## Introduction (Administrative Tribunal, November 14–15, 2007)

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### Overview of the case
- Tribunal composition: Judge Stephen M. Schwebel, President; Judges Nisuke Ando and Michel Gentot, Associate Judges.
- Applicant: Ms. “CC”, former IMF staff member, challenged SRP Administration Committee denial of disability retirement under SRP Section 4.3.
- Central legal issue: whether Applicant established she is “totally and permanently incapacitated for any duty that the Fund might reasonably ask her to perform.”
- Applicant’s procedural and substantive claims: denial not in accordance with fair and reasonable procedures; decision arbitrary, capricious and improperly motivated.
- Respondent’s position: SRP Administration Committee properly applied disability criteria and afforded Applicant due process.

### Procedural history and timetable
- July 19, 2006: Application filed with the Administrative Tribunal.
- July 20, 2006: Application transmitted to Respondent; Registrar circulated summary pursuant to Rule IV, para. (f).
- September 5, 2006: Respondent filed Answer.
- October 16, 2006: Applicant submitted Reply; initially noncompliant with Rule IX, paras. 2 and 5 but subsequently considered filed on original date.
- December 1, 2006: Fund’s Rejoinder filed.
- Tribunal denied Applicant’s earlier waiver request under Article VI, Section 3 for failure to show “exceptional circumstances.”

### Anonymity and confidentiality determinations
- Applicant requested anonymity under Rule VII, para. 2(j) and Rule XXII; Tribunal concluded good cause for privacy protection due to health and alleged misconduct issues.
- Facts relating to an incident of September 2003 treated as confidential; factual elements of alleged misconduct omitted from Judgment but separation circumstances included as relevant.

### Evidence considered and oral proceedings
- No oral proceedings: neither party requested them and Tribunal deemed them unnecessary.
- Documents considered: SRP Administration Committee proceedings, voluminous medical records, Committee minutes (initial application and review), Committee report of April 17, 2006, and additional medical records.

### Factual background — employment and medical history
- Employment:
  - Began IMF employment in 1988 as an Economist; promoted to Senior Economist in 2001.
  - Did not return to active service after September 2003 events; placed on administrative leave with pay from September 29, 2003 to April 19, 2004, then began separation leave.
- Medical history (selected entries and chronology):
  - March 2002: abdominal surgery.
  - Approximately six weeks later: emergency laparoscopy; continued abdominal distention and pain.
  - May–August 2003: consultations with an internist, two surgeons, three gastroenterologists, an HSD physician, and an acupuncturist.
  - May 2003 report: “significant abdominal bloating, pain and gas without any remittance whatsoever.”
  - Gastroenterologists’ assessments: tests “failed to show significant abnormality” and “nothing to suggest pseudo-obstruction.”
  - Acupuncturist: pain “off and on,” episodes sometimes “4 [to] 6 hours,” stress and certain foods aggravated pain; pain “affected her work and sometimes she has to take breaks from work due to pain.”
- Attendance and performance:
  - Attendance and Leave Balance Record (September 2002 to September 2003): fewer than the fifteen days allotted annually for sick leave.
  - Use of compressed work schedule (“CWS”) during June–August 2006 per personal calendar.
  - APR calendar year 2002: rating “2” (appraised as “fully satisfactory”).
  - Spring 2003 APR: Applicant stated post-surgical complications “have since been resolved,” requested mission leadership opportunities; supervisor and Senior Personnel Manager noted recovery.
  - September 2003 mission: mission chief commended Applicant’s technical quality, focus, organization, collegiality, and contribution to mission schedule.

### Misconduct investigation, medical submissions, and separation
- September 2003: incident during brief personal travel prompted GAO No. 33 misconduct investigation; placed on administrative leave with pay under GAO No. 13, Rev. 5, Section 9.01.
- December 2, 2003: Applicant informed of ongoing investigation.
- December 4, 2003 meeting and December 8, 2003 memorandum: Applicant attributed conduct to physical and mental exhaustion and requested return to work.
- Applicant’s cited contributing factors:
  - physical/mental stress from medical condition, recent car accident, heavy workload;
  - mental/physical exhaustion from assuming another economist’s workload, working “enormous hours, skipping most meals, and sleeping only 2-3 hours each night” (Applicant’s statement);
  - detention by local immigration authorities the day before the incident.
- January 6, 2004 treating psychiatrist letter: opined conduct resulted from “Adjustment Disorder with Disturbance of Conduct” with “dissociative symptoms,” described as an “acute episode” that does not persist for “any great length of time.”
- January 9, 2004: Applicant requested HSD evaluation; counsel sought psychological testing by HSD the same day.
- February 13, 2004: Applicant’s “special plea” to HRD Director seeking return to work and noting tenuous financial situation.

### HRD determination, separation offer, and conditions
- March 4, 2004 HRD memorandum: concluded Applicant “engaged in serious misconduct in violation of GAO No. 33,” conduct “sufficiently egregious as to warrant termination ... as provided under GAO No. 33, Section 10.05.”
- HRD offered resignation with monetary settlement “for health and humanitarian reasons” if independent medical evaluation corroborated that health factors contributed to behavior; settlement in salary continuation allowed delayed payments and continued administrative leave to reach age 50 for lifetime Medical Benefits Plan coverage.
- March 23, 2004 psychiatrist IME (separation-related): opined Applicant experienced Acute Stress Disorder with dissociative symptoms caused by a “combination of ... stressors” and that the condition “resolved within a few weeks”; IME recorded no remaining condition or predisposition as of March 2004.
- April 16, 2004: HRD denied reconsideration of termination but indicated willingness to proceed with settlement given IME opinion; Applicant signed separation terms the same day.

### Medical evaluations and clinical course after separation (2004–2006)
- Post-return to United States (~late November 2003): approximately nine months with no documented medical attention in record though Applicant asserts consultations in home country.
- August 2004–April 2005: evaluations by internist, surgeon, radiologist, gastroenterologists, and gynecologist.
  - August 2004 surgeon: “now chronic bloating”; no current abdominal pain; CT scans unremarkable.
  - October–December 2004 internist: bowel-regulating regimen; November 2004 “a little bit less bloating and no severe episodes of pain”; December 2004 “generally improved.”
  - February 23, 2005 internist note supporting disability retirement request: “freq[uent] unpredictable bouts of abd[ominal] pain (severe) bloating sufficient to disable for work. Chronic condition S/P [status post] surgery 3 + 5/02. Pain lasts for hours. Avg 2x/week.”
  - September 2004–March 2005 third gastroenterologist: severe left lower quadrant pain episodes often lasting about four hours; patient “working at home since January of this year.”
  - February 2005 Mayo Clinic evaluation: patient reported left lower quadrant pain once or twice per week, severity “ten out of a maximum score of ten,” lasting up to three hours; diagnosis “significant slow-transit constipation, as well as initial dumping of food from the stomach”; recommended medications and possible Sandostatin.
  - Patient reportedly discontinued Milk of Magnesia and Zelnorm because they “made her symptoms worse”; discussed possible subtotal colectomy which patient “appropriately reluctant to consider.”
- Psychiatric care and treatments:
  - October 2004–January 2006: resumed consultations with treating psychiatrist; notes reference Effexor, Cymbalta and Wellbutrin.
  - April–October 2006: resumed frequent acupuncture treatments, records show variable abdominal pain with repeated reports of improvement; October 2006: “some pain and bloating.”

### Disability retirement application and SRP Independent Medical Examiners (2005)
- May 5, 2005: Applicant filed Request for disability retirement under Section 4.3 of the SRP citing “continued severe abdominal pain, bloating and gastrointestinal disorders” after two 2002 surgeries; asserted pain “is acutely paralyzing and lasts for four to six hours about every other day.”
- Applicant attached April 28, 2005 internist letter asserting chronic condition since March and May 2002, severe episodes “on average about three times a week,” opining “her request for disability merits approval.”
- Two SRP-engaged IMEs:
  - June 28, 2005 gastroenterologist IME:
    - Opined pain pattern “strongly suggests functional rather than organic disease.”
    - Reported “virtually no objective evidence of disease.”
    - Noted Applicant’s regular exercise on treadmill and elliptical trainer.
    - Commented Applicant “relates significant secondary gain from a favorable disability ruling in the desire to financially support family members.”
    - Applicant objected July 22, 2005; IME replied August 9, 2005 standing by conclusions.
  - September 20, 2005 psychiatrist IME:
    - Based on records, two in-person evaluations (including MMPI-2 profile), and interviews with contacts and Mayo Clinic gastroenterologist.
    - Reported Applicant’s descriptions of piercing pain, inability to breathe or move during episodes, claimed inability to work at least half the days per month; reported non-pain days spent “reading and writing papers at home, but is unable to do anything.”
    - MMPI-2 profile: “extremely guarded and self-favorable response style,” pain and fatigue “likely beyond medical expectations,” personality profile associated with gastrointestinal complaints and intractable post-operative pain syndromes; noted potential for “extensive ‘secondary gains’”; diagnostic impressions tentative due to “extreme understatement of her problems ... excessively guarded and self-favorable responding.”
    - Diagnostic impressions included hysterical neurosis, conversion type; hypochondriacal neurosis; psychophysiologic disorder (tentative).
    - Psychiatrist IME reported Mayo Clinic gastroenterologist’s opinion of a large psychological component to illness and acquaintances’ observations of post-surgical decline.

