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402 U.S. 389 91 Supreme Court Reporter 1420 28 United States Reports Lawyer’s Edition 2d Series KF101.8 U54 842 Elliott L. RICHARDSON, Secretary of Health, Education and Welfare, Petitioner,v.Pedro PERALES. Number 108. Argued Jan. 13, 1971. Decided May 3, Syllabus Written reports by physicians who have examined claimant for disability insurance benefits under Social Security Act constitute 'substantial evidence' supporting a nondisability finding within the standard § 205(g) Act, notwithstanding reports' hearsay character, absence cross-examination (through claimant's failure to exercise his subpoena rights), directly opposing testimony medical witness; procedure followed does not violate due process requirements. 412 Federal Reporter, 2nd 44 416 1250, reversed remanded. Daniel M. Friedman, Washington, D.C., petitioner. Richard Tinsman, San Antonio, Tex., respondent. Mr. Justice BLACKMUN delivered opinion Court. 1 In 1966 Pedro Perales, Antonio truck driver, then aged 34, height 5 11 , weight about 220 pounds, filed claim Act. Sections 216(i)(1), 68 Statutes-at-Large 1080, 223(d) (1), 81 868, that 42 Code KF62 416(i)(1) 423(d)(1) (1964 ed., Supp. V), both provide term 'disability' means 'inability engage in any substantial gainful activity reason medically determinable physical or mental impairment which * *.'1 Section 205(g), 405(g), relating judicial review, states, 'The findings as fact, if supported evidence, shall be conclusive *.' 2 The issue here is whether physicians' written examinations they made may supportive nondisability, standard, when objects admissibility those only live presented side contrary reports. 3 Perales asserted on September 29, 1965, he became disabled result an injury back sustained lifting object at work. He was seen neurosurgeon, Dr. Ralph Atlantic Munslow, first recommended conservative treatment. When this provided no relief, myelography performed surgery possible protruded intervertebral disc L—5 advised. patient hesitated appeared improve. On recurrence pain, however, consented procedure. Munslow operated November 23. surgical note margin.2 No protrusion other definitive pathology identified surgery. post-operative diagnosis was: 'Nerve root compression syndrome, left.' discharged from Munslow's care January 25, 1966, with final 'Neuritis, lumbar, mild.' 4 continued complain, but Morris Haw. Hawai‘i KFH45 A2 Lampert, neurologist called consultation, were still unable find objective neurological explanation complaints. advised return April consulted Max Morales, Jr., general practitioner Antonio. Morales hospitalized 15 2. discharge 'Back sprain, lumbo-sacral spine.' 6 claim. As required 221 421, referred state agency determination. obtained hospital records report Morales. set forth laboratory studies, doctor again gave diagnosis: sprain—lumbosacral spine,' time 'moderately severe,' 'Ruptured disk ruled out.' arranged examination, cost patient, John Langston, orthopedic surgeon. This done 25. 7 Langston's ensuing Division Disability Determination devastating standpoint. Perales' being 'on crutches cane' since injury. noted slightly edematous condition legs, attributed 'inactivity sitting around'; slight tenderness some muscles dorsal spine, thought poor posture; 'a very mild sprain (of muscles) would resolve actually get little move.' Apart this, residuals pantopaque hemilaminectomy, Langston found abnormalities lumbar spine. Otherwise, described 'big healthy specimen obviously holding limiting all motions, intentionally. His upper extremities, though are completely uninvolved injury, holds rigidly semi-paralyzed. reach grasp limited intentionally so. Neurological examination entirely normal detailed sensory pinwheel, vibratory sensations, light touch. Reflexes active there atrophy anywhere.' orthopedist's summarization, impression, prognosis margin.3 8 denied requested reconsideration. submitted further attorney. outlined hospitalizations own continuing treatment medicines prescribed, administration ultrasound therapy, patient's constant concluded had complete recovery malingering, permanent, totally permanently disabled.4 against 9 James Bailey, board-certified psychiatrist sub-specialty neurology. Bailey's August 30, following 10 'Paranoid personality, manifested hostility, feelings persecution long history strained interpersonal relationships. 'I do feel has separate psychiatric illness time. It appears personality conducive anger, frustrations, etc.' 12 reviewed file. Bureau Insurance Administration its independent review. attending physician, considered, examining physicians. denied. 13 hearing before examiner. Mattson electromyography studies. Mattson's notes 'some chronic past disturbance function nerve supply' left right anterior tibialis extensor digitorium brevis 'strongly suggestive lack maximal effort' 'the kind typically associated functional psychogenic component weakness.' There evidence 'any effecting (sic) nerves present.' 