resulting in a 'diagnosis of pulmonary tuberculosis, and apparently inactive; pulmonary emphysema, advanced; cardiac failure under treatment; recurrent renal lithiasis; general arteriosclerosis, and general debility. Complaints were of shortness of breath, fatigue, suffocation, pains to the upper chest, and coughs.' (Tr. 112.) As the result of an x-ray study, 'the impression was suggestion of left renal calculus and evidence of old minimum re-infection tuberculosis of the right upper lobe of questionable activity.' (Ibid.) (Emphasis added.)
9. As a result of x-ray studies at the Burge Tuberculosis Clinic, on April 24, 1959, they found 'photofluorograph of chest of Mr. John Seldomridge, 1244 Ridge Avenue, revealed increased density in the right upper lobe. Could be due to reinfection type of tuberculosis. Suggest gest further study. The aortic shadow is widened. Suggest a cardiovascular study.' (Exhibit AC-5, Tr. 108.) (Emphasis added.)
10. 'March 18, 1959, examination through Glover Clinic in St. Lukes Hospital wherein it was noted 'culture examinations appear to normal, but I would certainly watch Mr. Seldomridge. I believe the lesion in the right upper lobe is an old arrested TB but he should be followed should it start breaking down.' (Tr. 176, 177.) (Emphasis added.)
11. Plaintiff's continued deterioration resulting in permanent hospital confinement in 1962 with active moderately advanced tuberculosis (Tr. 259-260); thus a corroboration of the Veterans Administration's suspicion that the questionable activity of TB reinfection was in fact taking place in 1959.
B. Evidence Favorable to the Secretary's Findings
In contrast to the above, the Secretary basically relied on the following medical to disallow Seldomridge's claim of disability.
(1) The Ventilatory Studies:
In behalf of the Secretary, ventilatory studies were conducted on October 29, 1959, by Dr. J. W. Savacool. These ventilatory studies pertaining to breathing capacity noted that '* * * The vital capacity was 109% Of predicted normal, the three second vital capacity was 87% Of predicted normal, and the maximum breathing capacity was 93% Of predicted normal.' (Tr. 119.) The claimant strenuously challenged these findings on the ground that the ventilatory tests actually were never performed because Dr. Savacool's machine was broken. (Tr. 54-56, 119.)
Approximately three years later (July 1962), when claimant was confined in Landis State Hospital for active tuberculosis, ventilatory pulmonary function studies were again performed with the results indicating that he had a 'vital capacity of 3320 ml. against a predicted norm of 3580 ml. (92%). The three seconds vital capacity was 90% Against a predicted normal of 95% And the maximum breathing capacity was 52 liters per minute against a predicted capacity of 93 liters per minute (55%).' (Tr. 119.)
Indicative of what appears to me to be the Secretary's inclination to resolve every permissible medical inference against the claimant is the manner in which the Secretary has handled the above mentioned ventilatory tests. In the Appeals Council's opinion written after the remand, there is substantial discussion of the ventilatory tests with the implication that claimant's performance on these tests was very persuasive evidence to the Secretary in establishing that the claimant was not totally or substantially disabled as of 1959. Yet, on the same day this Seldomridge matter was argued, the Secretary took a totally contrary position as to the importance of ventilatory tests in Anthony Yeckabofsky v. Anthony J. Celebrezze, Civil Action No. 28177.
In Seldomridge, the Appeals Council suggested that the claimant's performance on the 1959 and 1962 ventilatory tests was a significant criterion in establishing that in 1959 Seldomridge was not substantially disabled:
'Dr. Cander's examination (in 1962) although indicating a low oxygen saturation, serves primarily to demonstrate by the greatly increased respiration rate and reduced maximum breathing capacity that the claimant's condition was worsened subsequent to the period in issue.'
Thus the implication left by the Appeals Council is that the 1959 ventilatory studies are of value in establishing that at that time, Seldomridge had no disability.
Yet in Yeckabofsky v. Celebrezze, supra, where the ventilatory test results were somewhat more favorable to the claimant's position, the Secretary argued that such ventilatory tests were of little value in determining disability. In fact, in Yeckabofsky and Appeals Council concluded that:
'* * * the use of ventilatory tests in determining the degree of pulmonary impairment should be accorded limited significance. This is pointed out in a work entitled Chronic Bronchitis, Emphysema and Cor Pulmonale by D. H. Stuart-Harris, M.D., Sir George Franklin, Professor of Medicine at the University of Sheffield, and T. Hanley, M.D., Lecturer in Medicine at the same University (1957), p. 86, wherein in discussing ventilation studies, it is stated, '* * * the test appears to be subject to a relatively large error imposed by the necessity for cooperation of the patient and is not highly reproducible.' 'Dr. Hurley L. Motley, in the summary of his article 'The Pneumoconiosis,' published in Clinical Cariopulmonary Physiology, (Supra, pp. 857-8), stated: "The extent of the impairment of pulmonary function from inhalation of silica or other mineral dust as silicates, * * * coal, * * * or chalk requires pulmonary function measurements with adequate tests to evaluate (1) the ventilatory status, (2) the transport of oxygen and carbon dioxide in the lungs and (3) pulmonary blood flow. Single test of lung function or tests of only one aspect are unsatisfactory. The presence of x-ray changes constitutes no cause for removing the worker from the job as demonstrated in the 98 diotomite (earth consisting of diatom or the siliceous remains) workers studied. No further progression may occur with improved dust control in the plant." (Tr. 138-139.)
It is of more than passing interest that in Seldomridge, where a test result in ventilatory studies was possibly disadvantageous to the claimant's position, the Government did not cite the aforementioned treatises, which it found so persuasive as to permit disregarding ventilatory studies in Yeckabofsky.