### Psychiatrist IME findings and opinions (September 20, 2005)
- Observations during evaluation: Applicant appeared “in discomfort, and a bit depressed”; in second meeting could not sit up, interviewed while lying down, “got up and ran to the bathroom, and had dry heaves.”
- Diagnoses:
  - Axis I: Undifferentiated Somatoform Disorder
  - Axis II: No Diagnosis on Axis II
  - Axis III: Irritable Bowel Syndrome with Abdominal Pain and Bloating S/P Laparoscopic Left salpingo-oophorectomy
  - Axis IV: Problems related to work; Concern about her health; Possible financial concerns
  - Axis V: GAF 50
- Key clinical statements:
  - “The symptoms cannot be fully explained by the objective tests performed, including the history, the physical examination, or lab test findings.”
  - “The pain is so severe that [Ms. “CC”] states that she cannot function either occupationally or socially when she is having one of her attacks. She states that she has several attacks per month.”
  - “[Ms. “CC”] has had these physical complaints since her ovarian surgery in 2002.”
  - “I have no evidence that the symptoms have been intentionally produced or feigned.”
  - Concluded condition “totally and permanently incapacitates her from performing tasks that she may be asked to perform given her education, training and experience”; course described as “generally chronic and relapsing” with “substantial disability, work impairment, and excessive health care utilization.”
  - Recommended counseling linking emotional and physical functioning for potential partial restoration and saw “no way to accommodate [Ms. “CC”’s] illness with technical or other equipment.”

### Medical Advisor and SRP Administration Committee actions and conclusions
- October 25, 2005 Medical Advisor report reproduced psychiatrist IME findings almost verbatim and concluded:
  - “[Ms. “CC”] has an undifferentiated ‘somatoform disorder’ that is likely to be untreatable and permanent”
  - “[Ms. “CC”] is totally and permanently incapacitated from performing tasks that she may be asked to do by the IMF, given her education, training and experience.”
  - Recommended granting disability retirement with review of eligibility in eighteen months.
- December 1, 2005 SRP Administration Committee meeting:
  - Medical Advisor initially indicated potential future need to leave any job though “she might be able to work from home,” later revised view to “chronic but not permanent” and recommended granting disability with 18-month review following counseling while acknowledging “significant doubt about the degree of permanency and totality of the condition.”
  - December 9, 2005 Committee Decision: denied Request for disability retirement. Committee considerations included:
    - Applicant worked from September 2002 through most of September 2003; “No medical reasons for this change in your status were adduced.”
    - Committee “lacked reliable verification of your current professional and social incapacity,” noting psychiatrist IME spoke only with boyfriend and another friend.
    - Treating physician records and other evidence suggested Applicant had worked with symptoms and condition had not worsened since last return to work in 2002.
    - Applicant admitted exercising three times per week and overseas travel.
    - “When you are incapacitated, it is for a few days a week according to your physician. Consequently, there is no basis for concluding that the symptoms render you permanently and totally disabled.”
    - Gastroenterologist IME found “no objective evidence of disease” and suggested psychiatric component and potential secondary monetary gain.
    - Psychiatrist IME’s findings considered but Committee concluded psychiatric counseling had not been tried and permanence not established.

### Administrative review, additional evidence, and Committee review outcome
- January 18, 2006: Applicant applied for review under Rule VIII of SRP Rules of Procedure.
- Applicant’s principal review contentions included:
  - Committee decision contrary to medical evidence (Medical Advisor and psychiatrist IME);
  - During September 2002–September 2003 she could not resume regular activities and frequently worked short days under a flexible schedule;
  - Physical and mental condition precipitated the September 2003 incident;
  - From about July 2004 symptoms included nausea and severe pain up to four times a week and disability is “permanent in the sense that the disabling physical effects occur intermittently and regularly, without warning;”
  - “Intense counseling” with treating psychiatrist over the preceding two years.
- April 12, 2006 Committee review meeting: obtained additional records and concluded it could form its own views.
- April 17, 2006 Decision on Review: unanimous sustainment of original denial. Committee reaffirmed that Applicant:
  - “was able to successfully work after the surgeries to which she attributes her condition,”
  - “was not medically prevented from working as recently as April 2004 ... and that her symptoms have not significantly worsened subsequently....”
  - Found psychiatrist IME unreliable due to reliance on subjective reports, factual errors, lack of full record review, and inconsistencies.
  - Noted lack of evidence of sustained psychiatric treatment for a somatoform disorder and gaps/spotty compliance in treatment undermined permanence and severity conclusions.

### Tribunal’s legal framework and issues for review
- Precedent context: third Tribunal case challenging SRP Section 4.3 denial following Judgment No. 2003-1 (Ms. “J”) and Judgment No. 2003-2 (Ms. “K”), both dated September 30, 2003.
- Standard of review:
  1. Whether the SRP Administration Committee correctly interpreted SRP Section 4.3 or erred in law or fact.
  2. Whether the Committee’s decision followed fair and reasonable procedures.
  3. Whether the decision was arbitrary, capricious, discriminatory or improperly motivated.
- SRP Section 4.3(a) essential qualifications:
  - (i) participant “...became totally incapacitated, mentally or physically, for the performance of any duty with the Employer that he might reasonably be called upon to perform;”
  - (ii) “such incapacity is likely to be permanent;”
  - (iii) “such participant should be retired.”
- Tribunal’s reiteration: Administration Committee not bound by Medical Advisor; Committee has ultimate decision authority but denial must be supported by the weight of the evidence.

### Tribunal’s factual findings and assessment of the evidence
- Committee’s principal findings supporting denial:
  - Applicant worked successfully from September 2002 to September 2003 after surgeries.
  - No subsequent medical event explained change in work status leading to administrative leave and separation.
  - Applicant did not establish substantial worsening after stopping work in September 2003.
- Tribunal cited evidence supporting Committee conclusions:
  - 2002 APR completed Spring 2003 where Applicant stated “medical complications have since been resolved,” and supervisor noted recovery.
  - Performance rating “2” and seeking increased responsibilities in 2003.
  - Commendation for September 2003 mission performance.
  - Gaps in medical consultations: no record of medical attention for about eight months after return to work in September 2002.
  - May–August 2003 evaluations did not portray totally disabling condition; acupuncturist records showed intermittent relief with herbs and acupuncture.
  - No treating physician during 2002–2003 imposed workplace restrictions or opined a disabling condition; absence of records showing pain medications used while working.
- Tribunal emphasized assessment factors: internal consistency of physicians’ reports, separation of clinical observations from ultimate incapacity conclusions, and reasonableness of Committee inferences.

### Tribunal’s analysis of the September 2003 incident and fitness for duty at separation
- Treating psychiatrist (January 2004): described impairment as “acute” Adjustment Disorder and temporary; no chronic psychiatric illness in prior fourteen years except occasional depression.
- March 2004 psychiatrist IME: Acute Stress Disorder with dissociative symptoms caused by specific stressors, “resolved within a few weeks.”
- HRD actions: placed Applicant on administrative leave pending misconduct investigation; found serious misconduct warranting termination; offered resignation-in-lieu settlement conditioned on IME corroboration of health contribution to behavior.
- Tribunal found psychiatrists characterized the September 2003 impairment as transitory and resolving; none diagnosed a totally and permanently disabling condition (paras. 63-64, 95-99).
- Tribunal found Applicant’s statements seeking to return to work and absence of contemporaneous disability claim were probative against total incapacity.
- Tribunal noted legal standard: total and permanent incapacity requires inability to perform any duty the Fund might reasonably assign; inability to perform only prior duties or travel does not satisfy the standard (citing Courtney (No. 2), para. 33).

