Opinion ID: 281354
Heading Depth: 1
Heading Rank: 1

Heading: facts

Text: 4 Flake filed his application on October 10, 1963. It was denied by letter on January 13, 1964, and reconsideration was denied on June 27, 1964. He requested a hearing, which was held on November 16, 1964. 5 a. Flake's oral testimony. 6 In his application, Flake described his impairments as 'coronary' and 'osteoarthritis of the spine and extremities' and alleged that he became unable to work because of these impairments on June 10, 1963. At the hearing he was the principal witness. He was then fifty-eight years old, had a high school education, and had worked mainly as a retail clerk, although he had driven a truck for a short period. He had arthritis before entering the service in 1943 and had been on crutches for several months just before he was drafted. He was, however, able to walk into the induction center, and accordingly was drafted. The Navy in its infinite wisdom sent him to Farragut, idaho, in the middle of winter, and shortly thereafter he was discharged for physical disability. He returned to Fresno, was unable to resume work as a truck driver, and after a short period of recovery, went to work as a clerk in a liquor store. He and his brother bought the store in 1946, operating it jointly until his heart attack in 1963. He worked only 3 days a week, but on those days he worked 12 hours. His arthritis continued to bother him, necessitating 'boatloads of aspirin' and frequent shots. 7 On June 10, 1963, he suffered a heart attack and was hospitalized for fortytwo days. After his release from the hospital, he spent several months in bed and then began to become more active. He tried to help his brother out at the liquor store on two occasions, but was unable to do so because he become nervous and upset, had chest pains, and his feet began to swell. His daily routine consisted of dressing himself (which took 45 minutes), taking pills, and light activity. He did drive an automobile on short trips. 8 He also complained of respiratory problems caused by recurring nasal polyps, and of generally short wind. He also had some hearing loss and dizziness. He complained about increasingly severe pain in his neck and spine, and knots in his hands from his arthritis. 9 Asked if he felt he could work, he replied: 'I dno't think I could. I would like to. I worked all my life, even when I was crippled up with arthritis and could hardly work    The last deal I had just threw me and I guess my equilibrium and my hearing, every three to four weeks it threw me out, and I have to stay in bed, sometimes weeks at a time. I get nauseated ans sick to the stomach. I was picked up down town for being drunk and I don't drink.    I couldn't go back in the liquor store.' He also felt that no one would hire him (the liquor store had been sold). 10 He had three shots a month, although he did not know what they were for. He continued to have chest pain, for which he frequently took nitroglycerin tablets. Asked if he could work if it weren't for the arthritis, he replied: I don't think so    I don't know. Maybe I have gotten to be cowardly. I have had so many friends that did the same thing, and they went back to work and two or three months later they were dead.' His family doctor told him not to go back to work. He described work in a liquor store, saying that it involved a lot of tension because of drunks, appeals for credit, holdups, etc. It also involved being on one's feet and lifting cases of beer. 11 Finally, he described his equilibrium problems, for which he was treated by Dr. Snyder. He was taking pills that effectively controlled the problem. 12 Mrs. Flake then testified and corroborated her husband's story. When asked what she noticed to be wrong with her husband, she replied 'Everything.' 13 There was not other oral testimony. 14 b. The medical reports. 15 At the time of the hearing, a number of medical reports were before the Hearing Examiner. At the conclusion of that hearing, the examiner asked counsel for reports from various doctors who had treated Flake, but whose reports did not appear in the record. He also recommended that Flake go to an orthopedic specialist. He also wanted more in the way of objective medical findings from Flake's family doctor, who, he thought was 'just being liberal on symptoms.' The Hearing Examiner summed up his approach to a determination of disability: 16 'We can't grant disability on the applicant's own statements of his condition. We have to have a medically determinable impairment. It means just that. It must be supported by medical evidence. I would say that the oral testimony is very strong, but the medical evidence is pretty weak.' 17 As a result, Flake was examined by an orthopedist, and further medical reports were received and considered by the examiner. We summarize all of the reports that he considered. 