Opinion ID: 2966818
Heading Depth: 3
Heading Rank: 1

Heading: Hypertensive Cardiovascular Disease

Text: Newport News's physician, Dr. Hall, attested that the claimant suffered from hypertensive cardiovascular disease and that the Claimant's lung impairment, AMA rating and disability are materially and substantially contributed to and materially and substantially caused by the disease. First Dr. Hall letter, at 2. However Dr. Hall never treated or even examined the Claimant. The only evidence in the record that provided support for Dr. Hall's diagnosis was a discharge summary from when the claimant was treated for epididymitis in 1974, which refers to a history of hypertension. (J.A. at 18.) _________________________________________________________________ 5 A useful analogy can be drawn to the ALJ's role in Black Lung cases. There we have held that the testimony of a non-examining, non-treating physician should be discounted and is not substantial evidence if it is totally contradicted by other evidence in the record. Gordon v. Schweiker, 725 F.2d 231, 235 (4th Cir. 1984); see also Eagle v. Armco, Inc., 943 F.2d 509, 511 n.1 (4th Cir. 1991) (same). The ALJ may not merely credit the doctor's opinion, but must evaluate that opinion in light of the other evidence in the record. 9 There was no evidence whatsoever that the Claimant ever developed any symptoms of hypertensive cardiovascular disease after this single finding of some beginning elevation of his blood pressure. (J.A. at 18.) Nor did Dr. Hall point to any other evidence of hypertensive cardiovascular disease. Instead, he merely asserted that this single twenty-two-year old notation demonstrated a long history of hypertension -- the first stage of hypertensive cardiovascular disease, as early as 1974. First Dr. Hall letter, at 1 (citing only the 1974 discharge sheet). By contrast, the medical records of the doctors who actually examined the Claimant make no reference to hypertensive cardiovascular disease. The specialist who first diagnosed the Claimant's asbestosis, Dr. Moore, was aware of the past hypertension in his medical records. However, after a review of the Claimant's chart and an office examination of him, Dr. Moore attributed the Claimant's disability wholly to asbestosis, without mention of any cardiovascular disease. See letter from Dr. Laurie Moore, Jr., to Mr. Gary West of Aug. 12, 1992, at 1 [hereinafter Dr. Moore letter]. Dr. James Baker also examined the Claimant at the request of his treating physician, Dr. Frank Robert. Dr. Baker thoroughly described the Claimant's past medical history as well as his current condition, but made no mention of any cardiovascular disease. See letter from Dr. James Baker to Dr. Frank Robert of Sept. 18, 1991, at 1-3. The single twenty-two-year-old diagnosis of the beginning of high blood pressure is not substantial evidence in the record sufficient to persuade a reasonable mind that the claimant now has hypertension, much less that hypertensive cardiovascular disease contributed to the disability from the Claimant's asbestosis. Nevertheless, the ALJ accepted Dr. Hall's assertion that part of the Claimant's disability was caused by hypertensive cardiovascular disease, and further that the Claimant's disability was made substantially and materially worse by this disease. In defense of the ALJ's finding, Newport News asserts that [g]iven the original diagnosis in 1974, that twenty plus years that elapsed since then, it was certainly reasonable for Dr. Hall to conclude that [the Claimant's] impairment was due in part to his preexisting hypertensive cardiovascular disease. Brief of Respondent at 21. This is ridiculous. That the only evidence of the Claimant's suffering from hypertension is a solitary notation more than twenty years 10 old would lead a reasonable person to the very opposite conclusion, namely, that the Claimant is not currently suffering from hypertensive cardiovascular disease. Newport News also insists that the ALJ was right to accept Dr. Hall's medical opinion regarding hypertensive cardiovascular disease because it was uncontradicted. This is irrelevant. The Director was not a party to the original administrative hearing, and the Claimant had no interest in whether the employer or the government paid his benefits. Perhaps the Director ought to have intervened and submitted evidence at the hearing before the ALJ. His failure to do so does not affect whether the evidence that was offered was sufficient to support the ALJ's conclusion, however. Furthermore, because the employer never offered any evidence quantifying the disability that the Claimant would have suffered absent the alleged hypertensive cardiovascular disease, the ALJ had no basis upon which to determine that the Claimant's ultimate disability was materially and substantially greater than it would have been without the pre-existing disability. Our decision in Harcum requires a quantification of the level of impairment that would ensue from the work related injury alone, in order to determine whether the ultimate disability is materially and substantially greater than that which would have resulted from the work related injury absent the pre-existing condition. See Harcum, 8 F.3d at 185. Newport News's supplementary letter, attempting to meet Harcum's quantification requirement, reasserted that the Claimant suffered from hypertensive cardiovascular disease but never quantified the degree of disability that the Claimant would have suffered absent the cardiovascular disease. See second Dr. Hall letter. Instead, Dr. Hall limited his quantification to the degree of disability the claimant would have suffered absent prior lung scarring. Id. The evidence of the pre-existing disability of hypertensive cardiovascular disease was insufficient to support § 908(f) relief as a matter of law. See Harcum, 8 F.3d at 185-86. We now address whether the ALJ's award may be sustained based upon the evidence of preexisting lung scarring/interstitial fibrosis. 