### Evaluation of post-separation worsening claims and medical-record consistency
- Applicant’s asserted worsening after separation (by July 2004 nausea, vomiting, severe pain up to four times a week) not contemporaneously alleged in initial Request for disability retirement.
- Tribunal and Committee findings on documentation and symptom chronology:
  - Vomiting and nausea: records confirm only two vomiting episodes in September 2004 and periodic nausea in 2004–2005; recent gastroenterologists’ records indicate noncompliance with prescribed medications.
  - April–October 2006 acupuncturist records: no nausea/vomiting reports; frequent records showing pain “better” and only “some” pain by October 2006.
  - Gaps: no medical records November 2003–August 2004 and April 2005–April 2006.
  - Internist’s notes November–December 2004: “a little bit less bloating and no severe episodes of pain”; December 2004 “overall doing pretty well.”
  - February 2005 Mayo Clinic: pain “once or twice per week” up to three hours; diagnosis of slow-transit constipation.
- Tribunal highlighted inconsistent symptom accounts across Applicant’s submissions:
  - May 5, 2005 Request: pain “lasts for four to six hours about every other day.”
  - April 28, 2005 internist letter: bouts “about three times a week.”
  - Internist contemporaneous records: October 2004 episodic pain “up to 2x/week”; November 2004 “no severe episodes of pain”; December 2004 “doing pretty well.”
  - Tribunal noted Committee’s view that April 28, 2005 letter resembled Applicant’s February 23, 2005 statements to internist.

### Credibility, treating physicians’ conclusions, and evidentiary weight
- Tribunal guidance:
  - Treating physicians’ ultimate conclusions on incapacity are opinions, not facts; internal inconsistency and lack of correlation between observations and conclusions reduce reliability, especially where statements may be prepared to support disability applications (para. 126).
- Committee and Respondent conclusions:
  - Gave greater weight to gastroenterologist IME and medical records which did not show an incapacitating condition.
  - Discounted some treating physician opinions as lacking corroborating facts and not rendered for diagnosis/treatment purposes.
  - Considered possible unconscious financial motivation given Applicant’s financial statements and family-support assertions.

### Procedural fairness and Committee discretion
- Applicant claimed Committee contravened Medical Advisor’s recommendation, violated due process by not obtaining another expert, and improperly considered materials not reviewed by Medical Advisor.
- Tribunal findings:
  - Committee entitled to reach conclusions differing from Medical Advisor and was not required to obtain another expert opinion (para. 129).
  - No due process violation in Committee reviewing and drawing conclusions from additional medical evidence not considered by Medical Advisor (para. 129).

### Tribunal’s conclusions and decision
- Core findings:
  - Weight of the evidence showed Applicant was able to perform IMF duties until separation for misconduct; events surrounding separation do not support total and permanent incapacity.
  - Applicant failed to demonstrate deterioration since separation sufficient to meet SRP Section 4.3 total incapacity requirement; consequently Tribunal did not address whether incapacity was “likely to be permanent.”
  - Applicant’s inconsistent accounts and gaps in treatment reduced credibility and probative value of some medical evidence.
  - Committee permissibly considered potential unconscious secondary financial motivation.
- Decision:
  - The Administrative Tribunal of the International Monetary Fund unanimously denies the Application of Ms. “CC.”
  - Judgment rendered Washington, D.C., November 16, 2007.

*Judgment of the Administrative Tribunal of the International Monetary Fund — j2007-6*

### Introduction

### Introduction (Administrative Tribunal, November 14–15, 2007)

### Overview of the case
- On November 14 and 15, 2007, the Administrative Tribunal of the International Monetary Fund, composed of Judge Stephen M. Schwebel, President, and Judges Nisuke Ando and Michel Gentot, Associate Judges, met to adjudge the case brought against the International Monetary Fund by Ms. “CC”, a former staff member of the Fund.
- Applicant contests the decision of the Administration Committee of the Staff Retirement Plan (“SRP” or “Plan”) denying her application for disability retirement on the ground that she failed to establish she is “totally and permanently incapacitated for any duty that the Fund might reasonably ask her to perform.”
- Applicant further alleges the Administration Committee’s decision was not taken in accordance with fair and reasonable procedures, and was arbitrary, capricious and improperly motivated.
- Respondent maintains the SRP Administration Committee properly applied the criteria for disability retirement and afforded Applicant due process.

### Procedural history and timetable
- July 19, 2006: Ms. “CC” filed an Application with the Administrative Tribunal.
- July 20, 2006: The Application was transmitted to Respondent; pursuant to Rule IV, para. (f) the Registrar circulated within the Fund a notice summarizing the issues raised in the Application.
- September 5, 2006: Respondent filed its Answer.
- October 16, 2006: Applicant submitted her Reply; Registrar advised the Reply did not initially fulfill the requirements of Rule IX, paras. 2 and 5, but the Reply was brought into compliance within the indicated period and is considered filed on the original date.
- December 1, 2006: The Fund’s Rejoinder was filed.
- The Tribunal denied Applicant’s earlier request for a waiver of the time limit for filing the Application under Article VI, Section 3 because Applicant had not established “exceptional circumstances” as required by Article VI, Section 3.

### Anonymity and confidentiality requests
- Applicant requested anonymity pursuant to Rule VII, para. 2(j) and Rule XXII; Respondent presented its views under Rule VIII, para. 5.
- The Tribunal concluded that good cause has been shown for protecting the privacy of Ms. “CC”, noting the case involves matters both of health and of alleged misconduct and citing prior judgments for precedent.
- Applicant requested that facts relating to an incident of September 2003 be treated as “strictly confidential” because her request for disability is “based solely on her medical condition and not on the incident [in September 2003],” while asserting the incident “shed[s] light on Applicant’s psychological frailty and the fact that the Respondent had a legitimate concern about Applicant’s fitness for continued service.”
- The Tribunal determined the factual elements of the alleged misconduct would not be described in the Judgment, but circumstances of Ms. “CC”’s separation from service would be included insofar as relevant.

### Evidence considered and oral proceedings
- The Tribunal decided oral proceedings would not be held because neither party had requested them and they were not deemed useful to disposition of the case.
- The Tribunal considered documentation of the SRP Administration Committee proceedings, including voluminous medical records, minutes of the Committee’s meetings on Applicant’s initial application for disability retirement and her application for review, the Committee’s report of April 17, 2006, and additional medical records.

### Factual background — employment and medical history
- Employment:
  - Ms. “CC” began employment with the Fund in 1988 as an Economist and was promoted to Senior Economist in 2001.
  - Following events in September 2003, Applicant never returned to active service. She was placed on administrative leave with pay from September 29, 2003 to April 19, 2004 and then began a separation leave from the Fund.
- Medical history and treatment:
  - March 2002: Applicant underwent abdominal surgery.
  - She remained on sick leave through August 2002.
  - Approximately six weeks following her initial surgery, Applicant underwent an emergency laparoscopy; she continued to complain of abdominal distention and pain though further tests failed to explain symptoms.
  - May–August 2003: Applicant consulted with an internist, two surgeons, three gastroenterologists, a physician on the staff of the Joint Bank/Fund Health Services Department (“HSD”) and an acupuncturist.
  - Two gastroenterologists’ notes and the acupuncturist’s records were not provided to the SRP Administration Committee but were made part of the record before the Administrative Tribunal.
  - Medical documentation records recurrent left lower quadrant pain, abdominal distention, constipation and bloating; in May 2003 she reported “significant abdominal bloating, pain and gas without any remittance whatsoever.”
  - Gastroenterologists’ assessments included that tests “failed to show significant abnormality” and “nothing to suggest pseudo-obstruction.”
  - Acupuncturist’s notes: pain “off and on” but “in the background” most of the time; episodes lasted “sometimes 4 [to] 6 hours”; stress, overwork, constipation and certain foods aggravated pain; pain “affected her work and sometimes she has to take breaks from work due to pain”; episodes sometimes lasted “for [about] 6 hours and she had to lie down and rest due to pain.”
- Attendance and performance:
  - Applicant’s Attendance and Leave Balance Record from September 2002 to September 2003 indicates she took fewer than the fifteen days allotted annually to staff members for sick leave.
  - Applicant used the Fund’s compressed work schedule (“CWS”) policy during June–August 2006 according to her personal calendar.
  - Applicant’s Annual Performance Review (“APR”) for calendar year 2002 rated her “fully satisfactory” (rating “2”).
  - In Spring 2003 APR she wrote that complications from her first surgery “have since been resolved,” requested “the opportunity to lead ... missions,” and supervisor and Senior Personnel Manager noted she had recovered.
  - September 2003 mission: mission chief commended Applicant’s performance, stating the technical quality of her contribution was high, she displayed excellent focus and organizational skills, remained collegial, and “was instrumental in allowing the mission to continue its work on schedule.”