(2) Claimant's History at Philadelphia Department of Public Health:
From 1952 to 1962, Seldomridge attended the Tuberculosis Case Registry of the Philadelphia Department of Public Health where a series of x-rays were taken at intervals. A diagnosis of moderately advanced pulmonary tuberculosis -- active was made when he was first seen on May 22, 1952. After a period of hospitalization in 1954, the City Health Department diagnosis was moderately advanced pulmonary tuberculosis -- inactive. Seldomridge was not seen at the clinic from 1955 until December 29, 1958. At this latter time the diagnosis was moderately advanced pulmonary tuberculosis -- inactive. (Tr. 246-247.)
On December 21, 1959, he was again seen at the Health Clinic when the diagnosis was that he continued to 'show moderately advanced fibro-calcific tuberculosis in the right upper lobe. There is no evidence of any active tuberculosis at this time.' He was next seen at the clinic on June 4, 1962, at which time the diagnosis was revised to moderately advanced pulmonary tuberculosis -- active.
Thus, upon considering plaintiff's tuberculosis history prior to and subsequent to July 1959, and his complaints of breathlessness and inability to work, the Appeals Council could have sustained his claim on the basis of the following: The reports of the Veterans Administration that he had an old minimum reinfection tuberculosis of the right upper lobe of questionable activity with shortness of breath, fatigue, suffocation, pains to the upper chest, and coughs; related reports of Dr. Cohen; the findings of the Administrators of the New Jersey State Temporary Disability law; and the report of the Burge Tuberculosis Clinic. But in the exercise of their fact finding discretion, the Appeals Council found the contrary report of the City of Philadelphia Clinic 'to be more compelling.' (Tr. 121.)
POSSIBILITY OF GAINFUL EMPLOYMENT FOR INDIVIDUALS WITH SUCH DISABILITIES
Thus, taking the evidence most favorable to the defendant, the medical evidence establishes that in July 1959, Seldomridge was either 57 or 59 years old, and that he had a history of emphysema, arteriosclerotic disease and high blood pressure; in addition, he had a substantial extended history of prior active and inactive pulmonary tuberculosis and, as of July 1959, apparently there was a disagreement among medical experts as to whether his prior active tuberculosis was becoming reactivated.
Claimant could never return to his former vigorous duties as a shipfitter or to other tasks which require similar strenuous exertion. The inquiry therefore becomes -- with such permanent partial disability, what were the 'economic realities' of obtaining employment in this area for persons with the combination of disabilities which plaintiff
The Secretary has not established that employment opportunities are available merely because his doctor does not find the tuberculosis active; rather, under this test, the issue is whether employers would hire men when there is a medical disagreement about whether their tuberculosis has been reactivated. As the Court of Appeals has held:
'Thus in the case of an employee who can no longer perform the work he used to do but is not totally disabled the question is what can he do by way of any gainful employment. Kerner v. Flemming, 283 F.2d 916 (2 Cir. 1960). The words 'any substantial gainful activity' must be read in the light of what is reasonably possible and not what is conceivable. Hodgson v. Celebrezze, supra. Mere theoretical ability to engage in substantial gainful activity is not enough if no reasonable opportunity for this is available. Roberson v. Ribicoff, 299 F.2d 761, 763 (6 Cir. 1962).' (Emphasis added.) Janek v. Celebrezze, supra, 336 F.2d at p. 833.
To fill the gap between 'theoretical ability' and 'reasonable opportunity * * * available,' the Secretary relied exclusively on and made extensive citations from the Dictionary of Occupational Titles and the U.S. Census of Population: 1960. Detailed Characteristics of Pennsylvania. (Tr. 125-127.) As has apparently been his consistent practice with all claimants, the Secretary made his findings as to the availability of such employment opportunities in this area without ever advising plaintiff that the Secretary would rely on such documents or would have such documents formally admitted into evidence.
I listed the matter for reargument and required the relevant documents to be included in the instant record for the opportunity to read the 'substantial evidence' which the Secretary claims demonstrates the availability of such employment opportunities for individuals who have a disability of the type or similar to the type which plaintiff had.
The Dictionary of Occupational Titles makes extensive reference to skills which are required in light industry jobs. The U.S. Census of Population: 1960 is interesting reading as to the number of persons who are employed in various types of Pennsylvania industries. But none of the data is relevant to determine whether industries in Pennsylvania are hiring men in their late fifties who have disabilities similar to those which plaintiff had. Thus, at the oral argument the United States Attorney was pointedly asked the following:
'THE COURT: * * * What is the basis for my making the inference, or for even more, the Appeals Council making the inference that Pennsylvania industries are hiring men in their late fifties who had the limited disability which the Appeals Council found that he had. What documentation do you have of that?' (Tr. Oral Argument 5-6).
To which question the United States Attorney replied with appropriate candor:
'None that I can find.' (Tr.Oral Argument 6).
Neither can the Court find such evidence. Since there is no evidence to suggest 'what employment opportunities are there for a man who can do only what applicant can do?' Kerner v. Flemming, supra, 283 F.2d at 921, and since there has been no 'realistic showing * * * that * * * there (exists) a reasonable opportunity for the plaintiff to engage in substantial gainful employment' Fedor v. Celebrezze, 218 F.Supp. 667, 668 (E.D.Pa.1963), and since there is not a scintilla of evidence to suggest 'whether employers in competitive industry would hire claimant to do such work' Secoolish v. Celevrezze, 216 F.Supp. 935, 939 (D.N.J.1963), the decision of the Secretary must be reversed, and summary judgment granted for plaintiff.