or i ma be tr ni he n ndi dua s ntte o ne is ,t y d i n by t f c t tweha i or ton t t i dif r nt fom wha SSA rve he a t ha ve nf ma i ha s fe e r t c i r W eha notbe n pr de wih t bassf t SSD dee m i ton, onsde ed, ve e ovi d t he i or he tr na i a t e de e t t wa r le on f t SSD de e mi to has no be n nd he vi nc ha s e id or he t r nai n t e ie tfe t us T e eo e e e t o g yo a e r c iig S D b nft, we d n iid o . h rf r , v n h u h u r e evn S e e s a eu a et giei sgn a t ih i o rd tr n in.. . r n bl o v t i 6c n weg t n u ee miat o . (d.a 539)(mpha i a d) Aenat ac wldg isrs nsbiiyt weght SSA I t e ss dde . t hus kno e ed t epo i lt o i he detr na i butwa una et e an wh i r ac d adif r ntc l i be a ei l ke e mi ton s bl o xpl i y t e he fe e onc uson c us t ac d an i or ton r r ng t a r Huntrbega r c vi s als urt benehsi y nf ma i ega di he wa d. e n e ei ng oci ec iy f n Fe u r 2009, o e D r Ba l u' s a e e st tHunt rc d r t t wor A s s h, ti br a y bef r . lo s t t m nt ha e oul e um o k. uc i s pos i e t tA e na sco l i w a ba ed o a m or c pl t m e ca r cor t n t SSA ' . sbl ha t ' nc uson s s n e om e e di l e d ha he s The onl i or a i n r r ng t s i ls c iy a a d i t r or be or t s c t sa copy y nf m to ega di he oc a e urt w r n he ec d f e hi our i oft l te s ntt Hunt ri onni hi oft a oun ofhi be ft a t da e he w oul he e t r e o e nf ng m he m t s ne is nd he t d be nr c i ngt m.(d. t7 ) Thelte i l snoe a tonf isde sonorwha gi e evi he 1 a 26. etr ncude xplnai or t cii t 18 i or ton wa r le on.Lac ng mor ,Aena c d notf il ber quie t gi gr a e nf ma i s ei d ki e t oul a ry e r d o ve e t r e a ton f how isdec son dif r d fo t SSA'. xpl nai or t ii fe e r m he s 11 1. Conc us o l in A se aneda xpl i bove t cour dee m i sAenadi nota e isdic e i i , he t tr ne t d bus t s r ton n t r i tng H unt r s l t r di a lt be ft . A c or ng y, he c tgr nt A e na' m oton e m na i e ' ong-e m s biiy ne is c di l t our a s t s i f rs mmayj d me t Th Clr i drce t s n c riidc piso ti me rn u o u r u g n . e ek s ie td o e d e t e o e f h s mo a d m f opi on a t a com pa ng or rt a lc ni nd he c nyi de o 1 ouns ofr c d. el e or EN TER : Thi D ci da ofSe e r 2012. &1 y s pt mbe , t V z T ' 1 ' ! ' M''z-' % b cvd Y, Chi fUnie Stt sDititJ e t d a e src udge