I

104TH CONGRESS

1ST SESSION H. R. 615

To amend the Black Lung Benefits Act to provide special procedures for

certain claims due to pneumoconiosis, and for other purposes.

IN THE HOUSE OF REPRESENTATIVES

JANUARY 20, 1995

Mr. RAHALL introduced the following bill; which was referred to the

Committee on Economic and Educational Opportunities

A BILL

To amend the Black Lung Benefits Act to provide special

procedures for certain claims due to pneumoconiosis, and

for other purposes.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE.

4 This Act may be cited as the ‘‘Black Lung Benefits

5 Act Amendments of 1995’’.

6 SEC. 2. CLAIMS PROCEDURE.

7 The Black Lung Benefits Act is amended by adding

8 at the end the following new part:
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1 ‘‘PART D—SPECIAL PROVISIONS

2 ‘‘SEC. 441. CLAIMS.

3 ‘‘(a) STANDARD.—If a claim is filed after the date

4 of the enactment of this section under part C for death

5 or total disability of a miner due to pneumoconiosis, such

6 miner shall be presumed to have been totally disabled by

7 pneumoconiosis or to have died because of pneumoconiosis

8 if the conditions described in any one of the following

9 paragraphs are met:

10 ‘‘(1) A single positive chest roentgenogram (x11 ray), biopsy, or autopsy of such miner indicates the

12 existence of pneumoconiosis.

13 ‘‘(2) A single set of ventilatory studies of such

14 miner indicates the presence of a chronic respiratory

15 or pulmonary disease that meets or exceeds the se16 verity standards of regulations of the Secretary of

17 Health and Human Services published at 20 C.F.R.

18 410.490(b)(1)(ii).

19 ‘‘(3) A single set of blood gas studies of such

20 miner indicates the presence of an impairment in the

21 transfer of oxygen from the lungs to the blood that

22 meets or exceeds the severity standards of regula23 tions of the Secretary of Labor published at 20

24 C.F.R. 727.203(a)(3).

25 ‘‘(4) Other medical evidence involving such

26 miner, including the documented opinion of a physi-
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1 cian exercising reasonable medical judgment, indi2 cates the presence of a respiratory disease or pul3 monary impairment that would prevent the miner

4 from performing his usual coal mine work.

5 The person who submits such claim shall not be required

6 to prove the matters described in paragraph (1), (2), (3),

7 or (4) by a preponderance of the evidence or by any higher

8 evidentiary standard.

9 ‘‘(b) CAUSATION.—

10 ‘‘(1) If a claim is filed after the date of the en11 actment of this section under part C for death or

12 total disability due to pneumoconiosis and if the

13 miner with respect to whom the claim was filed

14 worked 10 or more years in a coal mine and pre15 sents evidence which proves the evidence of the mat16 ter described in any paragraph of subsection (a),

17 there shall be a rebuttable presumption that the

18 miner’s pneumoconiosis arose out of the miner’s coal

19 mine employment. No evidence shall be excluded in

20 determining the length of a miner’s coal mine em21 ployment. In the absence of complete Social Security

22 Administration records, affidavits from the miner’s

23 co-workers shall be accepted as sufficient proof of

24 the coal miner’s period of employment.
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1 ‘‘(2) If a miner is unable to prove 10 years of

2 employment in a coal mine, the miner may prove

3 that the miner’s pneumoconiosis is due to the min4 er’s coal mine employment through other evidence.

5 ‘‘(c) REBUTTAL OF PRESUMPTION.—

6 ‘‘(1) The presumption under subsection (a) that

7 a miner is totally disabled by pneumoconiosis may be

8 rebutted only if—

9 ‘‘(A) there is evidence that establishes that

10 the claimant is in fact doing the claimant’s

11 usual coal mine work, or

12 ‘‘(B) in light of all relevant evidence, it is

13 established that the miner is able to do the

14 miner’s usual coal mine work or comparable

15 and gainful work.

16 A physician’s opinion that the miner is not totally

17 disabled shall not rebut such presumption when in18 voked by qualifying ventilatory studies or arterial

19 blood gas testing.

20 ‘‘(2) In connection with a rebuttal of a pre21 sumption under subsection (a), the Secretary of

22 Labor may submit not more than 1 opinion from an

23 examining or consulting physician and not more

24 than 3 x-ray readings to supplement such evidence.
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1 ‘‘(3) The presumption under subsection (b) may

2 be rebutted only by clear and convincing proof that

3 the miner’s pneumoconiosis, established by a condi4 tion described in subsection (a), did not arise, in

5 whole or in part, out of the miner’s coal mine em6 ployment.