### Misconduct investigation, medical submissions, and separation
- September 2003: During brief personal travel after the mission, an incident occurred that became the subject of investigation for misconduct pursuant to GAO No. 33 (Conduct of Staff Members). Pending investigation, Applicant was placed on administrative leave with pay pursuant to GAO No. 13, Rev. 5, Section 9.01.
- Applicant remained overseas until around late November 2003 and sought medical attention; some medical records from that period were not provided to the SRP Administration Committee but are in the Tribunal record.
- December 2, 2003: Applicant was informed of the Fund’s ongoing investigation into her alleged misconduct.
- December 4, 2003 meeting with HRD representatives and December 8, 2003 memorandum: Applicant asserted the conduct under investigation was “attributable solely to my physical and mental exhaustion, fright, dizziness and inability to think rationally and unimpaired” and asked to be “permitted to return to my work at the Fund.”
- Circumstances cited by Applicant as contributing factors:
  - (i) physical and mental stress preceding the mission due to medical condition, a recent car accident, and a heavy workload requiring late nights and weekends;
  - (ii) mental and physical exhaustion at mission end from taking on another economist’s work, causing her to work “enormous hours, skipping most meals, and sleeping only 2-3 hours each night;”
  - (iii) a “horrifying” detention by local immigration authorities the day before the incident.
- Applicant described persistent acute abdominal pain and distension since her surgeries, frequent evaluations (“almost every Friday while on CWS, very early in the morning prior to my office arrival, and sometimes during lunchtime”), and asserted mission stress exacerbated her health problems.
- December 11, 2003: Applicant was provided a copy of the investigation report and formally charged with misconduct on December 18, 2003, pursuant to GAO No. 33.
- January 6, 2004 letter from treating psychiatrist (attached by Applicant’s counsel): treating psychiatrist opined Applicant’s conduct during the incident was the result of “Adjustment Disorder with Disturbance of Conduct,” involving “dissociative symptoms” and occurring “under the stress, including the stress of the mission, her mental and physical fatigue at the end of the mission, her encounter with the Border guards ... and the incident [under investigation]....” The treating psychiatrist described this as an “acute episode” and stated that “[o]nce the disturbance has terminated the symptoms do not persist for any great length of time.”
- January 9, 2004: Applicant submitted a memorandum to the HRD Director responding to the misconduct charge, asserting conduct “was related to a diagnosable condition,” citing the treating psychiatrist’s opinion, and requesting an evaluation by HSD; Applicant’s counsel wrote the same day seeking psychological testing by HSD.
- HSD physician noted that in June 2003 Applicant reported being mildly depressed with loss of pre-surgical body physique, persistent bloating and abdominal pain.
- Treating psychiatrist’s records reflect three consultations in December 2003–February 2004 and mention medications including Lexapro, Clonazepam and Alprazolam.
- February 13, 2004: Applicant wrote to HRD Director with a “special plea,” stating she hoped to return to work, that her financial situation was tenuous, that “a very large share of my income goes to the support of my mother and brother,” and that career opportunities outside the Fund were limited; Applicant’s counsel reiterated that the psychological impairment was not of a lasting nature and that Applicant was “eager to return to work in the very near future.”

*Judgment of the Administrative Tribunal of the International Monetary Fund — Introduction*

### 31.      By memorandum of March 4, 2004, the HRD Director informed Ms. “CC” that, while her

### j2007-6 - 31.

### HRD determination, separation offer, and conditions
- By memorandum of March 4, 2004, the HRD Director concluded that Ms. “CC” had “engaged in serious misconduct in violation of GAO No. 33,” conduct “sufficiently egregious as to warrant termination of [her] Fund employment as provided under GAO No. 33, Section 10.05.”
- The HRD Director stated that, notwithstanding the decision to terminate, he would allow Ms. “CC” to resign and receive a monetary settlement “for health and humanitarian reasons,” provided her claim that health factors contributed to her behavior was corroborated through an independent medical evaluation: “I am prepared to allow you to resign from the Fund in lieu of being terminated and to provide you with a monetary settlement for health and humanitarian reasons, provided that there is credible evidence, based on an independent medical evaluation, that health factors contributed to the behavior in question.”
- The HRD Director offered that, if the settlement were accepted in the form of salary continuation, Ms. “CC” could delay the start of those payments and remain on administrative leave with pay in the interim, enabling her to remain on staff status until reaching age 50 and thus becoming eligible for life-time coverage for health benefits under the Medical Benefits Plan.
- On April 16, 2004, the HRD Director denied Ms. “CC”’s request for reconsideration of the Fund’s decision while stating that because the psychiatrist IME “does opine that your behavior was influenced by health conditions. Therefore we are prepared to go forward with the settlement. However, the Fund is not prepared to reconsider its decision to terminate your employment.”
- On April 16, 2004, Ms. “CC” signed a letter setting forth the terms of her separation.

### Independent Medical Examiner (IME) in relation to separation (March 2004)
- On March 23, 2004, Ms. “CC” underwent an examination by a psychiatrist Independent Medical Examiner (“IME”).
- The psychiatrist IME opined that a “combination of ... stressors” caused Ms. “CC” to experience Acute Stress Disorder with dissociative symptoms at the time of the incident overseas.
- The psychiatrist IME noted post-surgical daily abdominal pain after eating that “lasted about 4 hours” and that while on mission she continued to suffer “severe pain” and abdominal distension daily.
- The psychiatrist IME recorded prior psychiatric care for “episodic depression related to family matters” and that “[h]er depression did not require treatment by antidepressants and did not interfere with her ability to work.”
- The psychiatrist IME opined that, as of March 2004, Ms. “CC” did not have any remaining condition or predisposition and that her “acute stress disorder was caused by a combination of highly specific, event-related stressors, and resolved within a few weeks.”

### Medical evaluations and clinical course after separation (2004–2006)
- For approximately nine months after returning to the United States around late November 2003, there is no documentation that Ms. “CC” sought medical attention for her abdominal condition in the record, although she asserts evaluation by doctors in her home country.
- Between August 2004 and April 2005, Ms. “CC” was evaluated by an internist, surgeon, radiologist, gastroenterologists, and a gynecologist.
- August 2004: surgeon consultation for “now chronic bloating”; surgeon recorded no current abdominal pain but recalled a six month period post-surgery where pain was predominant; abdominal and pelvic CT scans did not indicate abnormality.
- August 2004–February 2005: near-monthly internist consultations for “unpredictable” abdominal pain; internist recorded complaints of depression and anxiety and that Ms. “CC” had been treated by her treating psychiatrist for “some depression”; she took an antidepressant medication but did not pursue the internist’s psychiatric referral.
- October–December 2004: internist prescribed and monitored a bowel-regulating medication regimen; November 2004: reported “a little bit less bloating and no severe episodes of pain” and “[i]mprovement in GI symptoms and mood”; December 2004: gastrointestinal condition “generally improved” and mood “[o]verall doing pretty well.”
- February 23, 2005: internist recorded Ms. “CC”’s request for a letter to support application for disability retirement citing “freq[uent] unpredictable bouts of abd[ominal] pain (severe) bloating sufficient to disable for work. Chronic condition S/P [status post] surgery 3 + 5/02. Pain lasts for hours. Avg 2x/week.”
- September 2004–March 2005: consultations with a third gastroenterologist who recorded severe left lower quadrant pain episodes often lasting about four hours, sometimes preventing Ms. “CC” from calling for help or getting out of bed, and reported that she had been “working at home since January of this year.”
- October 22, 2004: third gastroenterologist referred records to the Mayo Clinic for “relentless digestive complaints and bowel dysfunction” and stated “[c]urrently she is incapacitated and has not worked really since the first of the year.”
- February 2005 Mayo Clinic gastroenterologist evaluation recorded Ms. “CC”’s report of significant left lower quadrant pain once or twice per week, severity “ten out of a maximum score of ten,” often lasting up to three hours, associated nausea, distention almost daily, and bowel movements improving from every three to four days to about once every one to two days after L-thyroxine, 50 mcg per day.
- Mayo Clinic diagnosis after tests: “significant slow-transit constipation, as well as initial dumping of food from the stomach”; prescribed Milk of Magnesia, Zelnorm, and Buspar, with suggestion of Sandostatin depending on progress.
- Ms. “CC” reportedly discontinued Milk of Magnesia and Zelnorm because they “made her symptoms worse”; local gastroenterologist noted Mayo Clinic had “raised the question of subtotal colectomy” and that Ms. “CC” was “appropriately reluctant to consider surgery.”
- March 2005: local gastroenterologist noted discussing Ms. “CC”’s “plan to apply for disability on the basis of the chronicity of her problem, and its refractoriness to treatment.”
- September 12, 2005: gastroenterologist letter stated Ms. “CC” suffers from “recurrent and chronic abdominal pain, the cause of which is unknown. ... Whether adhesions by themselves or working through recurrent intermittent low-grade bowel obstruction contribute to the pain is impossible to determine at this point.”
- April 5, 2005: gynecologist visit for “abdominal bloating,” without mention of pain.
- October 2004–January 2006: resumed consultations with treating psychiatrist after hiatus; psychiatric notes include “Still looking for a job” (October 29, 2004) and in August 2005 “Applying for disability”; records mention Effexor, Cymbalta and Wellbutrin.
- April–October 2006: resumed frequent acupuncture treatments (close to every other day); notes record variable reports of abdominal pain and bloating with repeated reports of improvement; October 2006 most recent report of only “some pain and bloating.”

