The opinion of the court was delivered by: LUONGO POWERS, III
This is an action brought pursuant to section 1631(c)(3) of the Social Security Act, 42 U.S.C. § 1383(c)(3),
for judicial review of the Secretary's denial of disability benefits under the Supplemental Security Income Program, specifically 42 U.S.C. § 1382c(a)(3). Both plaintiff and the Secretary have moved for summary judgment. The magistrate, to whom the case was referred for Report and Recommendation, recommends that the decision of the Secretary be reversed and judgment entered in favor of plaintiff. I agree that the disposition recommended by the magistrate is warranted on this record, although I do not adopt his report in its entirety.
The facts outlined in the magistrate's report, which is appended hereto, are essentially correct. Although the discrepancy is of marginal significance, I note that the magistrate fixes 1971 as the year when plaintiff last worked; the record, however, reveals that plaintiff was last employed in the first quarter of 1973.
Exhibit 34, Administrative Record (Document No. 4) at 207-09. During the past several years, plaintiff has received medical treatment for a variety of physical ailments,
and she has been in treatment, apparently on a weekly basis, at the Northeast Community Mental Health (COMHAR) facility since November 1976. Transcript & Exhibits 5, 15, 35, Administrative Record (Document No. 4) at 53-56, 132, 159, 211. In addition, plaintiff was examined subsequent to the hearing on disability by a psychiatrist and by a specialist in internal medicine and cardiology, both of whom were employed by the Social Security Administration.
The ALJ concluded that plaintiff did not have a disabling physical or mental impairment. With respect to disabling mental impairment, I agree with the magistrate that this conclusion is not supported by substantial evidence. As the magistrate points out, the ALJ improperly discounted the psychiatric diagnoses as evidence of mental disability. The ALJ characterized the reports of Dr. Heller, the treating psychiatrist at the COMHAR facility who diagnosed plaintiff's mental condition as severe situational depression, as "vague and non-specific" and "without substantiating information." Decision, Administrative Record (Document No. 4) at 16. The ALJ also rejected the diagnosis of latent schizophrenia submitted by Dr. Wallace, the psychiatrist employed by the Social Security Administration, Exhibit 35, Administrative Record (Document No. 4) at 212,
stating that Dr. Wallace's conclusions were "not consistent with his findings and are not supported by substantial demonstrable proof." Decision, Administrative Record (Document No. 4) at 16.
The ALJ discredited Dr. Wallace's diagnosis by selectively extracting from his report certain observations about plaintiff's orientation, judgment, and intellect, and coupling these observations with her findings that plaintiff was able to discharge her household chores and to care for her children. The ALJ also noted that plaintiff's neighbor testified that plaintiff's behavior was normal and that she got along well with others. Id. In addition, the ALJ observed that plaintiff had engaged in substantial gainful employment through 1974. Id. From this evidence, the ALJ concluded that plaintiff's "so-called situational depression and symptoms imposed very little restriction on her (; that the evidence contraindicates . . . mental impairments disabling in nature(; that her) mental condition create(s) no significant limitations(; and that she retains the residual capacity to meet the physical and mental demands of her former work." Id. at 16-17.
Plaintiff's ability to take care of her house and her children does not contradict Dr. Wallace's diagnosis. Indeed, he took into account that plaintiff "spends her days absorbed in the household chores and childrearing tasks." Exhibit 35, Administrative Record (Document No. 4) at 212. He concluded, however, that although there was only moderate deterioration in plaintiff's personal habits, her ability to relate to others was nevertheless severely impaired and her activities and interests were severely limited. Plaintiff's friendship with her neighbor, even given the frequency of the visits, does not, in my view, constitute substantial evidence either to undermine the doctor's conclusion or to support the ALJ's finding that "there is no marked restriction in . . . (plaintiff's) ability to relate to others."
Finally, as I noted in footnote 2, supra, the record contradicts the ALJ's finding that plaintiff had engaged in substantial gainful employment as late as 1974. Even were that finding to have been correct, however, plaintiff's ability to work in 1974 would cast little doubt on this diagnosis made in 1978.
