Opinion ID: 3187623
Heading Depth: 2
Heading Rank: 1

Heading: Whether the ALJ Violated the APA

Text: Under the APA, all administrative decisions must include a statement of the decision maker’s “findings and conclusions, and the reasons or basis therefor, on all the material issues of fact, law, or discretion presented on the record.” 5 U.S.C. § 557(c)(3)(A). We have interpreted this requirement to impose a duty on the ALJ to “accurately and specifically . . . reference the evidence supporting his decision.” A & E Coal Co. v. Adams, 694 F.3d 798, 802 (6th Cir. 2012) (citing Morehead Marine Servs., Inc. v. Washnock, 135 F.3d 366, 375 (6th Cir. 1998)). In assessing compliance with § 557(c)(3)(A)’s directive, the key inquiry is whether the ALJ discussed the evidence before her in a sufficiently specific and thorough matter to adequately explain the reasons for her conclusions on all material issues. See, e.g., A & E Coal, 694 F.3d at 802–03 (holding that the ALJ complied with APA where he thoroughly, accurately, and specifically discussed the evidence supporting his conclusions regarding the credibility of the physicians’ medical testimony); Yeager v. Cal-Glo Coal. Co., No. 99-4310, 2000 WL 1888768, at –4 (6th Cir. Dec. 22, 2000) (holding that the ALJ satisfied the APA’s requirements where he analyzed the physicians’ medical opinions, summarized their diagnoses, and stated his rationale for finding for finding certain opinions more persuasive than others); Peabody Coal Co. v. Wilkins, No. 97-3123, 1998 WL 416016, at –2 (6th Cir. July 9, 1998) (rejecting the defendant’s APA challenge where the ALJ’s explanations were “sufficiently reasoned to enable [the Court] to undertake meaningful review”). According to Lance Coal, “[t]he APA mandates that an ALJ’s decision be accompanied by a clear and satisfactory explanation of the basis on which it rests,” and the ALJ’s order awarding benefits “fail[s] to meet these standards.” Appellant’s Br. at 16. More specifically, Lance Coal argues that the ALJ failed to consider facts that detracted from Drs. DeFore and 15 No. 15-3008 Klayton’s medical opinions, including improved, non-qualifying PFT and arterial blood gas values derived from later studies performed by Drs. Fino and Castle. Lance Coal also asserts that the ALJ was required, under the APA, to explain why the medical opinions of Drs. DeFore and Klayton were not invalidated, or at least afforded less weight, based on the opinions’ failure to account for “subsequent” medical evidence, including evidence of which Drs. DeFore and Klayton were “unaware.” The Director maintains that imposing a categorical rule that requires ALJs to conclude that a “doctor’s opinion that does not account for later-developed evidence inconsistent with the doctor’s own findings is per se undocumented and unreasoned,” would (1) be contrary to the Act and its regulations, (2) undermine the ALJ’s discretion, as the fact-finder, to credit or discredit opinions based on whether they are well reasoned and supported by objective medical evidence, and (3) accelerate the production of medical evidence in black lung cases. Gov’t Respondent’s Br. at 19–26. For the following reasons, we agree with each of these contentions. First, we find that requiring ALJs to discredit or afford less weight to medical opinions that do not or (due to the chronology of when each medical examination occurred) cannot account for later developed medical evidence is contrary to the Act because the Act requires ALJs to consider “all relevant evidence” in determining whether a miner is eligible for black lung benefits. 30 U.S.C. § 923(b) (emphasis added). Indeed, the statute sets forth no chronology-based limit on the medical evidence the ALJ may consider, and imposes no balancing system requiring the ALJ to accord more weight to medical opinions that incorporate or account for older evidence and less weight to medical opinions that do not. Second, we find that Lance Coal’s suggested scheme would undermine the ALJ’s ability, as the fact-finder, to independently weigh conflicting medical opinions based on the examining 16 No. 15-3008 physicians’ credibility. This Circuit has made clear, on multiple occasions, that the ALJ’s “determinations to credit or discredit [conflicting] medical opinions based on whether they are sufficiently documented and reasoned is a credibility matter that we must leave to the ALJ.” Big Branch, 737 F.3d at 1073 (citations omitted); see also Morrison, 644 F.3d at 478 (stating that the Court’s review of the ALJ’s decision is limited to “consider[ing] whether the ALJ adequately explained the reasons for crediting certain testimony and documentary