Richardson v. Perales

402 U.S. 389, 91 S. Ct. 1420, 28 L. Ed. 2d 842, 1971 U.S. LEXIS 103
CourtSupreme Court of the United States
DecidedMay 3, 1971
Docket108
StatusPublished
Cited by22,352 cases

This text of 402 U.S. 389 (Richardson v. Perales) is published on Counsel Stack Legal Research, covering Supreme Court of the United States primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Richardson v. Perales, 402 U.S. 389, 91 S. Ct. 1420, 28 L. Ed. 2d 842, 1971 U.S. LEXIS 103 (1971).

Opinions

[390]*390Me. Justice Blackmun

delivered the opinion of the Court.

In 1966 Pedro Perales, a San Antonio truck driver, then aged 34, height 6' 11", weight about 220 pounds, filed a claim for disability insurance benefits under the Social Security Act. Sections 216 (i) (1), 68 Stat. 1080, and 223 (d)(1), 81 Stat. 868, of that Act, 42 U. S. C. § 416 (i) (1) and 42 U. S. C. § 423 (d)(1) (1964 ed., Supp. V), both provide that the term “disability” means “inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which . . . ,”1 Section 205 (g), 42 TJ. S. C. §405 (g), relating to judicial review, states, “The findings of the Secretary as to any fact, if supported by substantial evidence, shall be conclusive . . . .”

The issue here is whether physicians’ written reports of medical examinations they have made of a disability claimant may constitute “substantial evidence” supportive of a finding of nondisability, within the § 205 (g) standard, when the claimant objects to the admissibility of those reports and when the only live testimony is presented by his side and is contrary to the reports.

I

In his claim Perales asserted that on September 29, 1965, he became disabled as a result of an injury to his back sustained in lifting an object at work. He was seen by a neurosurgeon, Dr. Ralph A. Munslow, who first recommended conservative treatment. When this provided no relief, myelography was performed and surgery for a possible protruded intervertebral disc at L-5 was advised. The patient at first hesitated about surgery [391]*391and appeared to improve. On recurrence of pain, however, he consented to the recommended procedure. Dr. Munslow operated on November 23. The surgical note is in the margin.2 No disc protrusion or other definitive pathology was identified at surgery. The post-operative diagnosis was: “Nerve root compression syndrome, left.” The patient was discharged from Dr. Munslow’s care on January 25, 1966, with a final diagnosis of “Neuritis, lumbar, mild.”

Mr. Perales continued to complain, but Dr. Munslow and Dr. Morris H. Lampert, a neurologist called in consultation, were still unable to find any objective neurological explanation for his complaints. Dr. Munslow advised that he return to work.

In April 1966 Perales consulted Dr. Max Morales, Jr., a general practitioner of San Antonio. Dr. Morales hospitalized the patient from April 15 to May 2. His final [392]*392discharge diagnosis was: “Back sprain, lumbo-sacral spine.”

Perales then filed his claim. As required by § 221 of the Act, 42 U. S. C. § 421, the claim was referred to the state agency for determination. The agency obtained the hospital records and a report from Dr. Morales. The report set forth no physical findings or laboratory studies, but the doctor again gave as his diagnosis: “Back sprain — lumbo-sacral spine,” this time “moderately severe,” with “Ruptured disk not ruled out.” The agency arranged for a medical examination, at no cost to the patient, by Dr. John H. Langston, an orthopedic surgeon. This was done May 25.

Dr. Langston's ensuing report to the Division of Disability Determination was devastating from the claimant's standpoint. The doctor referred to Perales’ being “on crutches or cane” since his injury. He noted a slightly edematous condition in the legs, attributed to “inactivity and sitting around”; slight tenderness in some of the muscles of the dorsal spine, thought to be due to poor posture; and “a very mild sprain [of those muscles] which would resolve were he actually to get a little exercise and move.” Apart from this, and from the residuals of the pantopaque myelography and hemilaminectomy, Dr. Langston found no abnormalities of the lumbar spine. Otherwise, he described Perales as a “big physical healthy specimen . . . obviously holding back and limiting all of his motions, intentionally. . . . His upper extremities, though they are completely uninvolved by his injury, he holds very rigidly as though he were semi-paralyzed. His reach and grasp are very limited but intentionally so. . . . Neurological examination is entirely normal to detailed sensory examination with pinwheel, vibratory sensations, and light touch. Reflexes are very active and there is no atrophy anywhere.” The [393]*393orthopedist’s summarization, impression, and prognosis are in the margin.3

The state agency denied the claim. Perales requested reconsideration. Dr. Morales submitted a further report to the agency and an opinion to the claimant’s attorney. This outlined the surgery and hospitalizations and his own conservative and continuing treatment of the patient, the medicines prescribed, the administration of ultrasound therapy, and the patient’s constant complaints. The doctor concluded that the patient had not made a complete recovery from his surgery, that he was not malingering, that his injury was permanent, and that he was totally and permanently disabled.4 He recommended against any further surgery.

[394]*394The state agency then arranged for an examination by Dr. James M. Bailey, a board-certified psychiatrist with a subspecialty in neurology. Dr. Bailey’s report to the agency on August 30, 1966, concluded with the following diagnosis:

“Paranoid personality, manifested by hostility, feelings of persecution and long history of strained interpersonal relationships.
“I do not feel that this patient has a separate psychiatric illness at this time. It appears that his personality is conducive to anger, frustrations, etc.”

The agency again reviewed the file. The Bureau of Disability Insurance of the Social Security Administration made its independent review. The report and opinion of Dr. Morales, as the claimant’s attending physician, were considered, as were those of the other examining physicians. The claim was again denied.

Perales requested a hearing before a hearing examiner. The agency then referred the claimant to Dr. Langston and to Dr. Richard H. Mattson for electromyography studies. Dr. Mattson’s notes referred to “some chronic or past disturbance of function in the nerve supply” to the left and right anterior tibialis muscles and right [395]*395extensor digitorium brevis muscles that was “strongly suggestive of lack of maximal effort” and was “the kind of finding that is typically associated with a functional or psychogenic component to weakness.” There was no evidence of “any active process effecting [sic] the nerves at present.” Dr. Langston advised the agency that Dr. Mattson’s finding of “very poor effort” verified what Dr. Langston had found on the earlier physical examination.

The requested hearing was set for January 12, 1967, in San Antonio. Written notice thereof was given the claimant with a copy to his attorney.

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402 U.S. 389, 91 S. Ct. 1420, 28 L. Ed. 2d 842, 1971 U.S. LEXIS 103, Counsel Stack Legal Research, https://law.counselstack.com/opinion/richardson-v-perales-scotus-1971.