Court Opinion

ID: 9464544
Source: CourtListenerOpinion
Date Created: 2023-08-04 23:37:12.364693+00
Date Added: 2024-06-11T17:38:42.497397
License: Public Domain

STERN,* District Judge
(dissenting).
Because I believe that the hearing examiner improperly relied on the report of a physician who neither personally examined the claimant nor was present at the hearing, I would reverse and remand for a new administrative hearing.
On February 19, 1975, an administrative hearing was held to determine whether Eric Winfield, the appellant’s then two-year-old son, is entitled to disability benefits. Appellant testified that her son was bom with the lacrimal puncta (tear duct) missing from his left eye. She further testified that due to the blockage of tears in Eric’s eye, he becomes temporarily blinded and stumbles into things; that the child’s attempts to wipe away the tears make him prone to constant eye infections; and that because of his tendency toward infection, his toys have to be sterilized and he cannot play outside. (Tr. 113-133).1 In addition to *171her own testimony, Mrs. Winfield produced the medical reports of two physicians who had personally examined her son. Both physicians agreed that Eric was missing the lacrimal puncta from his left eye; that he was prone to severe and recurrent eye infections, and that his condition was not operable until he was fully grown. However, since the child’s vision apparently could not be tested during the pendency of the disability, the doctors were unable to ascertain how severely his vision was impaired by the blockage of tears in his left eye.
At the close of the hearing, the hearing examiner indicated to Mrs. Winfield that it would be necessary to secure the opinion of a physician designated by the Administration, as required by regulation, see 20 C.F.R. § 416.905(b), to determine the question of medical equivalence. (Tr. 121).2 Mrs. Winfield was told that she would be furnished a copy of the report and that she would have the opportunity to rebut it at a' later date. (Tr. 137).3 In fact, however, the hearing examiner’s covering letter (Tr. 223) dated March 13, 1975, — a Thursday— advises Mrs. Winfield that she had until March 23, 1973 — a Saturday — to get her response to him. Thus, the claimant’s mother, a pro se litigant, was called upon to formulate and mail her comments, objections and rebuttal to Dr. Wolkowicz’s “findings” within a period of less than one week. Faced with this impossible schedule, Mrs. Winfield requested and received an extension until April 4. (Tr. 230). She dutifully filed her objections to Dr. Wolkowicz’s report on April 4. The hearing officer, however, had filed his decision on April 3.
In his decision denying disability benefits, the hearing examiner found that Eric’s condition was not medically equivalent to those disabilities set forth in the regulations. See 20 C.F.R. Appendix I to §§ 416.901 et seq. While he apparently accepted the testimony of Mrs. Winfield, the hearing examiner based his decision in large part on the opinion of Dr. Michael I. Wolkowicz, the physician to whom he referred the question of medical equivalence. Although Dr. Wolkowicz had never personally examined him, he concluded of Eric that, even with his eye full of tears, his vision would not be significantly impaired:
How much of a hindrance this might be is difficult to predict, but I would say from previous experience, this eye should still be able to have a vision of 20/30 or 20/40.
(Tr. 220).4
In rebuttal, Mrs. Winfield reiterated that notwithstanding Dr. Wolkowicz’s specula*172tions, “several times each day this child does not see.” (Tr. 230) (emphasis in original).
Mrs. Winfield also submitted additional statements from persons close to Eric to rebut Dr. Wolkowicz’s report. Thus, for example, Eric’s grandmother stated by letter that:
Close watching has shown that most of the time he avoids chairs, tables and other things in his way then he crashes right into the things he missed before. Just this month he ran into the metal latch on an open door and gave himself a black eye. . . . It is unusual if he does not have several bad bruises on his poor little body from falling against chairs and toys . . .. Watching Eric at play I have noticed that when he laughs, sneezes or gets in the wind both of his eyes fill with tears.
(Tr. 227).
However, these words fell on deaf ears since the hearing examiner rendered his decision without ever awaiting Mrs. Win-field’s rebuttal.
Based on such a record, I cannot agree with the majority’s decision to uphold the denial of benefits. I do not agree that the testimony of Mrs. Winfield and other members of the family should be discounted simply because it is “non-clinical” and “exclusively lay”; certainly they were in a better position than Dr. Wolkowicz — who never even laid eyes on Eric — to evaluate the severity of the child’s symptoms. Nor can I agree with the majority’s statement that no reversible procedural error occurred when the hearing examiner rendered his decision without first affording Mrs. Win-field an opportunity for rebuttal.
