Opinion ID: 537072
Heading Depth: 1
Heading Rank: 3

Heading: entitlement to an alj hearing on a second claim

Text: 11 This case can be simplified to the question of whether a miner is entitled to a complete ALJ hearing when filing a second claim for black lung benefits more than one year after the denial of a previous claim. We hold that the applicable statutes and prior practice require such a hearing.
12 The plain language of the Longshore Act, incorporated into the Black Lung Benefits Act, 30 U.S.C. Sec. 932(a) (1982), mandates an ALJ hearing on any claim filed with a deputy commissioner whenever a party requests such a hearing. The applicable statutory provisions prescribe the basic adjudication procedures for all black lung and longshore claims. First, a claim for compensation may be filed with the deputy commissioner. 33 U.S.C. Sec. 919(a) (1982). After investigating the claim and upon application of any interested party[, the deputy commissioner] shall order a hearing [on the claim]. 33 U.S.C. Sec. 919(c) (1982). This hearing shall be conducted by a[n] administrative law judge in accordance with the Administrative Procedure Act. 33 U.S.C. Sec. 919(d) (1982) (emphasis added). 13 Thus, the statute mandates an ALJ hearing, on the record, upon request. The Longshore Act provides no authority for an appeal directly from a deputy commissioner to the Board, which is the procedure ordered by the Board in the decision below. Accordingly, it appears that Congress has directly spoken to the precise question of a claimant's right to an ALJ hearing, and this unambiguously expressed intent must be given effect. Chevron, U.S.A. v. NRDC, 467 U.S. 837, 842-43, 104 S.Ct. 2778, 2781-82, 81 L.Ed.2d 694 (1984). But even if the Longshore Act could be read as containing any ambiguity on this issue, the Director's interpretation must still be upheld as a permissible construction of the statute. Id. at 843, 104 S.Ct. at 2782.
14 Although the plain language of the Longshore Act alone substantiates a claimant's right to an ALJ hearing on a new claim, the evolution of the statute's adjudicatory provisions also underscores the importance of an ALJ hearing on all contested questions relating to a claim. Since its original enactment in 1927, the Longshore Act has consistently required a hearing on any claim if requested by a party. For forty-five years that hearing was conducted by a deputy commissioner, the same official that processed claims, gathered evidence, and informally decided claims. Even under the 1927 Act, however, the deputy commissioner lacked authority to resolve a claim without a hearing on the record, if any party requested a hearing. An award made without notice and a hearing could be attacked and set aside as without validity. Crowell v. Benson, 285 U.S. 22, 47-48, 52 S.Ct. 285, 291, 76 L.Ed. 598 (1932). 15 In 1972 Congress transferred the hearing powers of deputy commissioners to hearing examiners, which are now ALJs. Pub.L. No. 92-576, 86 Stat. 1251, 1261, Sec. 14 (Oct. 27, 1972). The sole purpose of this transfer was to separate the administrative and adjudicative functions. H.R.Rep. No. 92-1441, 92d Cong., 2d Sess. (1972), reprinted in 1972 U.S.Code Cong. & Admin.News 4698, 4708. But this transfer of the power to hold hearings, effectuated by amending section 19(d) of the Act, did not alter the language of section 19(c) requiring the deputy commissioner to order a hearing upon application of any interested party. See 33 U.S.C. Sec. 919(c) and (d) (1982). While the presiding official changed from a deputy commissioner to an ALJ, the right to a hearing remained. 16 The 1972 amendments also changed the first level reviewing body from the district court to the newly created Benefits Review Board. Again, however, the amendments did not change the standard of review. Thus, neither the original statute nor the present one has ever authorized the type of procedure ordered by the Board in this case. 17 In sum, the statute can only be read as requiring that all black lung claims, including subsequent claims, be processed and adjudicated via the same three-tier administrative review process, beginning with a deputy commissioner and proceeding in turn to an ALJ and then to the Board. No statutory basis exists for permitting a complete bypassing of an ALJ hearing or immediate review by the Board of a deputy commissioner's determination on any type of claim. 18
19 The black lung procedural regulations also provide no basis for the Board's elimination of an ALJ hearing. Those regulations make no distinctions between the procedures for handling initial and subsequent claims. All claims, whether initial or subsequent, are filed with the Department. See 20 C.F.R. Secs. 725.301-725.311 (1989). The deputy commissioner investigates the claim by collecting relevant evidence, arranging medical examinations of claimants, and identifying, notifying, and obtaining evidence from responsible operators who may be liable for the payment of benefits. See 20 C.F.R. Secs. 725.401-725.414 (1989). The deputy commissioner then makes an initial finding as to claimant's eligibility and attempts to resolve the claim informally. See 20 C.F.R. Secs. 725.410, 415-19 (1989). 20 However, the deputy commissioner can resolve a claim only if the parties are in agreement. The regulations are unequivocal on the right to an ALJ hearing in a disputed claim: In any claim for which a formal hearing is requested or ordered [by the deputy commissioner] ..., the deputy commissioner shall refer the claim to the Office of Administrative Law Judges for a hearing. 20 C.F.R. Sec. 725.421(a) (1989) (emphasis added). The regulations also provide that [a]ny party to a claim ... shall have a right to a hearing concerning any contested issue of law or fact unresolved by the deputy commissioner. 