Opinion ID: 3152012
Heading Depth: 2
Heading Rank: 2

Heading: Framework of Black-Lung-Benefits Cases

Text: The Black Lung Benefits Act was passed and enacted to “provide benefits . . . to coal miners who are totally disabled due to pneumoconiosis.” 30 U.S.C. § 901(a). “Pneumoconiosis” is defined succinctly in the Act as “a chronic dust disease of the lung and its sequelae, including respiratory and pulmonary impairments, arising out of coal mine employment.” 30 U.S.C. § 902(b). As might be expected, however, deciding whether a miner suffers from pneumoconiosis and whether the miner is entitled to receipt of benefits is not a straightforward determination. -10- No. 14-4263 Simco Peabody Coal Co. v. Dir. OWCP, et al. Generally, in order “[t]o establish entitlement to benefits, the claimant must prove by a preponderance of the evidence that (1) he has pneumoconiosis, (2) his pneumoconiosis arose in whole or in part out of his coal mine employment, (3) he is totally disabled, and (4) the total disability is due to pneumoconiosis.” Cent. Ohio Coal Co. v. Dir., Office of Workers Comp. Programs, 762 F.3d 483, 486 (6th Cir. 2014). In this case, Simco Peabody challenges the administrative law judge’s determination that Ruby has satisfied each of these claim elements. 1. Does Ruby Suffer from Pneumoconiosis Arising from Coal Mine Employment? Although 30 U.S.C. § 902(b) defines “pneumoconiosis” broadly, the implementing regulations promulgated by the Department of Labor’s Office of Workers’ Compensation Programs add sufficient details to aid in determining entitlement to benefits under the Act. Pursuant to those regulations, the statutory definition of “pneumoconiosis” is considered to include both medical, or “clinical,” pneumoconiosis and statutory, or “legal,” pneumoconiosis. “Clinical pneumoconiosis” “refers to a specific set of enumerated diseases,” Brandywine Explosives & Supply, 790 F.3d at 661, that are “characterized by permanent deposition of substantial amounts of particulate matter in the lungs and the fibrotic reaction of the lung tissue to that deposition caused by dust exposure in coal mine employment.” 20 C.F.R. § 718.201(a)(1). “Legal pneumoconiosis” is defined more broadly, however, to include, but not be limited to, “any chronic restrictive or obstructive pulmonary disease arising out of coal mine employment.” 20 C.F.R. § 718.201(a)(2). When considering whether such a pulmonary disease arose out of coal mine employment, a finder of fact examines whether “any chronic pulmonary disease or respiratory or pulmonary impairment [was] significantly related to, or substantially aggravated by, dust exposure in coal mine employment.” 20 C.F.R. § 718.201(b). -11- No. 14-4263 Simco Peabody Coal Co. v. Dir. OWCP, et al. The applicable regulations offer four ways in which a claimant can establish the existence of pneumoconiosis. 20 C.F.R. § 718.202(a)(1)-(4). Three of these four alternatives—chest x- rays, biopsies or autopsies, and certain regulatory presumptions—are not relied upon by Ruby in this litigation to support his claim for benefits. However, pneumoconiosis also can be shown by “objective medical evidence such as blood-gas studies, electrocardiograms, pulmonary function studies, physical performance test, physical examination, and medical and work histories,” if “supported by a reasoned medical opinion.” 20 C.F.R. § 718.202(a)(4). All parties and decision-makers in this litigation concur that Ruby’s blood-gas studies and electrocardiogram did not yield results supporting a finding of legal pneumoconiosis. Nevertheless, Dr. Knight still was able to diagnose Ruby with “COPD of moderate severity, based on history and physical examination, [and] pulmonary functions.” In doing so, Knight took into account the fact that Ruby was a lifelong non-smoker, yet after working in coal mines for portions of eight years, suffered from wheezing, shortness of breath, coughing, and occasional chest pain. Knight also relied on pulmonary-function-test results that indicated a mild restriction of total lung capacity and an obstruction to airflow. Similarly, Dr. Conibear concluded that Ruby suffered from legal pneumoconiosis, based upon her review of his medical and employment history, his productive cough and shortness of breath, and his “abnormal lung volumes,” as determined by use of the Hankinson reference range preferred by the American Thoracic Society to interpret pulmonary-function-test results.5 Even Rosenberg and Zaldivar, Simco Peabody’s own medical experts, did not dispute Ruby’s