Opinion ID: 752127
Heading Depth: 5
Heading Rank: 2

Heading: Errors in the ALJ's Finding Total Respiratory Disability

Text: 24 In concluding Hicks established that he was totally disabled due to a respiratory condition, the ALJ erred by failing to consider all of the relevant evidence, improperly weighing certain evidence, failing to adequately explain why he credited certain evidence and discredited other evidence, and never adequately addressing the evidence of Hicks' other health problems. 25 First, the ALJ erred in failing to examine all of the relevant evidence. See Sterling Smokeless Coal Co. v. Akers, 131 F.3d 438, 439 (4th Cir.1997). The ALJ gave absolute deference to the examining physicians' reports, with the exception of Drs. Subbaraya and Bembalker, who gave no rationale for their opinions. 9 The opinions of examining physicians Dr. Rasmussen and Dr. Zaldivar were the sole bases for the ALJ's determination pursuant to 20 C.F.R. § 718.204(c)(4). The ALJ completely disregarded the opinions of Dr. Fino and Dr. Sobieski, despite the fact that he found their opinions to be of high quality, simply because they did not examine Hicks. 10 We recently noted that an ALJ should not mechanistically credit[ ], to the exclusion of all other testimony, the testimony of an examining or treating physician solely because the doctor personally examined the claimant. Akers, 131 F.3d at 441. The ALJ has a statutory obligation to consider all of the relevant evidence bearing upon the existence of pneumoconiosis and its contribution to the miner's [disability]. Id. at 442. Therefore, the ALJ erred in considering Dr. Rasmussen's and Dr. Zaldivar's opinions to the exclusion of all the other competent medical opinion evidence. 26 Second, the ALJ, in his Second Order, improperly weighed the evidence of Hicks' length of employment in the coal mines and Hicks' own statements about his pulmonary symptoms, stating: 27 The evidence as to the length of the Claimant's employment at strenuous physical labor in underground coal mines strongly supports the conclusion expressed by Dr. Rasmussen ... that a respiratory or pulmonary condition prevents him from engaging in his former coal mine employment. This non-medical evidence and the testimony of the Claimant as to the pulmonary symptoms from which he is suffering also support the inference that Dr. Rasmussen's finding as to this issue is more persuasive than that of Dr. Zaldivar. 28 (J.A. at 22.) While relevant to the issue of whether there is a totally disabling respiratory impairment, a miner's own statements about his history of coal mine employment or symptoms of pneumoconiosis are not conclusive in resolving conflicting medical opinion evidence. To hold otherwise would be tantamount to allowing the ALJ to substitute his untrained opinion for that of qualified experts, which is not allowed. See Peabody Coal v. Lowis, 708 F.2d 266, 275 (7th Cir.1983) (holding ALJ erred in ignoring reasoned medical opinion of a board certified specialist in internal medicine and pulmonary diseases that claimant's respiratory impairment was due to cigarette smoking and not coal mine employment). Additionally, the length of a miner's coal mine employment does not compel the conclusion that the miner's disability was solely respiratory. See, e.g., Ramey v. Kentland Elkhorn Coal Corp., 755 F.2d 485, 492 (6th Cir.1985) (holding miner employed in coal mines twenty-nine years was totally disabled due to heart disease not pneumoconiosis). 29 Third, the ALJ failed to adequately explain why he credited certain evidence and discredited other evidence. For example, the ALJ cited no valid reasons for crediting Dr. Rasmussen's opinion over Dr. Zaldivar's. In his final order, the ALJ credited Dr. Rasmussen's opinion, stating: 30 In according greater weight to the opinion of Dr. Rasmussen, I find that, despite some discrepancy in Claimant's reported cigarette smoking history, his opinion is most consistent with the Claimant's extensive history of coal mine employment, Claimant's subjective complaints, some abnormal findings on physical examination, x-ray and medical opinion evidence of pneumoconiosis, and the preponderance of the valid arterial blood gas results. 