18 First, there is a report from the Veteran's Administration of an examination conducted in 1948. The diagnosis was 'chronic arthritis of the hands, feet and left shoulder and back.' 19 Next, there are several reports and letters from Flake's family doctor, Dr. Hickman. The first is a letter to the Veteran's Administration dated February 25, 1963. This was about four months before Flake claimed to have become disabled. In it, the doctor stated that he had been seeing Flake since 1948, that Flake had a progressive history of osteoarthritis of the spine and extremities, complicated by myo-fibrositis, progressive diminished hearing, and that Flake was unable to work because of his arthritis. The second is a report made shortly after Flake's heart attack. The diagnosis was that Flake had suffered an extensive posterior-lateral myocardial infarction, from which he had recovered, and that he suffered from arthritis, equilibrium problems, and loss of hearing. The third is dated November 19, 1963. In it the doctor described Flake's condition in more detail. He concluded that Flake had coronary artery disease, coronary insufficiency, and anginal syndrome and that Flake's American Heart Association classification was 'Class I' (no restrictions). He also diagnosed osteoarthritis of the spine and extremities with limitation of movement involving hands and knees. He described Flake's condition as static and said that 'he is not able to carry on a gainful employment.' The fourth report is dated on March 31, 1964. It described Flake's subjective symptoms as recurrent chest pains and fullness, inability to stand or work without distress, arthritis, diminished hearing, and recurrent nasal obstruction due to polyps. The medical findings were 'possible' coronary heart disease, post-coronary syndrome and apprehension, arthritis in both hands and feet and entire cervical spine with limitation of movement and use and some deformity, nasal polyps, and diminished hearing. The EKG (electrocardiogram) showed good recovery from the heart attack and Flake was on anti-coagulant therapy. His condition was static. The doctor concluded that Flake should be considered disabled because of his 'general physical condition.' Dr. Hickman's last report is dated November 4, 1964, and states that he felt 'this patient has physical incapacities that restricts him from carrying on any reasonable or strenuous, gainful employment.' 20 Also in the record are two other letters written before Flake claims to have become disabled. One, dated February 28, 1963, is from a Dr. Bolkovatz, who had treated Flake since 1939. He stated that Flake had a progressive arthritic condition since that time and 'at present his arthritic condition has become so severe that he is unable to conduct his business.' Dr. Bolkovatz also mentioned appellant's hearing problem. The other, dated March 1, 1963, was written by a Dr. Kass, who had treated Flake occasionally since 1950. He stated that Flake had had arthritis since that time, that it was getting progressively worse, and that he also had progressive loss of hearing. Dr. Kass says that 'his disability prevents him from carrying on his normal activities in his work.' 21 After the hearing, Flake was examined by an orthopedic surgeon, Dr. Downing. In his report, dated December 3, 1964, and after relating Flake's own version of his condition, Dr. Downing stated his findings: that Flake had a slight lower extremity limp, that motions were performed slowly, but throughout normal range, with some slight discomfort at the extremes, and that he noticed no swelling or deformities. He concluded that there were no definite positive findings. However, he wrote: 22 'Although this patient has no definite objective findings of arthritis at this time, his clinical history indicates that he has been suffering from a rheumatoid type of arthritis for many years and his general ageing plus association with this complaint is causing an incapacity for him to engage in gainful occupation. His complaints seem rational and can be accepted as true.' 23 There is also a letter dated December 7, 1964, from Dr. Snyder, who saw Flake from 1960 to 1964. He diagnosed a Meniere's syndrome and possible coronary heart disease during the period before Flake's heart attack. When he saw Flake in 1964, he felt that Flake had suffered a myocardial infarct with resultant loss of ability to sustain great physical effort. He did not assess the possibility of rehabilitation, but felt that it was possible that Flake did indeed become short of breath with exertion. He did not comment on Flake's arthritis. 24 There is also a report from a Dr. O'Brien, a cardiovascular specialist, that adds nothing to Dr. Hickman's reports, except that he classed Flake as American Heart Association Class III-C (moderate restriction of ordinary activity) shortly after the heart attack. 25 Finally, there are two reports from Dr. Graveline, who examined Flake for the government. The essence of his first report, dated November 21, 1963, was that Flake seemed fully recovered from his heart attack (which the doctor felt was a coronary occlusion rather than a myocardial infarction) and had only mild arthritis. He also found borderline diabetes. These findings were based on his examination of Flake, the hospital records, and X-ray and laboratory findings. Dr. Graveline concluded that 'it does not appear that there is any disability at this time other than excess weight.' Dr. Graveline again examined Flak on May 21, 1964, conducting a complete examination and having X-rays taken. Again, he was 'unable to come up with any objective findings that would indicate that there is disability here.' He said that Flake seemed fully recovered from his heart attack, and that the X-rays and the examination revealed only mild arthritis. 26