evidence over other testimony and documentary evidence”); Gray v. SLC Coal Co., 176 F.3d 382, 388 (6th Cir. 1999) (holding that an ALJ “may evaluate the relative merits of conflicting physicians’ opinions and choose to credit one opinion over the other”) (citation omitted). In weighing conflicting medical opinions, an ALJ errs only when he or she fails to consider all of the relevant evidence, applies an improper legal standard, or there is insufficient evidence to support the ALJ’s findings and conclusions. Morrison, 644 F.3d at 478 (citations omitted). Lance Coal cites this Court’s opinion in Director, Office of Workers’ Comp. Programs v. Rowe, 710 F.2d 251, 255 (6th Cir. 1983), for the proposition that the ALJ was required to “consider facts or evidence that detract from [the] physician’s conclusions” in determining how much weight to attribute to each physician’s medical opinion. See Appellant’s Br. at 16, 21–22; Reply Br. at 2–3. In relevant part, Rowe vacated and remanded the ALJ’s award of benefits because the ALJ “failed to set out and discuss all of the medical evidence presented” or “make important and necessary factual findings” in support of his conclusions. 710 F.2d at 254–56. No such flaw affects the ALJ’s decision and order in this case. As indicated above, the ALJ discussed the medical record for this matter in great detail, found that there was no indication that Caudill suffered from clinical pneumoconiosis, and noted the lack of qualifying values from the PFT and arterial blood gas studies to support invocation of the 15–year 17 No. 15-3008 presumption under sub-parts (i) and (ii) of 20 C.F.R. § 718.204(b)(2). Only after analyzing each physician’s medical opinion did the ALJ reach his conclusion that the opinions of Drs. DeFore and Klayton warranted substantially greater weight than those of Drs. Fino and Castle, and that these opinions supported Caudill’s invocation of the 15–year presumption under 20 C.F.R. § 718.204(b)(2)(iv). The ALJ also concluded that Lance Coal failed to rebut this presumption because Drs. Fino and Castle failed to explain how (1) they found that Caudill’s respiratory or pulmonary impairment arose solely from his obesity as opposed to his coal mine employment and other factors, including his obesity, or (2) how Caudill would be able to return to his former coal mine employment or substantially similar employment in light of his acknowledged pulmonary impairments. Lance Coal does not argue that the ALJ failed to consider relevant evidence and there is no indication that the ALJ’s explanation of his reasons for affording more weight to certain medical opinions and less weight to others was incomplete or under-inclusive. Thus, despite Lance Coal’s reassurances to the contrary, Lance Coal’s invocation of Rowe seems to call for this Court to re-weigh the medical evidence rather than examine whether the ALJ failed to provide a sufficiently specific explanation of his reasons for weighing the conflicting medical opinions in the manner that he did under the APA. We shall not entertain such a request. See, e.g., Big Branch, 737 F.3d at 1074 (rejecting the employer’s request to “reweigh the evidence [and] substitute our judgment for that of the ALJ”) (citation omitted) (alteration in original); Gray, 176 F.3d at 387 (“We should not re-weigh the evidence or substitute our judgment for that of the ALJ.”) (citation omitted). Finally, we agree with the Director’s assertion that Lance Coal’s proposed scheme, which would require ALJs to afford less weight to medical opinions that do not account for later 18 No. 15-3008 developed medical evidence, or, at minimum, explain why such opinions do not deserve to be accorded less weight, is both unworkable and unfairly weighted against the miner. With regard to workability, Lance Coal has failed to propose any kind of metric for measuring or defining what degree of “inconsistency” between a physician’s medical opinion and later developed medical evidence would require the ALJ to afford less weight to that opinion. Without a reliable standard for measuring degrees of inconsistency, imposing the rule Lance Coal seeks would likely create uncertainty for litigants, increase the number of black lung appeals, and require this Court to engage in impermissible re-weighing of the evidence in adjudicating petitions for review. In terms of tipping the scales in favor of the employer’s interests and against the miner’s, as noted previously, the Act provides that a miner seeking black lung benefits must be afforded a DOL-sponsored pulmonary examination at no expense. See 30 U.S.C. § 923(b); 20 C.F.R. § 725.406(a). According to the Director, this