# Thomas Williams v. Louis W. Sullivan, M.D., Secretary of Health and Human Services > Court of Appeals for the Third Circuit · August 13, 1992 · 970 F.2d 1178 URL: https://www.frixlaw.com/law-library/cases/9843071 ## Case - **Full name:** Thomas WILLIAMS, Appellant, v. Louis W. SULLIVAN, M.D., Secretary of Health and Human Services - **Court:** Court of Appeals for the Third Circuit - **Decided:** August 13, 1992 - **Citations:** 970 F.2d 1178 - **Precedential status:** Published - **Opinion:** Concurrence by Garth - **Judges:** Hutchinson, Cowen, Garth, Sloviter, Becker, Stapleton, Mansmann, Greenberg, Scirica, Nygaard, Alito, Roth - **Cited by:** 970 later opinions in the Frix Law Library ## Citator (automated) - No negative treatment found by the automated citator. That is not the same as a confirmation that the case is good law; read the citing cases. - Full citator and citing cases: https://www.frixlaw.com/law-library/cases/9843071 ## How later opinions describe it (automated extraction) - holding that a claimant had not met his burden of establishing that his intellectual disability “exist[ed] before age 22” where medical reports predating the qualifying IQ result were silent regarding claimant’s intellectual capacity, even though the earlier physicians did not… - holding that where the claimant had worked for 22 years in a steel drum factory and as a security guard for about a year, the claimant’s ability “to maintain a job for most of his adult life” called his mental retardation into doubt - explaining that the pinnacle legal principal that applies to the assessment of all of the other standards: A district court is not empowered to weigh the evidence or substitute its conclusions for those of the ALJ - holding that the failure to demonstrate that mental retardation onset occurred before age 22 precluded a finding of impairment despite production of evidence of a significant mental impairment - stating that “a valid verbal scale IQ test administered by a qualified professional using the WAIS may be sufficient to establish” mental retardation under the first prong of section 12.05C ## Opinion text GARTH, Circuit Judge, concurring: I. I agree with the majority that the record reveals substantial evidence that Williams is not disabled. Indeed, the most that can be gleaned from the record is that Williams is arthritic and suffers from diabetes, which is controlled. Apart from the very questionable medical reports of Williams’ physicians, 1 of which I shall say more later, no claim is made, nor does any suggestion appear, that Williams is unable to return to the same work in which he was last employed. I write separately, however, because I strongly dispute the majority’s toleration of boilerplate, stereotyped medical reports such as those presented in this case by Williams’ counsel. The majority asserts, in dictum, that an administrative law judge may not disregard such medical “evidence” simply because the medical reports are similar to reports filed by counsel in unrelated cases. Maj. op. at 1185 n. 5. I cannot agree. My thesis, which differs from that of the majority, is a simple one: I contend, and would hold, that if an administrative law judge is presented with medical reports *1189 from any source, including reports drawn by consultative physicians of the claimant or of the government, and if the administrative law judge recognizes these reports as mimicking, virtually word-for-word, reports submitted in connection with other, unrelated claimants, the administrative law judge should then be free to ignore or reject the reports as medical evidence. I have written about this problem before, see Coria v. Heckler, 750 F.2d 245 (3d Cir.1984) (Garth, J. concurring), as have several district court judges, including former district court judge Frederick Lacey, see Franklin v. Heckler, 598 F.Supp. 784 (D.N.J.1984) and Winston v. Heckler, 585 F.Supp. 362, 367-68 , (D.N.J.1984); and Judge Clarkson Fisher, see Bradley v. Bowen, 667 F.Supp. 161 (D.N.J.1987). Yet the problem persists, affecting both claimants and taxpayers and requiring the adoption of a prophylactic rule. My overriding concern is that a claimant with a legitimate ailment or disability should not be denied benefits simply because the boilerplate medical evidence which is submitted on his behalf is non-particularized and therefore inadequate. To my mind, such a denial would be an abuse of the claimant’s rights, generated by a failure of appropriate medical evidence and appropriate legal representation. By the same token, taxpayers should not be required to pay benefits for disabilities which do not exist and are either created by a physician’s word processor, copier, or which are taken from his form file. Thus, the failure to support a claim of disability with a professional and individualistic judgment not only operates against the claimant’s interest, but, if we require administrative law judges to give weight or credence to such unprofessional reports, it cannot help but impose an unconscionable strain on the taxpaying public — a public which is already burdened with enormous social costs arising from health care needs, disability benefits and the like. II. The administrative law judge who heard Williams’ claim, after considering the reports of Williams’ physicians, chose to give their reports little weight. To understand the context in which the administrative law judge analyzed the “evidence” submitted on behalf of Williams, and to appreciate the concerns which constrained the