Opinion ID: 623780
Heading Depth: 2
Heading Rank: 2

Heading: Scope of Board’s Authority

Text: Bridger first argues the 2009 panel decision is invalid because a majority of the full Board did not vote for its outcome. Because the 2009 panel decision was based on a 2-1 majority, and because no additional members of the en banc Board voted to affirm the panel decision, Bridger argues, it would be improper to allow two members of a five-member board to control the outcome of the case. Bridger’s argument misconstrues the statutory structure governing the Board’s review authority. The Board is composed of five members and is empowered to “hear and determine appeals . . . from decisions with respect to claims of employees” under the Act. 33 U.S.C. § 921(b)(1), (3) 5. Further, The Board is authorized to delegate to panels of three members any or all of the powers which the Board may exercise. . . . Official adjudicative action may be taken only on the affirmative vote of at least two members of a panel. Any party aggrieved by a decision of a panel of the Board may . . . petition the entire permanent Board for review of the panel’s decision. Upon affirmative vote of the majority of the permanent members of the Board, the petition shall be granted. Id. § 921(b)(5). Here, the Board delegated its power to hear Ashmore’s appeal from the 2008 ALJ decision to a three-member panel. On the affirmative vote of two members of the panel, the 2008 ALJ decision was reversed and the 2005 ALJ decision was reinstated. Bridger petitioned the entire permanent five-member 5 The Act incorporated the benefit review provisions of the Longshore and Harbor Workers’ Compensation Act for claims arising after December 31, 1973. 30 U.S.C. § 932(a). -13- Board for review of the panel’s decision. 6 However, there was no “affirmative vote of the majority of the permanent members of the Board” granting the relief Bridger requested. Instead, the en banc Board was divided 2-2-1 and could not reach a consensus on any disposition. The Board therefore properly left the 2009 panel decision undisturbed. See Curry v. Beatrice Pocahontas Coal Co., 67 F.3d 517, 522 n.8 (4th Cir. 1995) (stating where three members of Board did not vote affirmatively to “vacate” decision under review, Board’s action constitutes “affirmance-by-necessity” subject to judicial review as an effective affirmance). Bridger next argues the 2009 panel lacked authority to review and reinstate the 2005 ALJ decision after it concluded its prior reversal of that decision, and the subsequent 2008 ALJ decision on remand, was erroneous. We reject this argument. 33 U.S.C. § 921(b)(3) provides: The Board shall be authorized to hear and determine appeals raising a substantial question of law or fact taken by any party in interest from decisions with respect to claims of employees under this chapter and the extensions thereof. The Board’s orders shall be based upon the hearing record. The findings of fact in the decision under review by the Board shall be conclusive if supported by substantial evidence in the record considered as a whole. 6 In its Reply Brief, Bridger argues the “actual decision under review” by the en banc Board was not the 2009 panel decision at all, but rather, the 2008 ALJ order denying benefits after remand from the 2006 panel decision. This argument is implausible. The statutory scheme contemplates en banc review of an adverse panel decision, not an adverse ALJ decision. See 33 U.S.C. § 921(b)(5). Moreover, it was the 2009 panel decision from which Bridger sought reconsideration and requested rehearing en banc. -14- The relevant regulations further describe the scope of the Board’s review authority: The Benefits Review Board is not empowered to engage in a de novo proceeding or unrestricted review of a case brought before it. The Board is authorized to review the findings of fact and conclusions of law on which the decision or order appealed from was based. Such findings of fact and conclusions of law may be set aside only if they are not, in the judgment of the Board, supported by substantial evidence in the record considered as a whole or in accordance with law. 20 C.F.R. § 802.301(a). Bridger’s reading of these provisions restricting the Board’s authority elevates form over substance. Reviewing the 2008 ALJ decision in light of what it considered new developments in the law on the § 921(c)(3) presumption, the Board determined that decision was not “in accordance with law.” Although the Board went on to “reconsider whether the administrative law judge’s 2005 Decision and Order . . . is supported by substantial evidence and in accordance with applicable law,” such “reconsideration” necessarily occurred within the scope of its initial review of the ALJ’s 2008 order. Moreover, Bridger’s supplemental brief reiterated its objections to the 2005 ALJ decision. Having concluded the ALJ applied the wrong legal standard in its 2008 decision, the Board in its discretion could have remanded the case to the ALJ for a third hearing to apply the Eleventh Circuit -15- approach to the § 921(c)(3) presumption. 