Q. Alright, sir. Alright. Now, then for the second hypothetical and you partially answered that, I think. But let us assume that I will hold or I will find that from the medical evidence that there is no impediment or impairment of such a serious nature that would prevent the claimant from performing sedentary or very light work activities. Under that set of circumstances and, of course, considering his background, his education and transferrable work skills, would your answer be the same as it was a moment ago about the self-service station operator, or would there be other jobs that the claimant could perform?

A. Under those assumptions, Judge, there would be other jobs that Mr. Camp would have skills to perform.

Q. Alright. Could you give us some examples of those jobs?

A. Like going to a factory type situation, a shoe factory for example, a company in Conway. He lives close to Conway. Burk Manufacturing. They manufacture school furniture, lifting, he would be required to lift a piece of a chair and sand it or weld it. He would not actually have to be a welder.

Rockton (phonetic) Company in Conway where the manufacturing of cardboard boxes. Franklin Electronics in North Little Rock, for example, where they would not pick up more than five pounds.

But these are some of the industries employing people having these skills that you mentioned.

(Tr. at 66-67.)

At the administrative hearing, the motion of Camp for psychological and psychiatric examinations was granted. (Tr. at 69-70.) The record of the hearing was reopened on April 20, 1978 to admit into evidence the written psychological evaluation of Camp by Patrick Caffey, Ph.D., and the written psychiatric evaluation of Camp by Robert M. Thompson, M.D. (Tr. at 70-71.)

Dr. Caffey, a clinical psychologist, evaluated Camp in April 1978 and reported that psychological tests he gave Camp indicated that Camp was functioning in the borderline range of mental retardation, which Caffey felt however to be an underestimate of Camp's apparent basic average level capability, and also indicated depressed mood, considerable tension, anxiousness, and felt discomfort. (Tr. at 128.) Dr. Caffey also reported that the personality tests "indicated an underlying morbid apprehension regarding his own welfare and his apparent conflict between dependency needs and untoward feelings may cause concern with somatic problems" and that Camp's "concern about his condition and depressed mood could result in morbid personal notions." (Tr. at 128.) Dr. Caffey evaluated Camp's psychological impairment generally as moderate in severity in the Social Security form entitled "Supplemental Questionnaire As To Residual Functional Capacity."2 (Tr. at 129-30.)

Dr. Thompson, a psychiatrist, evaluated Camp in April 1978. In his written evaluation he reported: "In conclusion, this man does manifest significant impairment in his functioning due to his somatic preoccupations and depression. He has not responded to therapy. He is competent. Diagnosis: Depressive neurosis with anxiety and conversion features 300.4." (Tr. at 135.)

Dr. Thompson rated Camp's psychiatric impairment in the supplemental questionnaire form as mild in two areas, moderate in five areas, moderately severe in four areas. (Tr. at 136-37.)

Thereafter, a letter report concerning Camp's physical condition from Fred Robertson, M.D., was added to the claim file. (Tr. at 139.)The administrative law judge made the following findings in his memorandum decision dated July 24, 1978:

1. According to information given by the claimant, he was born on November 15, 1945, making him 32 years of age; completed the ninth grade in school; and has principally been employed in heavy pipeline construction work.

2. The claimant meets the special earnings requirement at all pertinent times herein and will continue to meet that requirement at least through September 30, 1978.

3. The claimant has degenerative disc disease of the lumbar spine but without any neurological changes. This condition would not prevent the claimant from performing medium to heavy type work.

4. The claimant probably has early rheumatoid arthritis but there is no evidence of this desease (sic) becoming active.

5. The claimant has a high uric acid level which is indicative of gout.

6. The claimant's mental condition is one of depressive neurosis with anxiety and conversion features. This condition, in itself, would not prevent the claimant from performing work activities involving simple and repetative (sic) tasks.

7. The above-mentioned impairments, whether considered singly or in combination, are not sufficiently severe so as to prevent the claimant from performing work activities as testified to by the vocational consultant at the hearing. These work activities include that of a self-service station operator, a shoe factory work (sic), a school furniture factory worker, and an electronics worker. These jobs exist in significant numbers in the local area.

8. The claimant was not disabled within the meaning of the Social Security Act at any time prior to the date of this decision.

(Tr. at 12.)

