SSR 68-76a: Rescinded 1975

20 CFR 404.1539(a)

SSR 68-76a

The claimant was determined to be under a disability as of December 1,

1963, based on the medical findings indicating arteriosclerotic heart

disease, manifested by angina pectoris, and congestive heart failure. In

September 1965 objective medical tests revealed no signs suggesting heart

failure, no indications of heart block or diagnostic abnormality and that

her condition had improved. The examining physician indicated claimant was

capable of light work such as clerical work. Claimant's attending

physician, while noting that most of the claimant's symptoms were without

objective medical support, but were subjective, was of the opinion

claimant was unable to work. Claimant performed the usual household

functions and drove a car when necessary. A vocational specialist,

summarizing the test results conducted by a rehabilitation center,

testified that the claimant demonstrated significant clerical skill

involving language usage, numerical ability, verbal reasoning, and

fluency, and good manual capacity for the fine hand manipulation. Another

vocational expert testified that the claimant had highly marketable

vocational skills currently in demand, listing types of jobs available in

the area in which she lived which she could obtain. Held , on the

basis of the medical and vocational evidence as a whole, the claimant's

heart condition, as reflected by the medical examination in September

1965, had not significantly improved as to establish that the claimant was

then capable of engaging in substantial gainful activity, and thus

claimant's disability ceased on September 3, 1965. Accordingly, the

claimant's entitlement to a period of disability and disability insurance

benefits terminated with the month of November 1965, pursuant to sections

216(i) and 223 of the Act.

ber

1965, had not significantly improved as to establish that the claimant was

then capable of engaging in substantial gainful activity, and thus

claimant's disability ceased on September 3, 1965. Accordingly, the

claimant's entitlement to a period of disability and disability insurance

benefits terminated with the month of November 1965, pursuant to sections

216(i) and 223 of the Act.

This case is before the Appeals Council on the claimant's request for

review of the hearing examiner's decision dated October 28, 1966. The

hearing examiner held that the claimant's entitlement to a period of

disability and disability insurance benefits ended with the close of the

last day of November, 1965.

The claimant filed an application for a period of disability and for

disability insurance benefits on June 22, 1964 alleging inability to work

from December 1, 1963 because of a heart disorder. On the basis of this

application, it was determined that the claimant became disabled on

December 1, 1963. Subsequently, it was decided that medical evidence

established that as of September 1965, the claimant's condition had

improved to a degree which would permit her to return to substantial

gainful activity within the scope of her vocational training and

experience.

STATEMENT OF THE LAW AND ISSUES

Section 404.1539(a) of the Social Security Administration Regulations No.

4 [20 CFR 404.1539(a)] provides that an individual's "disability" shall be

found to have ceased in the month in which the impairment, as established

by the medical or other evidence, is no longer of such severity as to

prevent the individual from engaging in any substantial gainful

activity.

Section 216(i) of the Social Security Act, as pertinent herein, provides

for the establishment of a period of disability and, in effect, that such

period shall end with the close of the last day of the second calendar

month following the month in which disability ceases.

idence, is no longer of such severity as to

prevent the individual from engaging in any substantial gainful

activity.

Section 216(i) of the Social Security Act, as pertinent herein, provides

for the establishment of a period of disability and, in effect, that such

period shall end with the close of the last day of the second calendar

month following the month in which disability ceases.

Section 223 of the Act, as pertinent herein, provides for the payment of

disability insurance benefits and, in effect, that entitlement to such

benefits shall end with the close of the second month following the month

in which the disability ceases.

The general issues before the Appeals Council are whether the claimant

continues to be entitled to disability insurance benefits and/or a period

of disability. The specific issues are whether the claimant's disability

has ceased, and if so, as of what date. This depends on whether the

evidence establishes that the claimant's impairment has improved

sufficiently so that it is no longer of such severity as to prevent

substantial gainful activity.

SUMMARY OF MEDICAL AND VOCATIONAL EVIDENCE

The medical evidence before the hearing examiner showed that the claimant

was admitted to a hospital in April 1964 because of difficulty in

breathing. She was treated and was ultimately discharged on May 23, 1964

with a final diagnosis of arteriosclerotic heart disease with cardiac

decompensation, and anterior myocardial ischemia.