administrative law judge in giving slight weight to that evidence, I take the rather unusual step of reproducing those parts of the administrative law judge’s opinion which identify the very serious problems resulting from rote examinations and robotic diagnoses 2 : Prior to evaluating the objective medical evidence the Administrative Law Judge notes that the claimant’s attorneys[, Freeman & Bass,] submitted a number of reports which were apparently prepared in connection with a worker’s compensation claim. These reports were submitted by Dr. Hermele, Dr. Ahmad, Dr. Klein, Dr. Pollock and Dr. Matthews. These doctors frequently submit reports in cases heard by the Secretary and the undersigned is constrained to note that their findings and conclusions rarely vary from ease to case and are carbon copy like in nature. Reports of these physicians have been reviewed frequently by the courts. Thus, in Franklin v. Heckler, 598 F.Supp. 784 (1984), the district court examined reports submitted by Dr. Pollock, Dr. Ahmad and Dr. Klein. It was noted that the physicians frequently prepared reports in Social Security claims and that with few exceptions these doctors’ findings and conclusions were remarkably similar in report after report. The court further noted that such reports were properly afforded little if any weight. The undersigned notes that similar conclusions have been reached in other unreported cases refer *1190 ring to reports from these and other doctors, including Morrison (CA 79-1962) and 81-1526, Davis (CA 83-2486) and Iacova, (CA 83-2646)- The undersigned fully considered the report of these physicians, delineated further below, but it is specifically noted that the carbon copy like nature of the reports cast significant doubt on their objective findings and conclusions. * * * * * * As noted, a number of reports were submitted which were prepared for a compensation claim. As noted as well, the undersigned frequently sees reports from these physicians and their findings rarely vary from case to case. In May of 1984 Dr. Matthews reported that the claimant suffered from rhinosinusitis and nasal pharyngitis. However, these conditions could be caused by something as simple as a cold and, more significantly, the claimant has been under no care for this nor did he have specific complaints referable to these problems at the hearing. Further, the doctor always diagnoses these conditions so that his conclusion is carbon copy like in nature and questioned. More significantly the claimant did not exhibit any significant hearing loss on an audiogram (Exhibit 27). In the same month, May 1984, the claimant was examined by Dr. Scannapiego. The doctor found the claimant’s corrected vision was essentially normal and found conjunctivitis and blepharitis [inflammation of the eyelids]. The undersigned notes that these conditions did not impair the claimant’s vision significantly and more importantly [Dr. Scannapiego] always diagnoses them. They are, however, easily treatable, even assuming they are present. The undersigned does not find the presence of any significant vision problems (Exhibit 24). Also in May of 1984 the claimant was examined by Dr. Hermele. The doctor concluded that the claimant suffered from restrictive lung disease. However, the doctor frequently submits reports to the Secretary which were originally prepared for compensation cases and he generally makes such a diagnosis. However, the claimant has not required any significant treatment, emergency or hospital care for such a problem. More significantly, while the doctor found increased pulmonary marking and increased heart size on x-rays, other reports, including 1984 hospital x-rays and the report of a consultative examiner fail to reveal similar findings." Not only does Dr. Hermele make them in nearly every report he submits, but increased pulmonary markings can be caused by smoking and need not be indicative of any objective active pulmonary disease .... In light of the lack of the treatment or care, the findings of a number of consultative examiners, the hospital record and the carbon copy like findings of Dr. Hermele it must be concluded that a pulmonary condition is not established at present. The undersigned also finds it significant that the reports of Dr. Hermele, Dr. Klein and Dr. Matthews were performed in 1984 and the claimant was able to continue to keep working well after these reports were prepared. Also in evidence are more recent reports prepared in connection with the claimant’s worker’s compensation claim. Dr. Pollock reported in January 1988 that the claimant suffered neurological residuals of exposure to fumes as well as an anxiety disorder, depression and an orthopedic impairment. However, the undersigned notes initially that numerous reports have been seen from this doctor originally prepared for compensation purposes. His diagnosis rarely varies from case to case and is carbon copy in nature. It is significant to note that the doctor found the claimant’s gait was normal, coordination was intact, sensation was normal and motor findings showed no abnormality. However, the doctor did find tremors of the eyelids, tongue and fingers but he finds this in every case and no other physician noted this while there was swaying on the Romlerg no other physician noted this and Dr. Pollock finds this in every case. ... However, the undersigned cannot accord the doctor’s conclusions great weight in light *1191 of the fact that Dr. Shah performed a full consultative psychiatric examination