7 ‘‘SEC. 442. APPLICATION OF SECTION 441.

8 ‘‘(a) IN GENERAL.—Section 441 shall apply to all

9 claims filed under part C on and after the date of the

10 enactment of this Act, except that the Secretary of Labor

11 shall review any claim that—

12 ‘‘(1) was filed under part B or part C, and

13 ‘‘(2) is either pending on the date of enactment

14 of this Act or has been denied on or before such

15 date,

16 to determine if the evidence establishes eligibility under

17 the presumption of section 441(a). The Secretary shall re18 view each such claim regardless of whether the claimant

19 also filed any subsequent claim under part B or C or such

20 claim resulted in an award of benefits. The Secretary’s

21 review of a claim which resulted in the award of benefits

22 may not result in the reversal or forfeiture of such bene23 fits. The Secretary shall promptly notify each claimant

24 having a claim subject to review under this subsection that
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1 the claim shall be reviewed by the Secretary in accordance

2 with this subsection.

3 ‘‘(b) PROCEDURE.—

4 ‘‘(1) In carrying out the review of a claim

5 under subsection (a), the Secretary shall not allow

6 the claimant or any other party to submit additional

7 medical or other evidence if the Secretary deter8 mines that the evidence on file meets the criteria of

9 eligibility set forth in section 441(a). If the Sec10 retary determines that the evidence on file does not

11 meet the criteria of eligibility set forth in section

12 441(a), the Secretary shall provide an opportunity

13 for the claimant to present additional medical or

14 other evidence to substantiate the claimant’s claim

15 under such criteria and shall notify the claimant of

16 that opportunity. The Secretary shall not be per17 mitted to supplement the evidence in any claim re18 viewed under subsection (a). Each claim reviewed

19 under this section shall be afforded the administra20 tive and judicial review that is afforded claims that

21 are not subject to this section.

22 ‘‘(2) If a claim is determined under subsection

23 (a) to meet the eligibility requirements of section

24 441(a), the individual for which the claim was sub25 mitted shall be awarded benefits prospectively (un-
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1 less, at the time of such determination, the individ2 ual is receiving black lung benefits prospectively pur3 suant to an award made in connection with a sepa4 rate claim) and retroactively for any period begin5 ning on or after January 1, 1974, for which the

6 claimant (1) has not received benefits, and (2) is eli7 gible under the statutory and regulatory provisions

8 governing the retroactive payment of benefits for

9 claims that are not subject to the special review re10 quired by subsection (a).

11 ‘‘SEC. 443. PAYMENT OF BENEFITS.

12 Benefits payable under any claim which is determined

13 under section 441 or 442 to be eligible for benefits shall

14 be paid from the fund.

15 ‘‘SEC. 444. JUDICIAL REVIEW.

16 ‘‘A claimant who files a claim after the date of enact17 ment of this Act and whose claim is denied by the Depart18 ment of Labor’s Benefits Review Board pursuant to the

19 procedure of section 21(b) of the Longshore and Harbor

20 Workers’ Compensation Act (33 U.S.C. 921(b)), may peti21 tion for review in the United States District Court for the

22 district in which the claimant last worked as a coal miner

23 or where the claimant resides at the time the appeal is

24 filed, whichever the claimant chooses. Section 205(g) of

25 the Social Security Act (42 U.S.C. 405(g)) shall govern
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1 all such petitions for review, except that (1) each reference

2 therein to the Secretary shall be interpreted as meaning

3 the Secretary of Labor, and (2) if the claim was denied

4 because of the application of a regulation which violates

5 this Act or any other Federal law, the period in which

6 a claimant may petition for review shall not apply. A peti7 tion for review under this section may not be denied be8 cause the claimant has not exhausted the administrative

9 remedies available to the claimant.

10 ‘‘SEC. 445. SURVIVORS AND DEPENDENTS.

11 ‘‘(a) IN GENERAL.—The Secretary shall award the

12 survivor or dependent of a deceased miner benefits under

13 a claim under part C if the conditions in any one of the

14 following paragraphs are met:

15 ‘‘(1) The deceased miner worked 25 years or

16 more in one or more coal mines.

17 ‘‘(2) The miner’s death was due in whole or in

18 part to pneumoconiosis.

19 ‘‘(3) The miner was receiving benefits for

20 pneumoconiosis at the time of the miner’s death.

