Case Name: Ashland COMPTON, Petitioner, v. INLAND STEEL COAL COMPANY and Director, Office of Workers' Compensation Programs, United States Department of Labor, Respondents
Court: United States Court of Appeals for the Seventh Circuit
Jurisdiction: United States
Decision Date: 1991-05-21
Citations: 933 F.2d 477
Docket Number: No. 89-2943
Parties: Ashland COMPTON, Petitioner, v. INLAND STEEL COAL COMPANY and Director, Office of Workers’ Compensation Programs, United States Department of Labor, Respondents.
Judges: Before CUMMINGS, COFFEY and RIPPLE, Circuit Judges.
Reporter: Federal Reporter 2d Series
Volume: 933
Pages: 477–496

Head Matter:
Ashland COMPTON, Petitioner, v. INLAND STEEL COAL COMPANY and Director, Office of Workers’ Compensation Programs, United States Department of Labor, Respondents.
No. 89-2943.
United States Court of Appeals, Seventh Circuit.
Argued June 13, 1990.
Decided May 21, 1991.
Rehearing and Rehearing En Banc Denied July 17, 1991.
Harold B. Culley, Jr., Raleigh, Ill., for petitioner.
Donald S. Shire, Sol. Gen., Dept, of Labor, Washington, D.C., John H. Secaras, Sol.Gen., Dept, of Labor, Chicago, Ill., Sylvia T. Kaser, Marta Kusic, Dept, of Labor, Black Lung Div., Linda Mikins, Benefits Review Bd., Dept, of Labor, Washington, D.C., Louis R. Hegeman, Jay D. Stein, Kathryn S. Mueller, Gould & Ratner, Chicago, Ill., for respondents.
Before CUMMINGS, COFFEY and RIPPLE, Circuit Judges.

Opinion:
CUMMINGS, Circuit Judge.
For more than thirty years, Ashland Compton, the claimant in this case, worked in the southern Illinois coal mines near Carbondale. He spent seventeen of his coal-mining years underground. Now he works no longer; he has heart disease and black lung disease ("pneumoconiosis") and, according to his doctor, can barely climb a flight of stairs, let alone descend into a coal mine to perform hard labor. For health reasons, Compton stopped working and finally left his job at Inland Steel Coal Company ("Inland Steel") in May of 1985, after having been on sick leave for a year. In 1984, he brought a claim to the Department of Labor for benefits he asserted were due to him under the Black Lung Benefits Act, as amended, 30 U.S.C. § 901-945. The Deputy Commissioner of the Department of Labor's Office of Workers' Compensation Programs subsequently determined that Compton was eligible to receive benefits under the terms of the Act. However, his employer, Inland Steel, responsible for payment of benefits under the Act, contested its liability, causing Compton's claim to be forwarded to an Administrative Law Judge. The ALJ held a hearing in Carbon-dale on June 4, 1987, and issued a written decision denying benefits on September 24, 1987. Compton appealed the AU's decision to the Benefits Review Board, which affirmed the AU.
Despite Compton's long career in the coal mines of Carbondale, the AU found that Compton failed to satisfy all three requirements of the regulations under the Act that serve as a precondition to the recovery of benefits. Compton came close, for the AU found (and it is uncontested here) that he satisfied the first two conditions. The regulations require that a miner, in order to receive black lung benefits, must first show that he has pneumoconio-sis arising out of his employment in the mines. 20 C.F.R. § 718.203. According to a physician's report, ample proof existed that Compton suffered from pneumoconio-sis. Moreover, because he served in the mines for ten years or more, Compton benefits from the rebuttable presumption contained in 20 C.F.R. § 718.203(b) that his pneumoconiosis arose out of his coal mine employment.
Next, Compton had to demonstrate that he was totally disabled within the meaning of 20 C.F.R. § 718.204. The AU found Compton to be totally disabled based on the result of an arterial blood-gas test and the medical assessment by his doctor, Dr. Rao, that Compton's pulmonary condition severely limited his physical abilities. According to Dr. Rao, Compton could walk only one-half block, could climb only two flights of stairs, could lift only fifty pounds, and could carry such a load for only fifty feet. In his testimony Compton asserted also that he had experienced difficulty breathing since 1980.
