Opinion ID: 670745
Heading Depth: 2
Heading Rank: 3

Heading: The Rebuttable Presumption: 20 C.F.R. Sec. 718.305

Text: 18 In our prior Mitchell decision we concluded, as a matter of law, that Mr. Mitchell had been a miner for more than fifteen years. We also made clear that Mrs. Mitchell would be entitled to the benefit of the Sec. 718.305 presumption if the other evidence of record demonstrates the existence of a totally disabling respiratory or pulmonary impairment. Of the five criteria to be applied in evaluating the existence of a totally disabling impairment under Sec. 718.204, only (c)(4) applies in this case. 7 19 (4) Where total disability cannot be established under paragraphs (c)(1), (c)(2) or (c)(3) of this section, ... total disability may nevertheless be found if a physician exercising reasoned medical judgment, based on medically acceptable clinical and laboratory diagnostic techniques, concludes that a miner's respiratory or pulmonary condition prevents or prevented the miner from engaging in employment as described in paragraph (b) of this section. 20 20 C.F.R. Sec. 718.204(c)(4). 21 Mrs. Mitchell contends that she carried her burden of proof by presenting the evidence of a physician exercising reasoned medical judgment, based on medically acceptable clinical and laboratory diagnostic techniques, who concluded that her husband's respiratory or pulmonary conditions prevented him from engaging in employment. However, the ALJ refused to give any weight to the opinions of the two physicians. Mrs. Mitchell submits that, in making that determination, the ALJ erroneously required her to prove the existence of pneumoconiosis rather than of a totally disabling pulmonary impairment. She also contends that the ALJ placed upon her the burden of showing that her husband's disability arose out of his coal mine employment. 22 We agree that the ALJ erred when evaluating the physicians' considered opinions. First, as the Board acknowledged, he required that the evidence (including that submitted by the physicians) provide proof of pneumoconiosis, rather than of a completely disabling impairment. This methodology was erroneous because Mrs. Mitchell was not attempting to qualify for benefits by proving directly that her husband was totally disabled by pneumoconiosis resulting from his coal mine employment. Rather than taking that more difficult route, she instead availed herself of the presumption that her husband was totally disabled due to pneumoconiosis because he was employed as a coal miner for 15 years and suffered from a totally disabling pulmonary impairment. 8 Once the claimant qualifies for the presumption of pneumoconiosis by establishing both prongs of the proof, the burden of rebutting that presumption shifts to the employer, who must show a lack of pneumoconiosis or a lack of relationship between disability and employment. 23 The ALJ's misplaced preoccupation with direct proof of pneumoconiosis is evident at several points in his decision. In discounting Dr. Fox's report, he emphasized the fact that the physician was not certain that the miner had pneumoconiosis, and did not indicate the tests or findings to support his conclusions. He also refused to accept Dr. Barkdull's report, because the physician referred only to the 1979 x-ray diagnosing simple pneumoconiosis and not to the two 1980 x-rays that had been read as negative for pneumoconiosis. Indeed, in assessing the x-rays, the ALJ placed great emphasis on whether they established the existence of pneumoconiosis and gave little weight to whether they were relevant to establishing the existence of a totally disabling pulmonary impairment. The ALJ found that, because there was only one positive reading (by the NIOSH B-reader) and fourteen negative readings by several radiologists, the existence of pneumoconiosis was not established by radiography. To the extent that the ALJ failed to credit the reports of the physicians or to give weight to the x-rays simply because they did not establish the existence of pneumoconiosis, the ALJ required too much. 24 The ALJ also required Mrs. Mitchell to prove that coal mine employment caused the claimant's totally disabling pulmonary impairment. The ALJ rejected Dr. Fox's diagnosis that Mr. Mitchell had chronic obstructive pulmonary disease because the opinion did not state whether it was caused by coal mine employment. R.4. He also discounted Mrs. Mitchell's testimony because she did not indicate that her husband's disability was caused by his coal mine employment. 25 By requiring this proof of causation, the ALJ erroneously denied Mrs. Mitchell the benefit of the presumption to which she was entitled. The claimant's showing that Mr. Mitchell had worked more than fifteen years in the mines and had become totally disabled from chronic obstructive pulmonary impairment is sufficient to trigger the presumption set forth in Sec. 921(c)(4). The claimant need not demonstrate a causal connection between Mr. Mitchell's disability and his coal mine employment to invoke the presumption. 9 Instead, it is the employer's burden to rebut the presumption by proving that such a causal connection did not exist. See Rose v. Clinchfield Coal Co., 614 F.2d 936, 939-40 (4th Cir.1980) (holding that claimant prevailed because she attained the benefit of the presumption and rebuttal was precluded, given uncontested fact that claimant did suffer from simple pneumoconiosis). The ALJ failed to credit Mrs. Mitchell with the benefit of the presumption and failed to impose on Old Ben the burden of rebutting the presumption. 10 2. 26 Although it recognized that the ALJ had not given Mrs. Mitchell the full benefit of the presumption to which she was entitled, the Board was of the view that the error was of no consequence because the ALJ had properly concluded that the reports of the physicians were unworthy of belief with respect to the existence of a totally disabling pulmonary disease. On this point, we find ourselves in respectful disagreement with the Board. It is not at all clear to us that the ALJ's preoccupation with the question of whether pneumoconiosis existed did not skew his ultimate assessment of the physicians' reports. More fundamentally, however, the ALJ failed to assess properly the adequacy of the physicians' reports with respect to the existence of a totally disabling pulmonary disease. In this respect, we do not believe that the ALJ was justified in rejecting out of hand the diagnosis of Dr. Barkdull, Mr. Mitchell's treating physician for over 25 years. The physician had properly relied on his own knowledge of Mr. Mitchell's medical history over the years and on the 1979 x-ray read by the NIOSH B-reader (a highly qualified and completely disinterested radiologist), see Mitchell, 855 F.2d at 491 n. 9, to determine that Mr. Mitchell was totally disabled due to a pulmonary condition. 