Shortly after discharge from the hospital, the claimant's attending

physician reported that under his care there had been excellent response

to medication, and that there were no longer any objective indications of

heart disease. He was of the opinion that the claimant would probably

become completely symptom-free, but that she should avoid strenuous

exertion.

erior myocardial ischemia.

Shortly after discharge from the hospital, the claimant's attending

physician reported that under his care there had been excellent response

to medication, and that there were no longer any objective indications of

heart disease. He was of the opinion that the claimant would probably

become completely symptom-free, but that she should avoid strenuous

exertion.

In September 1964 (about 4 months after hospitalization) a specialist in

internal medicine examined the claimant and reported that an

electrocardiogram gave the impression of: "Myocardial change and/or

digitalis effect. First degree block." His diagnoses included

arteriosclerotic heart disease, manifested by angina pectoris, and

congestive heart failure. However, he recommended re-evaluation of the

claimant's medical status in about a year because of the possibility of

reversible disease.

Since said internist had suggested the possibility of improvement, the

claimant was re-examined by him in September 1965. Medical findings

revealed that her chest was clear and free of signs suggesting heart

failure. Urinalysis and blood studies were within normal limits; and most

significantly, the electrocardiogram, when compared to the tracing of

September 1964, no longer demonstrated the previous indications of heart

block or other diagnostic abnormality. The internist interpreted this

tracing to be a normal electrocardiogram. In conclusion, he stated that

although there had been no subjective change, the claimant did not relate

a typical history of angina pectoris. Moreover, at the current examination

the electrocardiogram had reverted to normal and there was no objective

evidence of significant heart disease

ther diagnostic abnormality. The internist interpreted this

tracing to be a normal electrocardiogram. In conclusion, he stated that

although there had been no subjective change, the claimant did not relate

a typical history of angina pectoris. Moreover, at the current examination

the electrocardiogram had reverted to normal and there was no objective

evidence of significant heart disease. Apparently, the paucity of

objective medical findings that could be attributed to heart disease

prompted him to conclude that "the previous appraisal may have been

somewhat in error, or at least the patient's condition has improved

significantly despite the fact that she does not think that it has." He

was of the opinion that the claimant was now perfectly capable of light

work, such as clerical duties not involving heavy labor. He considered her

prognosis good with proper orientation and motivation.

The claimant's attending physician, in a medial report dated December 6,

1965 also expressed the opinion that most of her symptoms were without

objective medical support but were solely subjective in nature. However,

he advised against a job requiring "physical exertion." In another medical

report dated July 27, 1966, submitted by the claimant's attending

physician, he indicated that subsequent to the sole episode of cardiac

decompensation, her objective medical findings returned to normal.

Specifically, he stated that her heart has returned to normal size; the

claimant's lungs had cleared, her electrocardiograms had reverted to

normal, and her blood pressure had remained controlled with medication.

However, apparently because of her continued subjective symptoms, he

expressed the opinion that she is unable to work.

sation, her objective medical findings returned to normal.

Specifically, he stated that her heart has returned to normal size; the

claimant's lungs had cleared, her electrocardiograms had reverted to

normal, and her blood pressure had remained controlled with medication.

However, apparently because of her continued subjective symptoms, he

expressed the opinion that she is unable to work.

In view of the contrary medical opinion that light activity was possible,

an analysis of the claimant's vocational capabilities and potential was

obtained from the state rehabilitation center. Its report indicated that

the claimant's daily activities consisted of cooking, washing dishes,

dusting, and dry mopping. Also, that she enjoyed sewing, spectator sports,

attended her local church, and drove an automobile when necessary. Her

full scale I.Q. was calculated to be 108, which placed her within the

normal range of intellectual functioning. Her performance scores showed

that she achieved average or above average grades in vocational pursuits

that required fluency and verbal reasoning, i.e., business correspondence,

proofreading, etc. At least an average level of function was achieved in

those actions requiring eye and hand coordination, and fine

manipulation.

The vocational specialists summarized the test results as meaning that

the claimant had demonstrated significant clerical skills involving

language usage, numerical ability, verbal reasoning and fluency, as well

as good manual capacity (eye-hand coordination) for fine hand

manipulation. It was their considered opinion that she was cooperative,

but not particularly well motivated. She frequently complained of fatigue,

chest pain, dizziness, and numerous other bodily discomforts. They

indicated that if these symptoms were present to the degree that she

expressed, she could not be expected to secure or maintain a gainful job

e-hand coordination) for fine hand

manipulation. It was their considered opinion that she was cooperative,

but not particularly well motivated. She frequently complained of fatigue,

chest pain, dizziness, and numerous other bodily discomforts. They

indicated that if these symptoms were present to the degree that she

expressed, she could not be expected to secure or maintain a gainful job.