Compton therefore satisfied the first two preconditions for the recovery of benefits— he has black lung disease and is totally disabled. This only advances him two-thirds of the way toward recovery; he must also show that the "total disability is due to pneumoconiosis." 20 C.F.R. § 718.204(a). While Compton benefitted from the presumption that his pneumoconi-osis arose from his employment in the mines, the applicable statute does not contain a similar presumption that his total disability was due to pneumoconiosis. Nor did the AU find there to be any evidence that pneumoconiosis caused Compton's total disability. Therefore, the AU denied black lung benefits to Compton.
The crux of this coal miner's case is causation. In his decision denying benefits, the AU did not articulate the proper standard for determining whether Compton's total disability was due to pneumoco-niosis. Compton, the Department of Labor, and Inland Steel each urge a different standard for determining whether a claimant satisfies the regulatory causation requirement. Our task then requires us to choose among the three to the extent that our precedents allow.
Before reaching the question of legal causation, we must parse the record below to determine what medical findings were made by the physician who examined Compton concerning the extent to which his disability was due to pneumoconiosis. First, it is uncontested that Compton has a totally disabling respiratory impairment. According to Dr. Rao's medical report, pneumoconiosis was not claimant's only malady, for Compton also suffers from heart disease. However, Dr. Rao's report discloses that Compton's pneumoconiosis was related to dust exposure from coal mine employment and furthermore, that it was one of the conditions that brought about the pulmonary impairment.
Dr. Rao, having diagnosed the presence of pneumoconiosis and heart disease, did not specify the degree to which Compton's impairment could be attributed to one or the other of the diseases. Because Dr. Rao did not spell out the chain of causation, the AU found no basis in the medical record for concluding that Compton's total disability was due to pneumoconiosis.
The AU arrived at this conclusion without articulating the appropriate standard of causation. The Benefits Review Board, on review of the AU's decision, attempted to set forth what it viewed as the proper nexus under 20 C.F.R. § 718. Citing Wilburn v. Director, OWCP, 11 Black Lung Reporter (MB) 1-135 (BRB 1988), the Board affirmed the AU's decision on the grounds that Compton had failed to establish that pneumoconiosis, in and of itself, was totally disabling. The "in and of itself" language has become problematic, because, regardless of what the Benefits Review Board initially intended in articulating this standard, Wilburn now stands for the proposition that a miner who suffers from a totally disabling respiratory impairment related in part to coal mine employment and in part to some other disability {e.g., smoking or heart disease) would be ineligible for black lung benefits under the Act. Wilburn held that a miner who suffers from pneumoconiosis and any other malady that contributes to his disability will be denied benefits because the sole cause of the disability is not pneumoconiosis.
Were this the applicable rule in this case, Compton, afflicted with both pneumoconiosis and heart disease, would be out of luck. However, the Board's reliance on Wilburn is misplaced. The "in and of itself" rule contravenes our precedents and has also been expressly repudiated by other circuits and by the Board itself, which reversed Wilburn in an en banc decision. Scott v. Mason Coal Co., No. 88-1838 BLA (BRB June 22, 1990).
Our starting point is the decision recently announced by this Court in Shelton v. Director, OWCP, 899 F.2d 690 (7th Cir. 1990). In Shelton, we reviewed in detail the proper standard for determining whether a miner's total disability was due to pneumoconiosis within the meaning of 20 C.F.R. § 718.204(a). Like Compton, the claimant in that case had dual afflictions, but in Shelton, the claimant was a lifelong smoker; he did not suffer from heart disease. The Court explored all of the possible meanings attributable to "due to pneu-moconiosis." After rejecting Wilburn's stringent requirement that pneumoconiosis be the sole cause of the claimant's disability, the Shelton Court focused on a more plausible formulation.