7 However, none of the statutes or authorities Bridger cites indicate such remand was required. 8 Bridger also argues the Board was precluded by the law of the case doctrine from reconsidering its prior approach to the complicated pneumoconiosis issue. Initially, Bridger cites no authority, and the court is unaware of any, indicating the law of the case doctrine applies between administrative courts. See Andersen v. U.S. Dep’t of Labor, 422 F.3d 1155, 1180 n.50 (10th Cir. 2005). Assuming without deciding law of the case does apply, Bridger overstates the breadth of the doctrine. Bridger characterizes the law of the case doctrine as a rigid rule that “an issue once litigated and decided in a case is put to an end,” absent an intervening change in controlling law which dictates a different result. Bridger is correct that, “[g]enerally, the ‘law of the case’ doctrine dictates that prior judicial decisions on rules of law govern the same issues in subsequent phases of the same case.” Been v. O.K. Indus., Inc., 495 F.3d 1217, 1224 (10th Cir. 2007). However, “the rule is a flexible one that allows courts to depart from erroneous 7 Indeed, this was the preferred disposition of the fifth en banc Board member. 8 Bridger’s reliance on Bartley v. L & M Coal Co., 901 F.2d 1311 (6th Cir. 1990), is misplaced. Bartley concerned the court’s jurisdiction to review an ALJ decision which was subsequently vacated by the Board and superseded by a new decision and order by the ALJ on remand. See 901 F.2d at 1312. The Sixth Circuit stated it did not have such authority, as its jurisdiction is limited to review of final orders from the Board. Id. Here, the scope of this court’s jurisdiction is not at issue, as Bridger’s appeal is from a final order of the 2009 three-member panel of the Board. -16- prior rulings, as the underlying policy of the rule is one of efficiency, not restraint of judicial power . . . .” Prairie Band Potawatomi Nation v. Wagnon, 476 F.3d 818, 823 (10th Cir. 2007) (citation omitted); see also United States v. U.S. Smelting Ref. & Mining Co., 339 U.S. 186, 199 (1950) (characterizing the law of the case doctrine as “only a discretionary rule of practice”). Even if it were bound by the law of the case doctrine, therefore, the Board appropriately exercised its discretion to depart from the doctrine here. Intervening binding law from the controlling circuit is not the only circumstance in which it is reasonable for the Board to reconsider its prior interpretation of governing law. The development of a circuit split on an issue central to the Board’s resolution of a case that occurs during the pendency of that case is a legitimate reason for the Board to reconsider prior rulings. C. Standard for Applying 30 U.S.C. § 921(c)(3) and 20 C.F.R. § 718.304 This court has not considered what showing is necessary for a claimant, like Ashmore, who relies on the “massive lesions” prong of § 921(c)(3) of the Act to claim entitlement to the irrebutable presumption of disability and/or death due to pneumoconiosis. Neither the Act itself nor its implementing regulations define the term “massive lesions.” Under the approach of the Fourth Circuit, 9 to obtain 9 The court disagrees with Bridger’s assertion that the Fourth Circuit’s requirement of equivalency determinations is followed by the Third and Sixth Circuits. In Clites v. Jones & Laughlin Steel Corp., 663 F.2d 14, 16 (3d Cir. 1981), the Third Circuit held equivalency determinations were necessary to apply (continued...) -17- the benefit of the § 921(c)(3) presumption, a claimant relying on autopsy evidence as set forth in clause (B) of the statute must show such lesions would, if measured by x-ray, produce opacities greater than one centimeter as set forth in clause (A) of the statute. Double B Mining, 177 F.3d at 243. The central justifications for this approach were stated in Double B Mining: Because clauses (A), (B), and (C) of § 921(c)(3) are three different ways of diagnosing complicated pneumoconiosis, in construing the requirements of each, one must perform equivalency determinations to make certain that regardless of which diagnostic technique is used, the same underlying condition triggers the irrebuttable presumption. In other words, the