employment history or medical symptoms. Furthermore, both Rosenberg and Zaldivar conceded that, if the pulmonary function test conducted by Knight in 2009 is considered to be 5 The other medical experts who offered testimony or opinions in this matter used instead the Knudson reference range that is used more commonly in black lung examinations to interpret pulmonary-function-test results. -12- No. 14-4263 Simco Peabody Coal Co. v. Dir. OWCP, et al. valid—a concession they were not willing to make, other than for hypothetical purposes—Ruby suffered from severe, significant, or disabling pulmonary obstruction. Given that information, especially if the 2009 test is considered valid, the administrative law judge had before him substantial evidence to conclude that Ruby established that he suffered from legal pneumoconiosis. Rosenberg argued, however, that the 2009 test was invalid because the results revealed that Ruby hesitated during expiration and that his effort in the study was “incomplete.” Likewise, Zaldivar based his belief that Knight’s testing was not valid on his opinion that Ruby’s effort was “dismal,” inconsistent, and less than optimal. The administrative law judge considered the coal company’s evidence offered to show the invalidity of the 2009 testing but ultimately concluded that the test was nevertheless valid. In doing so, the administrative law judge simply chose, as was his prerogative, to give less credence to Rosenberg’s and Zaldivar’s claims of invalidity that were based on allegations of Ruby’s lack of effort even in light of the countervailing evidence both from Dr. Clapp, who determined that the test was valid, and from Knight, who contacted the technician who conducted the test and who stated that Ruby exhibited full effort during the examination. Moreover, the administrative law judge credited Knight’s statement that the doctor had reviewed the 2009 study results and found no evidence of hesitation on Ruby’s part. Knight also maintained that the test results satisfied Department of Labor standards and explained: Mr. Ruby exhaled for longer than seven seconds and reached a plateau at the end of his expiration. There was no hesitation at all on the pre-bronchodilator maneuvers at all and so both the pre-bronchodilator FEV1 and FVC values are valid. There was only some very minor hesitation during the post-bronchodilator maneuvers but long after the first second (which is the only time period that matters for the post-bronchodilator FEV1) and well before the last two seconds so that the post-bronchodilator FVC value is also valid. This hesitation is very minor and does not affect the validity of the FEV1 and FVC values. -13- No. 14-4263 Simco Peabody Coal Co. v. Dir. OWCP, et al. Substantial evidence in the record thus supports the administrative law judge’s conclusion that the 2009 pulmonary function test was valid. Evidence of that validity, in conjunction with the opinions of. Knight and Conibear and the begrudging concessions of. Rosenberg and Zaldivar, is sufficient to affirm the administrative law judge’s finding that Ruby suffered from severe pulmonary obstruction. However, for such a pulmonary condition to constitute “legal pneumoconiosis” requires proof that the disease or impairment actually arose out of coal mine employment. Simco Peabody claims that the administrative law judge erred in crediting Knight and Conibear’s opinions regarding the existence of legal pneumoconiosis because those doctors claimed that exposure to coal mine dust only “potentially” caused Ruby’s pulmonary obstruction. According to the coal company, “Both physicians referenced the fact that the Claimant was a non-smoker, but did no further analysis.” That assertion is based, in large part, on the company’s misguided implication that Knight and Conibear believed that coal dust is responsible “for every instance of non-tobacco related lung disease.” The record does not support Simco Peabody’s leap of logic. In fact, both Knight and Conibear considered, but rejected, asthma—a non-tobacco-related lung disease—as a potential cause of Ruby’s condition. Then, relying upon the concrete evidence of Ruby’s pulmonary symptoms and the lack of any evidence that past or present smoking could have contributed to the verifiable discomfort the claimant experienced, Knight concluded that “[t]he only apparent etiology for this person’s lung disease is dust exposure in the course of work over several years.” Such an analysis is far removed from a complete failure to consider alternatives and a