APPEAL FROM THE UNITED STATES DISTRICT COURT FOR THE EASTERN DISTRICT OF PENNSYLVANIA
Weis, Sloviter and Becker, Circuit Judges.
In the course of presenting a claim for benefits under the Social Security Act on the basis of several physical conditions, plaintiff produced hospital records which disclosed that he also suffered from severe alcoholism. Because the agency failed to properly evaluate this condition in conjunction with the plaintiff's contentions of disability, we remand for further consideration.
Plaintiff applied for payments under both the disability, 42 U.S.C. §§ 401-432 (1976 & Supp. IV 1980), and the supplemental security income, id. §§ 1381-1385 (1976 & Supp. IV 1980), provisions of the Social Security Act. After a hearing, the ALJ denied benefits in a ruling that was affirmed by the Appeals Council. The district court found there was substantial evidence to sustain the agency's decision.
Plaintiff is 61 years of age. He was an insurance adjuster for many years, but has not worked since 1973. He claims to be disabled because of paralysis on the left side, a heart condition, and a lung impairment. At the hearing before the ALJ, plaintiff stated, "I don't consider myself a heavy drinker," and added, "I still love my booze but I wouldn't touch it now, I'm afraid of it." However, he admitted that he still drank beer, and said, "There's no such thing as an alcoholic."
The medical evidence, as gleaned from hospital records, shows that in 1975 plaintiff disclosed a history of drinking two quarts of beer and a half pint of whiskey per day. In March 1976, he was admitted to Hahnemann Hospital in Philadelphia and discharged three weeks later. The diagnosis was tuberculosis. An admission note commented on "chronic alcohol abuse."
In December 1978, plaintiff was admitted to St. Agnes Hospital in Philadelphia after being found at the foot of some subway steps with a laceration on the back of his head. The admission report stated that plaintiff "looked severely intoxicated." The final diagnosis was fractured skull, cerebral contusion, alcoholism, and dementia. Plaintiff had a stormy, two-month confinement at the hospital. On discharge, the record noted, "The patient remained in a state of dementia, still confused, disoriented, hypokinetic with decreased level of speech." Plaintiff was then sent to a nursing home where he remained until November 1979.
The next hospital record is also from St. Agnes Hospital, where plaintiff was admitted in November 1979 after another fall. It noted that plaintiff "is known to have a left hemiparesis for the last four years . . . . and a heart condition." He was discharged two days later.
At the request of the Secretary, plaintiff was examined in March 1980 by a first-year medical resident. The resident found "peripheral neuropathy of a mild degree, probably on a nutritional basis[,] substantial alcohol abuse, with relative [sic] few stigmata of chronic alcohol or liver disease on physical examination[,] . . . . probable seizure disorders by history, . . . . needs EEG and Brain Scan." During the examination, plaintiff conceded that he "used to be a heavy drinker, up to over 1 quart a day of whiskey." Although the plaintiff's speech was fluent and coherent, "his thought content was disjointed." The resident found that plaintiff had adequate ranges of motion and could sit for sustained periods, but submitted no opinion on whether he was able to work.
The EEG and brain scan apparently were not performed after the resident's medical examination. However, the St. Agnes Hospital records show that EEGs were performed there in January 1979 and indicated "abnormal tracing."
The ALJ cited the report by the resident, and discredited the plaintiff's testimony about his physical condition as inconsistent with the medical evidence. Plaintiff was found able to work except when it required prolonged sitting, standing, walking, or medium to heavy lifting.
The medical records in this case reek of chronic and severe alcoholism. Nevertheless, the ALJ apparently discounted that evidence because of the resident's comment that there were "few stigmata of chronic alcohol or liver disease." No mention is made in the resident's report of a review of the prior hospital records, and it must be assumed that the medical history came from plaintiff. Under those circumstances, there is some doubt whether the resident would have come to ...