789 F. 2d 363 - Dorton v. M Heckler

On May 23, 1983 Daisy Dorton filed an application for widow's disability benefits alleging that she became disabled on January 1, 1981 at age 51.1 Dorton claimed she was disabled as a result of multiple and cumulative circulatory, respiratory and nervous system ailments. In particular, Dorton claimed to have angina which meets the Social Security listing of impairments at 20 C.F.R. Part 404, Subpart P, Appendix 1, Sec. 4.04(A)(2). Dorton's application was denied initially on July 14, 1983, and upon reconsideration on August 11, 1983. Dorton then requested a de novo hearing before an Administrative Law Judge (ALJ).

On January 16, 1984, a hearing was held before ALJ Arthur Yim who issued a decision denying benefits on February 3, 1984. The ALJ found that Dorton established the existence of angina, premature ventricular contractions, and bronchitis. Nevertheless, he concluded that the medical evidence of record did not establish that the claimant's impairment was evidenced by specific clinical findings that were the same as those for any impairment listed in 20 C.F.R. Part 404, Subpart P, Appendix 1. The Appeals Council declined review on April 27, 1984, thereby rendering the ALJ's decision the final decision of the Secretary of Health and Human Services.

On review of the final decision of the Secretary, pursuant to 42 U.S.C. Sec. 405(g), United States Magistrate Lynn V. Hooe, Jr. of the Eastern District of Michigan found there was substantial evidence to support the ALJ's decision, and recommended that defendant's motion for summary judgment be granted and plaintiff's claim dismissed. Claimant filed objections to the Magistrate's recommendation on March 4, 1985. These objections were considered by U.S. District Judge Robert E. DeMascio along with the administrative record and Magistrate's report. On May 29, Judge DeMascio accepted the Magistrate's report and rendered judgment for the defendant. Dorton appealed, claiming that there was not substantial evidence to support the finding that she was not disabled because the medical evidence she introduced was uncontradicted.

Section 402(e) of the Social Security Act provides disability benefits to a widow if (1) she is the widow of a wage earner who died fully insured, (2) she is between the ages of fifty and sixty, (3) she is disabled, and (4) her disability is expected to result in death or to last for a continuous period of not less than twelve months. It is uncontroverted that Dorton is the widow of a wage earner who died fully insured and that she is between the ages of fifty and sixty. Therefore the sole issue is whether she is disabled. It is well established that a widow must satisfy a stricter standard of disability than a wage earner. Wokojance v. Weinberger, 513 F.2d 210, 212 (6th Cir.), cert. denied, 423 U.S. 856, 96 S.Ct. 106, 46 L.Ed.2d 82 (1975). See also Price v. Heckler, 767 F.2d 281 (6th Cir.1985); Reynolds v. Secretary of Health and Human Services, 707 F.2d 927 (6th Cir.1983). A widow is not considered to be disabled unless "her physical or mental impairment or impairments are of a level of severity which under regulations prescribed by the Secretary is deemed to be sufficient to preclude an individual from engaging in any gainful activity." 42 U.S.C. Sec. 423(d)(2)(B). Moreover, in determining disability of a widow we may not consider her education and work experience. Rather, the widow's inability to work must be based solely upon medical considerations. 20 C.F.R. Sec. 404.1577 (1985).

Section 423(d)(2)(B) authorizes the Secretary to set standards of severity for alleged disabilities which will be deemed to preclude an individual from engaging in any gainful activity. Those regulations are contained in Appendix 1 to 20 C.F.R. Part 404, Subpart P. A widow must show her impairments through specific clinical findings. 20 C.F.R. Sec. 404.1578(a)(1). An individual cannot qualify for widow's disability benefits unless specific clinical findings show that she suffers from one of these impairments or that she suffers from one or more unlisted impairments that singly or in combination are the medical equivalent of a listed impairment. Id.; Price v. Heckler, 767 F.2d 281 (6th Cir.1985).