belief that coal dust exposure is the cause of all lung diseases found in non-smoking miners. -14- No. 14-4263 Simco Peabody Coal Co. v. Dir. OWCP, et al. Furthermore, the administrative law judge did not err in giving no credence to Rosenberg’s assertion in his deposition that Ruby’s pulmonary issues were unrelated to his coal mine employment because “any cough or sputum production [Ruby] has two decades after he has left the coal mine exposure would not [be] related to past coal mine dust exposure.” Applicable regulations dispute the legitimacy of Rosenberg’s suggestion. Indeed, 20 C.F.R. § 718.201(c) provides explicitly that pneumoconiosis is “a latent and progressive disease which may first become detectable only after the cessation of coal mine dust exposure.” (Emphasis added.) The administrative law judge’s finding that Ruby suffered from legal pneumoconiosis is supported by substantial evidence in the record. Consequently, Simco Peabody’s efforts to undermine that determination are without merit. 2. Does the Record Establish That Ruby Is Totally Disabled? The bulk of Simco Peabody’s petition for review involves challenges to the administrative law judge’s determination that Ruby was totally disabled. In contesting that factual finding, Simco Peabody argues that the administrative law judge erred: (1) in ignoring the 2011 pulmonary function test’s finding of no disability; (2) in not applying the “later-isbetter” rule to the 2011 test results; (3) in crediting the testimony of Dr. Conibear even though she used disability standards that differed from those approved by the Department of Labor; (4) in crediting the testimony of doctors who relied on information gained from review of the non-qualifying, yet valid, 2009 test; (5) in crediting opinions of total disability that were not based on objective medical testing; and (6) in rejecting the opinions of Rosenberg and Zaldivar simply because they found the 2009 test invalid when the administrative law judge himself -15- No. 14-4263 Simco Peabody Coal Co. v. Dir. OWCP, et al. determined that the results of that test would not qualify, in the absence of other findings, as evidence of total disability. For purposes of this litigation, the parties agree that Ruby should be considered totally disabled if he suffers from “a pulmonary or respiratory impairment which, standing alone, prevents [him] . . . [f]rom performing his . . . usual coal mine work.” 20 C.F.R. § 718.204(b)(1)(i). The regulations again provide four methods for establishing such a disability. Two of those methods—arterial blood-gas-test values and medical evidence of “cor pulmonale with right-sided congestive heart failure”—are not relevant here. However, a claimant also may seek to prove total disability through pulmonary-function-test results or through other diagnostic techniques. 20 C.F.R. § 718.204(b)(2)(i) and (iv).
As a prerequisite to relying upon pulmonary-function-test results to establish total disability in black lung cases, a claimant must be able to point to results showing FEV1 values equal to or less than base values listed in a Code of Federal Regulations table for individuals “of the miner’s age, sex, and height.” 20 C.F.R. § 718.204(b)(2)(i). For a male of Ruby’s age and height, the FEV1 value of any pulmonary function test must not exceed a level of 1.91 liters if the test if to qualify as a method of showing total disability. See 20 C.F.R. Pt. 718, App. B (Table B1). Ruby easy met this threshold requirement. In fact, the highest FEV1 values for the trials deemed acceptable from Knight’s 2009 test were 1.54 liters (pre-bronchodilator) and
In addition, however, in order to establish total disability, a claimant must submit test results that meet one of three other benchmarks: (1) values equal to or less than those listed in 6 Rosenberg recorded FEV1 values in his 2011 test of 2.27 liters (pre-bronchodilator) and 1.55 liters (postbronchodilator). -16- No. 14-4263 Simco Peabody Coal Co. v. Dir. OWCP, et al. the appropriate table “for an individual of the miner’s age, sex, and height for the FVC test” 7; (2) values equal to or less than those listed in the appropriate table “for an individual of the miner’s age, sex, and height for the MVV test”8; or (3) “[a] percentage of 55 or less when the results of the FEV1 test are divided by the results of the FVC test.” 20 C.F.R. § 718.204(b)(2)(i)(A), (B), and (C). The evidence presented to the administrative law judge indicates that Ruby failed to establish total disability by any of these three methods.