Finally, I do indeed believe that “reports of non-examining physicians cannot constitute substantial evidence unless the physician is available for cross-examination.” See majority opinion, ante at 170, n.8. The function of such a non-examiner is limited both by regulation and, I believe, by the Supreme Court’s decision in Richardson v. Perales, 402 U.S. 389, 91 S.Ct. 1420, 28 L.Ed.2d 842 (1971). The applicable regulation, 20 C.F.R. § 416.905(b), provides that the function of such a physician is to furnish an opinion on the question of medical equivalence, i. e., to determine whether the illness is of comparable severity to those enumerated in the Appendix to those regulations. In Richardson v. Perales, supra, at 408, 91 S.Ct. at 1431, the Supreme Court held that he is to be “used primarily in complex cases for explanation of medical problems in terms understandable to the layman-examiner.” The use of Dr. Wolkowicz’s opinion in this case violates the parameters of this limited function, for the majority overlooks the fact that he did not perform his administratively-defined function of simply defining the question of medical equivalence. Rather, without ever so much as having laid eyes on this child, without ever having been subjected to cross-examination or rebuttal, he was permitted to pass on the ultimate issue, by concluding that the child’s eyesight was normal. His conclusion was heavily relied upon by the hearing examiner. Such- an opinion should not be dispositive of an otherwise meritorious claim for disability benefits.
The majority views its holding as consistent with that of the Supreme Court in *173Perales. In that case, however, the Court held only that “a written report by a licensed physician who has examined the claimant . . . may be received as evidence in a disability hearing ... despite its hearsay character . . [and] may constitute substantial evidence . . .” (Emphasis supplied). While I agree that that decision does not preclude the use of the opinions of non-examining physicians, the Court never authorized a finding based solely on such a report. Indeed, in sanctioning the use of the reports of examining physicians, the Court expressly noted that such reports were reliable because they are based on “personal consultation and personal examination.” Id. at 403, 91 S.Ct. at 1428 (emphasis supplied). Of the opinions of non-examining physicians, the Court noted only that they are to be used by the hearing examiner for explanation of complex medical terms.
In sum, I read Perales to require either that medical opinions be based on personal knowledge or that the physician be present at the hearing and subject to cross-examination, if such a report is to be relied on to deny disability benefits. Thus, I would follow the decisions of other circuits which have held that reports of non-examining physicians do not constitute substantial evidence unless the physician is available for cross-examination. See Allen v. Weinberger, 552 F.2d 781 (7th Cir. 1977); Martin v. Secretary of Health, Education and Welfare, 492 F.2d 905 (4th Cir. 1974); Landess v. Weinberger, 490 F.2d 1187 (8th Cir. 1974); Mefford v. Gardner, 383 F.2d 748 (6th Cir. 1967); Hayes v. Gardner, 376 F.2d 517 (4th Cir. 1967).
I dp not agree with the majority that these cases are distinguishable. For example, in Allen v. Weinberger, supra, the opinion of the claimant’s personal physician that the claimant was disabled as a result of a back injury — an opinion which was not based on “clinical findings” — was contradicted by the opinions of two non-examining physicians and a physician who had examined the claimant only once. The Seventh Circuit reversed the denial of benefits, noting that “[i]n light of Dr. Acosta’s close familiarity with plaintiff’s condition and his opinion to the contrary, the speculative statement of Dr. Swink and the retrospective evaluations of Dr. Brav and Dr. Green do not constitute substantial evidence . . ” 552 F.2d at 786. In Martin v. Secretary of Health, Education and Welfare, supra, claimant’s personal physician and another examining physician agreed that claimant’s diabetes rendered her disabled. This conclusion was contradicted by the opinion of the non-examining physician appointed by the Social Security Administration, who opined that the claimant was capable of performing sedentary work. The Fourth Circuit reversed the denial of benefits, finding support for this result in Justice Black-man’s repeated emphasis in Perales of the fact that the medical reports there were based on personal examination. See 492 F.2d at 909. In Landess v. Weinberger, supra, the severity of claimant’s back problems was confirmed by the reports of two examining physicians and by her own testimony. Contradicting this were the reports of one physician who had examined her only once and two non-examining physicians. The Eighth Circuit reversed and remanded for a new hearing, noting of the reports of the two non-examining physicians that:
We think these written reports, without personal examination of the claimant, deserve little weight in the overall evaluation of disability. The advisers’ assessment of what other doctors find is hardly a basis for competent evaluation without a personal examination of the claimant.
490 F.2d at 1190.
Those cases present the situation where the report of a non-examining physician had been given greater weight than the more probative testimony of physicians who have had personal contact with the claimant. I am not convinced that the instant case is distinguishable; for here we have not only the testimony — albeit that it is “exclusively lay” — of Mrs. Winfield who had daily contact with the child, but also the confirming diagnosis of two examining physicians.
*174We must be mindful of the great numerical burden placed upon the hearing examiners who must daily administer claims for disability benefits. We should also not forget that these proceedings are to preserve the tone of informality, and that they are not to be confined by strict adherence to the prohibition against hearsay or other evidentiary rules. But informality may be strained beyond the confines of basic fairness and, at least for me, those borders are breached when the opinion of a non-examining, non-appearing physician is by itself utilized as “substantial evidence” to defeat an otherwise persuasive claim for assistance made on behalf of a disabled child.