same condition that triggers the presumption by producing opacities greater than one centimeter in diameter on an x-ray should be considered “massive lesions” under the statute if diagnosed through biopsy. By explicitly referencing prongs (A) and (B) as guides, prong (C) of the statute requires “plainly that equivalency determinations shall be made.” Logic commands that prongs (A) and (B) be similarly equivalent. Any other rule would lead to the irrational result that the determination of whether a miner has totally disabling pneumoconiosis could turn on the method of diagnosis rather than on the severity of his disease. Because prong (A) sets out an entirely objective scientific standard, it provides the mechanism for determining equivalencies under prong (B) or prong (C). In prong (A), Congress mandated that the condition that triggers the irrebuttable presumption is one that creates, on an x-ray, at least one opacity greater than one centimeter in diameter. When that condition is diagnosed by biopsy rather than 9 (...continued) clause (C) of § 921(c)(3), but did not decide whether such a requirement is implicit in clause (B). The Sixth Circuit, in Gray v. SLC Coal Co., 176 F.3d 382, 390 (6th Cir. 1999), stated the § 921(c)(3) presumption could be invoked only if an autopsy physician opined that a lesion discovered during autopsy would produce an opacity of greater than one centimeter if viewed by x-ray or that such lesion constitutes a “massive lesion.” -18- x-ray, it must therefore be determined whether the biopsy results show a condition that would produce opacities of greater than one centimeter in diameter on an x-ray. That is to say, “massive lesions,” as described in prong (B), are lesions that when x-rayed, show as opacities greater than one centimeter in diameter. Id. (citation omitted). The Eleventh Circuit described “at least four basic shortcomings” with the equivalency determination requirement of the Fourth Circuit. Pittsburg & Midway, 508 F.3d at 987 n.7. First, the Fourth Circuit’s approach conflates clause (A) with clause (B) of § 921(c)(3). Congress used the term “or” when setting forth the three ways complicated pneumoconiosis could be established under § 921(c)(3), indicating alternatives were intended. Id. Second, reading clause (B) to require an equivalency determination would make it superfluous in light of clause (C), which makes the irrebutable presumption applicable where a claimant shows, by “other means,” a condition which would be expected to yield results described in parts (A) and (B). Id. Third, citing Supreme Court precedent and the legislative history of the Act, the Eleventh Circuit noted autopsy examinations frequently reveal a greater prevalence of pneumoconiosis than x-ray examinations. Id. (citing Usery, 428 U.S. at 32). Fourth, the equivalency determination requirement appears to conflict with the Act’s mandate that claims not be denied solely on the basis of negative x-ray results. Id. (citing 208 U.S.C. § 923(b)). -19- This court is persuaded by the approach of the Eleventh Circuit. Requiring “equivalency determinations” in applying the § 921(c)(3) presumption is contrary to the plain language of the statute and, thus, inconsistent with congressional intent. The Fourth Circuit’s rationale that “logic commands” equivalency determinations be implied in interpreting clauses (A) and (B) because they are expressly required by clause (C) is unpersuasive. To the extent clause (C) demonstrates Congress knew how to require equivalency determinations through the use of specific language in one part of the statute, the lack of similar language in another part of the statute indicates congressional intent not to require such determinations. See United States v. Salas-Mendoza, 237 F.3d 1246, 1248 (10th Cir. 2001). Additionally, it is not at all “irrational” that claimants in some cases will be able to demonstrate entitlement to benefits under one clause of the statute even if they are unable to demonstrate such entitlement under another clause. When Congress provides multiple methods by which claimants can demonstrate entitlement to benefits, it is to be expected such claimants will attempt to prove their claims using the easiest method available to them. This result is also consistent with the broad remedial purposes of the Act. See Magnus v. Dir., Office of Workers’ Comp. Programs, 882 F.2d 1527, 1531 (10th Cir. 1989). Moreover, regardless of whether equivalency determinations are required, the ALJ is not relieved of its obligation to consider “all relevant evidence” in making a benefits determination. See 30 U.S.C. § 923(b). -20- Bridger argues the 2005 ALJ decision was not