and found no significant emotional condition and concluded that there was no acute psychiatric problem present. The undersigned further notes that the claimant has not sought out or required care for the condition and no other consultative examiner noted emotional problems nor did the hospital report of August 1984. In light of the carbon copy like nature of Dr. Pollock’s reports and other objective evidence contrary a significant emotional problem is not established (Exhibit 25 and 20). Also in evidence is a report from Dr. Ahmad dated January 25,1988. The doctor concluded that the claimant suffered fibromyositis [inflammation of fibromus-cular tissue] and spinal sprain. The undersigned notes that Dr. Ahmad submits reports which are frequently seen by the undersigned as well as by the district courts, as noted above, and his findings and conclusions rarely vary from case to case being carbon copy like in nature_ However, the undersigned does not accord these findings great weight as the doctor generally lists the exact same restrictions in nearly every case in which a report is submitted.... Also in evidence is a report from Dr. Dyer (Ph.D) a psychologist. This report was also, apparently, prepared for a compensation case and more significantly the doctor’s report is markedly deficient.... The doctor frequently submits reports and generally does not provide a full range of scores nor, apparently, have the claimant’s attorneys informed the doctor of the need to meet the Secretary’s requirements. This is so despite the fact that these attorneys are well versed in the Secretary’s regulations, appear frequently before him and the fact that such comments have been made in the past regarding the doctor’s reports. (A. 22-25) (emphasis added). III. A. As the administrative law judge observed, the medical reports submitted on behalf of Williams mimic, almost word-for-word, the medical reports which these same physicians have consistently submitted in the past on behalf of other claimants. As former district court Judge Lacey noted: [P]laintiffs representative, the law firm of Freeman and Bass, invariably submits these physicians’ reports to support their clients’ claims. After a review over several years of reports from each of these physicians, it must be said that the reports before me are of questionable weight. With few exceptions over the years, these physicians’ findings and conclusions have been remarkably similar in report after report, while dealing with males and females of widely disparate backgrounds. They certainly do not reflect a highly individualized examination of the kind required in matters such as this. Franklin, 598 F.Supp. at 790 . Clearly, as will be demonstrated below, the medical reports submitted by Freeman & Bass in the present case contain little more than the boilerplate language to which Judge Lacey referred in Franklin . Thus, those medical reports cannot constitute reliable expert or professional testimony and, in my opinion, should properly be rejected. I recognize, of course, that the administrative law judge in Williams’ case did not reject this evidence outright, but rather analyzed it and, only after his recognition of virtually identical evidence in unrelated cases, determined that the evidence presented by Williams should be accorded little weight. Nevertheless, the majority, in its footnote 5, instructs in dictum that “the finder of fact may not disregard medical evidence simply because it comes from a particular source, nor because the medical reports are similar to reports filed by counsel in other non-related cases.” Maj. op. at 1185 n. 5. In my view, the majority has, like the proverbial ostrich, hidden its head in the sand by refusing to recognize the evils of a *1192 practice which subverts the very purpose of the disability provisions of the Social Security Act — an act designed to provide benefits for the truly disabled. See In re Petition of Sullivan, 904 F.2d 826, 845 (3d Cir.1990) (identifying “Congress’s intent in limiting disability benefits under the Social Security Act only to those who are unable to perform substantial gainful activity.”). It is thus clear that the concerns expressed in the above-cited cases have not yet been adequately recognized by this court, leading the majority to state that an administrative law judge may not disregard medical reports that are similar to reports filed by counsel in other non-related cases even though the AU has identified the flaws in such reports after comparing them to other unrelated disability claims. I refer below to a sampling of instances where boilerplate, carbon-copy reports have been submitted as medical evidence in support of claims made by several different disability claimants. B. Dr. Samuel L. Pollock, a neuro-psychia-trist, diagnosed Williams, who had been employed as a security guard and as a worker in a steel drum factory, as suffering from “[n]eurological residuals of exposure to noxious fumes, dust and loud noise and post traumatic anxiety stress disorder, attributable to exposure at work.” Dr. Pollock concluded that “[a]s a physiological industrial unit, regardless of cause, he appeared to be 100% disabled.” (A. 185-86). In Franklin , Judge Lacey documented several randomly selected medical reports which Dr. Pollock had submitted on behalf of Freeman & Bass clients. On July 26, 1979, Dr. Pollock diagnosed Adolfo Cruz, an outdoor maintenance worker, as suffering from “[n]eurological residuals of exposure to noxious fumes, dust and loud noise and traumatic anxiety psychoneurosis, also sciatic neuritis, attributable to accident and exposure at work.” Dr. Pollock concluded that “[a]s a physiological industrial unit, regardless of cause, he appeared to be 100% disabled.” 