In order to satisfy the causation requirement, we held that pneumoconiosis must be a "contributing cause" of the total disability, such that "mining must be a necessary, but need not be a sufficient condition of the miner's disability." Shelton, 899 F.2d at 693. As Judge Posner explained, "if [Shelton] had not mined, he would not have become totally disabled, although he might have avoided the disability by care on some other front, for example, by not smoking." Id. The same analysis applies here: if the ALJ finds that Compton could have become totally disabled without having pneumoconiosis, then he does not recover. In the alternative, a miner's disabled condition may be caused only in part by pneumoconiosis. Under the rule of Shelton, if Compton did not also have heart disease, he might have escaped classification as totally disabled within the meaning of the Act.
Shelton establishes a workable, sensible framework for determining whether the causation requirement is satisfied so that a disabled miner can recover black lung benefits. Shelton's utility has been proven already in this Court's decision in Hawkins v. Director, OWCP, 907 F.2d 697 (7th Cir. 1990). In Hawkins, the Court recognized that "[a]s Shelton makes clear, claimants must prove a simple 'but for' nexus to be entitled to benefits," id. at 701, and rejected a reading of Shelton that would require pneumoconiosis to be a "substantial contributing cause" of the total disability.
Hawkins explicitly declined to heighten a miner's burden further by requiring that he prove that pneumoconiosis was a "substantial" or "primary" cause of total disability. Hawkins reaffirms the result in Shelton that a miner need show only that he possesses a total pulmonary disability which is necessarily due in part to pneumo-coniosis. The Court remanded the case to the AU to permit the claimant to make such a showing under the proper Shelton standard.
With slight variation, other circuits mirror our approach to the causal question. The Tenth Circuit was the first to clarify the causation requirement for a miner to recover benefits:
If the pneumoconiosis is at least a contributing cause, there is a sufficient nexus between the pneumoconiosis and the total disability to satisfy claimant's burden of proof. This standard is consistent with congressional intent of liberal assistance to totally disabled coal miners. It is also consistent with nearly twenty years of court interpretation of the Act in eight different circuits during the course of three sets of legislative amendments.
Mangus v. Director, OWCP, 882 F.2d 1527, 1531-1532 (10th Cir.1989) (emphasis in original). In requiring that pneumoconiosis be a contributing cause of a miner's total disability, the court declined to modify the causation requirement further by appending such "nebulous terms as 'significant' or 'substantial,' " id. at 1531, believing them to impose an inappropriately heavy burden. See also Robinson v. Pickands Mather & Co./Leslie Coal Co., 914 F.2d 35, 38 (4th Cir.1990) ("[T]he formulation of the disability causation requirement that is easiest to apply and is most consistent with the remedial purpose of the Act is simply 'contributing cause.' ").
The Third Circuit in Bonessa v. United States Steel Corp., 884 F.2d 726 (1989), however, took a somewhat different tack. It also rejected the Wilburn approach, concluding, upon a review of Benefits Review Board precedents, that Wilburn imposed a stringent causation requirement unsupported by either the plain language of the regulation or the case law. Bonessa carved an intermediate path, interpreting the statute to mean that:
one may not prove total disability due to pneumoconiosis simply by demonstrating the presence of any respiratory or pulmonary ailment. Rather a miner must show that pneumoconiosis is a substantial contributor to the disability.
Bonessa, 884 F.2d at 734 (emphasis supplied). In reaching its decision, the Third Circuit concluded that the interpretation of 20 C.F.R. § 718.204(c)(5), requiring that a miner, in order to recover, must have a "total disability due to pneumoconiosis," logically gave rise to the same interpretation as virtually identical language conditioning recovery of benefits by a miner's survivors only if they show "death due to pneumoconiosis." Id. at 733.
