Court Opinion

ID: 9476375
Source: CourtListenerOpinion
Date Created: 2023-08-05 05:54:22.968604+00
Date Added: 2024-06-11T17:45:16.684108
License: Public Domain

VAN GRAAFEILAND, Circuit Judge,
concurring in part and dissenting in part:
I concur in that portion of my colleagues’ decision which directs that the case be remanded to the Secretary for further proceedings. I do so, not because I endorse my colleagues’ summary of the medical record, with much of which I disagree, but because I believe the record should be amplified concerning the existence vel non of disabling symptoms during the intervals between appellant’s episodic attacks of gout. I dissent from that portion which “retains jurisdiction” of the case and directs Government counsel to file with the Court within two weeks an affirmation that the Secretary has taken steps to comply with “our order in Sehisler.’’
In Richardson v. Perales, 402 U.S. 389, 91 S.Ct. 1420, 28 L.Ed.2d 842 (1971), the Court laid to rest any uncertainty that theretofore may have existed concerning the admissibility and probative value of written medical reports. The Court held that “despite the presence of opposing direct medical testimony and testimony by the claimant himself, [such reports] may constitute substantial evidence supportive of a finding by the hearing examiner adverse to the claimant____” Id. at 402, 91 S.Ct. at 1428. The Court continued, “The courts have reviewed administrative determinations, and upheld many adverse ones, where the only supporting evidence has been reports of this kind, buttressed sometimes, but often not, by testimony of a medical adviser____” Id. at 405, 91 S.Ct. at 1429. The Court pointed out that medical advisers are used in approximately 13 percent of disability claims, and it approved of that practice. The purpose of such advisers, said the Court, is to explain complex medical problems in terms understandable to the layman-examiner. Id. at 408, 91 S.Ct. at 1430.
The medical records in the instant case establish beyond dispute that appellant suffered from periodic attacks of gout. This is an illness which results from an excess *300of uric acid in the blood and which causes painful “gouty arthritis” in affected joints. However, it is an illness that comes and goes, and the intervals between attacks are usually symptom free. “With remission urinary excretion of uric acid becomes normal again and recovery is usually complete, and the affected joint regains full function. An asymptomatic period then follows. The duration of these intervals may be months or may be even years.” A. Johnston & L. Caswell, Gout, in 1C R. Gray, Attorneys’ Textbook of Medicine ¶ 19G.43, at 19G-11.
Gouty arthritis should not be confused with either Rheumatoid Arthritis or Osteoarthritis (Degenerative Joint Disease). “In contrast to other forms of arthritis, the treatment is relatively effective and results can be dramatic.” Id. 1119G.80, at 19G-25. “Local symptoms and signs eventually regress and joint function returns to normal.” The Merck Manual Fourteenth Edition 1201 (1982).
Appellant was diagnosed as having “gouty arthritis” at the Bellevue Hospital in 1981, at the Lutheran Medical Center in 1982 and again in 1984. In 1985, Dr. Brigino also diagnosed appellant’s problem as “gouty arthritis”. During all this time, x-rays of appellant’s hands, knees, ankles and shoulder were negative for degenerative arthritis.
Dr. Wagman, who was the ALJ’s Medical Adviser, simply summed up what already was in the record, namely, that appellant was having periodic attacks of gout and that repeat x-rays of his joints showed no evidence of significant arthritic changes or chronic damage to joints such as one would expect from a chronic arthritic condition. Dr. Wagman then explained the well-accepted symptomatology of gout, i.e., that between attacks, the victim can function adequately.
Because I agree that the case be remanded to the Secretary, there is little to be gained in discussing in detail where my view of the facts differs from that of my colleagues. However, in fairness to Dr. Wagman, I must respectfully note my disagreement with the statements in the majority opinion that both Dr. Contractor and Dr. Brigino found that appellant had “degenerative arthritis of the left arm and wrist and the right knee [which] were verified by x-rays” and that Dr. Wagman’s testimony “is contrary to all the other medical opinions in the record.”
I must also respectfully note that the degenerative changes in appellant’s spine, a condition that “is present to some degree in most people after fifty years of age”, L. Sante, Principles of Roentgenological Interpretation 177 (1952), was not the subject of any recorded findings or complaints until May 1984, one year after the “attending physicians” stated that appellant was suffering from “recurrent” attacks of asthma and arthritis. Moreover, the May 24, 1984 hospital record dealing with appellant’s spinal condition refers to an unidentified automobile accident which, so far as I can determine from the poorly copied hospital records, was never referred to prior to that date.
For the foregoing reasons and others hereafter discussed, I conclude that this is not a proper case for this Court to take up the cudgels on behalf of the so-called attending physicians rule. This “rule”, if it may be properly called such, was adopted for this Circuit in the seminal case of Gold v. Secretary of HEW, 463 F.2d 38, 42 (2d Cir.1972), where we said:
The expert opinions of plaintiff’s treating physicians as to plaintiff’s disability are binding upon the referee if not controverted by substantial evidence to the contrary.
The rule, with minor modifications, was adhered to in subsequent decisions of this Court. However, there came a time when we were not sure that the Secretary was proceeding in accordance with it. Accordingly, in Schisler v. Heckler, 787 F.2d 76 (2d Cir.1986), we directed the district court to issue an order directing the Social Security Administration to “state in relevant publications to be determined by the district court that adjudicators at all levels, state and federal, are to apply the treating physician rule of this circuit.” Id. at 84. Although we left to the district court the task of fashioning the precise order to ac*301company the remand, id. at 85, we defined the rule as follows:
That rule provides that a treating physician’s opinion on the subject of medical disability is binding on the factfinder unless contradicted by substantial evidence. “Medical disability” refers to medical questions of diagnosis and nature and degree of impairment. In addition, the treating physician’s opinion on the subject of medical disability is entitled to some extra weight because the treating physician is usually more familiar with a claimant’s medical condition than are other physicians, although resolution of genuine conflicts between the opinion of the treating physician, with its extra weight, and any substantial evidence to the contrary remains the responsibility of the fact-finder.