DOL-sponsored examination is almost always “the first to be conducted after a claim has been filed,” and it is rare for the physician who administers this initial evaluation to “review[] later-developed evidence.” Gov’t Respondent’s Br. at 24 (footnote omitted). Thus, a rule that categorically results in physicians’ opinions being afforded less weight if they fail to account for contrary, later developed medical evidence and opinions would render the DOL’s provision of a cost-free pulmonary examination largely meaningless because a DOL-sponsored examination would receive less weight any time there was an employer-sponsored examination that both accounted for and contradicted the medical evidence from the DOL examination. As indicated above, there is nothing in the Act or the regulations that dictates or even suggests that a medical opinion should be afforded more or less weight based on its chronology. Further, this type of rule would significantly weaken a miner’s ability 19 No. 15-3008 to rely on a DOL-sponsored examination to support his claim for benefits and thereby increase the likelihood that he would have to rely on later examinations paid for out-of-pocket in order to assure that his physician’s examination accounted for the evidence produced by any subsequent, employer-sponsored examinations. In the same vein, such a scheme would likely tip the scales in black lung benefits cases in favor of employers because of their greater financial ability to engage in a medical opinions arm’s race, trumping each medical opinion procured by the miner with a later, more comprehensive opinion by a physician of the employer’s choosing. See, e.g., Woodward v. Dir., Office of Workers’ Comp. Programs, 991 F.2d 314, 321 (6th Cir. 1993) (stating that “hiring armies of experts often results in needless expense” and “when one party is able to hire significantly more experts because it has infinitely more resources, the truthseeking function of the administrative proceeding is skewed and directly undermined”). Additionally, we have explicitly rejected the “later evidence rule” when the later developed evidence shows that the miner’s pulmonary condition has improved—as is the case in this matter—because “[i]t is impossible to reconcile the evidence,” and where “[e]ither the earlier or the later result must be wrong, . . . it is just as likely that the later evidence is faulty as the earlier.” Id. at 319 (emphasis in original). Thus, “[t]he reliability of irreconcilable items of evidence must therefore be evaluated without reference to their chronological relationship.” Id.; see also Mullins Coal Co., Inc. of Va. v. Dir., Office of Workers’ Comp. Programs, 484 U.S. 135, 151 (1987) (stating that because pneumoconiosis is a progressive and irreversible disease, “early negative X-ray readings are not inconsistent with significantly later positive readings,” but “[t]his proposition is not applicable where the factual pattern is reversed”) (citation omitted). 20 No. 15-3008 For the aforementioned reasons, we reject Lance Coal’s argument that the ALJ’s order— including his underlying decision to afford greater weight to the medical opinions of Drs. DeFore and Klayton—does not comply with the APA’s requirement that the fact-finder state the reasons and bases supporting his conclusions as to all materials issues of fact. B. Whether the ALJ’s Conclusion that Caudill Suffered from Legal Pneumoconiosis was Supported by Substantial Evidence Second, we consider Lance Coal’s argument that the ALJ’s conclusion that Caudill was totally disabled due to legal pneumoconiosis was not supported by substantial evidence. “In reviewing an appeal from the Board, we review the Board’s legal conclusions de novo.” Big Branch, 737 F.3d at 1068 (citation omitted). Although this Court “must affirm the Board’s decision ‘if the Board has not committed any legal error or exceeded its statutory scope of review of the ALJ’s factual determinations,” our review “is ‘focused on whether the ALJ—not the Board—had substantial evidence upon which to base his decision.’” Morrison, 644 F.3d at 477 (citation and ellipses omitted). “The ALJ’s findings are conclusive if they are supported by substantial evidence and are in accord with the applicable law.” Id. (citation omitted). “Substantial evidence means ‘such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.’” Id. at 478 (quoting Kolesar v. Youghiogheny & Ohio Coal Co., 760 F.2d 728, 729 (6th Cir. 1985)); accord Brandywine, 790 F.3d at 664. “In deciding whether the substantial evidence standard is satisfied, we consider whether the ALJ adequately explained the reasons for crediting certain testimony and documentary