'very verified what earlier examination. 14 12, 1967, notice thereof given copy contained definition disability, should bring already presented, afforded him opportunity examine documentary file prior hearing, told might physician witnesses represented lawyer. took place designated. A supplemental held March 31. attorney formally objected introduction several Drs. Mattson, records. Various grounds objection asserted, including hearsay, cross-examination, proof licensed practice Texas, demonstrate proved Business Records conclusory nature These objections overruled introduced. counsel admitted. 16 At two hearings oral former fellow employee claimant, vocational expert, Lewis Leavitt, medicine rehabilitation, chief of, professor in, Department Physical Medicine Baylor University College Medicine. Leavitt examiner 'medical adviser,' is, expert hears reviews offer opinion. adviser paid fee Government. through counsel, based upon hypothetical. testified over cross-examined stated consensus various low-back syndrome musculo-ligamentous origin. 17 examiner, reliance observed decision, 'There heavy preponderance indicates severity. Taken altogether, Hearing Examiner conclusion met burden proof.' specifically 'is suffering low origin, severity'; while 'has emotional overlay it require minimal contribution, any, ability activity'; '(n) either nor overlay, singly combination, defined' Act; capable engaging salesman work previously engaged, working watchman guard where strenuous required, ticket-taker janitor. examiner's decision then, entitled period benefits. 18 point 205(d) 405(d), provides power subpoenas requiring attendance production Secretary's regulations authorized 205(a), 405(a), request issuance subpoenas, 20 Regulations 404.926. did hearings. 19 review Appeals Council judgment dated June 2, favor company workmen's compensation aggregating $11,665.84, plus related expenses, letter December 28, Coyle W. Williams, apparently support welfare Perales. essentially negative except area straight leg raising. observed, cannot explain symptoms basis. & N Dec. Immigration Nationality Decisions recommend recondition himself My estimation, 15% permanent partial body whole.' correct. Upon adverse ruling instituted present action pursuant 205(g). Each moved summary administrative transcript. District reluctant accept opinions experts form unsworn reports, admission effect denying opposition cross-examination; never probative value, especially opposed physician; court amounted hearsay. case remanded new different versus Secretary, 288 F.Supp. 313 (WD Tex. 1968). appeal Fifth Circuit that, having exercising it, position complain been rights confrontation cross-examination. admissible specifically, hearing; Leavitt's also admissible; together contradicted witnesses. Cohen (1969). 21 rehearing, mean uncorroborated could claimant. emphasized applicable person. 1250 Certiorari granted order important procedural issue. 397 1035, 90 1365, 25 646 (1970). II 22 We therefore uncommon situation conflicting evidence. trier fact duty conflict. have, one hand, findings, expressed suspicion complaints, unwillingness anything remedying unprovable situation. personal physician's earnest pleas significant disabling mishap 1965 indeed present. 23 revolves, around system produces mass form. material ever stands alone client's testimony? courts below not. III 24 us 1935. 14, 1935, 49 620. affects nearly us. system's structure procedures, essential determinations numbering into millions, size extent difficult comprehend. But, Government's brief accurately pronounces, 'Such must fair—and work.'5 Congress 'shall full authority make rules establish procedures necessary appropriate carry out such provisions, adopt reasonable proper regulate proofs method taking furnishing same hereunder.' 405(a). 26 205(b) directs decisions; give course receive provides: 27 'Evidence received even inadmissible procedure.' carrying these statutory duties adopted state, among things: 29 inquire fully matters documents relevant matters. generally discretion afford parties fair hearing.' 404.927. 30 From apparent (a) regulation procedures; (b) strict courtroom, operate social security so bar otherwise pertinent; (c) conduct rests discretion. emerges emphasis informal rather than formal. This, we think, be, procedure, hearings, understandable layman necessarily stiff comfortable trained attorney, liberal tone operation. obvious intent fundamentally fair. IV 31 With background atmosphere mind, turn prescribed considered concept other, yet similar, contexts. National Labor Relations 10(e), original form, NLRB's 'if conclusive.' 454. said meant 'supported 32 'more mere scintilla. mind adequate conclusion.' Consolidated Edison NLRB, 305 197, 229, 59 206, 217, 83 L.Ed. 126 (1938). 