consider such evidence as "substantial" in this case.
Other evidence was introduced solely by exhibits. Throughout the record there are reports of interviews by claims representatives with the plaintiff, where something, and sometimes much, is made of the fact that the plaintiff has no tremors, no deformities and sits and stands without apparent difficulty. (For example, see Exhibit 11, page 65.) Obviously, anthracosilicosis does not create deformities, does not create tremors and does not prevent a man from sitting or walking. Such observations, within the confines of a limited interview, give no consideration to the results of such disease on exertion and on sustained effort. Any lack of medical attention of a concentrated nature, is explained by the fact that the plaintiff does not feel that medical attention will do him any substantial good and that his condition will "get worse". (p. 13) This is true of the condition of anthracosilicosis. Thus far, the medical profession has accomplished little or nothing by way of arresting the progress of this insidious disease.
Exhibit 21 (p. 79 et seq.) discloses that the plaintiff suffers, as previously indicated, shortness of breath, constant cough and weakness, all the result of a second stage anthracosilicosis with emphysema. Dr. Weaver, noting dyspnea, "barrelchestedness", and a decrease in vital capacity, concludes that plaintiff is totally and permanently disabled and, after labeling the condition as "progressive", concludes "no exertion allowed". Such evidence does not support the findings and conclusions of the examiner.
Dr. Corazza apparently saw the plaintiff on one occasion only and, like all other witnesses, found the plaintiff suffering from anthracosilicosis. If we read his report correctly, he found maximum breathing capacity of only forty-three per cent. (p. 83) It is unlikely that an individual with a maximum breathing capacity of only forty-three per cent could, on a sustained basis, perform either light or sedentary work.
Dr. Corazza suggested that the lack of breathing capacity may be the result of "lack of effort" on the part of the plaintiff. This then suggested that a psychiatric condition might be involved for which plaintiff was apparently referred to Dr. John T. Delehanty (Exhibit 24, pages 92 and 93). Although the facts are to the contrary, Dr. Delehanty suggested that plaintiff had received no medical attention since 1954. (p. 93) If he assumed this as a fact, his opinion might well have been mistakenly influenced. Aside from this, he too found plaintiff suffering from "bizarre breathing patterns" and concluded with the "possibility that the patient's affect might be just a little bit flattened". (p. 93) His was apparently a psychiatric examination with emphasis on plaintiff's mental condition and with little reference to his anthracosilicotic condition.
However, Dr. Grynkewich (Exhibit 23, page 88 et seq.) found the plaintiff "cooperative" and he too found stage two anthracosilicosis. (p. 89) He found "ventilatory difficulty". (p. 90) He likewise found pulmonary insufficiency, and "hyperventilation syndrome", all obviously related to anthracosilicosis.
We have thus reviewed the evidence in considerable detail in order to determine whether the findings and conclusions of the examiner, as affirmed by the Appeals Council, is supported by substantial evidence.
Turning now to the examiner's decision, it will be noted that in summarizing the plaintiff's statements and allegations, he recognizes the existence of anthracosilicosis as determined by X-ray findings, the fact that plaintiff was, as early as 1964, advised not to work because of such condition, the fact that plaintiff noticed shortness of breath as early as 1963, the fact that he has not worked since 1960, the fact that he is short of breath after walking a block or less, the fact that he has headaches, shortness of breath, fatigue and chest pains and that he has been awarded benefits by the Pennsylvania compensation authorities.
In summarizing the medical evidence produced, the examiner recognizes plaintiff's total disability to do his usual work, the existence of a stage two anthracosilicosis, the existence of pulmonary emphysema, the fact that at least one medical report suggests that "no exertion was allowed", the existence of wheezing with shortness of breath and coughing with expectoration, soreness or pain in the chest, a decreased maximum breathing capacity, pulmonary insufficiency and fatigue.
In evaluating the medical and other evidence of record, the examiner recognizes, by way of reference to the code of Federal regulations, that a disease of the lungs evidenced by X-rays and other objective findings, when producing breathlessness, pain or fatigue on slight exertion, "such as walking several blocks * * * or doing small chores", is an example of an "impairment which would ordinarily be considered as preventing substantial, gainful activity". (p. 9) That is precisely what is involved in the instant case. Additionally, the examiner recognizes other references to the code of Federal regulations which suggest that "an alleged impairment is medically determinable only if it can be verified by the use of clinical and laboratory diagnostic techniques". (p. 10) In the instant case, it is uncontradicted that the existence of anthracosilicosis has been unequivocally established by X-ray studies and by other clinical studies with particular reference to the lungs, such as the tests involving maximum breathing capacity. The examiner refers to the report of Dr. Weaver as being unsupported by clinical and other information. However, other sources of medical information based upon X-ray and clinical studies, clearly established the soundness of Dr. Weaver's conclusions. The language of the examiner's decision appears to be devoted less to an objective review of the evidence than to justification for his ultimate findings. This is perhaps best demonstrated by language to the effect that "extensive studies disclose only anthracosilicosis, stage two, with no significant evidence of emphysema". (p. 12) To suggest that the plaintiff suffers only anthracosilicosis is to ignore the fact that this disease is in and of itself, and without complications, many times totally disabling.
To justify his conclusions, the examiner (p. 12) went outside the record and quoted from an article written by Professor Christie of McGill University, on the subject of pneumoconiosis as follows: "A radiological diagnosis of silicosis is compatible with perfect health and there may be unimpaired work capacity for many years after the disease is recognized". In so stating, the examiner overlooks that "pneumoconiosis" and "anthracosilicosis", although related symptomatically, are not precisely the same condition. This is best evidenced by the fact that in 1965, although "anthracosilicosis" was for many years a compensable condition under the Pennsylvania Occupational Disease Act, the Legislature, nonetheless, found it necessary to amend the Act to include as an additional compensable condition "coal miner's pneumoconiosis". The difference as we understand it in the language of a layman is that "anthracosilicosis" is contracted by reason of the inhalation of coal dust and rock dust (free silica) whereas pneumoconiosis is contracted by reason of the inhalation of coal dust only.
In any event it matters not what Professor Christie may say as regards the average man or as regards the "standard" man. As was said in Klimaszewski v. Flemming, supra, 176 F. Supp. at 931:
"* * * However, the definition of disability cannot be considered in vacuo. The definition relates to the individual claimant. 'The act is concerned not with a standard man of ordinary and customary abilities, but with the particular person who may claim its benefits and the effect of the impairment upon that person, with whatever abilities or inabilities he has'. Dunn v. Folsom, D.C.W.D.Ark. 1958, 166 F. Supp. 44, 48."
Other language in the Klimaszewski case likewise becomes pertinent. There, as here, it was suggested that the plaintiff could resort to employment of a clerical nature, quite unlike the duties which he had performed throughout his entire lifetime. The Court stated at page 932:
"* * * Thirty-one years as a stevedore is hardly qualification for any task which requires skilled manual dexterity or the use of figures or letters. * * *"