evidence over other testimony and documentary evidence.” Morrison, 644 F.3d at 478 (citing Peabody Coal Co. v. Hill, 123 F.3d 412, 415 (6th Cir. 1997)). “A remand or reversal is only appropriate when the ALJ fails to consider all of the evidence 21 No. 15-3008 under the proper legal standard or there is insufficient evidence to support the ALJ’s finding.” Morrison, 644 F.3d at 478 (citations omitted). “We do not reweigh the evidence or substitute our judgment for that of the ALJ,” Big Branch, 737 F.3d at 1069 (quoting Tenn. Consol. Coal Co. v. Kirk, 264 F.3d 602, 606 (6th Cir. 2001)), and we must uphold the ALJ’s decision where it “‘rest[s] within the realm of rationality.’” Brandywine, 790 F.3d at 664 (quoting Piney Mountain Coal Co. v. Mays, 176 F.3d 753, 756 (4th Cir. 1999)). Therefore, as long as the substantial evidence requirement is met, “we may not set aside the ALJ’s findings, ‘even if we would have taken a different view of the evidence were we the trier of facts.’” Morrison, 644 F.3d at 478 (quoting Ramey v. Kentland Elkhorn Coal Corp., 755 F.2d 485, 486 (6th Cir. 1985)). As stated above, in order to be eligible for black lung benefits, Caudill needed to establish by a preponderance of the evidence that (1) he has pneumoconiosis, (2) his pneumoconiosis arose out of his coal mine employment, (3) his is totally disabled, and (4) his pneumoconiosis contributes to his total disability. 20 C.F.R. § 725.202(d)(2)(i)–(iv). In this case, the ALJ found that Caudill could invoke the Act’s 15–year presumption that he was totally disabled due to pneumoconiosis because he (1) suffered from a total respiratory disability or pulmonary impairment and (2) was employed for fifteen years or more in an underground coal mine or a surface mine for which conditions “were substantially similar to conditions in an underground mine.” 30 U.S.C. § 921(c)(4); see also 20 C.F.R. § 718.305(b). Thus, although Caudill bore the initial burden of establishing his entitlement to the 15–year presumption, once he was found eligible, Lance Coal was required “‘to rebut the presumption of disability due to pneumoconiosis’” in order to prevail. Brandywine, 790 F.3d at 662 (quoting Morrison, 644 F.3d at 479). 22 No. 15-3008 In this case, the ALJ concluded that Caudill demonstrated his total disability through two well-documented, well-reasoned medical opinions finding that the Caudill’s respiratory and pulmonary impairments prevented him from engaging in coal mine employment. The ALJ accorded more weight to the medical opinions of Drs. DeFore and Klayton and less weight to the opinions of Drs. Fino and Castle because he found that the former opinions were better-reasoned with regard to their conclusions regarding whether or not Caudill could perform his usual coal mine work or comparable work. As the ALJ noted, neither Dr. Fino nor Dr. Castle explained how Caudill retained the capacity to perform his usual coal mine work, which required heavy exertion, in light of his documented inability to walk more than short distances without experiencing shortness of breath. By contrast, the medical opinions of Drs. DeFore and Klayton, which noted that Caudill had hypoxemia, a low FEV1 value, an abnormal physiological response to exercise, mild restrictive lung disease, and a diminished ability to lift heavy objects, clearly explained why Caudill’s legal pneumoconiosis prevented him from returning to his former, heavy exertion coal mine employment. Based on the medical evidence before the ALJ, we find that a “reasonable mind might accept” that Drs. Fino and Castle’s failure to explain how Caudill could perform his usual, heavy exertion coal mine work in light of his acknowledged respiratory impairments warranted according these opinions with less weight. See Brandywine, 790 F.3d at 664. Further, because the ALJ’s order adequately explained a rational basis, supported by the record, for crediting the two sets of medical opinions with different respective weights, we find that the ALJ’s conclusion that Caudill was entitled to invoke the 15–year presumption satisfies the substantial evidence standard. See Morrison, 644 F.3d at 480. Once Caudill invoked the 15–year presumption, the burden shifted to Lance Coal to rebut the presumption by establishing that (1) Caudill did not have pneumoconiosis or (2) Caudill’s 23 No. 15-3008 respiratory or pulmonary impairment did not arise out of, or in connection with, his coal mine employment. See 30 U.S.C. § 921(c)(4); see also Morrison, 644 F.3d at 479; Big Branch, 737 F.3d at 1069. Ultimately, the ALJ found that Lance Coal failed to rebut the presumption because it could not disprove the existence of legal