supported by substantial evidence even if no equivalency determination is required. This court disagrees. The 2005 ALJ decision involved the weighing of conflicting medical evidence, i.e., the weighing of the opinion of Dr. Dobersen against the contrary opinions of Drs. Crouch, Tomashefski, and Tuteur. Such weighing is the sole province of the ALJ and cannot be disturbed by this court on substantial evidence review. Hansen, 984 F.2d at 368. As Bridger acknowledges, Lambright’s medical history was extremely complex. The opinion of the ALJ reviewed Lambright’s medical history and included a detailed discussion of the opinions of Drs. Dobersen, Crouch, Tomashefski, and Tuteur, as well as more than a dozen other doctors who either treated or examined Lambright or analyzed his medical records. The ALJ found the autopsy evidence the most compelling and credited the opinion of Dr. Dobersen over the contrary opinions of Drs. Crouch and Tomashefski. The ALJ provided four reasons for preferring the opinion of Dr. Dobersen: his board certifications in the most sub-disciplines of pathology, his position as prosector, his detailed findings, and his demonstrated understanding of complicated and simple pneumoconiosis. Dr. Dobersen’s opinion included an observation of a 2.5 inch (6.35 cm) lesion of anthracotic scarring in Lambright’s lung, which was consistent with one of Bridger’s doctor’s observation of a “large node” on earlier CT scans. Although Bridger claims this observation was unsupported by Drs. Crouch and Tomashefski, Bridger does not attempt to argue -21- such a lesion would not qualify as “massive” under § 921(c)(3)(B). While the other reasons Bridger advances for preferring the opinions of its experts over that of Dr. Dobersen might be persuasive on de novo review, they ultimately amount to invitations to re-weigh the evidence, which this court may not do. See Energy W. Mining Co., 555 F.3d at 1217. D. Benefits Award Period Bridger challenges the ALJ’s award of benefits on Lambright’s lifetime claim commencing in March, 1998, the month in which his claim was first filed. Bridger does not suggest an alternative entitlement date. A miner is entitled to benefits under the Act beginning the month he becomes totally disabled due to pneumoconiosis. 20 C.F.R. § 725.503(b). If the evidence does not establish the onset date of the miner’s total disability, benefits become payable the month the miner filed his claim. Id. However, if the evidence affirmatively shows the miner was not disabled for some period of time after the claim filing date, benefits cannot be backdated to the filing date. Dir., Office of Workers’ Comp. Programs v. Gurule, 653 F.2d 1368, 1371–72 (10th Cir. 1981), abrogated on other grounds by Lukman v. Dir., Office of Workers’ Comp. Programs, 896 F.2d 1248, 1250–51 (10th Cir. 1990); see also Rochester & Pittsburgh Coal Co. v. Krecota, 868 F.2d 600, 603–04 (3d Cir. 1989). Because a miner with complicated pneumoconiosis is irrebutably presumed to be totally disabled, see supra Part II.A., a miner is entitled to benefits the month his simple pneumoconiosis -22- becomes complicated pneumoconiosis, or, if the onset date of complicated pneumoconiosis cannot be determined, the month he filed his claim. The exact month Lambright’s simple pneumoconiosis became complicated pneumoconiosis cannot be determined because the diagnosis of complicated pneumoconiosis came from Dr. Dobersen’s autopsy report. Therefore, absent an affirmative showing that Lambright did not have complicated pneumoconiosis, an award of lifetime benefits as of his filing date was appropriate. Bridger argues the onset date for Lambright’s lifetime benefits can be no earlier than the month of his death because Dr. Dobersen’s autopsy was the first diagnosis of complicated pneumoconiosis. The autopsy evidence, however, does not establish the date of onset, but merely shows Lambright developed complicated pneumoconiosis at some point prior to his death. “It is well recognized that pneumoconiosis is often a latent, progressive and insidious disease and therefore evidence establishing total disability due to pneumoconiosis may relate backward in time to establish an earlier onset date in the absence of earlier contradictory like evidence.” Gurle, 653 F.2d at 1368 (emphasis added). 