### Disability retirement application and SRP Independent Medical Examiners (2005)
- May 5, 2005: while in contributory service with the Staff Retirement Plan, Applicant requested disability retirement pursuant to Section 4.3 of the Plan, citing “continued severe abdominal pain, bloating and gastrointestinal disorders” following two surgeries in 2002 and asserting “The abdominal pain is acutely paralyzing and lasts for four to six hours about every other day.”
- Applicant attached an April 28, 2005 internist letter stating the condition is chronic since surgeries in March and May of 2002, that severe episodes “occur on average about three times a week,” and opining “her request for disability merits approval.”
- Two SRP-engaged IMEs evaluated Applicant: a gastroenterologist IME (report dated June 28, 2005) and a psychiatrist IME (report dated September 20, 2005).
- June 28, 2005 gastroenterologist IME findings:
  - Opined the pain pattern “strongly suggests functional rather than organic disease.”
  - Noted Ms. “CC”’s regular exercise in her apartment exercise room using a treadmill and an elliptical trainer.
  - Reported “virtually no objective evidence of disease” in the extensive work up and that the applicant “relates significant secondary gain from a favorable disability ruling in the desire to financially support family members.”
  - Ms. “CC” objected to this report on July 22, 2005; the gastroenterologist IME replied on August 9, 2005 that he stood by his conclusions.
- September 20, 2005 psychiatrist IME findings:
  - Based on records, two in-person evaluations (including MMPI-2 profile), and interviews with personal contacts and the Mayo Clinic gastroenterologist.
  - Reported Applicant’s descriptions of “piercing” pain, inability to breathe or move during episodes, and claimed inability to work at least half of the days per month; also reported spending non-pain days “reading and writing papers at home, but is unable to do anything.”
  - Noted Applicant reported exercising about three times every two weeks and taking Zelnorm, Miralax and Buspar, using suppositories for pain, and that Percocet, acupuncture, and homeopathic remedies did not help.
  - MMPI-2 profile findings: extremely guarded and self-favorable response style suggesting concern about damaging results; pain, weakness and fatigue likely beyond medical expectations; personality profile often associated with gastrointestinal complaints and intractable post-operative pain syndromes; secondary depression described as moderate; potential for extensive “secondary gains”; diagnostic impressions (hysterical neurosis, conversion type; hypochondriacal neurosis; psychophysiologic disorder) are tentative due to “extreme understatement of her problems, her strongly idealized self-presentation, and her excessively guarded and self-favorable responding.”
  - Psychotherapeutic intervention described as difficult because Applicant is “strongly oriented toward physical illness.”
  - Psychiatrist IME reported that the Mayo Clinic gastroenterologist via telephone opined there is a large psychological component to Ms. “CC”’s illness; one acquaintance reported Applicant had been in “perfect health” prior to surgeries but subsequently “in pain ‘most of the time’” and sometimes having to pull over while driving due to pain.

*Source: Tribunal record (j2007-6 - 31).*

### 57.      The psychiatrist IME observed that Ms. “CC” appeared to be “in discomfort, and a bit

### j2007-6 - 57

### Psychiatrist IME findings and opinions
- The psychiatrist IME observed that Ms. “CC” appeared to be “in discomfort, and a bit depressed.”
- During a second meeting the IME recorded that Ms. “CC” was unable to sit up due to pain, was interviewed while lying down, “got up and ran to the bathroom, and had dry heaves.”
- The psychiatrist IME diagnosed:
  - Axis I: Undifferentiated Somatoform Disorder
  - Axis II: No Diagnosis on Axis II
  - Axis III: Irritable Bowel Syndrome with Abdominal Pain and Bloating S/P Laparoscopic Left salpingo-oophorectomy
  - Axis IV: Problems related to work; Concern about her health; Possible financial concerns
  - Axis V: GAF 50
- The psychiatrist IME described the impairment in answering questions about Ms. “CC”’s Request for disability retirement, stating:
  - “The symptoms cannot be fully explained by the objective tests performed, including the history, the physical examination, or lab test findings.”
  - “The pain is so severe that [Ms. “CC”] states that she cannot function either occupationally or socially when she is having one of her attacks. She states that she has several attacks per month.”
  - “[Ms. “CC”] has had these physical complaints since her ovarian surgery in 2002.”
  - “I have no evidence that the symptoms have been intentionally produced or feigned.”
  - “[Ms. “CC”] has missed a substantial amount of work because of her pain and bloating, and has had to cancel many social engagements, as verified by her boyfriend ... and her friend of many years ....”
- The psychiatrist IME defined Undifferentiated Somatoform Disorder by the clinical features:
  - “(1) somatic complaints that suggest major medical maladies yet have no associated serious, demonstrable, peripheral organ disorder;
    (2) psychological factors and conflicts that seem important in initiating, exacerbating, and maintaining the disturbance; and
    (3) symptoms or magnified health concerns that are not under the patient’s conscious control.”
- The psychiatrist IME noted that patients with Undifferentiated Somatoform Disorder are “not malingerers.”
- The psychiatrist IME concluded the condition affects Ms. “CC”’s ability to perform the work of an economist:
  - “[Ms. “CC”] states that she is sick half the days of the month. Her pain attacks last for many hours and necessitate her staying in bed, and refraining from any movement.”
  - “For the most part, she is unable to travel, and is constantly consulting with various specialists ... When she is in pain, it is impossible for her to focus on the work that she has been hired by the World Bank (sic) to do.”
- The psychiatrist IME opined that Ms. “CC”’s condition “totally and permanently incapacitates her from performing tasks that she may be asked to perform given her education, training and experience,” and described the course of the disorder as “generally chronic and relapsing” with “substantial disability, work impairment, and excessive health care utilization.”
- The psychiatrist IME also stated a pathway for partial restoration: “[i]n order to have partial restoration of her functional capacity, [Ms. “CC”] would have to undertake some form of counseling where she begins to make an association between emotional and physical functioning.”
- The psychiatrist IME “saw ‘no way to accommodate [Ms. “CC”’s] illness with technical or other equipment.’”

### Medical Advisor and SRP Administration Committee actions and conclusions
- On October 25, 2005, the Medical Advisor to the SRP Administration Committee reported and reproduced almost verbatim the psychiatrist IME’s findings, stating:
  - “[Ms. “CC”] has an undifferentiated ‘somatoform disorder’ that is likely to be untreatable and permanent”
  - “[Ms. “CC”] is totally and permanently incapacitated from performing tasks that she may be asked to do by the IMF, given her education, training and experience.”
  - The Medical Advisor recommended granting disability retirement with a review of eligibility in eighteen months.
- On December 1, 2005, the SRP Administration Committee met to decide on the Request for disability retirement. The Medical Advisor at the meeting expressed that:
  - “whatever job [Ms. “CC”] had she might eventually have to leave although she might be able to work from home.”
  - He revised his view to state the condition “is chronic but not permanent,” and recommended granting disability retirement with review in 18 months following counseling, while acknowledging “significant doubt about the degree of permanency and totality of the condition.”
- On December 9, 2005, the Committee issued a Decision denying the Request for disability retirement. The Committee’s stated considerations included:
  - Ms. “CC” worked from September 2002 through most of September 2003 before being placed on Administrative Leave with Pay; “No medical reasons for this change in your status were adduced.”
  - The Committee felt it “lacked reliable verification of your current professional and social incapacity,” noting the psychiatrist IME spoke only with the boyfriend and another friend.
  - According to the treating physician, Ms. “CC” had these chronic symptoms since March 2002 yet “was able to work at the Fund with these symptoms, and your condition has not worsened since you last returned to work in 2002.”
  - Ms. “CC” admitted being able to exercise three times per week and had traveled overseas.
  - “When you are incapacitated, it is for a few days a week according to your physician. Consequently, there is no basis for concluding that the symptoms render you permanently and totally disabled.”
  - The gastroenterologist IME found “no objective evidence of disease,” thought there was a psychiatric component, and opined the application may be motivated by secondary (monetary) gain.
  - The psychiatrist IME indicated the symptoms cannot be fully explained by objective tests and considered a psychiatric disorder.
  - Treating physicians thought there was a psychiatric component but psychiatric counseling had not been tried, so “it has not been established that your condition is total and permanent in this regard.”