 Herbert J. Stem, United States District Judge for the District of New Jersey, sitting by designation.

. Thus, I find somewhat uncharitable the majority’s statement, ante at 168, that Eric “tended to stumble into objects as a learning walker”, implying that his stumbling was part of his learning. Even the hearing examiner conceded that Mrs. Winfield “feels her son falls down more than an average child on the basis of her experience raising 4 children of her own [one of whom had brain damage] and 10 foster children.” (Tr. 13).

. In fact, the record suggests that he led her down the primrose path, implying that the medical judgment would be a mere formality and that she had already met her burden:
Hearing Examiner Kozma: There is one other thing that we have to get in this file. That is why I can’t render a decision today.
I do not have the authority without having a medical report from this particular doctor from the Administration to find the equivalent.
If I do, the Appeals Council has their own authority in 60 days to deny the case.
I don’t think that I am going to do you justice by finding him disabled without a report, okay?
Mrs. Winfield: Yes.
(Tr. 121-122).

. Here, Mrs. Winfield was led down yet another primrose path, for the hearing examiner assured her that she would have the absolute right to examine and rebut that report before any decision would be rendered:
[Hearing Examiner Kozma]: I will write to you when I get that medical advisor’s report in, all right?
I will send a copy of it to you before I even mark it as an exhibit number. This is the report dealing with the medical equivalence issue, all right?
At least you can comment on it before we put the records away. You may agree with it or disagree with it or you may introduce other evidence to rebut [sic] it.
In other words, I want to know your thoughts before I make a further record. . . I am doing that because that is what the law requires me to do. 1 am not being a good guy by mailing this. The law requires me to, before I put that record into that exhibit box, mail it to you for your comments.
(Tr. 133).

. In denying benefits, the hearing examiner specifically relied on this “finding” that Eric’s vision was no worse than 20/40 when the affected eye was blocked with tears:
*172Though the medical evidence of record clearly establishes that the child has a total congenital absence of the lacrimal puncta of the left eye, it also clearly establishes that both eyes are otherwise normal. Funduscopia findings show no problems. Even if there are repeated drainage and infection problems, the medical evidence shows that they respond to antibiotic treatment. It is reported no visual field loss or muscle co-ordination is anticipated. Visual efficiency in the child’s right eye can be predicted to be 100 percent, and the percentage of central visual efficiency in the left eye might be reduced later on to 85 percent. Dr. Wolkowicz indicates, if one assumes that the visual acuity, as a result of excessive watering, might be reduced to 20/40 on a Snellen chart. He believes one can anticipate the reduction of the tearing symptoms due to autoregulation of the tear function, particularly with the child’s age. Even though an eye is constantly moist, the eye should still be able to have a vision of 20/30 or 20/40 according to the medical evidence.
(Tr. 20) (Emphasis supplied).