University as a result of the physical complaints which were the basis of her application.
Lyle Nelson, M.D., a specialist in cardiology and internal medicine, and plaintiff's treating physician, testified at the hearing on plaintiff's behalf. He concluded that plaintiff was totally and permanently disabled from employment on a day-to-day basis. The factors contributing to this conclusion were congestive heart failure resulting in extreme fatigability and requiring limitations on exertion; hypertension, which was labile; recurring urinary difficulties, due to a stricture of the urethra and a cystocele, which manifest themselves with respect to both frequency and urgency; hiatal hernia; and mild osteoarthritis in the knees. There was also evidence of chronic anxiety reactions (R., p. 128). Dr. Nelson's testimony indicated that of these difficulties, only congestive heart failure was significant with respect to plaintiff's ability to engage in substantial gainful employment. The facts upon which Dr. Nelson relied in making the diagnosis of congestive heart failure were edema or swelling of both of plaintiff's ankles, a sinus tachycardia (rapid heart beat) shown on an electrocardiagram, her shortness of breath and easy fatigability.
That all of these factors did exist on or before March 16, 1967 is not disputed in the record. It appears that after plaintiff stopped working on that date, and while she restricted her activities, got more rest, and continued to take a variety of medicines prescribed by her doctors, all signs and symptoms of congestive heart failure disappeared. She voluntarily resumed work at the Duquesne University Alumni Office on a part-time basis on August 21, 1967, but, by September, plaintiff's symptoms had returned notwithstanding that she had continued with her medication, and on Dr. Nelson's recommendation she discontinued this limited employment in October, 1967. After plaintiff ceased working, she again began to feel better. The reasons for this, according to Dr. Nelson, were: "Rest, digitalis [a powerful heart stimulant], diuretics and * * * mild sedation" (R., p. 56). She has not worked since 1967 and, by March 18, 1969, the hearing date, plaintiff had not had a recurrence. William R. Bailey, M.D., examined plaintiff on January 11, 1968, and was "unable to demonstrate evidence of structural heart disease or evidence of hypertension which the patient is supposed to have had in the past" (R., p. 118).
A vocational expert testified, assuming that plaintiff's symptoms had not existed, that various jobs, including her most recent job, were within her capability and that these jobs exist in plaintiff's area in various numbers. He also testified, assuming that plaintiff's symtoms did exist, that she could perform no jobs (R., pp. 71-76).
There was no evidence supporting the first assumption upon which the vocational expert based his opinion. The hearing examiner's finding that there was such evidence was based upon the erroneous notion that the subjective complaints of a claimant are not probative of a disability. Cf. Dillon v. Celebrezze, 345 F.2d 753 (4th Cir. 1965); Marshall v. Cohen, 295 F. Supp. 649 (W.D. Pa. 1969); 20 CFR §§ 404.1501(c), 404.1524(c).
Although the only evidence of record concerning congestive heart failure points to a finding of disability, the decision of the Secretary must be affirmed because the undisputed evidence of congestive heart failure is not sufficient to prove a disability for purposes of the Act.
Section 223(d) of the Act, supra, provides that "an individual shall not be considered to be under a disability unless he furnishes such medical and other evidence of the existence thereof as the Secretary may require." 42 U.S.C. § 423(d)(5). The Secretary has pursuant to § 205(a) of the Act, 42 U.S.C. § 405(a), made regulations which set out the prerequisites to establishing certain types of impairments. The pertinent regulation provides:
"Congestive heart failure is not considered to be established * * * unless there is evidence at some point in time of signs of vascular congestion such as * * * peripheral or pulmonary edema as well as other appropriate findings." 20 CFR § 404.1539-4.00-B.
One of three conditions must be shown in order to establish congestive heart failure:
"A. Cardio-thoracic ratio of 55 percent or greater, or equivalent enlargement of the transverse diameter of the heart, as shown on teleroentgenogram (6-foot film) [an x-ray]; or