### Administrative review, additional evidence, and Committee review outcome
- On January 18, 2006, Ms. “CC” submitted an application for review under Rule VIII of the Rules of Procedure of the SRP Administration Committee. Principal contentions in the application for review included:
  - The Committee’s decision was contrary to the weight of the medical evidence, including the Medical Advisor and psychiatrist IME.
  - While working during September 2002-September 2003, Ms. “CC” was “unable to resume her regular schedule of activities,” worked only short days and was often absent; a flexible schedule was accommodated by her Division Chief.
  - Her physical and mental condition precipitated the September 2003 incident that led to placement on paid administrative leave.
  - From about July 2004, symptoms included nausea and severe pain up to four times a week.
  - The disability is “permanent in the sense that the disabling physical effects occur intermittently and regularly, without warning.”
  - Ms. “CC” had been in intense counseling with her treating psychiatrist for the preceding two years.
  - Objections to Committee findings concerning her ability to exercise and travel abroad.
- Ms. “CC” attached supporting correspondence dated January 12, 2006 from her treating psychiatrist stating she “has been in intense counseling with me for the past two years and it has made no difference in her symptoms which have worsened significantly since middle 2004.” The treating psychiatrist objected to the gastroenterologist IME’s secondary gain comment.
- Ms. “CC” attached a letter from her boyfriend (a physician) reporting post-2002 surgery observations of bloating, vomiting, cramps, pain, and “a steady decline in [her] health since her surgeries, especially since mid-2004,” and asserting she “cannot sit at a desk due to pain and ... international travel would be a physical hardship and not advisable.”
- On April 12, 2006, the SRP Administration Committee met on review, noted medical records reviewed previously were incomplete and that additional records had been obtained and provided to the parties, and concluded it could form its own views on the additional evidence.
- On April 17, 2006 (Decision on Review), the Administration Committee unanimously sustained its original Decision. The Committee reaffirmed conclusions that Applicant is not totally incapacitated on grounds that:
  - Applicant “was able to successfully work after the surgeries to which she attributes her condition,”
  - Applicant “was not medically prevented from working as recently as April 2004 [i.e. at the time of her separation from the Fund], and that her symptoms have not significantly worsened subsequently....”
  - The Committee considered the gastroenterologist IME and the MMPI-2 report suggesting Applicant’s distress about finances and desire to continue supporting her mother “may be an unconscious motive” for complaints.
  - The Committee reaffirmed the evidence did not establish the condition was likely permanent (paras. 120-136).
- The Committee found the psychiatrist IME’s opinion unreliable for reasons including:
  - The diagnosis was largely based on subjective pain reports that had not been reliably verified.
  - The psychiatrist IME was unaware of the circumstances under which Ms. “CC” stopped working and incorrectly assumed she missed a lot of work for pain and bloating.
  - The psychiatrist IME did not review records of her treating psychiatrist or internist or the opinion of the psychiatrist IME engaged in separation proceedings.
  - The psychiatrist IME’s report “contains inconsistencies and makes factual errors.”
  - Prior to the psychiatrist IME’s report, Ms. “CC” had never been diagnosed with Undifferentiated Somatoform Disorder or a similar chronic psychiatric condition.
- The Committee observed potential lack of candor by Applicant given discrepancies between statements to the psychiatrist IME and medical records regarding prior psychiatric treatment.
- The Committee concluded from its records review that:
  - “[Ms. “CC”] was in good mental health as recently as March 2004, and she experienced some depression and anxiety for which [her treating psychiatrist] has treated her. It is not clear whether this is an acute or a chronic problem.”
  - “To the extent that Applicant’s physical symptoms are a manifestation of a somatoform disorder, the Committee has no records that Applicant has pursued any treatment for that. Accordingly, the Committee has little basis to find that Applicant’s psychological problem is permanently incapacitating or otherwise of a severe or of long-standing character.”
  - The Committee rejected the claim of “intense counseling” for the past two years.
  - Unevenness in reports, spotty compliance with treatment, and large gaps between medical consultations tended to corroborate that the medical condition did not deteriorate significantly after separation.

### Procedural milestones and exhaustion of administrative remedies
- Rule X, para 1 of the Rules of Procedure of the SRP Administration Committee provides that administrative review is exhausted for filing with the Administrative Tribunal when the Committee has notified the Requestor of the results of its review.
- On July 19, 2006, Ms. “CC” filed her Application with the Administrative Tribunal.

### Summary of Applicant’s principal contentions in Tribunal filings
- Applicant contended:
  1. She should be granted a disability pension under the SRP because she is totally incapacitated and her disability is likely to be permanent.
  2. The weight of the medical evidence, including the opinions of the Medical Advisor and psychiatrist IME, supports total incapacity for any duty with the Fund.
  3. While on work status during September 2002-September 2003, she was unable to resume her regular schedule of activities; her flexible schedule was accommodated by her Division Chief.

*Source: SRP Administration Committee and Administrative Tribunal materials in the record.*

### 4. Ample evidence was provided that the precipitating factor in the incident abroad

### 4. Ample evidence was provided that the precipitating factor in the incident abroad in September 2003, which led to Applicant’s separation, was her physical and mental condition

### Background and Applicant’s medical and employment circumstances
- Applicant was placed on paid administrative leave in September 2003 “out of consideration for her health problems and for ‘humanitarian’ reasons.”
- After placement on administrative leave in September 2003, Applicant’s physical/mental condition worsened such that she “could not meet the normal and usual requirements of any position in the Fund,” with severe abdominal pain or discomfort requiring her to remain for extended periods in a reclining position.
- Applicant’s condition combines mental and physical factors that “incapacitates her at unpredictable intervals that recur on a regular basis, particularly when aggravated by stress.”
- While looking for a job in October 2004, Applicant was unable to attend the single interview she obtained due to pain.
- The psychiatrist IME diagnosed Applicant with Undifferentiated Somatoform Disorder and opined that she is “totally and permanently incapacitated.” That diagnosis and opinion were supported by the Medical Advisor and by Applicant’s treating psychiatrist.
- Applicant did not inform the psychiatrist IME of the September 2003 incident because Applicant and the Fund had agreed to treat it with “the utmost confidentiality.”

### Applicant’s assertions and legal arguments
- Applicant contends the precipitating factor in the September 2003 incident was her physical and mental condition and that the Fund could not trust her performance particularly under stressful conditions.
- Applicant argues the Administration Committee improperly relied on a single medical opinion (the gastroenterologist IME), which “lacked reliability and contained unprofessional comment about financial motive.”
- Applicant alleges the Committee imposed a layman’s view of her physical problems, failed to consult with its Medical Advisor about perceived new or inconsistent information, and thereby “improperly assumed the role of a medical expert.”
- Applicant asserts intensified counseling with her treating psychiatrist during the past two years and an increase in gastrointestinal disorders and pain.
- Applicant maintains the weight of the medical evidence supports that her disability is likely to be permanent.
- Applicant alleges denial of due process by the Administration Committee and that the Committee’s decision was “improperly motivated,” failed to apply established case law on disability retirement, was inconsistent with the weight of the evidence, was arbitrary and capricious, and “indicative of a prejudiced attitude towards [Applicant] due to failure to understand the ... [September 2003] incident and instead to improperly see it as misconduct.”
- Applicant seeks as relief:
  - rescission of the Administration Committee decision and an order granting disability retirement retroactive to January 1, 2006 (the date on which she was placed on unpaid administrative leave); and
  - legal costs.

### Respondent’s principal contentions
- The SRP Administration Committee properly denied Applicant’s request for a disability pension.
- The Administration Committee correctly determined the medical evidence did not support a finding of total incapacity; Applicant worked successfully after her surgeries from September 2002 until September 2003 and stopped working only because of misconduct, not medical condition.
- Respondent contends there was no evidence Applicant was medically unable to continue working due to stress; but for misconduct, Applicant would still be working successfully at the Fund.
- The Fund asserts Applicant is qualified to work in a number of positions and that the Fund has progressive policies on working from home.
- Respondent alleges Applicant’s conflicting accounts of symptoms, treatments and employment lacked credibility and rendered some treating physician reports unreliable.
- The Administration Committee concluded the opinions of the psychiatrist IME and the Medical Advisor were unreliable due to material errors and inconsistencies, in particular because of Applicant’s alleged lack of candor.
- Only three treating physicians opined Applicant was incapacitated; the Committee discounted those opinions as not rendered for diagnosis/treatment, lacking corroborating facts, and inconsistent with medical records and Applicant’s contentions.
- The Administration Committee relied on the gastroenterologist IME and medical records that, in the Committee’s view, contradicted Applicant’s claim of crippling abdominal pain and showed she had not been diagnosed with, nor treated for, an incapacitating condition.
- The Administration Committee found the evidence did not support that Applicant’s condition was likely to be permanent.
- Respondent maintains Applicant was not denied due process and the Committee acted in accordance with its Rules of Procedure.
- The Administration Committee asserts it properly reviewed medical reports, including additional reports not reviewed by the Medical Advisor, and lawfully exercised ultimate determination authority on disability.