The court in Bonessa believed the plain language of the regulations conditioning benefits on a finding of "death due to pneumoconiosis" to be clearer than the regulations predicating benefits on a showing of "total disability due to pneumoconiosis." The court rested its belief on an additional provision, 20 C.F.R. § 718.205(c), defining the showing required for a deceased miner's survivors to recover black lung benefits. Section 718.205(c) conditions benefits on a showing that pneumoconiosis is a "significant contributor to a living miner's disability." Id. at 733. But this provision does not require a showing of "significant" contribution in all cases. The other four subsections of the regulation governing entitlement to benefits when death is due to pneumoconiosis mandate an award of benefits to survivors if any of the statutory presumptions are satisfied, 20 C.F.R. § 718.205(b)(3) — (4), or if "death was due to multiple causes including pneumoconiosis and it is not medically feasible to distinguish which disease caused death or the extent to which pneumoconiosis contributed to death," 20 C.F.R. § 718.205(b)(2). Despite the fact that a survivor can acquire benefits in several ways, the court in Bonessa seized upon the language in § 718.205(b)(2) and required that there be a "substantial nexus" linking the pneumoco-niosis and the miner's disability. Id.
We agree with Bonessa insofar as it rejects Wilburn in favor of a more sensible rule. However, we decline to complicate unnecessarily the legal analysis by requiring that a miner show pneumoconiosis to be a "substantial contributor" to a miner's disability. Rather, we agree with the conclusion by the Tenth Circuit in Mangus, followed by this Court in Hawkins, that a heightened showing imposes unnecessary burdens on claimants. Such a requirement inappropriately transforms a medical question into a legal question, since it is the attending physician who is best qualified to determine whether pneumoconiosis causes a miner's disability. The ALJ reviewing a claim should only examine the medical conclusion to determine whether the statutory threshold has been met. When a physician asserts that pneumoconiosis contributes to a miner's disability, ALJs should not be required to make a medical assessment whether pneumoconiosis substantially contributes to a miner's total disability. That is the job of the physician, not of the ALJ. Our approach, as explained in Shelton and Hawkins, reflects this.
By the same token, we cannot accept the concurrence's far-flung proposal requiring a miner to show that his pneumoconiosis caused at least 51% of his disability. This approach may seem seductive at first — proposing a numerical bright line in place of more flexible statutory language and the cases applying it. To its credit, the concurrence, in formulating the rule, rejects the stringent sole cause rule of Wilburn, recognizing that it has been uniformly rejected by other circuit courts. Concurrence at 490, citing Lollar v. Alabama By-Products Corp., 893 F.2d 1258 (11th Cir.1990); Adams v. Director, OWCP, 886 F.2d 818 (6th Cir.1989); Bonessa v. United States Steel Corp., 884 F.2d 726 (3d Cir. 1989); Mangus v. Director, OWCP, 882 F.2d 1527 (10th Cir.1989). However, the concurrence does not stop at Wilburn; it attempts to replace the "contributing cause" approach of our Court in Shelton and Hawkins with an unprecedented, more restrictive approach.
Under the concurrence's proposed rule, a determination that pneumoconiosis is a contributing cause of a miner's disability is not enough; a miner must be able to attribute 51% or more of his disability to pneumoco-niosis. In identifying this numerical minimum, the concurrence draws principally upon its understanding of congressional intent in passing the 1981 amendments to the Black Lung Benefits Act and upon its novel definition of the word "primary". The concurrence states that a logical interpretation of the Act requires that pneumoconiosis be the "primary" cause of total disability and inserts "51 percent," concurrence at 490, in parentheses, as the meaning of the word "primary". The concurrence thus equates "primary" with 51 percent. In fact, neither the legislative history nor the precedents of this Court impute any such meaning to the word primary. After conducting a painstaking tour of the legislative history, the concurrence concludes that the 1981 amendments to the Act were designed to tighten eligibility requirements and dramatically reduce disbursements to disabled miners. Concurrence at 488. The concurrence has quantified its reading of the legislative record by drawing a bright line, and it has justified this bright line by reference to comparative negligence in tort law. According to the concurrence, requiring a miner to quantify the causes of his disability is akin to a regime in tort in which "fact-finders routinely consider the percentage of fault of various parties in apportioning liability." Concurrence at 493.