598 F.Supp. at 794 . On August 9, 1979, Dr. Pollock diagnosed Mary Franklin, a clothes presser, as suffering from “[njeurological residuals of exposure to noxious fumes, dust and loud noise and traumatic anxiety psychoneurosis, also sciatic neuritis, attributable to accident and exposure at work.” Dr. Pollock concluded that “[ajs a physiological industrial unit, regardless of cause, this petitioner appears to be 100% disabled.” 598 F.Supp. at 793 . On July 24, 1980, Dr. Pollock diagnosed James Bryant, a painter, as suffering from “[njeurological residuals of exposure to noxious fumes, dust and loud noise and traumatic anxiety psychoneurosis, also sciatic neuritis, attributable to accident and exposure at work.” Dr. Pollock concluded that “[ajs a physiological industrial unit, regardless of cause, he appeared to be 100% disabled.” Id. at 796 . On October 19, 1981, Dr. Pollock diagnosed Robert Lee, a construction laborer, as suffering from “[njeurological residuals of exposure to noxious fumes, dust and loud noise and traumatic anxiety psychoneurosis, also sciatic neuritis, attributable to accident and exposure at work.” Dr. Pollock concluded that “[ajs a physiological industrial unit, regardless of cause, he appeared to be 100% disabled.” Id. at 795 . On September 22, 1983, Dr. Pollock diagnosed Eddie Felder, a laborer in a lumber factory, as suffering from “[n]eurological residuals of exposure to noxious fumes and dust and loud noise, also sciatic neuritis, and traumatic anxiety psychoneurosis, attributable to exposure at work.” Dr. Pollock concluded that “[a]s a physiological industrial unit, regardless of cause, he appeared to be 100% disabled.” Id. at 792 . Surely, an administrative law judge or a district court judge, when confronted with such undifferentiated medical reports, should feel free to regard them as entirely non-probative. A physician who identifies the same job-related ailment in every benefits claimant, regardless of the claimant’s job or particular circumstances, is simply not credible. *1193 C. In Winston , the district court judge noted that in each of three social security-appeals then before him, Dr. Frank J. Dyer reported that the “perceptual rotations, fragmentations, simplifications, integration problems, and other gross, distortions observed in this client’s Bender Gestalt Test record are suggestive of a very severe visual-motor integration problem ...” 585 F.Supp. at 368 n. 5. Similarly, in the present case, Dr. Dyer reported that the “rotations, simplifications, perseverations, and other distortions observed in this client’s Bender Gestalt Test record are suggestive of a severe visual-motor integration problem.” (A. 187). In the three reports cited in Winston , Dr. Dyer concluded that “[bjased on the above findings, it is felt that [plaintiff’s] prospects for success would be virtually nil in any employment requiring complex oral communication, fine perceptual motor skills, rapid cognitive processing of large amounts of information, or basic reading, arithmetic, and written language skills.” 585 F.Supp. at 368 n. 5. In the present ease, Dr. Dyer reached the same conclusion: “[b]ased on the above findings, it is felt that Mr. William’s prospects for success would be virtually nil in any employment requiring complex oral communication, fine perceptual motor skills, rapid cognitive processing of large amounts of information, or basic reading, arithmetic, and written language skills.” (A. 188). Williams’ remaining physicians similarly provided standardized diagnoses to Williams. Dr. Warren Klein, for example, diagnosed Williams as suffering from chronic conjunctivitis of both eyes, (A. 184), a diagnosis that he consistently gives to clients represented by Williams’ present counsel. See, e.g., Franklin, 598 F.Supp. at 817-26 . IV. There is no reason why we should require administrative law judges to give any credence to physicians whose diagnoses are standardized and remain constant from claimant to claimant. I could register no objection to the testimony of Williams’ physicians if they had discharged their responsibilities in a professional manner. I do, however, object to giving judicial recognition to the type of boilerplate medical reports submitted by Williams’ physicians in this case, which have been documented as having been submitted in countless other cases in connection with unrelated claimants. This type of medical evidence can only have a disastrous effect on a claimant who may indeed have a serious physical ailment or mental disability, but who, having been diagnosed by rote and subject to the type of robotic diagnoses that I have catalogued here, cannot hope to succeed in having legitimate benefits awarded. Unless .we protect such individuals from this invidious practice and identify those who are responsible for subverting the very programs designed to benefit the. disabled, we will be condoning and abetting the continuation of an exercise that should, instead, be condemned. How can we effect such a condemnation? We can do so, as I advocate here, by holding that an administrative law judge who recognizes and identifies such rote and undifferentiated reports should not accept them as competent medical evidence. On the other hand, the mere fact that medical evidence in one case originates from