31 (J.A. at 35.) None of these reasons is a sufficient basis for concluding Hicks was disabled due to a respiratory impairment. We examine each in turn. The length of Hicks' coal mine employment does not conclusively confirm that the claimant was disabled due to a respiratory or pulmonary condition. Similarly, Hicks is not an expert as to the cause of his shortness of breath and wheezing and cannot make a medical judgment as to whether such subjective symptoms are fairly attributable to a respiratory condition or to cardiac disease or to obesity. Cf. Peabody Coal Co. v. Helms, 859 F.2d 486, 490 (7th Cir.1988) (noting with approval physician's statement that shortness of breath can be a symptom of heart disease and ... [claimant's] heart disease was not related to his coal mine employment). The ALJ's statement that some abnormal findings on physical examination also supported Dr. Rasmussen's opinion is too vague to support a finding of total disability due to a respiratory condition. Reliance upon the x-ray evidence is also misplaced; all of the physicians who submitted reports agreed that x-rays revealed Hicks had pneumoconiosis, but the mere presence of pneumoconiosis is not synonymous with a totally disabling respiratory condition. As discussed in part III.A.1., the arterial blood-gas results were contradictory. 32 In addition to failing to give sufficient reasons for crediting Dr. Rasmussen's opinion, the ALJ did not provide adequate reasons for discrediting Dr. Zaldivar's opinion. In his Second Order, the ALJ discredited Dr. Zaldivar's opinion on the basis that Dr. Zaldivar used inappropriate criteria in evaluating the blood-gas study evidence, misconstrued other examining physicians' findings, and expressed partisan advocacy in justifying his medical conclusions. The Board subsequently reversed each of these findings. The ALJ never articulated alternative reasons for discrediting Dr. Zaldivar's opinion. 33 Finally, the ALJ erred in merely giving lip service to the evidence of Hicks' other health problems. Specifically, the ALJ did not address Dr. Rasmussen's failure to provide a meaningful evaluation of Hicks' heart-related ailments, a reason for which the ALJ had previously discredited Dr. Rasmussen's opinion in his First Order. The record in this case contained ample evidence that Hicks had numerous other health problems in addition to pneumoconiosis, including cardiac disease, coronary artery disease, obesity, and hypertension. The evidence showed that Hicks stopped working because of a heart attack and subsequent coronary artery bypass surgery in 1982. Dr. Zaldivar concluded Hicks had no respiratory impairment and was disabled solely due to his cardiac condition. Dr. Fino attributed Hicks' disability to his obesity, and Dr. Sobieski determined Hicks was disabled because of his coronary artery disease. 34 The ALJ failed to explain why he rejected all of this evidence of Hicks' other health problems. In his Third Order, rather than providing any reasons for discrediting these physicians' conclusions, the ALJ merely stated even assuming that the Claimant's cardiac condition is the primary cause of Claimant's total disability as suggested by Dr. Zaldivar, it is not the exclusive cause.... The Claimant's coal worker's pneumoconiosis clearly is, at least, a significant contributing cause of such total disability. (J.A. at 35-36.) The ALJ's statement directly contravenes our previous holding that, to establish eligibility for benefits, a miner must prove he has a totally disabling respiratory condition. See Jewell Smokeless Coal Corp. v. Street, 42 F.3d 241, 243 (1994). In Jewell Smokeless, we rejected the argument that [a] miner need only establish that he has a total disability, which may be due to pneumoconiosis in combination with nonrespiratory and nonpulmonary impairments. Id. Thus, the ALJ erred in concluding that even if Hicks' cardiac condition was the primary cause of Hicks' total disability, Hicks would still be eligible for benefits because he suffered from pneumoconiosis. 35 Even if the ALJ determines, after considering all of the relevant evidence, that Hicks suffered from a totally disabling respiratory condition, Hicks will not be eligible for benefits if he would have been totally disabled to the same degree because of his other health problems. A claimant cannot establish eligibility for benefits if he would have been totally disabled to the same degree[and] by the same time in his life had he never been a miner. Dehue Coal Co. v. Ballard, 65 F.3d 1189, 1196 (4th Cir.1995); see also Shelton v. Director, OWCP, 899 F.2d 690, 693 (7th Cir.1990) (holding miner not entitled to benefits if he would have become disabled by reason of heavy smoking or other activity or condition). 36 Therefore, on remand, the ALJ must determine whether Hicks suffers from a totally disabling condition that is entirely respiratory or pulmonary in nature and whether Hicks would have been totally disabled to the same degree because of his other health problems. In making this determination, the ALJ must consider all of the relevant evidence, addressing Dr. Zaldivar's and the other physicians' conclusions with respect to Hicks' nonpulmonary conditions.