The concurrence's black lung bright line, however, is unjustified, for a disabled miner's black lung benefits claim does not resemble a tort suit in a comparative negligence regime. A numerical bright line depends upon the ability of some factfinder, be it juror or judge, to assign a percentage to some act or condition with confidence that he or she is best positioned to make such an assessment. In a comparative negligence case, percentage fault reflects the extent to which a party bears legal responsibility for a tort. Such a percentage can only be determined upon the eon- elusion of a trial or evidentiary hearing in which the plaintiff, on the one hand, has proven a prima facie .case of tort liability, and the defendant has responded by presenting plausible tort defenses. After all the evidence is presented, the factfinder in a comparative negligence jurisdiction weighs the defenses against the prima fa-cie case and apportions fault accordingly.
In contrast, the conclusion that pneumo-coniosis accounts for 51% of a miner's total disability entails a medical judgment rather than a legal conclusion, and therefore properly remains within the purview of a treating physician rather than a legal factfinder. Not only does the 51% rule put the Benefits Review Board and the AU in the shoes of the doctor, requiring them to ascertain whether the 51% threshold has been passed, it also places doctors in the impossible position of accounting for the exact degree of impairment caused by pneumoco-niosis. Doctors measure the extent of disease by identifying the presence of physical symptoms, not by assigning percentages. Under the proposed rule, pinpoint precision would be required in close cases. Doctors would be forced to decide whether pneumo-coniosis accounts for 50% or 51% of a miner's disability. The validity of the physician's determination would then be subjected to the scrutiny of the AU and the Benefits Review Board—all of whom would be placed in the awkward position of second-guessing the doctor's estimate. The AU and the Benefits Review Board are ill-positioned to adjudge the relative presence of black lung disease in the body of a miner, for this entails a medical conclusion outside their expertise.
Not only does logic lead us away from the bright line; so does the applicable regulation. Section 718.204(c)(4) of the Code of Federal Regulations provides that where pulmonary function and/or blood-gas studies produce conflicting results, an AU can nevertheless find a miner to be totally disabled by relying on a "physician exercising reasoned medical judgment, based on medically acceptable clinical and laboratory diagnostic techniques." 20 C.F.R. § 718.204(c)(4). In cases where benefits are contingent upon the satisfaction of a statutory requirement, the AU's role is to review the medical determination to determine whether it falls within the purview of the statute. However, the AU should rely on the medical judgment—if, in the opinion of the doctor, pneumoconiosis contributes to a miner's disability, then he will recover; otherwise, he will not. To impose a numerical threshold obfuscates the essential inquiry and promotes distrust in a doctor's ability to exercise sound medical judgment.
In rejecting the mine operator's argument for a substantial contributing cause standard for recovery of benefits, the court in Mangus could find no evidence that either the plain language of the 1981 amendments or their legislative history "require a heightened causal relationship between a claimant's pneumoconiosis and his or her total disability." Mangus, 882 F.2d at 1532. Absent such support, the Mangus court refrained from legislating a more stringent standard and acknowledged that "[t]he creation of a higher standard is for someone other than the courts." Id.
In the case at hand, Compton's physician, Dr. Rao, concluded that Compton had pneumoconiosis and heart disease and that he was totally disabled. A lifetime non-smoker and a career coal miner, Compton now suffers from a respiratory ailment that totally disables him within the meaning of the Black Lung Benefits Act. We adhere to Shelton and Hawkins and again hold that so long as the AU concludes that, based on the medical evidence, pneu-moconiosis is a contributing cause of a miner's disability, the miner will recover benefits. Such a determination is not for us, and we remand to the AU for application of the contributing cause standard.
. The Wilburn rule also overlooks the possibility that Compton's twin afflictions may be linked— that his heart disease is an out-growth of his pneumoconiosis: "In advanced cases of [coal miners'] pneumoconiosis the patient becomes grossly disabled and death from cor pulmonale [heart disease] is usual." J.C. Houston, C.L. Joiner & J.R. Trounce, A Short Textbook of Medicine 304 (1985); cf. John Noble, Textbook of General Medicine and Primary Care 96 (1987).
. Webster's Third New International Dictionary defines primary as "something that stands first in order, rank, or importance." This is not the same as 51 percent. The more appropriate term for the concurrence's proposition is "majority," a word which is nowhere to be found in either our precedents or in the legislative history of the Act.
. This is true of course in either modified or pure comparative negligence jurisdictions.