Opinion ID: 1252614
Heading Depth: 3
Heading Rank: 2

Heading: Dr. Carey's Deposition Testimony

Text: We also find the ALJ's decision to assign no probative value to Dr. Carey's opinion because of the doctor's conditional response to a hypothetical question to be severely flawed. The ALJ was particularly dismissive of the following testimony during Dr. Carey's deposition: Q. Well, how are they affected, in what sense, with respect to comparing him to someone who didn't have the lung disease but with all of those problems? A. Someone with a chronic lung disease or chronic obstructive pulmonary disease is going to have lower volumes of oxygen that makes everything work harder. His heart's going to work harder. If this is occupational exposure that has caused this chronic obstructive pulmonary disease it's also going to cause his arteriosclerotic, to an extent, his arteriosclerotic cardiovascular disease. His renal failure, if your kidneys aren't getting enough oxygen, that tends to push towards renal failure. The ALJ indicated, as cited above, that this was tantamount to stating that with anyone and everyone who suffers from a chonic lung disease or COPD and dies, those conditions are always substantial contributors to or hasteners of death. App. at 32. However, Dr. Carey was asked by counsel to draw a broader comparison between Hill and a person without any pulmonary disease. His response relies upon the chronic lung disease already stipulated to by both parties and evidenced in chest x-rays. Dr. Carey connected these facts to the symptoms that Hill manifested prior to his death. His statement is not a general characterization; it is directly related to Hill's condition, and responsive to the question he was asked. Moreover, we have previously cautioned that an expert's testimony with respect to the pulmonary disease of a miner must be examined in light of the all of the testimony offered, rather than simply by way of selective quotes. See Balsavage, 295 F.3d at 396 ([S]tatements must be viewed in contextboth as responses on cross-examination to general questions and against the backdrop of repeated assertions that pneumoconiosis contributed to the [m]iner's death.); cf. Mancia, 130 F.3d at 590 (noting valid use of a hypothetical question and answer in assessing whether a miner's death was caused by underlying lung disease). In Balsavage, the ALJ rejected an expert's testimony because of his use of the word could when discussing whether pneumoconiosis was a factor in the development of coronary artery disease and atrial fibrillation. 295 F.3d at 396. We rejected such parsing, especially when viewed against the expert's unequivocal testimony about the contributory role of pulmonary disease to his patient's death. Dr. Carey firmly asserted that the other factors related to Hill's death would not have been as severe, but for the presence of pulmonary disease. Nothing on this record, including the report of Dr. Sherman undermines, Dr. Carey's testimony about the effect a compromised respiratory system has on one's health and resilience. To the extent that Dr. Carey's testimony was at all conditional, the meaning is unmistakable when viewed in context. See Mancia, 130 F.3d at 593 (The ALJ was not free to selectively credit testimony merely because it supports a particular conclusion while ignoring all evidence contrary to that conclusion.). More significantly, however, we are at a loss to understand why the ALJ was so troubled by Dr. Carey's testimony about the effect of a compromised respiratory system on the human body. One need not be board certified in pulmonology nor have an advanced degree in anatomy to appreciate the impact that low oxygen levels in the blood can have on the human body. Common sense suggests that if the heart and lungs do not have a sufficient supply of oxygen to function properly, the result could surely include organ failure as well as other complications. Here, Dr. Sherman's testimony even confirmed that Mr. Hill was malnourished when admitted to the nursing home. It is difficult to conclude that an inadequate oxygen supply in the blood because of a compromised respiratory system would not hasten the demise of any patient in that condition. That is what Dr. Carey said, and that is the natural consequence of the simple biological fact that our bodies need an adequate supply of oxygen for organs to function properly. If there are concerns that it becomes too easy to establish that a miner's death was due to pneumoconiosis given that causation, those concerns must be addressed by amending the Act or the regulations promulgated under it. [7] They can not be addressed by denying claimants like Mrs. Hill benefits they are entitled to when a spouse has pneumoconiosis as a result of working in mines, and that pneumoconiosis hastens his death in some way.