Nevertheless, in their opinion she possessed significant work skills, and

could be expected to return to gainful employment within the scope of her

previous occupational area, if she could be successfully rehabilitated.

To supplement the rehabilitation center's report and to define the

claimant's actual employability, a vocational expert was called to testify

at the hearing. He stated that he had made a careful review of the

claimant's occupational background and experience. On the basis of his

evaluation he stated that even if all of her subjective symptoms could be

adequately substantiated by objective medical findings, she would still be

employable.

In support of this conclusion the expert pointed out that the claimant's

clerical work had been sedentary and that the work which she admitted

performing at home is heavier and more physically demanding than some

clerical work which she could do. After direct discussion with prospective

employers located in the general area where the claimant lived, it was the

vocational expert's opinion that she was reasonably able to compete for

jobs in small commercial establishments, or in various nonprofit

organizations. He considered these jobs more or less ideally suited to the

claimant's needs because the work pace was slower, and the job pressures

much less. The vocational expert determined that the claimant would

qualify for such jobs as a cataloguer in a library and a file clerk, and

that she had the capacity to perform various clerical duties at the

neighboring community college or court house

ns. He considered these jobs more or less ideally suited to the

claimant's needs because the work pace was slower, and the job pressures

much less. The vocational expert determined that the claimant would

qualify for such jobs as a cataloguer in a library and a file clerk, and

that she had the capacity to perform various clerical duties at the

neighboring community college or court house. Also, he indicated that

there were sedentary jobs at the local hospital that required the

claimant's particular skills. Moreover, the expert was of the opinion that

the claimant would make a good receptionist or cashier. Other job

opportunities which he found available to the claimant were with local

financial institutions and real estate offices, where the hours are

relatively short and personal relationships more relaxed. He further

testified that the claimant could have her choice of position, and that no

job placement problem need be expected. The vocational expert concluded by

indicating that it was not necessary to retrain the claimant for other

types of work and that the jobs for which she qualified existed in or

around the area in which she resided.

Medical evidence in addition to that before the hearing examiner included

a more complete clinical record in connection with the single episode of

hospitalization in 1964 for treatment of cardiac decompensation and

anterior myocardial ischemia. This hospital summary also indicates that

the claimant had responded well to treatment and at the time of discharge

she was symptom- free.

The other medical statements dated October 12, 1966 and November 1, 1966,

indicated that the claimant continued to have symptoms of dyspnea and

angina with evidence of cardiac abnormality. Dr. P, who examined the

claimant in September and October 1966, recommended continued dietary

control along with the avoidance of heavy exertion, exposure to cold or

emotional upset. He believed that she would do well to continue at light

activity.

66 and November 1, 1966,

indicated that the claimant continued to have symptoms of dyspnea and

angina with evidence of cardiac abnormality. Dr. P, who examined the

claimant in September and October 1966, recommended continued dietary

control along with the avoidance of heavy exertion, exposure to cold or

emotional upset. He believed that she would do well to continue at light

activity.

EVALUATION OF MEDIAL AND VOCATIONAL EVIDENCE

The question before the Appeals Council is whether the claimant continues

to be disabled. In resolving this issue, the Council must decide whether

the medical evidence establishes that the claimant has improved to a

degree sufficient to permit resumption of substantial gainful activity. In

reaching its conclusion, the Appeals Council will consider not only the

medical evidence but such factors as the claimant's age, education,

training, and occupational background. However, it is essential to bear in

mind that mere self-serving allegations of inability to work as a result

of impairments causing shortness of breath, lack of bodily functions,

etc., must be adequately confirmed by objective evidence, preferably

including appropriate clinical and laboratory diagnostic

techniques. [1]