Id.

I am informed that the district court has held hearings and received legal memoranda in preparation for the carrying out of its task, but that an order has not yet issued. Nonetheless, this panel now demands an affirmation from the Secretary that he is complying with our order in Schisler. In the process, we add a “corollary” to the rule as enunciated in Schisler to the effect that the opinion of a non-examining doctor “by itself” cannot constitute the contrary substantial evidence required to override the treating physician’s diagnosis. This corollary was taken from a statement of dictum in Havas v. Bowen, 804 F.2d 783, 786 (2d Cir.1986), that the opinions of non-examining physicians “in themselves” cannot constitute substantial evidence overriding the opinions of examining physicians. Assuming that the dictum in Havas should be treated as binding precedent, it is difficult, if not impossible, to conceive of a situation in which a non-examining doctor would fashion an opinion out of thin air. As in the instant case, the non-examining doctor must of necessity base his opinion on hospital records, medical reports, x-rays, etc. Since such reports, standing alone might “constitute substantial evidence supportive of a finding ... adverse to the claimant”, Richardson v. Perales, supra, 402 U.S. at 402, 91 S.Ct. at 1428, testimony by a non-examining medical expert based on those reports should be worthy of even greater weight. Assuming that a situation could ever be presented in which the majority’s so-called “corollary” might be applicable, this is not such a situation.
I suggest that the proper procedure would be to permit the district court in Schisler to issue its order and then have the order come up to this Court in the customary manner for review. See Stieberger v. Bowen, 801 F.2d 29, 36-38 (2d Cir.1986). If this were done, further refinements of the rule might well be made. For example, the rule makes no reference to either the honesty or the caliber of the attending physician whose diagnosis, we say, must be accepted. One need only examine the numerous actions brought against doctors under 18 U.S.C. § 1001, e.g., United States, v. Greber, 760 F.2d 68 (3d Cir.), cert. denied, 474 U.S. 988, 106 S.Ct. 396, 88 L.Ed.2d 348 (1985), United States v. Abadi, 706 F.2d 178 (6th Cir.), cert. denied, 464 U.S. 821, 104 S.Ct. 86, 78 L.Ed.2d 95 (1983), to realize that doctors are not immune from temptation to stray from the straight and narrow. The ever-growing body of malpractice litigation indicates that they likewise are not immune from medical error. This Court should carefully consider whether it can or should direct the Secretary to accept the word of dishonest or incompetent doctors as binding. See Cummins v. Schweiker, 670 F.2d 81, 84 (7th Cir.1982). This Court might also want to decide whether the testimony of either a non-examining or a non-treating physician should be rejected out of hand where it does not stand alone but is instead based upon and supported by competent medical evidence in the record such as x-rays. See Richardson v. Perales, supra, 402 U.S. 389, 91 S.Ct. 1420, 28 L.Ed.2d 842; Ransom v. Heckler, 715 F.2d 989, 993-94 (5th Cir.1983); Lewis v. Schweiker, 720 F.2d 487 (8th Cir.1983); Oldham v. Schweiker, 660 F.2d 1078, 1084-85 (5th Cir. 1981); Lawson v. Secretary of HHS, 688 F.2d 436, 438 (6th Cir.1982). In any event, I believe we err in injecting ourselves into issues presently being resolved in other *302litigation in district court. If we insist on immediate results, the proper way to secure them is through action by that court.