33 adhered varying situations. See NLRB Columbian Enameling Stamping Co., 306 292, 300, 501, 505, 660 (1939); Universal Camera Corporation 340 474, 477—487, 71 456, 459 464, 95 456 (1951); Consolo Maritime Comm'n, 383 607, 619—620, 86 1018, 1026—1027, 131 (1966). V 34 propositions advanced them established, adjudicative proceeding involving differing play, years, become types proceedings,' Hannah Larche, 363 420, 442, 80 1502, 1515, 1307 (1960); 'right' sense 'earned." Flemming Nestor, 603, 610, 1367, 1372, 1435 35 'extent recipient influenced 'condemned suffer grievous loss'. Accordingly 'consideration circumstances begin determination precise government involved well private interest affected governmental action." Goldberg Kelly, 254, 262—263, 1011, 287 36 question, requires respect hearing. 37 conclude sets competence and, despite character presence direct himself, exercised reporting thereby physician. 38 prompted number factors feel, assure underlying reliability value: 39 1. identity five significant. prepared practicing claimant.6 majority (Drs. Mattson) agency. Although each fee, recompense talent devoted professional assignment. cannot, not, ascribe bias physicians, their part outcome beyond curiosity dedicated man possesses. 40 vast workings impartiality consultant bear operates essentially, intended do, adjudicator advocate adversary. congressional plan. presume record say works unfairly.7 41 3. One familiar routine specific, will recognize elements detail value. particular consultation rested accepted tests. operating pre-operative observations diagnosis, surgery, observations. neurologist, neurologic tests, impressions recommendations. orthopedist, post-operatively, tests performed, results prognosis. electromyography, test, impressions. And psychiatrist, history, emerged typical routine, unbiased specialists concerning subject whom seen. That itself indication nonprobative character. 43 4. impressive range subjected. specialist neurosurgery, neurology, psychiatry, orthopedics, rehabilitation add up specialties, somewhat related, emphases. scale most persons reveals careful endeavor ascertain truth. 5. So far can detect, inconsistency whatsover specialists. Yet reached writer's field specialized training. 45 6. complains cross-examine take advantage 404.926 five-day specified surely real obstacle notified available further, requested. more half months after initial inaction supports Appeals' view, F.2d, 50—51, consequence precluded now complaining 46 7. Courts recognized worth formal trials acknowledging admitted exception rule. Notable Judge Parker's well-known war-risk Long States, 602, 603—604 (CA4 1932), deserves quotation here, which, because length, reproduce. Second like White Zutell, 263 613, 615 (1959), doing, relied 1732. 47 8. Past reviewing cases revealing. Until case, appeals, Circuit, occasional criticism practice,8 uniformly value determinations, upheld many ones, kind, buttressed sometimes, often Leavitt.9 contested, decisions traditional ready acceptance cases. 48 9. additional pragmatic factor although controlling, mention. Chief Brown '(t)he sheer magnitude burden,' resulting necessity without 'elaboration facility testimony.' Page Celebrezze, 311 757, 760 (CA5 1963). 20,000 annually, providing need demonstrated subpoena, above examiners, drain trust fund energy short supply. VI relies heavily Court's statements supra, particularly comment 'and effective defend confronting U.S., 267—268, S.Ct., 1020. termination AFDC notice. concerned situation, said, 'where credibility veracity issue, proceedings.' 269, 1021. 50 same. once granted. Neither change status Notice Perates. inspection counsel. authors known asserts enjoyed. Further, specter questionable present; disagreement conclusions, sure, attack doctors' veracity. Kelly affords comfort 51 also, 53, 1251, describe question 'mere hearsay' relate Hughes' sentence 230, 217: 'Mere rumor evidence.' 52 technical sense, content produced read too much single Edison. contrast drawing, page cited, deemed proceedings 'without basis rational force.' blanket rejection irrespective opposite case. 53 Court, criticize use adviser. F.Supp., 314; 142 53—54. Mefford Gardner, 748, 759—761 (CA6 1967). Inasmuch advisers used approximately 13% indicated. see nothing 'reprehensible' practice, it. trial layman; specialist. primarily complex problems terms layman-examiner. neutral discloses explained technique significance electromyography. condition. opinion, differ vouch accuracy facts assumed understood otherwise. Doe Transportation, 674, 678—680 (CA8 1969). unconstitutional improper 54 Finally, processing claims. suggests, joined briefs amici, Administrative Procedure governs claims 556(d). V). goes assert event invalid grounds. says responsibility gathering 'to strong possible'; naturally leans toward gathered; justice satisfy appearance justice, citing Offutt 348 11, 75 99 (1954), re Murchison, 349 133, 136, 623, 942 (1955); 'independent the' Longshoremen's Harbor Workers' Compensation provided. 