20 C.F.R. Sec. 725.450 (1989) (emphasis added). Nowhere do these regulations suggest that a subsequent claim is to be processed any differently from an initial claim or that a subsequent claim does not entitle a party to an ALJ hearing. These regulations are mandatory and apply by their terms to all claims and all contested issues of law or fact. There are only two instances in which the Secretary has varied the black lung regulations to allow direct appeal from a deputy commissioner to the Board. These involve attorneys' fee awards, see 20 C.F.R. Sec. 725.366(e) (1989), and commutation of black lung benefits to a lump sum award, see 20 C.F.R. Sec. 725.521(c) (1989). Those two exceptions prove that where the Secretary believes a deviation from the three-tier statutory claims review process is appropriate, she has promulgated a regulation to that effect. The Secretary has promulgated no such regulation for duplicate claims, and the Board, which lacks rulemaking powers, has no authority to do so itself. 21 Except in the two examples noted, the regulations nowhere give a party dissatisfied with a deputy commissioner's determination, on any issue, the right to appeal it to the Board. The Board attempts to circumvent these regulations by labeling the deputy commissioner's denial a final determination, and by claiming that there is no need to develop a record and therefore no need for a full-blown hearing. However, whether a claimant has shown a material change in condition requires consideration and comparison of medical evidence on two different dates, a typical factfinding process for which an ALJ hearing is quite appropriate. 22
23 It should also be emphasized that the Board's decision in this case is an abrupt departure from past administrative practice by the Department, where full-fledged ALJ hearings have always been available for new claims, in accordance with the statute and regulations. Nonetheless, the Board's decision appears to be based on an attempt to foster administrative efficiency and to avoid delays and administrative burdens by eliminating one tier of the claims review process. Benefits Review Board Decision and Order, March 30, 1988, at 2-3. When the same justification was offered for eliminating deputy commissioner consideration of modification requests, it was not accepted by other courts of appeal. See Saginaw Mining Co. v. Mazzulli, 818 F.2d at 1280-81; Lee v. Consolidation Coal Co., 843 F.2d at 161-62. Efficiency, no matter how desirable, is not a justification for rewriting the statute and regulations, neither of which is within the Board's authority. Even if we accept the notion that duplicate claims is an area that can be handled more efficiently, it is not our function, nor is it the Board's, to legislate. We must simply apply the statutes and regulations as they stand. 24
25 The Board relies on section 725.309(d) to support its abolition of an ALJ hearing. However, the real purpose behind the statute was to open the door for subsequent claims. 26 When the duplicate claims regulation, section 725.309(d), was first proposed, it provided only that a later claim would be denied on the grounds of a prior denial unless the later claim was a request for modification meeting the requirement of 20 C.F.R. Sec. 725.310 (1989). 43 Fed.Reg. 17,743 (1978). Modification requests, however, can only be filed within one year of final denial of the earlier claim. Accordingly, a number of commentators pointed out that the proposed regulation did not sufficiently take into account the progressive nature of the disease. They explained that the proposed regulation would prohibit the filing of new claims by miners whose conditions have progressed to total disability. The Department therefore modified the language of section 725.309 to reflect its agreement that a miner whose claim has once been finally denied ... should be allowed to file a new claim on the grounds of a progression to total disability. Id. The current regulatory language was thus added to permit a new claim, even more than a year after a prior denial, if the deputy commissioner determines that there has been a material change in conditions. 20 C.F.R. Sec. 725.309(d) (1989). 27 This explanation makes clear that the sole purpose of section 725.309(d) was to provide relief from the ordinary principles of finality and res judicata to miners whose physical condition deteriorates. It follows that the Board is simply wrong in assuming, with no cited authority, that [t]he purpose of 20 C.F.R. Sec. 725.309(d) is to avoid the necessity of holding repeated full-blown hearings in previously denied claims and that its basis ... lies in the doctrine of res judicata. Benefits Review Board Decision and Order, March 30, 1988, at 3. The Secretary actually adopted the key regulatory language to permit, not to restrict, the filing of new claims that might otherwise be barred by res judicata. 28 The Board's misunderstanding of the purpose of section 725.309(d) caused it to attempt to achieve administrative efficiency rather than the intended remedial goal of providing miners with progressively worsening health full and equal access to black lung benefits. The real purpose of section 725.309(d) was to permit new claims to be filed even where modification under section 725.310(a) was no longer available because more than a year had passed since the first claim was denied. 29
30 The judges on the Board suggested several differing methods for dealing with second claims filed more than one year after the denial of a first claim. On rehearing en banc, the majority held that ALJ hearing or review was not necessary or even allowed. Other judges suggested differing roles for the deputy commissioner, the ALJ, and the Board. We hold that the Longshore Act and the black lung regulations create only a preliminary issue for consideration and no unique procedure for adjudication of second claims where modification is no longer available. Thus, we conclude that second claims for benefits filed more than one year after denial of an initial claim must be treated procedurally very similarly to any other claim. We therefore reject the bifurcated approach adopted by the Board and hold that a deputy commissioner must determine simultaneously whether (1) there has been a material change in condition, and (2) whether the claimant is entitled to benefits. 4 After such determinations by the deputy commissioner, a claimant is entitled to a hearing before an ALJ to examine both issues de novo. Finally, review on the merits of the ALJ's decision by the Board and the appropriate court of appeals is to be made available.