### Tribunal’s legal framework and issues for review
- This is the third Tribunal case challenging an Administration Committee denial of disability retirement under SRP Section 4.3, following Judgment No. 2003-1 (Ms. “J”) and Judgment No. 2003-2 (Ms. “K”), both dated September 30, 2003.
- The Tribunal applies the standard that disability retirement decisions are subject to scrutiny on whether:
  1. The SRP Administration Committee correctly interpreted SRP Section 4.3 and applied it to the facts, or whether the decision was based on an error of law or fact.
  2. The Committee’s decision was taken in accordance with fair and reasonable procedures.
  3. The Committee’s decision was arbitrary, capricious, discriminatory or improperly motivated.
- SRP Section 4.3(a) (quoted in full) sets the conditions for disability retirement, including:
  - retirement on the first day of a calendar month not less than 30 nor more than 120 days immediately following receipt of written application;
  - the Pension Committee must find, on the recommendation of the Administration Committee and the certification of physician(s) designated by the Administration Committee, that:
    - (i) the participant “...became totally incapacitated, mentally or physically, for the performance of any duty with the Employer that he might reasonably be called upon to perform;”
    - (ii) “such incapacity is likely to be permanent;” and
    - (iii) “such participant should be retired.”
- The two essential qualifications under SRP Section 4.3 are that (1) the applicant is totally incapacitated for the performance of any duty she might reasonably be called upon to perform and (2) the incapacity is likely to be permanent.
- The Tribunal has held the Administration Committee is not bound by the Medical Advisor’s opinion; the Committee has ultimate decision authority but its decision must be supported by the weight of the evidence.

### Tribunal’s factual findings and assessment of the evidence
- The Administration Committee’s principal findings supporting denial of total incapacity were:
  - Applicant was able to work successfully from September 2002 to September 2003 after surgeries;
  - No subsequent medical event of significance explained the change in work status when she was placed on administrative leave and later separated;
  - Applicant did not establish that her medical condition substantially worsened after stopping work in September 2003.
- The Tribunal found the evidence sustained the Committee’s determination that Applicant’s condition did not preclude successful performance of duties from September 2002 until September 2003.
- Evidence cited by the Tribunal in support of the Committee’s conclusion included:
  - Applicant’s 2002 APR (completed in Spring 2003) where Applicant stated “medical complications have since been resolved” and her supervisor noted he was “pleased that she has recovered from her ordeal.”
  - Applicant’s performance rating of “2” (appraised as “fully satisfactory”) and her seeking increased responsibilities in 2003, including “the opportunity to lead ... missions.”
  - Recognition that Applicant performed “exceptionally well” during the September 2003 mission assignment despite an “extraordinarily heavy workload,” and Applicant’s statement to the Director of HRD that beginning in August 2003 she was “working regularly 12 to 15 hours per day, including weekends.”
  - Medical records that, while indicating abdominal distention and episodes of pain following 2002 surgeries, did not portray a totally disabling condition; there is “no record of Applicant’s seeking medical attention for about eight months following her return to work in September 2002.”
  - Between May-August 2003 Applicant underwent multiple medical evaluations but did not, in the record, describe pain as “severe,” “paralyzing” or incapacitating except in reaction to certain laxatives.
  - Acupuncturist records that in June-August 2003 Applicant reported sometimes having to take breaks due to pain and sometimes having to lie on the floor at work, but also repeatedly reported that herbs and acupuncture alleviated pain and constipation.
  - No treating physician during that one-year period imposed workplace restrictions or opined the condition was disabling; Tribunal found significance in the absence of records of Applicant taking pain medications while working at the Fund during that period.
- Regarding administrative leave and separation, the Committee initially found “No medical reasons for this change in your status were adduced.” The Committee was not initially informed of the HRD investigation details; on Review it was informed Applicant had been placed on administrative leave pending investigation, was found to have engaged in misconduct under GAO No. 33, and was offered resignation and separation benefits in lieu of termination. The Committee was not apprised of the details of Applicant’s conduct.

### Tribunal’s assessment of disability under SRP Section 4.3
- The Tribunal emphasized that in assessing whether the Administration Committee’s decision was supported by the weight of the evidence, factors include internal consistency of physicians’ reports, separating clinical observations from ultimate conclusions regarding incapacity, and whether the Committee drew reasonable conclusions from the evidence.
- In the instant case the Tribunal noted the distinctive circumstance that the psychiatrist IME and the Medical Advisor attributed Applicant’s gastrointestinal symptoms to a disabling psychiatric condition not previously diagnosed, and that the Administration Committee rejected the Medical Advisor’s recommendation to grant disability retirement.
- The Tribunal reiterated precedent that while the Committee is not bound by the Medical Advisor, its denial must nonetheless be supported by the weight of evidence; the ultimate decision lies with the Committee, but its conclusions must be reasonable in light of the medical record.

*International Monetary Fund*

### conclusion that there was no medical reason for the change in her work status.

### j2007-6 - conclusion that there was no medical reason for the change in her work status.

### Background and triggering incident
- The event preventing return to work was the September 2003 incident.
- Applicant described pre-existing problems: surgeries in early 2002, “persistent acute abdominal pain and distention following two surgeries in 2002,” and stressors including a recent car accident, extraordinary mission workload, and a “horrifying” detention by local immigration authorities the day before the incident.
- Applicant was placed on administrative leave with pay in September 2003 pending investigation under GAO No. 13, Rev. 5, Section 9.01 (Administrative Leave With Pay Pending Investigation of Misconduct).

### Medical evidence and diagnostic opinions
- Treating psychiatrist (January 2004): opined conduct resulted from “Adjustment Disorder with Disturbance of Conduct” caused by mission stress and fatigue; described the impairment as an “acute episode” and temporary; stated no history of chronic psychiatric illness in fourteen years of knowing the Applicant except occasional depression.
- Psychiatrist IME (March 2004): concluded Applicant experienced an “Acute Stress Disorder with dissociative symptoms” caused by a combination of event-related stressors and “resolved within a few weeks”; regarded gastrointestinal symptoms as among several contributing stressors; noted episodic family-related depression that “did not require treatment by antidepressants and did not interfere with her ability to work.”
- Medical Advisor and psychiatrist IME later produced opinions that Applicant relied upon in her Request for disability retirement; Respondent and the Administration Committee questioned the reliability of some expert opinions, citing material errors, inconsistencies, and lack of candor.
- Gastroenterologist IME and Applicant’s own medical records were cited by Respondent and the Committee as contradicting the claim of crippling abdominal pain or a disabling medical diagnosis.

### Tribunal analysis of fitness for duty at time of separation
- The record shows psychiatrists characterized the September 2003 impairment as transitory and resolving shortly after the incident; none indicated a totally and permanently disabling condition (paras. 63-64, 95-99).
- Applicant repeatedly represented to HRD that she was able and willing to return to work and made a “special plea” in February 2004 to be permitted to return.
- The Administration Committee concluded the Applicant’s medical condition “was not a consideration in the decision to place her on administrative leave” in September 2003 (para. 61).
- HRD placed Applicant on administrative leave pending misconduct investigation and ultimately found serious misconduct warranting termination under GAO No. 33, Section 10.05; the Fund offered a resignation-in-lieu settlement on the condition of an independent medical evaluation showing health factors contributed to the behavior.
- The psychiatrist IME diagnosis of a transient psychiatric disorder was a condition of the Fund’s settlement offer, which included extension of administrative leave with pay to enable lifetime coverage under the Fund’s Medical Benefits Plan (para. 106).
- Administration Committee’s conclusion: at the time of Applicant’s acceptance of the settlement agreement in April 2004, she was “in no way prevented from returning to work at the Fund by reason of her medical condition. Rather, it was her conduct that prevented her from returning to work.” (Para. 69) (para. 107).

### Legal standard and comparison to precedents
- Total and permanent incapacity requires inability to perform any duty the Fund might reasonably call upon the staff member to perform; inability to perform only “usual duties” is insufficient (para. 102).
- Cited precedent: Courtney (No. 2) — the standard of reasonableness does not require ability to do exactly prior work; inability to travel but capacity for headquarters duties may preclude finding total incapacity (Courtney (No. 2), para. 33).
- Tribunal distinguished Applicant’s case from Ms. “J” and Ms. “K”, where separation for medical reasons supported total incapacity findings because those applicants were deemed unable to perform any reasonable duty with the institution (paras. 104, 107).

### Applicant’s post-separation worsening claim and Tribunal response
- Applicant’s contention: after administrative leave she worsened and by around July 2004 experienced nausea with vomiting and severe abdominal pain bouts increased to “about four times a week,” requiring extended reclining periods and rendering her unreliable for IMF positions (para. 108).
- The initial Request for disability retirement did not allege worsening; it referenced “acutely paralyzing” abdominal pain since the 2002 surgeries. The claim of significant worsening was asserted only after the Administration Committee found her condition had not worsened since last working at the Fund (para. 110).
- Respondent and the Administration Committee held that post-separation the Applicant did not experience a serious downturn sufficient to totally incapacitate her; they attached greater weight to the gastroenterologist IME and to medical records that did not show a disabling condition (para. 109).

