Opinion ID: 3000589
Heading Depth: 2
Heading Rank: 1

Heading: Invocation of the Interim Presumption

Text: The Black Lung Benefits Act (“BLBA”) affords benefits only if pneumoconiosis, known colloquially as “black lung disease,” prevents a coal miner from performing his job at the coal mine. 30 U.S.C. § 902(f)(1)(A).4 The governing regulations establish an “interim presumption” of total disability for a miner who can demonstrate disability due to pneumoconiosis. 20 C.F.R. § 727.203(a) (4); see also Gulley v. Dir., Office of Workers’ Comp. Programs, United States Dep’t of Labor, et al., 397 F.3d 535, 538 (7th Cir. 2005). 4 30 U.S.C. § 902 (f)(1)(A) provides: (f)(1) The term “total disability” has the meaning given it by regulations of the Secretary of Health and Human Services for claims under part B of this subchapter, and by regulations of the Secretary of Labor for claims under part C of this subchapter, subject to the relevant provisions of subsections (b) and (d) of section 923 of this title, except that— (A) in the case of a living miner, such regulations shall provide that a miner shall be considered totally disabled when pneumoconiosis prevents him or her from engaging in gainful employment requiring the skills and abilities comparable to those of any employment in a mine or mines in which he or she previously engaged with some regularity and over a substantial period of time[.] No. 06-1248 11 This “interim presumption” applies to claims for black lung benefits filed between July 1, 1973, and April 1, 1980.5 See Mullins Coal Co. v. Dir., Office of Workers’ Comp. Programs, United States Dep’t of Labor, et al., 484 U.S. 135, 137 (1987). In order to invoke the rebuttable presumption in the case of a living miner, the claimant must have been engaged in coal mine employment for at least ten years and meet one of the physical conditions set forth in the regulation.6 Zeigler conceded that Mr. Griskell had worked in the 5 The black lung benefits program was developed through several statutory enactments and thus various rules govern individual claims depending upon when the initial claim was filed. See Mullins Coal Co. v. Dir., Office of Workers’ Comp. Programs, United States Dep’t of Labor, 484 U.S. 135, 138 n.1 (1987). 6 20 C.F.R. § 727.203(a) provides: (a) Establishing interim presumption. A miner who engaged in coal mine employment for at least 10 years will be presumed to be totally disabled due to pneumoconiosis, or to have been totally disabled due to pneumoconiosis at the time of death, or death will be presumed to be due to pneumoconiosis, arising out of that employment, if one of the following medical requirements is met: (1) A chest roentgenogram (X-ray), biopsy, or autopsy establishes the existence of pneumoconiosis (see § 410.428 of this title); (2) Ventilatory studies establish the presence of a chronic respiratory or pulmonary disease (which meets the requirements for duration in § 410.412(a)(2) of this title) as demonstrated by values which are equal to or less than the values specified in the following table: (continued...) 12 No. 06-1248 6 (...continued) Equal to or less than— FEV MVV 67” or less. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.3 92 68”. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.4 96 69”. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.4 96 70”. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.5 100 71”. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.6 104 72”. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.6 104 73” or more. . .. . . . . . . . . . . . . . . . . . . . . . . . . 2.7 108 (3) Blood gas studies which demonstrate the presence of an impairment in the transfer of oxygen from the lung alveoli to the blood as indicated by values which are equal to or less than the values specified in the following table: Arterial pCO2 equal to or less than (mm.Hg.) Arterial pO2. 30 or below. . . . . . . . . . . . . . . . . . . . . . . . . . . 70 31. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 32. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 33. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 34. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 35. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 (continued...) No. 06-1248 13 coal mines for fourteen years.7 Therefore, in order to find that Mr. Griskell merited the interim presumption, the ALJ only needed to find that he met one of the medical requirements set forth in the regulation. Zeigler submits that it was error for the ALJ to invoke the interim presumption of total disability under 20 C.F.R. § 727.203(a). Zeigler attempts to support this contention with two arguments. Zeigler submits that the ALJ improperly weighed the opinions of the various physicians, impermissibly according too much weight to the opinions of Dr. Hessl and too little weight to the opinions of some of the other physicians who reached a different conclu- 6 (...continued) 36. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 37. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 38. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 39. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 40-45. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 Above 45. . . . . . . . . . . . . . . . . . . . . . . . . . . . . Any value. (4) Other medical evidence, including the documented opinion of a physician exercising reasoned medical judgment, establishes the presence of a totally disabling respiratory or pulmonary impairment; (5) In the case of a deceased miner where no medical evidence is available, the affidavit of the survivor of such miner or other persons with knowledge of the miner’s physical condition, demonstrates the presence of a totally disabling respiratory or pulmonary impairment. 7 See Petitioner’s Br. at 10. 14 No. 06-1248 sion regarding the etiology of Mr. Griskell’s impairment. Zeigler also contends that Mr. Griskell was disabled due to a back injury and prevented from working due to his criminal conduct, not as a result of pneumoconiosis. We have stated that “[w]hether a medical opinion is reasoned . . . is a decision that rests ultimately with the ALJ, not with us.” Summers, 272 F.3d at 483. Furthermore, the ALJ needs only to be persuaded, judging from all available evidence, that pneumoconiosis is a contributing cause of the miner’s disability. Compton v. Inland Steel Coal Co., 933 F.2d 477, 483 (7th Cir. 1991). In determining whether substantial evidence supports the ALJ’s determinations regarding Mr. Griskell’s benefits “[w]e cannot reweigh the evidence or make credibility determinations.” Peabody Coal Co. v. Vigna, 22 F.3d 1388, 1393 (7th Cir. 1994). Zeigler submits that the ALJ improperly gave additional weight to Dr. Hessl’s opinion merely because Dr. Hessl was Mr. Griskell’s treating physician. We “have disapproved any mechanical rule that the views of a treating physician prevail.” Peabody Coal Co. v. McCandless, 255 F.3d 465, 469 (7th Cir. 2001). However, the fact that a particular opinion comes from a treating physician certainly does not bar an ALJ from crediting this opinion. We simply stated in McCandless that “the treating physician’s views may not be accepted unless there is a good reason to believe that they are accurate.” 255 F.3d at 469-70. Conversely, when the views of the treating physician are accurate and supported by medical evidence, those views may be accepted. We have acknowledged that, in selecting from opposing medical viewpoints, the ALJ instead “’must have a medical reason for preferring one physician’s conclusion over another’s.’ ” Stalcup v. Peabody Coal Co., 477 F.3d 482, 484 No. 06-1248 15 (7th Cir. 2007) (quoting McCandless, 255 F.3d at 469) (emphasis in original). We think it clear that the ALJ properly weighed the various medical opinions, and we therefore conclude that his decision to invoke the interim presumption is supported by substantial medical evidence. In his decision, the ALJ stated that “[t]hroughout his opinions, Dr. Hessl set forth clinical observations and findings, and his reasoning is supported by adequate data. His opinions are reasoned and documented. I find that Dr. Hessl’s opinion is entitled to probative weight enhanced by his board-certification in internal medicine.” A.R. at 146. The ALJ also stated that Dr. Hessl’s reports demonstrate “superior reasoning.” A.R. at 147. The ALJ’s conclusions regarding Dr. Hessl also find support in the record. In his reports, Dr. Hessl took an extensive medical history and described in detail Mr. Griskell’s chief complaints and symptoms. Relying on chest x-rays, ventilation studies, arterial blood gas studies, an EKG and a GXT, Dr. Hessl diagnosed Mr. Griskell with chronic bronchitis and coal workers’ pneumoconiosis. His reports stated that the primary etiology for both diagnoses was coal dust exposure, and that the secondary etiology was tobacco use. The ALJ was on solid ground in characterizing Dr. Hessl’s reports as well-reasoned and as reflecting a careful examination of Mr. Griskell and a thoughtful evaluation of diagnostic tests. It is clear that the ALJ did not credit Dr. Hessl’s medical opinions merely because he was a treating physician. Furthermore, substantial evidence clearly supports the ALJ’s decision to invoke the interim presumption of total disability. The ALJ explicitly stated that he was according more weight to Dr. Hessl’s opinion based on “the strength of his reasoning.” Id. Though Zeigler fervently 16 No. 06-1248 contends that the ALJ was engaging in impermissible “head counting,” it is not the role of this court to reweigh evidence or to make credibility determinations. The ALJ clearly found Dr. Hessl to be credible, and Dr. Hessl’s opinions demonstrate that Mr. Griskell is totally disabled due to pneumoconiosis. These conclusions do not rely solely on Dr. Hessl’s status as a treating physician, but rather draw from the well-reasoned reports he prepared. Indeed, in a similarly well-reasoned report, Dr. Barnett concluded that Mr. Griskell is totally disabled due to coal workers’ pneumoconiosis. We have no trouble concluding that there is substantial evidence in the record to support invocation of the interim presumption that his total disability is due to coal workers’ pneumoconiosis.