21 ‘‘(4) The miner had a claim for benefits for

22 pneumoconiosis pending at the time of the miner’s

23 death—

24 ‘‘(A) in which the existing medical evidence

25 or such evidence combined with any additional
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1 medical evidence submitted by survivors or de2 pendents demonstrates a level of impairment

3 sufficient to qualify for benefits under section

4 441(a), or

5 ‘‘(B) in which the medical evidence was not

6 sufficient to qualify for benefits under section

7 441(a) but lay evidence (i) demonstrates by a

8 preponderance of the evidence the existence of

9 a respiatory disease or pulmonary impairment

10 that would prevent the miner from performing

11 the miner’s usual coal mine work, and (ii) such

12 disease or impairment is established in accord13 ance with section 441(b)(2) as resulting from

14 the miner’s coal mine work.

15 ‘‘(b) DEFINITION.—For purposes of this section, sur16 vivors and dependents are those individuals who filed

17 claims under part C after the date of enactment of this

18 Act or whose claims under part B or C are eligible for

19 review under section 442.

20 ‘‘SEC. 446. GENERAL PROVISIONS.

21 ‘‘(a) MULTIPLE CLAIMS.—If a claimant has had a

22 claim denied under this Act, the Secretary shall permit

23 the claimant to file an additional claim under this part

24 without a showing of a material change in the claim. Such
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1 an additional claim shall be considered de novo on the

2 merits.

3 ‘‘(b) APPEALS BY THE SECRETARY.—The Secretary

4 may not file an appeal from a decision of the Deputy Com5 missioner, the Office of Administrative Law Judges, the

6 Benefits Review Board, or a district court of the United

7 States with respect to a claim under this part which is

8 adverse to the Secretary.

9 ‘‘(c) REOPENING CLAIMS.—No claim under this part

10 under which the claimant was awarded benefits and with

11 respect to which no appeal is pending may be reopened

12 by the Secretary unless the Secretary offers reasonable

13 evidence to suspect fraud in connection with the adjudica14 tion of the claim.’’.

15 SEC. 3. CONFORMING AMENDMENT.

16 Section 224(a)(2)(B) of the Social Security Act (42

17 U.S.C. 424a(a)(2)(B)) is amended by striking out ‘‘and

18 (iv)’’ and inserting in lieu thereof ‘‘(iv)’’ and by inserting

19 at the end the following: ‘‘and (v) benefits payable under

20 the Black Lung Benefits Act,’’.

21 SEC. 4. BENEFIT REPAYMENTS.

22 Part C of the Black Lung Benefits Act is amended

23 by adding at the end the following:

24 ‘‘SEC. 436. (a) In the administration of the benefits

25 payable under this part, if a claimant receives benefits
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1 under this part under a claim but before final adjudication

2 of the claim for benefits is made and if the final adjudica3 tion is that the claimant is ineligible for benefits, the pay4 ment of such benefits to the claimant shall not be consid5 ered an overpayment of benefits and the claimant shall

6 not be legally responsible for the return of such benefits.

7 ‘‘(b) If, before the date of the enactment of this sec8 tion, a claimant received benefits under this part under

9 a claim but before a final adjudication of the claim for

10 benefits was made, the claimant will not be required to

11 repay such benefits. If, before the date of the enactment

12 of this section, a claimant who received benefits under this

13 part under a claim but before final adjudication of the

14 claim for benefits was made was required under regula15 tions of the Secretary to repay the benefits as an overpay16 ment of benefits, the Secretary shall refund to the claim17 ant the amount repaid by the claimant.’’.

18 SEC. 5. WIDOW’S BENEFITS.

19 (a) IN GENERAL.—In the administration of the Black

20 Lung Benefits Act—

21 (1) a widow of a miner who received or is re22 ceiving benefits under that Act shall not be disquali23 fied to receive such benefits if the widow remarries,

24 and
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1 (2) a widow of a miner shall be entitled to re2 ceive such benefits without regard to the length of

3 time the widow was married to the miner.

4 Any regulations of the Secretary of Labor which disqualify

5 a widow described in paragraph (1) or impose a minimum

6 marriage period as described in paragraph (2) shall on

7 and after the date of the enactment of this Act have no

8 legal effect.

9 APPLICATIONS.—Any widow who on the date of the

10 enactment of this Act is entitled to receive benefits under

11 the Black Lung Benefits Act because of subsection (a)

12 shall file a claim for such benefits within 3 years of the

13 date of the enactment of this Act.

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