11 B. Pleurisy-Related Lung Scarring/Interstitial Fibrosis The Claimant's medical records document three instances of pleurisy (an inflammation of the air sacks in the lungs, the pleura), in 1948, 1954 and 1960. Dr. Hall opined that the Claimant's lung scarring/interstitial fibrosis, noted in x-rays from 1967, 1968, 1970, 1973, 1979 and 1981, was due to these bouts of pleurisy. First Dr. Hall letter, at 1. He claimed that the lung scarring was a pre-existing condition[ ], which, because of its permanent and serious nature, itself caused substantial impairment and contributed to the Claimant's lung impairment caused by the asbestosis. Id. at 1-2. The lung scarring was first identified in an x-ray of January 30, 1967, seven years after the final instance of pleurisy but during the culmination of more than three decades of daily exposure to asbestos. That original x-ray noted old scarring in the right middle lobe of the Claimant's lungs, which could possibly have been due to the old pleurisy. (J.A. at 14.) However, subsequent x-rays document the progressive scarring of the Claimant's lungs, noting  increased interstitial fibrosis in 1968, scarring in the right lower lobe in 1970, and pleural thickening on the left in 1973. (J.A. at 14-15 (emphasis added).) The scarring was eventually diagnosed, in 1990, as asbestosis. There is no evidence of any bouts of pleurisy after 1960 to explain the progressive lung scarring, nor is there any evidence that the old pleurisy in 1948, 1954 or 1960 could have caused such progressive lung disease throughout the next few decades.6 On the contrary, Dr. Moore explained that the scarring, seen on an x-ray in 1990, was consistent with pulmonary asbestosis. (J.A. at 20.) Dr. Moore knew of the Claimant's history of pleurisy, but after examining him opined that his 25-30% impairment was due to his pulmonary asbestosis without making any mention of the pleurisy. Dr. Moore letter. Nevertheless, the ALJ credited Dr. Hall's opinion and found that the Claimant's permanent partial disability was not due solely to the _________________________________________________________________ 6 Dr. Hall's letter attributing the scarring to pleurisy implies that the same scarring is seen on the x-rays from 1967 through 1981. He does not seem to realize that these x-rays and accompanying medical records describe a progressive increasing of the lung scarring/interstitial fibrosis. 12 asbestosis, but that the disability was materially and substantially greater than that which would have resulted from the asbestosis alone but for the pre-existing conditions, including the lung scarring/ interstitial fibrosis. Carmines, No. 93-LHC-1051, slip op. at 7. It is the Administrative Law Judge's prerogative to select the inference that is most reasonable from the evidence. But even were we to accept the ALJ's dubious finding, the evidence is still insufficient as a matter of law to support § 908(f) relief. In Newport News's supplementary letter, Dr. Hall reasserted that the Claimant's AMA rating due to his disability was 28%. In an attempt to meet Harcum's requirement that an employer quantify the degree of disability that would have occurred without the pre-existing conditions, Dr. Hall explained: If [the Claimant] merely had asbestosis, his AMA rating would be no more than 10%. I based this opinion on the long-standing x-ray evidence of prior lung scarring before the asbestosis, and the pulmonary impairment such scarring causes. By the time a chest x-ray shows scarring, it is significant and causes substantial pulmonary impairment. Second Dr. Hall letter, at 1 (emphasis added). We have already explained that the long-standing x-ray evidence is not actually prior lung scarring, but rather begins after three decades of exposure to asbestos and was eventually diagnosed as asbestosis. Moreover, the reasoning that Dr. Hall used is precisely the invalid reasoning described above at pages 6-7: Dr. Hall found that asbestosis accounted for no more than 10 of the 28% impairment that the Claimant suffered because the pre-existing pulmonary impairment was itself quite substantial -- apparently 18 of the 28%. This was not proper quantification because the seriousness of the supposed pleurisy-related scarring is irrelevant to the seriousness of the asbestosis. Harcum requires that Dr. Hall determine what the Claimant's disability would have been independent of the pre-existing injury. It is not proper simply to calculate the current disability and subtract the disability that resulted from the pre-existing injury (which is what Dr. Hall did). Perhaps the Claimant's asbestosis from 30 years of expo13 sure was serious enough to lead to a 28% disability rating whether he got that asbestosis after having healthy lungs or after having lungs that were scarred by pleurisy. In that case, regardless of how serious the damage due to pleurisy was, it could not be said that the ultimate disability was materially and substantially greater than it would have been without the pleurisy -- it would have been a 28% disability either way. We have previously recognized the analogous proposition that [w]here a subsequent injury and its effects are alone sufficient to cause permanent total disability the mere presence of a pre-existing disability will not warrant contribution from the special fund. John T. Clark & Son of Maryland, Inc. v. Benefits Review Board, 621 F.2d 93, 95 & n.2 (4th Cir. 1980). And other cases have recognized this understanding of § 908(f). For example, the Second Circuit has rejected the proposition that the mere fact that the claimant had a preexisting impairment can establish that the resulting disability was materially greater than it would have been absent the pre-existing impairment. See Luccitelli, 964 F.2d at 1305-06. Where a claimant's work-related knee injury was enough totally to disable him, the Second Circuit held that the extent of disability resulting from a previous knee injury was irrelevant. See id. In the instant case, the ALJ should have determined what degree of disability the Claimant would have suffered from his asbestosis alone. To meet its burden, the employer should have offered evidence from a doctor, such as a treating physician, who could testify to the extent and seriousness of the asbestosis suffered by the Claimant and the degree of disability it would have caused alone. 7 Such evidence is necessary before the ALJ can compare that degree of disability that would have resulted solely from the asbestosis to the degree of disability ultimately produced by the combination of the asbestosis and the supposed pre-existing conditions. Without such evidence, the _________________________________________________________________ 7 The only such evidence available here was Dr. Moore's opinion that the Claimant has a 25-30% impairment of the whole person, due to his pulmonary asbestosis. Dr. Moore letter. Because this opinion attributes the entirety of the Claimant's disability to asbestosis, it undermines a finding that the Claimant's ultimate 28% disability was materially and substantially contributed to by pre-existing conditions. 14 mere assertion by the employer's in-house physician that the Claimant's ultimate disability was made materially and substantially worse by the pre-existing conditions is not sufficient to warrant § 908(f) relief.