Because Ruby was unable to rely upon pulmonary function testing, arterial blood-gas tests, or the presence of cor pulmonale to establish total disability, the success of his claim for black lung benefits hinged upon his ability to comply with the provisions of 20 C.F.R. § 718.204(b)(2)(iv). Pursuant to that subsection of the regulation: When total disability cannot be shown under paragraphs (b)(2)(i), (ii), or (iii) of this section, or where pulmonary function tests and/or blood gas studies are medically contraindicated, total disability may nevertheless be found if a physician exercising reasoned medical judgment, based on medically acceptable clinical and laboratory diagnostic techniques, concludes that a miner’s respiratory or pulmonary condition prevents or prevented the miner from engaging in [his usual coal mine work]. To support his claim for benefits, Ruby highlighted the medical reports of Knight and Conibear. Simco Peabody counters the assertion of total disability with the contrary opinions of Rosenberg and Zaldivar. As has been detailed previously, Knight and Conibear based their determinations of total disability on the results of Knight’s physical examination of Ruby and on the doctors’ review of the claimant’s complaints of wheezing, coughing, and chest pain, as well as on Ruby’s description of his prior coal mine work. In light of their medical findings and the fact that Ruby asserted that he had difficulty climbing stairs, could not walk even one block on a 7 “FVC” stands for “forced vital capacity.” 8 “MVV” stands for “maximum voluntary ventilation.” -17- No. 14-4263 Simco Peabody Coal Co. v. Dir. OWCP, et al. level sidewalk without becoming short of breath, and could not lift a bag of groceries repeatedly, Knight and Conibear made reasoned medical judgments that the claimant no longer could crawl or duckwalk through dust-filled coal mines carrying or dragging 50-pound boxes of explosives. Furthermore, even though the 2009 pulmonary function study performed on Ruby at Knight’s direction was determined to be non-qualifying for purposes of the Act, both Knight and Conibear considered that Ruby’s FEV1/FVC percentage of 56 was as close to a qualifying pulmonary function study as possible without actually qualifying. The administrative law judge noted the bases for the opinions of Knight and Conibear and concluded that they adequately supported the findings of total disability. c. Simco Peabody’s Objections to the Finding of Total Disability Simco Peabody argues that the administrative law judge erred in crediting the medical opinions of Knight and Conibear when those doctors considered the results of the 2009 pulmonary function study in forming their medical diagnoses. According to the coal company, because the administrative law judge correctly determined that the study did not meet the qualifying standards set forth in the regulations to support, on its own, a finding of total disability, reliance by Knight and Conibear upon that 2009 test was improper. However, Simco Peabody’s disagreement with the administrative law judge’s recognition of the validity of the non-qualifying study’s results in formulating a reasoned medical opinion is ill-founded and contrary to established circuit precedent. In Cornett v. Benham Coal, Inc., 227 F.3d 569, 577 (6th Cir. 2000), for example, we reviewed a denial of benefits to a miner that had been based upon an administrative law judge’s rejection of a physician’s determination of total disability that “relied, in part, on a pulmonary function study that ‘yielded numbers above the qualified amount.’” According to our analysis in Cornett: -18- No. 14-4263 Simco Peabody Coal Co. v. Dir. OWCP, et al. This is clearly an inappropriate reason to reject a physician’s opinion because, as the regulations explicitly provide, a doctor can make a reasoned medical judgment that a miner is totally disabled even “where pulmonary function tests and/or blood-gas studies are medically contraindicated.” 20 C.F.R. § 718.204(c)(4). Under the regulations, [the physician] was entitled to base a reasonable opinion on non-qualifying test results, see Jonida Trucking, Inc. v. Hunt, 124 F.3d 739, 744 (6th Cir. 1997), and the ALJ erred by rejecting his opinion for this reason. Thus, substantial evidence in the record supports the decision of the administrative law judge that the opinions of Knight and Conibear were reasoned, valid, and based on objective medical testing. Similarly, because the valid, although non-qualifying, 2009 test results properly could be considered in forming a reasoned medical opinion regarding Ruby’s total disability, the administrative law judge was justified in questioning the validity of the medical opinions of. Rosenberg and Zaldivar. Both Rosenberg and Zaldivar had testified during their depositions that if the 2009 test was valid—a factual finding actually made by the administrative law judge—they would consider Ruby to be suffering from severe, even disabling, pulmonary obstructions. Nevertheless, when pressed, they concluded that Ruby was not totally disabled due to pneumoconiosis. Thus, once the administrative law judge concluded that the 2009 test indeed was valid, he was justified, if not compelled, to conclude that Rosenberg’s and Zaldivar’s opinions regarding Ruby’s total disability were entitled to little credence or weight. Nor is there any merit to Simco Peabody’s argument that the administrative law judge improperly ignored the results of the 2011 pulmonary function test conducted during Rosenberg’s examination of Ruby. Far from ignoring the results of that study, the administrative law judge engaged in extensive analysis of that test and a discussion of why the test results were of little value in determining whether Ruby was totally disabled as a result of pulmonary obstruction. Significantly, even though the pre-bronchodilator studies in 2011 resulted in non- -19- No. 14-4263 Simco Peabody Coal Co. v. Dir. OWCP, et al. qualifying levels, Rosenberg admitted that Ruby’s efforts during the test were “incomplete and quite variable.” In