a particular physician who may also have presented evidence in other cases should not taint that medical evidence, so long as the evidence is individualized and tailored to the particular claimant. In such a case, the evidence may be given whatever weight the administrative law judge deems appropriate, subject always, of course, to the evidence satisfying the requirements of the Secretary’s regulations.' The majority justifies the use of undifferentiated medical reports by stating that “just as claimant’s counsel tend to use their own consultative physicians, the government likewise time and again uses its own selected Social Security consultative physicians, whose medical reports may, to a lay reader, bear striking similarities from one case to the next.” Maj. op. at 1185 n. 5. First, I do not comprehend the relevance of the majority’s test, which is measured by whether a lay reader may *1194 discern any similarities among medical reports. It is uncontroverted that the evaluation of such reports is the function not of lay readers but of experienced administrative law judges, and the review of those evaluations the task of the Secretary’s Appeals Council, whose members are similarly familiar with and experienced in assessing medical evidence. Second, it is significant to me that although the majority implies that consultative physicians engaged by the government file reports which may be construed as similar, the majority provides not a scintilla of evidence to support any comparison between the undifferentiated reports of the physicians consulted on Williams’ behalf by Williams' counsel and the reports prepared by the government’s consultative physicians. Before tarring the government’s physicians with the same brush as the physicians who submitted Williams’ reports, it would appear to me that some evidence, no matter how slight, should be cited. I therefore believe that it is grossly unfair for the majority to level such an unproven charge against the physicians consulted by the Secretary without providing even a shred of evidence, a case citation, or an example, supporting the inference that government physicians engage in the same practices in which Doctors Hermele, Ahmad, Klein, Scannapiego, Pollock, Dyer and Matthews have engaged. I myself have yet to read a report prepared by a government physician that parrots word-for-word diagnoses previously made by the same physician for a different patient, and I sincerely doubt that my colleagues who constitute the majority in this case have encountered such reports either. If they had, I am certain that they would have called them to my attention. V. Despite the fact that the majority and I agree on the primary issue which confronts us, i.e., that substantial evidence supports the denial of benefits to Williams, I have digressed in writing this separate opinion to highlight my concern about a practice in the disability area that has become all too prevalent. That practice, which I condemn, and which I urge the court to condemn, is the practice of accepting as competent evidence, even though little weight may be given to it, stereotyped medical reports which contain virtually the same language and diagnoses regardless of the claimant and the claimant’s condition. Although the majority charges me with having misconstrued its position, I think a fair reading of my disagreement with the majority will not bear out that characterization. I acknowledge that the majority does not require more than mere consideration of boilerplate physicians’ reports, with the weight to be accorded those reports left in the discretion of the administrative law judge. My position, however, is substantially different. I would authorize the administrative law judge to reject such evidence outright. The cases cited by the majority in its footnote 5, Maj. op. at 1185, which do not involve the same kind of rote medical reports that were submitted in this case, do not hold otherwise. I agree with the majority that “ ‘[t]he ALJ has a duty to hear and evaluate all relevant evidence in order to determine whether an applicant is entitled to disability benefits.’ ” Maj. op. at 1185, n. 5, quoting Cotter v. Harris, 642 F.2d 700, 704 (3d Cir.1981). However, unlike the majority, I do not believe that undifferentiated medical reports, of the sort which were submitted on Williams’ behalf, can possibly be considered “relevant evidence.” I therefore urge the court, in reviewing future disability appeals, to closely scrutinize the quality of the medical evidence submitted by claimants who are represented by the same counsel who represent Williams or, indeed, any counsel who engage in similar practices. Where the administrative law judge identifies the same egregious circumstances as I have documented here, I urge the court to hold that such judges are free to totally disregard and reject that evidence. . The physicians whose reports were submitted on behalf of Williams’ claims are Doctors Her-mele, Ahmad, Klein, Scannapiego, Pollock, Dyer and Matthews, all of whom were apparently engaged as consultative physicians by Williams’ counsel. . In reproducing the administrative law judge’s report, I have taken the liberty of correcting any typographical errors that appeared in the original text. I have also emphasized certain portions of the administrative law judge’s opinion so as to call immediate attention to the issue that concerns me. --- Source: Frix Law Library, https://www.frixlaw.com/law-library/cases/9843071. Public record. Not legal advice.