The opinion of the court was delivered by: John E. Miller, Chief Judge.
This is an action in which the plaintiff, Albert J. Wray, seeks
to establish "a period of disability" under provisions of the
Social Security Act, 42 U.S.C.A. § 416. The action was filed in
this court on June 24, 1958, after the plaintiff had exhausted
all administrative procedures.
On September 25, 1958, plaintiff moved to remand the cause to
the Secretary of Health, Education and Welfare for the receipt of
additional evidence. Accordingly the case was remanded to the
Secretary on October 15, 1958, for the receipt of additional
medical evidence, together with any other evidence the Secretary
might wish to receive. See Wray v. Folsom, D.C.W.D.Ark. 1958,
166 F. Supp. 390.
On November 3, 1958, Arthur Flemming, Secretary of Health,
Education and Welfare was substituted as the party defendant by
agreement of counsel.
Counsel for the plaintiff and for the Government have waived
the filing of any additional briefs, and the case is now ready
The basic facts established at the original hearing are not in
serious dispute and are discussed in detail in the court's prior
opinion reported in 166 F. Supp. 390. For present purposes it is
sufficient to note that the plaintiff was born in 1905 and
obtained a 4th-grade education. During most of his adult life he
has been employed as a cross-country truck driver. In the summer
of 1955 he experienced some difficulty with his health. In
October 1955 the plaintiff's condition suddenly became worse, and
he became dizzy and unable to stand. This condition interfered
with his work as a truck driver. At that time he weighed
approximately 375 pounds.
The medical evidence presented at the original hearing is
discussed in detail in the original opinion.
The additional medical evidence offered by the plaintiff and
included in the supplemental transcript is based on a series of
tests and examinations conducted at the Holt-Krock Clinic at Fort
Smith, Arkansas, on June 20, 1958. Examinations were conducted by
Drs. Charles T. Chamberlain, E.A. Mendelsohn, and Carl L. Wilson.
However, the principal reports were made by Dr. Chamberlain, and
fully describe plaintiff's condition.
Dr. Chamberlain stated that on the basis of the findings, he
diagnosed the claimant's condition as diabetes mellitus; obesity;
arteriosclerosis with hypertension; hypertensive and
arteriosclerotic heart disease; and angina pectoris. He added
that in his opinion the claimant was permanently and totally
disabled from performing any gainful activity for which he has
been trained, namely, heavy manual labor.
In January 1959 the plaintiff was examined by Dr. Cecil F.
Boulden of the Cooper Clinic in Fort Smith, Arkansas, at the
request of the Appeals Council. In his report of January 22,
1959, Dr. Boulden recites the history given by the plaintiff
which has been noted before. In the physical examination the
plaintiff's height and weight were shown as 6 feet, 2 inches, 272
In summarizing, Dr. Boulden indicated in his first report that
on the basis of incomplete liver tests, it appeared from the
first cephalin flocculation test that there was at least a
moderate amount of liver damage. However, his supplemental report
of January 29, 1959, corrected this finding as the subsequent
complete liver profile failed to bear out the suspicion of liver
disease previously reported. Despite a moderate amount of
proteuria (protein in the urine), as represented by the pooled
albumin, Dr. Boulden stated that the kidney function test was
quite satisfactory. He diagnosed the claimant's condition as
diabetes mellitus of the obesity type. Dr. Boulden concluded his
report by stating:
"It is a well-known fact that diabetes is
ameliorated when the body weight is reduced by
decreasing the caloric intake. Also the need for
insulin increases remarkably with increasing body
weight. It is a well-known observation that the obese
diabetic is relatively resistant to insulin, and if
insulin is administered to such patients, relatively
large amounts are necessary to make much impression
on the hyperglycemia. Therefore, the amount of
insulin required to control diabetes is not an index
of the severity. I would like to quote from Duncan's
Diseases of Metabolism, third edition, page 636: `A
diabetic state in an obese person must be mild, else
he would not maintain his obesity.'
"* * * His renal function test as indicated above
is quite satisfactory, despite a moderate amount of
proteuria. This latter finding may be the result of
his hypertension and prolonged diabetes, which has
been poorly controlled. It is difficult to make a
statement as to the degree of disability that his
diabetic status has incurred, as his main problem has
been that of obesity, and certainly the diabetes, and
likewise the disability would greatly improve if he
were to lose weight. His prognosis of course will
depend upon his future dietary control."
Dr. Boulden indicated that before dismissing the claimant, he
gave him a diet prescription for a 1200 calorie diabetic diet,
and advised him that maintaining the diet was extremely important
if his diabetes was ever to improve. The claimant was told that
eventually his insulin dosage would be reduced, and in all
probability he would be able to do without insulin if he were
ever to obtain an ideal weight, ranging between 179 to 196
pounds, requiring a weight loss ...