11 Nor could the opinion of Dr. Fox, the physician treating Mr. Mitchell during his hospitalizations over an eighteen-month period, be so summarily rejected. While this physician was understandably concerned primarily with Mr. Mitchell's cancer, he nevertheless expressed the opinion that Mr. Mitchell certainly had pulmonary compromise. 12 In fact, Dr. Fox's diagnosis six months prior to Mr. Mitchell's death had included both cancer and chronic obstructive pulmonary disease. [I]t is the attending physician who is best qualified to determine whether pneumoconiosis causes a miner's disability. Compton, 933 F.2d at 482. 27 We believe that the physicians' medical opinions are sufficiently reasoned to be relevant to the inquiry of whether Mr. Mitchell was disabled on account of a pulmonary impairment, even without elaborations on the conclusions. See Poole v. Freeman United Coal Mining Co., 897 F.2d 888, 893 (7th Cir.1990) (upholding a physician's report as reasoned even though the physician did not elaborate on the reasons for his diagnosis on the Department of Labor form which required an explanation). The lack of detail in the letters does not indicate that the doctors' opinions were not well-reasoned medical judgments. The ALJ's rejection of these two physicians' opinions was, under the circumstances presented here, improper. The ALJ was also obliged to weigh all of the medical evidence in determining the existence of a pulmonary disease. Even though only one of the x-ray readings established the existence of pneumoconiosis, a majority of the x-ray readings indicated granulomata and old inflammatory disease. These data were relevant to the issue of whether a totally disabling pulmonary disease was present. 28 The ALJ improperly rejected the medical evidence of pulmonary impairment by the two treating physicians, despite the absence of countervailing evidence. See Wetherill v. Director, O.W.C.P., 812 F.2d 376, 382 (7th Cir.1987) (setting forth the requirements that the ALJ consider all relevant medical evidence and not disregard the medical conclusions of a qualified physician absent countervailing clinical evidence or a valid legal basis for doing so); Underhill v. Peabody Coal Co., 687 F.2d 217, 223 (7th Cir.1982) (holding that it was error to refuse to credit a physician's report based on examination and test results in the absence of contradictory evidence). A doctor's opinion cannot be rejected because it was based on tests that were interpreted differently by others. Poole, 897 F.2d at 893. By discrediting the well-reasoned medical opinions of Drs. Fox and Barkdull, the ALJ substituted his own judgment for that of the physicians. Compare Old Ben Coal Co. v. Luker, 826 F.2d 688, 692 (7th Cir.1987) (finding ALJ did not substitute his expertise for the physician's) with Wetherill, 812 F.2d at 382 (finding that ALJ did substitute his expertise for the physician's). He also rejected the positive x-ray reading simply by recognizing more negative readings, 13 and he failed to consider the fact that Old Ben had accepted the NIOSH positive reading and had moved Mr. Mitchell to a less dusty job as a result. There was substantial evidence before the ALJ, had he considered all the relevant medical evidence, that Mr. Mitchell was totally disabled due to chronic obstructive pulmonary impairment and simple pneumoconiosis. There was no medical evidence to the contrary. This evidence of total disability, when considered in the case of a miner with fifteen years of coal mine employment, establishes that Mr. Mitchell was totally disabled due to pneumoconiosis pursuant to 30 U.S.C. Sec. 921(c)(4). 14 See Bosco v. Twin Pines Coal Co., 892 F.2d 1473, 1480-81 (10th Cir.1989) (concluding that ALJ's denial of presumption for failure to establish pneumoconiosis or total respiratory or pulmonary disability arising out of coal mine employment denied the claimant the benefit of the presumption). 3. 29 The presumption established by a claimant can be rebutted by the employer's proof that the miner did not have pneumoconiosis or that his respiratory or pulmonary impairment did not arise out of his employment in a coal mine. 20 C.F.R. Sec. 718.305(a). In this case the ALJ concluded that the presumption was not invoked, and that, even if Mrs. Mitchell had proven her claim, the presumption would be rebutted on the failure of this record to show the existence of pneumoconiosis. ALJ Order at 5. By failing to acknowledge that Old Ben had the burden of proof on the matter of rebuttal, as the Act requires, the ALJ again erred. 15 The rebuttal requirement under Sec. 921(c)(4) is not that the record fail to show the existence of pneumoconiosis, but rather that the respondent establish that the miner did not have pneumoconiosis or that his pulmonary impairment did not arise out of his coal mine employment. The record does not reflect that a positive showing of either factor was made by Old Ben. The ALJ's strained interpretations of other evidence of record in order to conclude that there was no total impairment prior to Mr. Mitchell's death reflects graphically his failure to allocate properly the burden of proof in his assessment of the evidence. For example, the ALJ found that, because the death certificate did not list the impairment, there was no respiratory or pulmonary disability. This reliance on the death certificate's recital of the cause of death denied Mrs. Mitchell the full benefit of the presumption as it exists for survivor's claims filed before January 1, 1982. 16 It simply was not necessary for Mrs. Mitchell to establish that her husband died due to pneumoconiosis. A misallocation of the burden of proof is also obvious in the ALJ's mention that he found nothing to indicate that the disability [Mrs. Mitchell] described was not directly related to the husband's serious cancer illness which eventually led to his death. The presumption has not been rebutted.