I recognize that the ALJ was concerned by the absence in the record of what she termed "acceptable and credible documentation" and "substantial demonstrable proof." Decision, Administrative Record (Document No. 4) at 16. And I would probably agree that the naked diagnosis of situational depression submitted in the several reports of Dr. Heller was, standing alone, insufficient to establish a disabling mental impairment. I cannot agree, however, that the diagnosis of Dr. Wallace, the psychiatrist employed by the Social Security Administration, was inadequate and unacceptable. Dr. Wallace personally examined plaintiff and he noted that in the course of his examination plaintiff "exhibited a wealth of psychiatric symptomatology." Exhibit 35, Administrative Record (Document No. 4) at 212. His report evidences that his diagnosis and prognosis were based not only on plaintiff's representations of her symptoms but also on his own observations and evaluation of her responses during the interview.
The ALJ's principal stumbling block appears to be that a psychiatric impairment is not as readily amenable to substantiation by objective laboratory testing as is a medical impairment and that consequently, the diagnostic techniques employed in the field of psychiatry may be somewhat less precise than those in the field of medicine. However, where, as here, there is no other reason to question the diagnostic technique, the relative imprecision of the psychiatric methodology and the absence of substantiating documentation is not a sufficient basis upon which to reject the report. See, e. g., Taddeo v. Richardson, 351 F. Supp. 177, 180 (C.D.Cal.1972) (letter from regular attending physician, plus psychiatric report and intake interview constitute medically acceptable technique); cf. Kennedy v. Weinberger, 369 F. Supp. 336, 339-40 (E.D.Pa.1974) (Lord, Ch.J.) (general conclusions or naked medical diagnoses may establish disability absent substantial evidence to contrary).
There are no objective laboratory findings to corroborate Dr. Wallace's diagnosis. Nevertheless, there are several other medical opinions in this record which lend support to, rather than cast doubt upon, his conclusion. I have already noted that Dr. Heller was regularly treating plaintiff at the COMHAR facility for situational depression. Dr. Beckett, who treated plaintiff a number of times at Episcopal Hospital, noted that plaintiff might possibly suffer from psychogenic housewife syndrome. Exhibit 32, Administrative Record (Document No. 4) at 199. Dr. Lizardo, whose specialty is pediatrics but who treated plaintiff on several occasions, reported that plaintiff suffered anxiety neurosis. Exhibit 18, Administrative Record (Document No. 4) at 169. Finally, Dr. Goodman, the internist and cardiologist employed by the Social Security Administration to examine plaintiff, reported that his examination revealed an "extremely anxious" and "extremely nervous patient." Exhibit 37, Administrative Record (Document No. 4) at 217. Dr. Goodman concluded that in light of his significant physical findings as well as the objective evidence, which revealed no physiological basis for many of plaintiff's complaints, "the anxiety factor and psychotherapeutic regime are certainly major factors in her disability." Id. at 218.
The cumulative effect of these opinions leads me to conclude that the Secretary's decision is not supported by substantial evidence, and that plaintiff has met her burden of establishing a disabling mental impairment. In this case, because the medical evidence is in and of itself sufficient to establish disability, there is no need to consider the vocational factors that are ordinarily attendant to a finding of disability. According to section 416.903(d) of the regulations promulgated by the Secretary, "(w)here an individual's impairment(s) meets the duration requirement and is either listed in Part A of Appendix 1 or is determined to be medically the equivalent of a listed impairment, a finding of disability shall be made without consideration of the vocational factors." 20 C.F.R. § 416.903(d). Dr. Wallace's uncontradicted diagnosis of latent schizophrenia, manifested by, inter alia, severe depression, limited activities and interests, and a seriously impaired ability to relate to other people, falls into this category of impairments. See 20 C.F.R. Part 416, Subpart I, App. 1, 12.03.
After considering Dr. Wallace's prognosis that increase in plaintiff's level of functioning is unlikely and that psychotherapy would probably be ineffective, I conclude that plaintiff's mental impairment is of sufficient severity and of sufficient duration to warrant a finding of disability.
In light of the foregoing, I will enter an order reversing the Secretary's decision and granting summary judgment for plaintiff on the issue of disability. I will also remand the case to the Secretary for a determination and award of benefits.