### Key determinations and implications
- Evidence did not sustain that the September 2003 incident evidenced a totally and permanently disabling psychiatric condition; treating and examining psychiatrists described the impairment as transient and resolvable (paras. 95-99).
- Applicant’s repeated statements of eagerness and willingness to return to work, and absence of contemporaneous claim of disability, were probative against total incapacity findings (paras. 95-101, 110).
- Even if Applicant could not perform some duties (e.g., mission travel), total incapacity requires inability to perform any reasonable duties compatible with experience and the Fund’s needs; the Fund argued economists can be used in a wide range of capacities beyond travel-intensive roles (paras. 102-103).
- The Administration Committee and Tribunal gave weight to the circumstances of the misconduct proceeding, the transient nature of the psychiatric episode, the absence of a Fund determination under GAO No. 13, Rev. 5, Annex I and GAO No. 16 that Applicant was medically prevented from continuing employment, and the lack of evidence that the Fund deemed her unfit for continued employment when settlement was offered (paras. 104-107).

*j2007-6 - conclusion that there was no medical reason for the change in her work status.*

### 112.     Accordingly, the question arises whether the Administration Committee reasonably

### 112. Accordingly, the question arises whether the Administration Committee reasonably concluded that “based on the weight of the evidence, ... Applicant’s condition has not significantly worsened since she last worked at the Fund in 2003 so as to leave her totally and permanently incapacitated from any work the Fund might reasonable ask of her.”

### Evidence considered by the Administration Committee
- The Committee considered:
  - (i) Ms. “CC”’s medical records;
  - (ii) the opinions rendered by her treating physicians on the question of disability;
  - (iii) statements made by Ms. “CC”’s boyfriend and another friend in support of her application for disability retirement;
  - (iv) the opinions of the IMEs and the report of the Medical Advisor. (Paras. 71-111; 122-128.)
- The Medical Advisor concluded that “there has been neither improvement nor worsening of her condition.” (Para. 113.)

### Medical-record findings and symptom chronology
- Vomiting and nausea:
  - Medical records appear to confirm only two episodes of vomiting in September 2004, and periodic reports of nausea in 2004-2005. (Para. 113.)
  - More recent records of two gastroenterologists indicate she was not taking prescribed medication for these symptoms. (Para. 113.)
  - April-October 2006 acupuncturist records: no report of nausea or vomiting; detailed records nearly every other day. (Para. 113.)
- Abdominal pain and treatment compliance:
  - August 2004 gastroenterologist: “does not complain of abdominal pain at this time”; contrasted with prior six-month postoperative period when pain was predominant. (Para. 114.)
  - Internist’s records show improvement in pain and other abdominal symptoms in November-December 2004; November entry: “no severe episodes of pain”; December entry: “sporadic compliance” with regimen “because [she was] doing better;” assessment: “overall doing pretty well.” (Para. 114.)
  - Gaps in medical consultations: no record of seeking medical attention for abdominal symptoms during November 2003-August 2004 and April 2005-April 2006. (Para. 115.)
  - February 2005: did not follow up on Mayo Clinic gastroenterologist recommendations. (Para. 115.)
  - Acupuncturist 2006 records show consistent reports of only “some” pain and that pain was “better” between May and early October 2006, except for occasional increased pain in June and August 2006. (Para. 117.)

### Credibility, consistency, and reliability of accounts and treating-physician statements
- Applicant’s inconsistent symptom accounts:
  - May 5, 2005 Request: abdominal pain “lasts for four to six hours about every other day.” (Para. 116.)
  - April 28, 2005 letter (internist in support): bouts of “severe” pain “about three times a week.” (Para. 116.)
  - Internist’s own contemporaneous records: October 2004 “episodic [left lower quadrant] pain up to 2x/week”; November 2004 “no severe episodes of pain”; December 2004 “doing pretty well.” (Para. 116.)
  - February 23, 2005 account to internist: bouts occur “[on average] 2x/week”; Mayo Clinic (February 2005): “once or twice per week” lasting “up to three hours.” (Para. 117.)
- Administration Committee’s observations:
  - Committee concluded internist’s April 28, 2005 letter was “almost verbatim from what Applicant asked him on February 23, 2005 to write.” (Para. 117.)
  - Respondent argues inconsistent accounts undermine credibility and reliability of treating physicians’ reports. (Para. 116.)

### Psychiatric diagnoses, symptom impact, and functional capacity
- Applicant’s claim:
  - Cites psychiatrist IME opinion that she is totally and permanently incapacitated due to Undifferentiated Somatoform Disorder; Medical Advisor echoed that view. Applicant asserts gastrointestinal symptoms and “excessive health care utilization” incapacitate her and that complaints and resulting social or occupational impairment are “in excess of what would be expected from the history, physical examination, or laboratory findings.” (Para. 120.)
- Tribunal and Committee findings:
  - Medical records of treating psychiatrist and internist do not support a disabling psychiatric condition or a significant downturn in mental health from mid-2004. (Para. 121.)
  - No record of diagnosis by treating physicians of any chronic psychiatric illness. (Para. 121.)
  - Post-separation prescriptions for depression and anxiety appear to have been beneficial; records do not suggest these are totally and permanently incapacitating. (Para. 121.)
  - Treating psychiatrist’s only recorded diagnosis: acute Adjustment Disorder in January 2004; sporadic consultations; no indication of need for systematic counseling before or after mid-2004. (Para. 122.)
  - January 6, 2004 letter: psychiatrist supported Ms. “CC”’s plea to resume work, opining the September 2003 incident caused a transient psychiatric impairment from which she had fully recovered; prior history: “other than her occasionally being depressed as a result of her relative she never exhibited any psychiatric symptoms.” (Para. 122.)
  - Consultation chronology with treating psychiatrist: three occasions December 2003-February 2004; next contact late October 2004; two more consultations November 2004; then not again until August 2005; only one other consultation in 2005, and one more in 2006. (Para. 122.)

### Capacity to perform Fund duties and alternative work arrangements
- Administration Committee and Respondent positions:
  - Respondent: as a skilled economist with experience in three Fund departments, Applicant is qualified for a number of Fund positions, including research roles and positions amenable to working from home supported by Fund IT systems; “[t]here is every reason to believe that, but for her misconduct, Applicant would still be working successfully at the Fund today, even if she did intermittently experience bouts of painful constipation or depression that would require her to recuperate at home.” (Para. 123.)
  - Applicant argues the Fund is “speculating without sound foundation that Applicant could have worked on some relaxed schedule or from home.” (Para. 123.)
- Legal standard cited:
  - Whether a current vacancy exists is not determinative in assessing capability to perform any duty the Fund may reasonably call upon an applicant to perform. (Para. 124, citing Ms. “J”, Courtney (No. 2).)

### Weight to be accorded to treating physicians’ conclusions on incapacity
- Tribunal guidance:
  - Physicians’ ultimate conclusions regarding incapacity are “opinions and not facts”; internal inconsistency and lack of correlation between recorded observations and conclusions reduce reliability and probative value, especially where statements are made to advance a disability application rather than for diagnosis and treatment. (Para. 126, citing Ms. “K” and Courtney (No. 2).)
- Administration Committee conclusion:
  - Treating physicians’ statements do not constitute reliable and probative evidence that Applicant’s condition deteriorated to render her totally incapacitated. (Para. 125-126.)

### Procedural fairness and Committee’s discretion
- Applicant’s procedural challenges:
  - Claims Committee contravened the Medical Advisor’s recommendation;
  - Claims Committee violated due process by not obtaining another expert opinion;
  - Challenges Committee’s drawing conclusions from additional medical evidence not reviewed by the Medical Advisor. (Para. 128.)
- Tribunal’s response:
  - Committee is entitled to reach conclusions not in accord with those of the Medical Advisor and was not required to obtain another expert opinion. (Para. 129.)
  - No due process violation in Committee reviewing and drawing conclusions from additional medical evidence not reviewed by the Medical Advisor. (Para. 129.)

### Tribunal’s conclusions and decision
- Findings:
  - Weight of the evidence showed Ms. “CC” was able to perform successfully her functions with the Fund until her separation for reasons of misconduct. Events surrounding separation do not support a finding of incapacity. Applicant has not demonstrated deterioration since separation. As Applicant is not “totally incapacitated” under the terms of the Plan, the Tribunal did not address whether her condition is “likely to be permanent.” (Para. 127.)
  - Applicant repeatedly provided inconsistent accounts of material facts; Committee permissibly considered potential unconscious financial motivation for the disability application. (Para. 119.)
  - Applicant’s contention that Committee misunderstood the September 2003 incident is not persuasive; the Committee’s decision did not turn on that incident, facts of which were not disclosed to it. (Para. 130.)
- Decision:
  - The Administrative Tribunal of the International Monetary Fund unanimously decides that: The Application of Ms. “CC” is denied. (Decision; signatures and date: Washington, D.C., November 16, 2007.)

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_Source: https://www.imf.org/-/media/files/imfat/j2007-6.pdf_