The Appeals Council of the Social Security Administration approved the decision of the administrative law judge on August 28, 1978. (Tr. at 3.) That decision is the final decision of the Secretary.

Camp brought this action pursuant to 42 U.S.C. § 405(g), in the United States District Court for the Eastern District of Arkansas, for review of the final decision of the Secretary. In an unreported order dated December 18, 1980, the district court granted the motion of the Secretary for summary judgment, affirmed the final determination of the Secretary, and dismissed the complaint of Camp with prejudice. This appeal followed.

The question we must decide is whether the final decision of the Secretary is supported by substantial evidence. 42 U.S.C. § 405(g).

Camp contends that the evidence of psychological and psychiatric impairments was not available at the March 1, 1978 administrative hearing, that the hypothetical questions asked of the vocational expert did not include any consideration of psychological and psychiatric impairments, and that therefore the opinion of the vocational expert was not substantial evidence upon which the final decision of the Secretary could be based.

The Secretary contends that it was not necessary to include the psychological and psychiatric evaluations in the hypothetical questions the administrative law judge asked the vocational expert because the administrative law judge could properly later conclude on the basis of those evaluations that there was no impairment, because of any alleged psychological and psychiatric condition, in the ability of Camp to perform simple repetitive tasks.

"We must uphold the Secretary's decision if it is supported by substantial evidence on the record as a whole. 42 U.S.C. § 405(g)." Gilliam v. Califano, 620 F.2d 691, 693 (8th Cir. 1980). "For the reviewing court, substantial evidence is 'more than a mere scintilla. It means such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.' Richardson v. Perales, 402 U.S. 389, 401, 91 S. Ct. 1420, 1427, 28 L. Ed. 2d 842 (1971); Stephens v. Secretary of HEW, 603 F.2d (36) at 41 (8th Cir. 1979). See also Celebrezze v. Bolas, 316 F.2d 498, 501 (8th Cir. 1963)." Wroblewski v. Califano, 609 F.2d 908, 912 (8th Cir. 1979) and Gilliam v. Califano, supra, 620 F.2d at 693.

The standards for disability insurance benefits were clearly set forth by this Court in Wroblewski v. Califano, supra, 609 F.2d at 912-13, as follows:

This court has stated a three-fold requirement for the determination of disability under 42 U.S.C. § 423 (1976): (1) a medically determined physical or mental impairment which has or will last at least twelve months; (2) inability to engage in any substantial gainful activity; and (3) the inability must be by reason of the impairment. Stephens v. Secretary of HEW, supra, at 41; Johnson v. Califano, 572 F.2d 186, 187 (8th Cir. 1978); Dressel v. Califano, 558 F.2d 504, 506-07 (8th Cir. 1977); Timmerman v. Weinberger, 510 F.2d 439, 442 (8th Cir. 1975).

The claimant has the burden of establishing the existence of her disability, but that burden shifts to the Secretary upon a showing by claimant of an inability to perform her past occupation due to a medically determinable ailment. Stephens, supra at 41; Lewis v. Califano, 574 F.2d 452, 455 (8th Cir. 1978); Timmerman, supra at 443. Once such a showing has been made the Secretary must then demonstrate that the claimant can perform some other type of substantial gainful employment. Boyer v. Califano, 598 F.2d 1117, 1118 (8th Cir. 1979); Brinker v. Weinberger, 522 F.2d 13, 17 (8th Cir. 1975); Celebrezze v. Bolas, supra, 316 F.2d at 507. (Footnotes omitted.)

See also Gilliam v. Califano, supra, 620 F.2d at 693.

The evidence, including the testimony of the vocational expert at the hearing established that Camp was unable to perform his previous occupations of pipeline equipment operator and tilesetter. (Tr. at 66.) Therefore, the district court properly found that the claimant Camp met his primary burden of proof of inability to perform his past occupations because of medically determinable ailments. (Record at 54.) This finding was fully supported by the evidence of the claimant, his wife and the examining and treating physicians, without consideration of the later developed psychological and psychiatric evidence. Therefore, as the district court correctly concluded, the "burden shifted to the Secretary to establish by a preponderance of the evidence that there was work available in the national economy that (Camp) could perform in his disabled condition." Gilliam v. Califano, supra, 620 F.2d at 693. The Secretary must base that judgment upon the testimony of a vocational expert. Warner v. Califano, 623 F.2d 531, 532 (8th Cir. 1980); Boyer v. Califano, 598 F.2d 1117, 1119 (8th Cir. 1979).

