APPEAL FROM THE UNITED STATES DISTRICT COURT FOR THE MIDDLE DISTRICT OF PENNSYLVANIA
Before Aldisert, Van Dusen and Hunter, Circuit Judges.
In this appeal, Mamie Lewis challenges the district court's grant of summary judgment for defendant, including its holding that her religious beliefs do not qualify as good cause for her decision to decline remedial surgery under 20 C.F.R. § 404.1507 (1977), and the conclusion of the Department of Health, Education and Welfare (HEW) that she is not disabled within the meaning of 42 U.S.C. §§ 416(i)(1) and 423(d) (1976)*fn1 and 42 U.S.C. § 1381a. Lewis' claim for disability benefits was denied by an administrative law judge (ALJ) in an opinion after a hearing at which Lewis was represented by counsel. The ruling of the ALJ became the final decision of the Secretary of HEW when it was approved by HEW's Appeals Council on Lewis' request for review. Lewis then filed suit in the district court under the authority of 42 U.S.C. § 405(g), seeking reversal of HEW's decision or a remand to the agency for an additional hearing in order that further evidence could be developed. After both parties had moved for summary judgment, the district court referred the case to a magistrate, who recommended the grant of summary judgment for the defendant Secretary. In a separate opinion, the district court adopted the magistrate's opinion and independently stated its reasons for such grant of summary judgment for the defendant. The case comes before us on appeal under 28 U.S.C. § 1291. We vacate the district court order and remand the case to the district court for entry of an order remanding the case to the Secretary for further evaluation and consideration.
Lewis (claimant) is 55 years old. She worked as a clerk-typist for the Commonwealth of Pennsylvania from 1955 until 1967, when she left work due to back problems. From 1969 until February 1977 she was employed as a cafeteria assistant for the Harrisburg School District, working approximately 21/2 hours per day preparing frozen lunches and cleaning up after lunch.
The medical evidence examined by the ALJ consisted of medical reports from several doctors. These reports indicated that claimant has had a massive uterine tumor since 1967. A 1974 medical report noted that claimant had difficulty moving and breathing because of the pressure created by the tumor. An April 27, 1977, letter of Dr. Charles Delone stated that the tumor was larger than a full-term fetus. A July 14, 1977, report of Dr. S. Clayton, who works for the Dauphin County Board of Assistance and saw claimant at the request of the welfare authorities, concluded that claimant could not work as a result of her condition.
Claimant testified at the hearing that she had substantial pain, weakness and shortness of breath (Ap. 31-33). Claimant also testified concerning her daily routine to the effect that she became exhausted doing light housework and had reduced her participation in church events, although she was still in the choir.
Claimant had been repeatedly advised by her doctors that the tumor could be surgically removed and that she would be cured if she underwent a hysterectomy. The ALJ found that the condition was remediable with surgery.
Claimant has consistently refused to undergo such surgery due to her religious belief in faith healing. Claimant is a devout member of the Church of God. Her minister accompanied her to the hearing before the ALJ and testified concerning the Church's tenets and Lewis' beliefs. The minister explained that the Church had no tenet against resorting to surgery, but that he was willing to pray with claimant to achieve her cure. The minister stated that he supported her decision to rely on divine healing. Claimant testified that she believed in divine healing because she had been relieved of a back ailment in 1967 without the aid of medical science. She attributed this cure to the power of prayer. The ALJ stated that "(t)he claimant indicated at the hearing that she is reluctant to undergo surgery as a result of her religious beliefs." Although defendant does not challenge her religious belief as the cause of claimant's refusal of surgery for a condition "remediable with surgery," neither the ALJ nor the Appeals Council made a specific finding that claimant was sincere in her stated religious objection to surgery on her abdomen (Ap. 14-15).
The ALJ also noted claimant's physical appearance as part of the evidence available for determining disability. The ALJ stated that "(a)t the hearing she appeared to be healthy and answered the questions clearly and intelligently. She was a soft-spoken, very pleasant woman who did not appear to be disabled." This was the final piece of evidence noted by the ALJ.
After reviewing the evidence, the ALJ concluded that the claimant was not disabled. The ALJ stated that:
"Having considered the claimant's age, education, and work experience, and in light of her testimony, medical reports and doctor's opinions, it is this Administrative Law Judge's conclusion that the claimant is not disabled. Her problem is not so significantly severe that it would prevent her from working. The condition is remediable with surgery. Therefore in light of these facts it is this Administrative Law Judge's conclusion that the claimant is not entitled to disability insurance benefits or supplemental security income benefits."
The ALJ's opinion was adopted by the Secretary.
The claimant appeals on the basis of lack of evidence to support this finding of non-disability by the Secretary and argues that, if we conclude that claimant is disabled, we must award her benefits because her religious belief in faith healing is justifiable cause for refusing to accept remedial surgery under the regulations to § 423, which deny disability benefits to claimants who willfully refuse to undergo remedial care to cure their disability, unless the claimant can show "justifiable cause" for such refusal. 20 C.F.R. § 404.1507 (1977).
In reviewing the Secretary's finding of disability we are mindful that any findings of fact by the Secretary must be accepted as conclusive by a reviewing court "if supported by substantial evidence." 42 U.S.C. § 405(g) (1976). "Substantial evidence" is "such relevant evidence as a reasonable mind might accept as adequate to support a conclusion." Richardson v. Perales, 402 U.S. 389, 401, 91 S. Ct. 1420, 1427, 28 L. Ed. 2d 842 (1971), Dobrowolsky v. Califano, 606 F.2d 403 (3d Cir. 1979).
In this case, claimant offered substantial evidence concerning the details of her ailment. Most importantly she submitted the report of Dr. Clayton, who was hired by the Dauphin County Board of Assistance to determine whether claimant was disabled in regard to her obtaining welfare benefits. Dr. Clayton found that claimant "cannot work." This doctor made the finding for another government agency, and his finding is entitled to substantial weight. Clearly, from this evidence, claimant has carried her initial burden to prove disability.
The burden now shifts to the Secretary to prove non-disability. The ALJ offers no explanation why he rejected Dr. Clayton's finding or claimant's subjective complaints concerning her health. The ALJ's review of the evidence demonstrates only two factors which might serve to justify his conclusion. First, after describing petitioner's daily routine, he concludes that "(h)er ability to get around and function normally appears to be generally unimpeded." In view of the fact that claimant has difficulty moving and breathing,*fn2 frequently feels too sick to go to church*fn3 or clean her house,*fn4 needs ...