Smith v. Gardner

• Decision Date: 04 March 1966
• Docket Number: No. C-139-WS-65.,C-139-WS-65.
• Citation: 251 F. Supp. 262
• Court: U.S. District Court — Middle District of North Carolina
• Parties: Ruth SMITH, Plaintiff, v. John W. GARDNER, Secretary of Health, Education and Welfare, Defendant.

251 F. Supp. 262

Ruth SMITH, Plaintiff, v. John W. GARDNER, Secretary of Health, Education and Welfare, Defendant.

No. C-139-WS-65.

United States District Court M. D. North Carolina, Winston-Salem Division.

March 4, 1966.

J. N. Buck Freeman, Mount Airy, N. C., for plaintiff.

William H. Murdock, U. S. Atty., and H. Marshall Simpson, Asst. U. S. Atty., Greensboro, N. C., for defendant.

EUGENE A. GORDON, District Judge.

On May 5, 1964, the claimant filed an application for disability insurance benefits under the provisions of §§ 216(i) and 223(a) of the Social Security Act as amended, 42 U.S.C.A. §§ 416(i) and 423 (a). She alleged that she became unable to work in September 26, 1963 because of a "heart condition". Her application was disallowed on July 23, 1964, and on July 28, 1964, she requested that her application be reconsidered. On November 27, 1964, the plaintiff's request for reconsideration was denied. Thereafter, on February 5, 1965, the plaintiff requested a hearing, which hearing was held on April 7, 1965, before Hearing Examiner, Charles H. Evans. On April 28, 1965, the Hearing Examiner rendered his decision holding that the plaintiff had not established that she had impairments, either singularly or in combination, of such severity as to preclude her from engaging in any substantial gainful activity and denied her a period of disability and disability insurance. Thereafter, the Appeals Council, on June 16, 1965, held that the decision of the Hearing Examiner was correct thereby making such decision the final decision of the Secretary of Health, Education and Welfare.

This action, seeking judicial review of the final decision of the Secretary, was commenced on August 9, 1965, following which the parties cross-moved for summary judgment.

As stated by the Hearing Examiner, the issues for decision are whether the plaintiff is entitled to disability insurance benefits under § 223(a) of the Social Security Act, 42 U.S.C.A. § 423(a), and whether a period of disability may be established under § 216(i) of that Act, 42 U.S.C.A. § 416(i). The issues are dependent upon specific findings as to whether during the effective period of the application, filed May 5, 1964, and while the special earnings requirements are met, the claimant was under a disability in that she was unable to engage in any substantial gainful activity by reason of a medically determinable physical or mental impairment which can be expected to result in death or to be of long-continued and indefinite duration, and, if so, the beginning date of such disability.

The Hearing Examiner further correctly stated that the evidence must establish that the claimant was under a disability as defined by the Act beginning on or before August 1, 1964 for entitlement to disability insurance benefits and on or before August 5, 1964 for establishment of a period of disability.

The Hearing Examiner decided that the plaintiff was not entitled to the aforesaid period of disability and disability insurance benefits finding that:

"1. The claimant has suffered from paroxysmal arrhythia tachycardia since her teens.

2. The aortic insufficiency which has been diagnosed as mild, does not, in itself, result in the inability to engage in a substantial gainful activity.

3. The claimant has met the special earnings requirements during the effective period of the application filed on May 5, 1964 and continues to meet such requirements through September 30, 1968.

4. The claimant is capable of performing the duties of her prior position of looper and seamer in a hosiery mill.

5. The claimant has not established that she has impairments, either singularly or in combination, of such severity as to preclude her from engaging in any substantial gainful activity at any time for which her application of May 5, 1964 was effective."

On April 11, 1962, the plaintiff became ill at her place of employment and was examined by J. Dale Simmons, M.D. Over a period of many months, there followed a series of examinations and tests which will be discussed, infra.

The sole issue before this Court is whether the decision of the Hearing Examiner (made the decision of the Secretary of Health, Education and Welfare by the action of the Appeals Council) was supported by substantial evidence. In Thomas v. Celebrezze, 4 Cir., 331 F.2d 541, 543 (1964) the prescribed standard for judicial review is clearly set out by Judge Sobeloff as follows:

"The prescribed standard for review, found in § 205(g) of the Act, 42 U.S.C.A. § 405(g) is as follows: `* * * The findings of the Secretary as to any fact, if supported by substantial evidence, shall be conclusive * * *.' Consolidated Edison Co. of New York v. N. L. R. B., 305 U.S. 197, 59 S.Ct. 206, 83 L.Ed. 126 (1938). The Secretary, and not the courts, is charged with resolving conflicts in the evidence, and it is immaterial that the evidence before him will permit a conclusion inconsistent with his. Snyder v. Ribicoff, 307 F.2d 518, 520 (4th Cir. 1962). If his findings are supported by substantial evidence, the courts are bound to accept them. Underwood v. Ribicoff, 298 F.2d 850 (4th Cir. 1962). In short, the courts are not to try the case de novo. At the same time, they must not abdicate their traditional functions; they cannot escape their duty to scrutinize the `record as a whole' to determine whether the conclusions reached are rational. Universal Camera Corp. v. N. L. R. B., 340 U.S. 474, 71 S.Ct. 456, 95 L.Ed. 456 (1951); Boyd v. Folsom, 257 F.2d 778 (3d Cir. 1958) * * * if * * * reliance has been placed upon one portion of the record to the disregard of overwhelming evidence to the contrary, the courts are * * * bound to decide against the Secretary. * * In such a circumstance the courts are empowered either to modify or reverse the Secretary's decision `with or without remanding the cause for a rehearing.' 42 U.S.C.A. § 405(g)."

There are four elements of proof to be considered in making a finding of claimant's ability or inability to engage in any substantial gainful activity: (1) objective medical facts which are the clinical findings of examining or treating physicians divorced from their expert judgments or opinion as to the significance of these clinical findings; (2) the diagnoses or expert medical opinions of these physicians; (3) the subjective evidence of pain and disability testified to by claimant, and corroborated by claimant's family and neighbors; (4) the claimant's educational background, work history and present age. Underwood v. Ribicoff, 4 Cir., 298 F.2d 850, 851 (1962).

"For the purpose of making a finding of act on this issue, the fact finder must recognize the obvious interrelation of these elements of proof. The objective medical findings may show more or less clearly the existence of certain clinically determinable physical * * * impairments. However, a recitation of objective, clinical findings will seldom show, without more, the over-all effect of these impairments on a particular individual. This is a matter of medical judgment to be decided with reference to the individual's general physical condition and the state of development of each of the defects." Ibid.

Therefore, considering these first two elements of proof together, the following is the medical evidence.

The first medical record is a report of J. Dale Simmons, M.D., undated and received by the Social Security Administration on August 4, 1964. Dr. Simmons indicates that he examined the plaintiff in April, 1962 for a cardiac complaint and that she had a history of paroxysmal arrhythia tachycardia (the medical abbreviation of "PAT" will hereinafter be used) for several years. Other records indicate that she had, in fact, been so afflicted since her teens.

Next, there is a hospital report covering her stay and examination in Baptist Hospital where she was admitted on August 24, 1962. The report provides few objective facts relating to her heart trouble. It does indicate that Dr. Simmons had diagnosed her condition as PAT and had confirmed this finding by an electrocardiogram. In the part of the hospital report relating to the examination of her heart, it was stated that in beating,

"P2 is slightly louder than A2; there is a bare grade one systolic murmur heard over the pulmonic region only, on expiration. Blood pressure is 130/70 * * *"

Jack Crutchfield, M.D., a cardiologist, submitted a report to Dr. Simmons dated July 28, 1962, wherein, after his own examination and after studying the hospital report, he diagnosed the plaintiff's condition as "functional PAT and premature beats". In that report, he entertained the suspicion that she was suffering from rheumatic heart disease.

In a report made to Dr. Simmons on September 23, 1963, Dr. Crutchfield indicated that after re-examining the plaintiff there were two new findings:

"There was a third sound all over the precordium and on expiration there was a definite grade one, A1 murmur, best heard at the junction of the manubrium and the body of the sternum. The grade one pulmonic systolic murmur remained unchanged."

The premature beat was noted and Dr. Crutchfield continued:

"I now feel, therefore, that we must diagnose rheumatic heart disease with slight A1 and incomplete right BBB and irritability * * *" He then indicated that he had re-examined the electrocardiogram made at Baptist Hospital on July 28, 1962 and found some change therein, which change suggested that:

"* * * rheumatic myocradtes has affected her right arm BB since she was here on 7/28/62."

In a medical report to the Social Security Administration dated May 8, 1964, Dr. Simmons referred the Administration to the information contained in the report of Dr. Crutchfield last referred to and that he diagnosed her condition as (1) Rheumatic heart disease and (2) aortic insufficiency. In reply to the question on "Progress?", Dr. Simmons replied:

"Due to frequent episodes of PAT and premature beats * * * I feel that this patient should

...