We conclude that the decision of the Secretary was deficient in several respects.

First, it is clear from the record that the vocational expert did not consider the later developed psychological and psychiatric impairments of Camp in expressing his opinion, in answer to the hypothetical questions posed by the administrative law judge. The psychiatric and psychological reports were not prepared until after the vocational expert testified at the hearing before the administrative law judge. In Stephens v. Secretary of Health, Education and Welfare, 603 F.2d 36, 41 (8th Cir. 1979), it was stated that

the vocational expert's testimony was fatally deficient in that the hypothetical question failed to precisely set out all of Stephens' impairments. See Behnen v. Califano, 588 F.2d 252, 255 (8th Cir. 1978); Lewis v. Califano, 574 F.2d 452, 456 (8th Cir. 1978); Daniels v. Mathews, 567 F.2d 845, 848 (8th Cir. 1977).

In Daniels v. Mathews, supra at 848, this Court held:

We think it is fundamental when the ALJ (administrative law judge) uses a hypothetical question in examining the vocational expert, that the ALJ relate with precision the job capacity and opportunity to the physical and mental impairment of the particular claimant. (Footnotes omitted.)

The administrative law judge failed to do so here. In the hypothetical question, he asked the expert to assume that Stephens could do "light or sedentary work with such limitations as are noted in the record." The exact nature of these "limitations" was undisclosed and, thus, we have no way of determining whether the vocational expert recognized all of Stephens' disabilities.

See also Gilliam v. Califano, supra, 620 F.2d at 694, in which a substantially similar hypothetical question was held to be deficient.

Because the hypothetical questions failed to precisely set out all of Camp's impairments, including the psychological and psychiatric impairments, they were deficient. Therefore, the opinions of the vocational expert could not be relied upon by the Secretary as substantial evidence that there was work in the national economy that Camp could perform in his disabled condition.

The decision of the Secretary was also deficient in that the evidence of physical and mental impairments were considered separately. "Evidence as to claimant's impairments must be considered as a whole and cannot be fragmented so as to diminish their combined impact." Lewis v. Califano, 574 F.2d 452, 456 (8th Cir. 1978). The mental disabilities of Camp were never considered by the vocational expert. In the decision of the Secretary, it is stated that the mental condition of Camp, "in itself, would not prevent the claimant from performing work activities involving simple and repetative (sic) tasks." (Tr. at 12, emphasis added.) The decision of the Secretary next recites that "the above mentioned impairments, whether considered singly or in combination, are not sufficiently severe so as to prevent the claimant from performing work activities as testified to by the vocational consultant at the hearing." (Tr. at 12.) Because the vocational expert never considered the psychological and psychiatric mental disabilities of Camp, even on the basis that the alleged mental disabilities alone "would not prevent claimant from performing work activities involving simple and repetative (sic) tasks," the conclusion of the Secretary is not supported by substantial evidence.3 Further, it is shown that the administrative law judge considered first the physical impairments of Camp, and then, separately, without further submission of a proper hypothetical question to the vocational expert, the mental impairments of Camp.

The conclusion of the administrative law judge that Camp could perform work activities involving simple and repetitive tasks is based, in part, upon the "Supplemental Questionnaire As To Residual Capacity" completed by Dr. Thompson. In reference to the counterpart questionnaire relating to physical disability, this Court has recently stated that "although such forms are admissible, they are entitled to little weight in the evaluation of disability. Landess v. Weinberger, 490 F.2d 1187 (8th Cir. 1974). The form does not constitute 'substantial evidence' upon the record as a whole." Gilliam v. Califano, supra, 620 F.2d at 693.

42 U.S.C. § 405(g) provides in relevant part that in reviewing a final decision of the Secretary, a court "shall have the power to enter, upon the pleadings and the transcript of the record, a judgment affirming, modifying, or reversing the decision of the Secretary, with or without remanding the cause for a rehearing."

ORDERED that the judgment of the district court be, and it is hereby, affirmed in part and reversed in part with directions to remand the cause to the Secretary for rehearing and further proceedings consistent with this opinion.