Court Opinion

ID: 9463888
Source: CourtListenerOpinion
Date Created: 2023-08-04 23:19:18.704397+00
Date Added: 2024-06-11T17:38:20.614408
License: Public Domain

SNEED, Circuit Judge,
dissenting:
This case may raise an important issue pertaining to the administration of disability benefits under 42 U.S.C. §§■ 416(i) and 423. It is whether a claimant whose disabling impairment reasonably can be regarded as remediable is entitled to disability benefits notwithstanding a refusal to undergo the remedy. My answer to the question is no. Under such circumstances, the refusal is wilful within the meaning of 20 C.F.R. § 404.1507 (1976).
I am not certain how the majority responds to the issue. Judge Kennedy acknowledges that there exists in this case “substantial evidence to support a finding that Nichols’ condition could be corrected by surgery.” Nonetheless, he then proceeds to find that Nichols had justifiable cause to refuse to undergo the surgery that would have corrected her condition. As a consequence her refusal was not wilful within the meaning of § 404.1507. Justifiable cause turns on factors such as the “physician’s outlook as to the success of the treatment,” the nature of the relationship between the physician and claimant, the nature of the surgery required, the severity of the claimant’s ailment, and the claimant’s age, background, and medical history.
My difficulty with this approach is that either it involves an internal contradiction, or it amounts to a finding of no substantial evidence to support the Secretary’s finding. An internal contradiction is present if the majority mean to say that even when a disabling impairment reasonably can be regarded as remediable the claimant reasonably can refuse to submit to the remedy without sacrificing his right to the disability benefits. A remedy is not reasonably available when the claimant can reasonably refuse it. This, I believe, is the teaching of Purdham v. Celebrezze, 349 F.2d 828 (4th Cir. 1965) and Ratliff v. Celebrezze, 338 F.2d 978 (6th Cir. 1964). If, on the other hand, the majority believe that a reasonably available remedy cannot be refused without the claimant sacrificing his right to disability benefits, they and I agree, except they do not believe, while I do, that the Secretary’s finding that Nichols’ impairment had a reasonably available remedy is supported by substantial evidence.
There is, of course, a third possibility. This is that the majority do not recognize the internal contradiction and do believe that a reasonably available remedy reasonably can be refused without sacrificing disability benefits. The inclusion of the relationship between the physician and claimant in the factors to be considered in determining whether the refusal was justified suggests precisely that. If this third possibility is the majority’s view, I do not believe *935it is supported by any relevant authority.1 Moreover, it undoubtedly, will expand the coverage against disability provided by 42 U.S.C. §§ 416(i) and 423. In that event, this case is an important one indeed, because the majority’s answer to the issue posed at the outset of this dissent is “Yes, but only when the refusal is reasonable.”

. No court has held that a reasonably available remedy reasonably can be refused without sacrificing disability benefits. Cases dealing with the question of whether a refusal is reasonable do not distinguish it from the question of whether a disability can be reasonably classified as remediable. Colwell v. Gardner, 386 F.2d 56 (6th Cir. 1967); Purdham v. Celebrezze, 349 F.2d 828 (4th Cir. 1965); Budds v. Richardson, 313 F.Supp. 1048 (W.D.Mis. 1970). As these cases indicate, a disability cannot reasonably be classified as remediable if the remedy requires an unreasonable effort on the part of the claimant or unreasonably jeopardizes the safety of the claimant. If the remedy presents the claimant with either of these possibilities, the claimant may reasonably refuse to undergo the treatment without sacrificing his disability benefits. The question of reasonableness of the refusal is the other side of the coin of the question of reasonableness of the remedy. Both are basically objective questions and turn on the same factors, which include the remedy’s probability of success and accompanying danger to the claimant. See Morse v. Gardner, 272 F.Supp. 618, 629 n. 9 (E.D.La.1967).