In this case, claimant contends that she meets the impairment listed at section 4.04(D) of Appendix 1. Section 4.04 concerns ischemic heart disease with chest pain of cardiac origin. It must be documented by a treadmill exercise test demonstrating "[p]remature ventricular systoles which are multiform or bidirectional or are sequentially inscribed (3 or more)" at an exercise level of 5 METS or less. Sec. 4.04(F)(2).

Dorton submitted the results of a treadmill exercise report dated February 4, 1983 which was conducted by the Disability Determination Service of the State of Michigan. The test was discontinued because of "premature ventricular systoles which are multiform or bidirectional ventricular tachycardin (three or more sequentially inscribed PVCs)." There was also a handwritten comment at the bottom of the report stating that, "Multiple P.V.C.s were noted." Although this apparently meets the requirements as set out above, upon close inspection of the test results it is evident that the premature ventricular systoles did not occur at the exercise level of 5 METS as required, but rather at 6 METS. Another treadmill test was conducted in March 1984. Although the report indicated there was "more marked ST segment depression and significant ST segment straightening suggestive of ischemia" at the time of chest pain, "no definite ischemic ST segment changes were seen" during the treadmill test. Thus, although Dorton does indeed present substantial evidence that she has ischemic heart disease with chest pain of cardiac origin, the ALJ was correct that Dorton did not demonstrate with specific clinical findings that she met the requirements of section 4.04(D) or any other section of Appendix 1.

A widow will also be considered disabled if she suffers from one or more unlisted impairments that singly or in combination are the medical equivalent of a listed impairment. An impairment or combination of impairments will be deemed medically equivalent to a listed impairment if the symptoms, signs and laboratory findings as shown in medical evidence are at least equal in severity and duration to the listed impairments most like the claimed impairment. 20 C.F.R. Sec. 404.1526. Such a decision must be based solely on medical evidence supported by acceptable clinical and diagnostic techniques. 20 C.F.R. Sec. 404.1526(b) (1985). The ALJ found that when Dorton's medical evidence was viewed as a whole, her impairments "even in combination" were not medically equivalent to any impairments listed in Appendix 1. If this determination is supported by substantial evidence, it must be considered conclusive. See, 42 U.S.C. Sec. 405(g). Substantial evidence is defined as such relevant evidence as a reasonable mind might accept as adequate to support a particular conclusion. Beavers v. Secretary of Health, Education and Welfare, 577 F.2d 383, 388 (6th Cir.1978).

Dorton asserts that there is not substantial evidence to support the Secretary's finding. She contends that in addition to her angina she has chronic obstructive pulmonary disease, chronic nervous tension, migraine headaches, diabetes, asthma, labyrinthine vertigo, and tinnitus, which, when taken together, are medically equivalent to a listed impairment, and renders her unable to engage in any gainful activity. Dorton's treating physician reports that she has these maladies, concluding that she has "multiple and cumulative factors of disability." Joint Appendix at 127. From the medical evidence produced, however, it is difficult to determine how many of these ailments have developed since the 1982 denial of disability which is res judicata.2 Moreover, for many of the impairments asserted there is no clinical support or the medical evidence fails to demonstrate the requisite severity.

There is substantial testimony and non-medical evidence to the effect that Dorton's combination of medical impairments prevent her from performing any gainful activity. In determining whether she is disabled, however, we may not consider her complete lack of any work experience nor her second grade educational level which left her functionally illiterate. Nor may we rely upon the evidence in the record which indicates that her physical impairments when taken together are sufficiently severe to prevent her from engaging in any gainful activity.3

Even in a close case in which the myriad medical problems of the claimant are as evident as they are in Dorton's case, the ALJ's findings of fact should not be disturbed unless we are persuaded that his findings are legally insufficient. Admittedly Dorton's medical evidence almost establishes a disability under section 4.04(D) of Appendix 1. Nonetheless, even when her additional ailments are added to the equation, we find that she has not presented adequate medical evidence of disability to demonstrate that her combined impairments are equivalent to any listed impairment so as to qualify Dorton as disabled under the stricter standards for widows. For these reasons, we must therefore affirm the district court's denial of Social Security widow's disability benefits to appellant.