10 Therefore, to establish a benefits onset date subsequent to Lambright’s claim-filing date, 10 In support of its argument Bridger relies on two prior ALJ decisions. See Gruller v. BethEnergy Mines, Inc., 11 Black Lung Rep. 3-316 (1988); Gordon v. Cedar Coal Co., 13 Black Lung Rep. 3-146 (1989). These decisions have no precedential value and are not binding on this court. -23- Bridger must point to “earlier contradictory like evidence” disproving the presence of complicated pneumoconiosis. In this respect, Bridger points to x-ray, CT-scan, biopsy, and medical opinion evidence produced prior to Lambright’s death which did not diagnose complicated pneumoconiosis. This showing is inadequate. As both Congress and the Supreme Court have recognized, x-ray evidence is not a reliable indicator of the absence of complicated pneumoconiosis, particularly when weighed against contrary autopsy evidence. See Usery, 428 U.S. at 31–32. The CT-scan evidence is not wholly inconsistent with Dr. Dobersen’s diagnosis of complicated pneumoconiosis. As early as 2000, one of the CT-scans revealed the presence of a “large mass” which the 2005 ALJ considered consistent with Dr. Dobersen’s observation of a 2.5 inch lesion of anthracotic scarring. By rule, negative biopsy evidence cannot establish the absence of pneumoconiosis. 20 C.F.R. § 718.106(c). Lastly, as set forth supra Part III.C., the decision of the ALJ to credit the opinion of Dr. Dobersen over the contrary opinions of Bridger’s experts was rational and supported by substantial evidence. Bridger also attempts to avoid this result by characterizing the ALJ’s award of benefits to Lambright as subsequent to a modification proceeding. After a finding of entitlement, the Act permits the district director to modify an award on his own motion or upon request of either party. 33 U.S.C. § 922; 30 U.S.C. § 932(a) (incorporating modification provisions of Longshore and Harbor -24- Workers’ Compensation Act). Modification may be granted based on a change in conditions or because of a mistake in a determination of fact. 33 U.S.C. § 922; 30 U.S.C. § 932(a); 20 C.F.R. § 725.310(a) (1999). When the grant of a modification request is based on a change in conditions and the evidence does not establish the onset date of total disability due to pneumoconiosis, benefits are payable as of the date of the modification request rather than the initial filing date. 20 C.F.R. § 725.503(d)(2). The default entitlement date does not change, however, when a modification request is granted based on mistake of fact. Bridger therefore argues the decision of the ALJ was preceded by a grant of a “change in conditions” modification request based on Lambright’s death, and so benefits cannot be backdated further than the month of death. 11 This argument is not supported by the record. Lambright initially filed his claim for lifetime benefits in March 1998. On December 21, 1998, the district director entered a determination of entitlement, awarding lifetime benefits to Lambright. Bridger subsequently requested modification of this award. On February 23, 2001, pursuant to Bridger’s request, the director issued a “Proposed Decision and Order Approving Request for Modification After Remand.” The director suspended payment of benefits pending the final adjudication of Lambright’s claim. The order also specified: “If 11 Bridger’s interpretation of the proceedings would therefore entitle Lambright to one month of lifetime benefits. See 20 C.F.R. § 725.502(c). -25- no request for a formal hearing is received within 30 . . . days from the date of this Proposed Order . . ., the proposed order will be deemed to have been accepted by all parties and the findings set forth herein shall become final.” On March 14, 2001, within the appropriate thirty-day window, Lambright requested a hearing before an ALJ. Before that request was acted on, Lambright died. On March 19, 2002, Ashmore filed her claim for survival benefits and submitted additional medical evidence, including Dr. Dobersen’s autopsy report. The claim was not styled as a request for modification. Nonetheless, on August 3, 2002, the district director issued a new order, styled as a “Proposed Decision and Order Granting Request for Modification,” which awarded Ashmore benefits on Lambright’s lifetime claim and on her survivor claim. The Decision and Order thereby disposed of all pending motions, implicitly denying Bridger’s original motion for modification which had not yet been finally ruled on. Thus, it appears the director interpreted Ashmore’s motion as a motion for modification based on change in conditions, but only to the extent Ashmore alleged she was entitled to additional (survivor) benefits due to Lambright’s death. To the extent the order granting modification was based on a change in conditions, the ruling only implicated the claim for survivor benefits, not Lambright’s original claim for lifetime benefits. Therefore, there are no grounds for a change in the default entitlement date for Lambright’s lifetime benefits. -26-