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Williams v. Bowen

decided: October 13, 1988.


Joyce E. Williams appeals from a February 25, 1988 judgment of the United States District Court for the Western District of New York (Elfvin, J.) dismissing appellant's claim for Supplemental Security Income Benefits under Title XVI of the Social Security Act and affirming the decision of the Secretary of Health and Human Services to deny disability benefits. Reversed and remanded for the computation of benefits.

Feinberg, Chief Judge, Cardamone and Pratt, Circuit Judges.

Author: Cardamone

CARDAMONE, Circuit Judge :

This appeal from a denial of disability benefits is somewhat uncommon because it requires us to reverse an administrative determination for lack of substantial evidence. Such a determination must demonstrate a rational connection between the agency's legal conclusion and the medical and lay testimony presented. Only then can a reviewing court be assured that the evidence on which the administration determination rests is "substantial." The constituents of this required foundation are wanting in this appeal brought by Joyce E. Williams on behalf of her daughter Loretta Lynn Williams (claimant) from a judgment of the United States District Court for the Western District of New York (Elfvin, J.), which upheld the determination of the Secretary of Health and Human Services (Secretary) denying claimant's application for supplemental disability benefits under Title XVI of the Social Security Act. 42 U.S.C. § § 1381-1385 (1982 & Supp. III 1985).

In a memorandum and order dated February 25, 1988, the district court ruled that substantial evidence supported the Secretary's determination that the claimant had not proven her entitlement to disability benefits. Because the Secretary's determination runs sharply against virtually all the medical evidence presented and makes no specific finding as to the credibility of the claimant's otherwise uncontroverted testimony, we cannot adopt that view. We hold instead that the administrative decision to deny disability benefits is not supported by substantial evidence.


On behalf of her then ten-year-old daughter Loretta, Joyce E. Williams filed an application for Supplemental Security Income Benefits on November 5, 1984. Born on December 28, 1973, Loretta was diagnosed at birth as having bilateral congenital hip disease. Dr. Denzel initially treated Loretta by requiring her to wear a soft "Freyka" pillow that maintained flexion and abduction in her thighs. In February of 1974 Drs. Denzel and Fricke conducted a non-surgical procedure to realign bone fragments in Loretta's hip. Four months later, when Loretta was seven months old, her left hip again dislocated and the same doctors performed a surgical procedure to regain and stabilize the alignment of her hip bones.

In 1975 the hip once again dislocated, and Loretta had surgery at the Hospital for Sick Children in Toronto where her hip bones were realigned and the sockets into which the femurs fit were reoriented to prevent further dislocation. At this time, her physicians believed her left hip was properly located and her right hip unimpaired, though she wore a series of specialized casts for eight months to stabilize her hips and to permit bone growth. Despite some signs of improvement, Dr. Salter at the Hospital for Sick Children was forced to realign Loretta's hips surgically and to suture a torn joint capsule in her hip socket. This operation was deemed a success, and the patient was instructed to begin engaging in more ordinary activities.

Nonetheless, in August of 1982 when Dr. Denzel examined the now eight-year-old claimant he found that she had a congenital persistent dislocation of her left hip, "a short leg gait" and a "significant Trendelenburg;" that is, the walk of a person whose gluteus medius muscle is paralyzed, characterized by an unbalanced gait throwing weight directly over one femur. The medical significance of a Trendelenburg is that it makes abduction of the thigh more difficult. Dr. Denzel further noted that Loretta's left leg was two inches shorter than her right, she was wearing a one-half inch corrective shoe insert, and her left thigh muscles were significantly atrophied relative to those of her right thigh. These findings were confirmed later in 1982 at the Shriners Hospital for Crippled Children in Erie, Pennsylvania.

When Dr. Nadler examined Loretta in May, 1983 he noted her Trendelenburg and that she walked with a "marked limp." Dr. Nadler expressed "doubt that she could ever be able to do any occupation which would require prolonged standing or walking or use of her left lower extremity." He further noted the atrophy of her left thigh. Also in May, 1983 Dr. Banwar of Shriners Hospital examined Loretta for leg length discrepancy and confirmed that she had a "marked Trendelenburg and a . . . discrepancy of 3 centimeters." Tests indicated that her leg length discrepancy was only 0.4 centimeters and that the relative shortness of the left leg was caused by "a significant higher riding left hip." On October 9, 1984 Loretta was successfully operated on to arrest bone growth in her right leg.

At the request of the Secretary, Loretta was examined by Dr. Rupsis on March 8, 1985. He reported that claimant had occasional pain in her hip and experienced some difficulty riding a bicycle, that she walked with a "marked short leg gait," demonstrated a "significant drooping of the pelvis," and that she was overweight. The Secretary's physician also noted that despite some limitation of flexion and abduction, claimant showed "surprisingly good" mobility and motion in her left hip, "considering the amount of previous surgery."


Claimant's initial application for Supplemental Security Income Benefits and subsequent request for reconsideration were both denied. On July 29, 1985 an administrative hearing was held before an Administrative Law Judge (ALJ). Loretta and her mother both testified. Joyce Williams testified that her daughter walked with a limp and that her leg sometimes "gives out" causing her to fall. The mother stated that when she walked at her normal pace, Loretta could not keep up.

Loretta testified that she was 5'4" tall and weighed about 200 pounds. She takes a special bus for the handicapped to school, but does not use a cane or a walker. She indicated that she can do most ordinary household tasks such as cleaning her room, picking up clothes, sweeping the floor, setting and clearing the table, and making beds. She told the ALJ that she could not ride a bicycle or jump rope, but that she did use a stationary bicycle built for her by her father. She further testified that she helped her brother bundle advertisements for neighborhood delivery, but that she was unable to walk fast enough to help deliver them. She said she was a "Girl Scout" in a "Brownie" group, and that she had gone "hiking" in a campground. She tires easily, her ...

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