55 decide APA application claims, vary proscribed APA. Indeed, latter modeled Final Report Attorney General's Committee Procedure, Government Agencies, S.Doc.No.8, 77th Cong., 1st Sess., 157 (1941); remarks Senator McCarran, chairman Judiciary Senate, 92 Cong.Rec. 2155. cited 556(d) 'may received' exclusion irrelevant, immaterial, unduly repetitious. 'party defense true disclosure facts' 'determining money may, party prejudiced thereby, submission form.' 56 provisions conform, consistent with, supersede, Act's §§ 205(a) procedures,' benefits,' 'even Hearsay, thus relevancy. 57 matter comes down procedure's integrity fundamental fairness. derogation fairness consultants' consequent precisely fits statutorily 'cross-examination facts.' standard. clear workable fall process. 58 persuaded advocate-judge-multiple-hat suggestion. assumes designed, well, great growing complexity. furthermore, act acts charged developing facts. 44.2% reversal rate federal grant benefits, Rock, An Evaluation SSA Process, 7, HEW, (1970), attests refutes implication impropriety. reverse proceedings. intimate view merits. determine proffered admissible, command 60 ordered. 61 Reversed 62 DOUGLAS, BLACK BRENNAN concur, dissenting. 63 serious disabled. defeated, doctors Only Five testify But Still another doctors. All received, (5 V)) '(a)ny received.' ruling. section states '(a) facts.'1 64 said: 65 'Our holds, reaffirm, physicial standing more, tried our (testifies) person bar.' 1251. 66 Cross-examination facts.2 67 'substantial' enough sustain itself. '(e)vidence procedure,' 405(b), 405(g). (Emphasis added.) Uncorroborated untested Particularly where, testifies family behalf able HEW patient. minuscule relation staggering Nation. grave injustice wreaked individual presently powerful bureaucracy, concern everyone, days average say: grace God go I.' 69 whose word cast limbo saw him, vital statistics try walk bend lift weights. 70 adviser' HEW. circuit-riding claimants defeat beneath dignity nation. Three retained Some, told, employed respondent's Spears heard way officers parrot 'almost conclusions' 'nausea' him. added: 72 '(H)earsay ex parte critical man's just violation am bears play 73 'Then, you pyramid so-called advisor, who, compound it—compound simply tolerate my can't why wants abrogate advisor.' 74 Review vice allows testing Those defending look defense-minded salvation. press recognition experts. problem law neither, let ordeal distill stable submitting cutting corners—a certainly indulge. barred provided; enforce spirit written. 76 affirm judgment. Not pertinent durational aspects statute's definition. 'Midline incision border spine L4 downward midline sacrum. Dissection carried subperiosteal space exposing interspaces L4—5 L5 S1. interspace, laminectomy bone adjacent interspace resection intervening ligament thoroughly explored palpation. instance, identified. Further sacrum overlook fragment extruded extra-durally none found. seems tightness structures roots dural sac usually encountered. felt representing exact mechanics apparent. hemilaminectomy decompression out. After bulges upward position. Repeat intact dura intradural mass. Likewise aspect canal normal. *' 'IMPRESSION: congenital anomalies x-ray, impressed attempt exaggerate difficulties moving—not extremities. Thus, tremendous psychological illness, sincerely suggest psychiatrist. 'PROGNOSIS: intensive physio-therapy exercise, walking, bicycling, rehabilitation. Were follow program, effective, estimate three six months. considering disease, illness.' 'Diagnosis crush region ruptured slipped subsequently Munslow. Since operation, recovery; contrary, continues bitterly 'Since started seeing occasion talk times. During visits, convinced malingering. sincerity genuine truthful corrected injurv things stand, totally, completely, finds continue employment common laborer. previous area, know belt help relieve symptoms, walking cane, analgesics relief symptoms.' Brief 14. Although, above, ground Texas licensure, understand possession licenses Mattson. brief, 18, nn. 8, fiscal 1968, 515,938 processed; these, 343,628 (66.601%) allowed stage; one-third went allowed; 320,164 obtained. Ratliff 338 978, 982 1964); Miracle 351 361, 365, 382—383 1965). Ber 332 293, 296—298 (CA2 Stancavage 323 373, 374 (CA3 1963); Dupkunis 380, 382 Cochran 325 137, 138 Cuthrell 330 48, 50—51 Aldridge 339 190, 191 Dodsworth 312, 314 1965); Bridges 368 86, 89 1966); Green 391 606 1968); Martin Finch, 415 793, 794 1969); Breaux 421 687, 689 1970); Phillips 360 998, 1000—1001 Moon 926, 928 (CA7 Pierce 388 846, 847 1967), cert. denied, 393 885, 162; Celebrezze Sutton, 417, 419—420 Brasher 413, 414 McMullen 335 811, 815 (CA9 1964), 854, 106, 92; Flake 399 532, 534 Warren, 833, 836 (CA10 McMillin 384 596, 597 S.Rep.No.752, 79th 22—23. extends, last subsection open To truth, House view. provision face confer 'unlimited' Presiding pressed unreasonable lengths 'full provision. Nor intention eliminate agencies sound presiding extent. test states—whether 'for H.R.Rep.No.1980, 37. While exceptions 556 explicit ban (42 405)

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