The medical evidence clearly established that the claimant had

experienced an episode of cardiac decompensation in about May 1964. With

appropriate treatment significant improvement is shown to have taken

place, and at the time of her discharge from the hospital, her vital

functions were operating normally and she was symptom-free. Repeated

studies, and findings by the claimant's attending physician over a

considerable period of time, consistently indicate the sustained course of

the initial improvement. In other words, it has been established that the

claimant's heart, with treatment, has remained compensated

of her discharge from the hospital, her vital

functions were operating normally and she was symptom-free. Repeated

studies, and findings by the claimant's attending physician over a

considerable period of time, consistently indicate the sustained course of

the initial improvement. In other words, it has been established that the

claimant's heart, with treatment, has remained compensated. Specific

studies reported by both the claimant's physician and the specialist in

internal medicine revealed that her heart size had returned to normal, her

chest had become clear, her electrocardiograms had reverted to normal, her

laboratory studies were within normal limits, and her blood pressure

remained controlled. Significantly, there were no longer signs of

myocardial ischemia (decreased blood supply to the heart muscle). Although

the claimant's physician in his last report (in contrast with his previous

report), stated that there were definite cardiac abnormalities, he did not

describe the type or degree of abnormality present. In any event, on the

basis of widely separated examinations, it was found that clinically, the

claimant was substantially improved over her condition in 1964. Moreover,

the more persuasive medical opinion is to the effect that while it would

be inadvisable for the claimant to undertake heavy exertion, or risk undue

emotional stress, light activity would be beneficial to her. The

specialist in internal medicine specifically stated that the claimant was

capable of doing clerical work.

Based upon the medical conclusion that the claimant was capable of at

least light activity, an impartial vocational expert testified that she

had highly marketable vocational skills currently in demand, and that she

had an excellent employment potential. In reaching his conclusion, the

vocational expert stated that he had personally investigated the

employment possibilities available to the claimant and that no placement

problem need be expected.

e of at

least light activity, an impartial vocational expert testified that she

had highly marketable vocational skills currently in demand, and that she

had an excellent employment potential. In reaching his conclusion, the

vocational expert stated that he had personally investigated the

employment possibilities available to the claimant and that no placement

problem need be expected.

On the basis of the medical and vocational evidence as a whole, the

Appeals Council concludes that the claimant has a medically determinable

heart condition for which she received treatment; that this treatment

brought about significant improvement, and that as established by medical

examination in September 1965, the claimant now is capable of light work

activity. The Council further concludes, based on the vocational evidence

of record, that there are many suitable jobs in the claimant's labor

market for which she can reasonably compete.

FINDINGS OF THE APPEALS COUNCIL

After careful consideration of the entire record, the Appeals Council

makes the following findings:

- The evidence establishes that the claimant's medical condition had

improved by September 3, 1965 to a degree which permitted light work

activity.

- The claimant has regained the physical capacity to perform substantial

gainful activity within the scope of her previous training and vocational

experience.

- Jobs for which the claimant is qualified are readily available to her in

the area in which she resides.

- The claimant's inability to engage in substantial gainful activity by

reason of her impairment continued from December 1, 1963 to September 3,

1965, but not thereafter.

- The claimant was under a "disability" as defined in the Act which

commenced on December 1, 1963 and continued to September 3, 1965, but not

thereafter.

The evidence establishes that the claimant's medical condition had

improved by September 3, 1965 to a degree which permitted light work

activity.

her impairment continued from December 1, 1963 to September 3,

1965, but not thereafter.

- The claimant was under a "disability" as defined in the Act which

commenced on December 1, 1963 and continued to September 3, 1965, but not

thereafter.

The evidence establishes that the claimant's medical condition had

improved by September 3, 1965 to a degree which permitted light work

activity.

The claimant has regained the physical capacity to perform substantial

gainful activity within the scope of her previous training and vocational

experience.

Jobs for which the claimant is qualified are readily available to her in

the area in which she resides.

The claimant's inability to engage in substantial gainful activity by

reason of her impairment continued from December 1, 1963 to September 3,

1965, but not thereafter.

The claimant was under a "disability" as defined in the Act which

commenced on December 1, 1963 and continued to September 3, 1965, but not

thereafter.

DECISION

It is the decision of the Appeals Council that the claimant's disability

ceased in September 1965, and that her entitlement to a period of

disability and to disability insurance benefits ended effective with the

close of November 1965. The decision of the hearing examiner is affirmed.

Date: August 1, 1967

[1] See section 404.1510(a) of

Social Security Administration Regulations No. 4 [20 CFR 404.1510(a)]. [In

effect prior to August 20, 1968, Ed.]