pneumoconiosis or demonstrate that Caudill’s respiratory impairments were unrelated to his coal mine employment. We have held that “[w]here the burden is on the employer to disprove a presumption, the employer must ‘rule-out’ coal mine employment as a cause of the disability.” Big Branch, 737 F.3d at 1071. In other words, once the burden has shifted to the employer to rebut the 15– year presumption, the employer must “prove that pneumoconiosis played no part in causing a miner’s disability.” Id. (citation and quotation marks omitted) (emphasis in original); Brandywine, 790 F.3d at 667. As noted by the ALJ, although Drs. Fino and Castle concluded that Caudill’s respiratory impairments—including his hypoxemia, hypercarbia, and mild restrictive lung disease—arose solely from his obesity, they did not explain how they ruled out the possibility that Caudill’s respiratory impairments arose in part from his obesity and in part from his more than 17 years of coal mine employment. Similarly, the opinions from both doctors, which opined that Caudill did not have legal pneumoconiosis because his PFT and arterial blood gas values improved somewhat over time, failed to account for the possibility that these improvements were attributable to “marginally reversible causes,” such as alleviation of Caudill’s obesity through weight loss,16 even though Caudill still experienced permanent respiratory problems arising from the “lasting and non-reversible effects of his employment related exposure to coal dust.” (J.A., PageID# 292). We have approved similar applications of the rule-out standard. See Premium 16 Caudill weighed 274 pounds at the time that his DOL-sponsored examination yielded a qualifying value, and weighed 265 pounds or less at each of the three subsequent examinations. 24 No. 15-3008 Coal Co. v. Dir., Office of Workers’ Comp. Programs, 619 F. App’x 447, 453 (6th Cir. 2015) (“Because the 15–year presumption applied in this case, it was not an error for the ALJ to require [the employer] to ‘rule out’ that [the miner’s] coal mine employment aggravated his disability.”) (citations omitted); Island Creek Coal Co. v. Calloway, 460 F. App’x 504, 510 (6th Cir. 2012) (finding that the defendant’s physicians failed to “rebut the presumption by explaining why coal dust did not cause [the miner’s] pneumoconiosis”). Further, we agree with the ALJ that Dr. Fino’s clearest attempt to eliminate a causative link between Caudill’s respiratory impairments and his coal mine employment—his emphasis on the 17-year gap between Caudill’s retirement from coal mining and his first experiences with severe shortness of breath—directly conflicts with the regulations’ recognition of pneumoconiosis as a “latent and progressive disease which may first become detectable only after the cessation of coal mine dust exposure.” 20 C.F.R. § 718.201(c). Finally, the ALJ concluded that the same analytical shortcomings that prevented Lance Coal from showing that Caudill did not have pneumoconiosis also prevented it from showing that Caudill’s respiratory or pulmonary impairment did not arise out of, or in connection with, his coal mine employment. On this record, such a conclusion is in accord with our precedent. See Brandywine, 790 F.3d at 668 (quoting Morrison, 644 F.3d at 480 n.5) (noting that “rebuttal requires ‘that the evidence affirmatively proved the absence of pneumoconiosis’”). We find that a reasonable mind might accept the ALJ’s decision to credit the medical opinions of Drs. Fino and Castle with little weight due to their inability to explain how they “ruled-out” the possibility that Caudill’s respiratory impairments arose, at least in part, from his coal dust exposure. We also find that based on the minimal weight due to such opinions, they were insufficient to rebut the 15–year presumption. See Big Branch, 737 F.3d at 1071; see also, 25 No. 15-3008 e.g., Premium Coal Co., 619 F. App’x at 453 (affirming ALJ’s finding that the medical opinions proffered by the employer did not rebut the 15–year presumption because the opinions did not “address[] how bronchiectasis was mutually exclusive with the lung impairments referenced in the definition of legal pneumoconiosis” or why the miner’s “15 years of mining exposure did not aggravate his rheumatoid arthritis and bronchiectasis”) (citation omitted). Once Caudill invoked the 15–year presumption, Lance Coal was required to rebut this presumption. Because the ALJ’s order adequately explains a rational basis, supported by the record, for his finding that Lance Coal failed to rebut the 15–year presumption, we find that the order satisfies the substantial evidence standard. See Morrison, 644 F.3d at 478.