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November 14, 1963

Richard KARAS
Anthony J. CELEBREZZE, Secretary of Health, Education and Welfare

The opinion of the court was delivered by: WOOD

This is an action *fn1" to review the final decision of the Secretary of Health, Education, and Welfare (Secretary) who denied the plaintiff's application for disability insurance benefits.

The plaintiff filed an application for disability insurance benefits on November 23, 1960, alleging that he became unable to work in August, 1960, at age 43, because of a fractured spine. The initial application was denied and reconsideration affirmed this denial.

 A hearing was requested and on May 16, 1962 the hearing examiner considered the case de novo on the basis of the testimony, medical evidence and documents. After the hearing the examiner caused additional consultative examinations to be performed in order to clarify the nature and severity of the plaintiff's impairments.

 On August 31, 1962, the hearing examiner found that the plaintiff was not under a disability. The hearing examiner's decision became the final decision of the Secretary when the Appeals Council, after receiving a current medical report by plaintiff's personal physician (October 24, 1962) which was made part of the record, denied the plaintiff's request for review on November 27, 1962.

 The facts found by the examiner showed that the plaintiff stopped work at the age of 43 as a result of a back injury sustained in an industrial accident on August 25, 1960, when a drill fell and struck his back. He was hospitalized for three days and discharged. The admitting physician made a preliminary diagnosis of a fractured sacrum. There is no indication that clinical and laboratory diagnostic procedures confirmed that initial impression.

 The plaintiff has a seventh or eighth grade education and from 1947 to 1960 he was employed on heavy equipment as a driller and operator. Prior to 1947 he was self employed as a truck driver hauling coal. At the time of the accident he was employed as a driller operating an air drill for a construction company engaged in road construction.

 From the time of his injury the plaintiff has claimed that he has had a constant pain in his back and was unable to resume work. Also, he has complained of pain in his hands, wrists and legs which he attributes to the accident. Some swelling was noted in his hand by the examiner which the plaintiff claimed to be arthritis. Based on his own observation the examiner initiated further medical studies to determine the nature of this alleged arthritic condition.

 The medical evidence shows that the plaintiff has been under treatment continuously for two years following the accident and has been studied at six hospitals.

 On July 12, 1962, when the plaintiff was given a comprehensive examination at the Geisinger Medical Center no objective evidence showed that he had any significant systemic problem. At the time of the examination, there was no marked tenderness in the joints nor were there symptoms present indicative of rheumatoid arthritis. The examining physician expressed doubt that the plaintiff was suffering from rheumatoid arthritis and stated that if severe joint swelling does occur further studies should be made. Dr. Pytko, the examining physician, stated: 'His hands are somewhat pudgy, and this precludes, I think, adequate evaluation of swelling.' (Tr. 107) This statement clarifies somewhat the hearing examiner's observation that the plaintiff's hand appeared to be swollen (Tr. 55). In this connection it is significant that an X-ray examination of the right hand in February 1961, and a subsequent X-ray examination of both hands and wrists on July 12, 1962, showed no abnormality (Tr. 89, 109).

 Psychiatric examinations of the plaintiff at Government expense did not reveal the presence of any significant mental disorder. Dr. Gatski found only a mild anxiety with mild irritability (Tr. 102-104). Dr. Angus in a prior examination found only mild irritability and faint paranoid suggestions and a defective memory. However, he made a conclusion that the plaintiff was totally incapacitated because of an anxiety neurosis. This neurosis he attributes to the instant litigation being unresolved. He also recommended appropriate medical treatment to encourage a return to work. (Tr. 92, 93)

 Two other doctors, Monahan and Tomlin, examined the plaintiff and reported that he was restricted in his ability to stand, bend or walk. Dr. Monahan found the plaintiff to be suffering from traumatic arthritis, spondyletes, arthritis of both wrists and sciatica. Dr. Tomlin found the plaintiff to be totally disabled due to arthritis of the psomatic type.

 Doctor J. J. Canfield, a general practitioner, who examined the plaintiff on July 18, 1961, found an anxiety reaction and that he should return to work. (Tr. 90) Dr. Canfield found that the plaintiff could bend well and that he presents no positive clinical or X-ray ...

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