addition, Ruby suffered from “a fair amount of coughing during the evaluation,” further skewing the results. Then, when post-bronchodilator results proved significantly worse than the pre-bronchodilator readings—an illogical development—Rosenberg aborted the entire test. Furthermore, Rosenberg admitted that medical records showed that Ruby was using bronchodilators and inhaled steroids for some unspecified period of time prior to the initiation of the 2011 test. Not surprisingly, he also conceded such usage could explain why the claimant performed better on that later evaluation than he did in 2009. Clearly, the administrative law judge did not ignore the results of the 2011 pulmonary function test; rather, he recognized the flaws inherent in its administration, found it invalid, and gave little credence to its results or to the opinion of physicians who sought to use those results as a valid medical evaluator. The coal company puts forward two other arguments in its attempt to validate some of the results of the 2011 pulmonary function test that even its own experts found flawed. First, the company proposes that the administrative law judge improperly considered the prior use of bronchodilators to invalidate the 2011 study because the post-bronchodilator results in the 2009 study did not show significant improvement in Ruby’s lung capacity. Consequently, argues Simco Peabody, Ruby’s use of bronchodilators prior to the 2011 test cannot alone be used to explain the claimant’s improved test levels. The company fails to take into account, however, the logical explanation that prolonged use of bronchodilators and inhaled steroids can, over time, ease breathing in individuals suffering from pulmonary afflictions.9 9 Even if use of bronchodilators led to a lessening of Ruby’s breathing difficulties, such a fact would not call into question the validity of the administrative law judge’s finding of total disability. As the Benefits Review Board has ruled, “In making disability determinations, the question is whether the miner is able to perform his job, not whether -20- No. 14-4263 Simco Peabody Coal Co. v. Dir. OWCP, et al. Second, the company insists that application of a “later-is-better rule” necessarily would lead to the conclusion that the results of the 2011 test, not the 2009 test, should be given greater weight. The shortest and best reply to this contention is that the 2011 test was deemed invalid and, therefore, never could be considered “better” than another valid test, regardless of its timing. Simco Peabody’s final challenge to the administrative law judge’s finding of total disability in this case involves its disagreement with standards of interpretation used by Dr. Conibear in her review and analysis of the 2009 and 2011 pulmonary function tests. The coal company surmises that in concluding that Ruby suffered from legal pneumoconiosis and was totally disabled from it, Conibear erroneously relied upon the so-called Hankinson reference range that “uses Lower Limit of Normal values,” rather than upon the Department of Laborapproved Knudson reference range that “uses fixed cut off limits for normal values.” Consequently, argues Simco Peabody, the administrative law judge erred in crediting Conibear’s opinion on total disability. It is true that Conibear questioned Rosenberg’s use of the Knudson reference range to interpret the results of the 2011 pulmonary function test and offered that, “[a]pplying the American Thoracic Society’s preferred Hankinson 1999 reference range . . ., it can be seen that even though there was improvement compared to the Nov. 12, 2009 [test], Mr. Ruby still has levels below the population-based lower limit of normal value.” Significantly, however, Conibear neither stated nor implied that reference to the Hankinson values provided the sole, or even the most important, basis for her medical opinions of Ruby’s condition. Instead, her finding of total disability was based more inclusively upon Ruby’s “[s]ymptoms of dyspnea on exertion with sedentary activities [and] [o]bjective findings on his spirometry, lung volumes, he is able to perform his job after he takes medication.” Maynard v. Pen Coal Corp., BRB No. 09-0599 BLA, 2010 WL 3073532, at  n.3 (BRB July 27, 2010). -21- No. 14-4263 Simco Peabody Coal Co. v. Dir. OWCP, et al. blood gasses, physical examination, and METs developed during the stress test that would preclude the kind of exertion required in his last coal mine job.” Thus, as the Benefits Review Board concluded on its review, “the administrative law judge’s error, if any, in failing to address Dr. Conibear’s use of the Hankinson standards, is harmless.” (Emphasis added.) 3. Was Ruby’s Total Disability Due to Pneumoconiosis? The final element of a claimant’s case for benefits under the Black Lung Benefits Act is the requirement that the miner establish by a preponderance of the evidence that total disability was due to pneumoconiosis. The standards for making such a determination are set forth in 20 C.F.R. § 718.204(c)(1): A miner shall be considered totally disabled due to pneumoconiosis if pneumoconiosis . . . is a substantially contributing cause of the miner’s totally disabling respiratory or pulmonary impairment. Pneumoconiosis is a “substantially contributing cause” of the miner’s disability if it: (i) Has a material adverse effect on the miner’s respiratory or pulmonary condition; or (ii) Materially worsens a totally disabling respiratory or pulmonary impairment which is caused by a disease or exposure unrelated to coal mine employment. Both Knight and Conibear concluded that exposure to coal mine dust caused Ruby’s COPD and other pulmonary problems. The reasoned opinions of those medical experts provide the substantial evidence necessary to affirm the conclusion reached by the administrative law judge that Ruby was totally disabled due to pneumoconiosis. The contrary opinions of Rosenberg and Zaldivar do not detract from that finding given the fact that the coal company experts failed even to find that Ruby suffered from pneumoconiosis.