Opinion ID: 2973367
Heading Depth: 2
Heading Rank: 1

Heading: Material Change in Condition

Text: To award benefits on a claim filed more than a year after the denial of an earlier claim, the ALJ must first determine, based on all the evidence accompanying the new claim, that the miner has proved at least one of the elements of entitlement previously adjudicated against him. Ross, 42 F.3d at 997; see also Grundy Mining Co. v. Flynn, 353 F.3d 467, 480 (6th Cir. 2003). This court explained in Kirk, a case decided after the ALJ issued her second opinion, that to consider only the new evidence might allow relitigation of claims in which the old and new evidence was essentially the same but some legal error resulted in the denial of the first claim. Tenn. Consol. Coal Co. v. Kirk, 264 F.3d 602, 609 (6th Cir. 2001). “A ‘material change’ exists only if the new evidence both establishes the element and is 8 Although 20 C.F.R. § 725.309(d) was revised effective on January 19, 2001, the new provision does not apply to claims such as this one that were pending on the effective date. See 20 C.F.R. § 725.2(c); Grundy Mining Co. v. Flynn, 353 F.3d 467, 476 n.3 (6th Cir. 2003) (current version, which does not include the “material change” language, does not apply to claims pending at the time it was adopted). No. 04-4297 10 substantially more supportive of claimant.” Id. The actual difference between the bodies of evidence represents the “change,” while the “materiality” of the change is “marked by the fact that this difference has the capability of converting an issue determined against the claimant into one determined in his favor.” Id. at n.6. For this reason, we held that the ALJ must also find, based on a comparison of the sum of the new evidence and the sum of the evidence considered in connection with the previously denied claim, that the evidence is sufficiently more supportive of the claim so as to warrant a change in outcome. Id; see also Grundy, 353 F.3d at 480. Whether the ALJ and BRB applied the appropriate “material change” standard is a question of law that we review de novo. Grundy, 353 F.3d at 476. To the extent the determination rests upon factual findings, they are reviewed under the substantial evidence standard. Id.
The ALJ found that a material change in condition had been established because the new evidence established pneumoconiosis—an element previously adjudicated against Spivey. However, as petitioner argues, the ALJ made no findings comparing the old and new bodies of evidence to determine the materiality of the change. This error was raised by Mountain Clay in its second appeal to the BRB. Although vacating the award for other reasons, the BRB found that the failure to make this comparison was harmless error in this case. The BRB explained that: A review of the record in this case reveals that the earlier evidence on which the denial of claimant’s prior claim was premised contains no evidence of pneumoconiosis or disability, see Director’s Exhibit 34. The evidence No. 04-4297 11 submitted with claimant’s prior claim consists of four negative readings of two x-rays, two non-qualifying pulmonary function studies and two non-qualifying blood gas studies, as well as medical opinions from Drs. Dahhan and Broudy, neither of whom diagnosed pneumoconiosis or found that the claimant was totally disabled, id. Thus, as there was no evidence of pneumoconiosis in the earlier claim, any error by the administrative law judge in failing to compare the sum of the new evidence, which the administrative law judge found established the existence of pneumoconiosis, with the earlier evidence, on which the denial of claimant’s prior claim had been premised, in accordance with the Sixth Circuit’s holdings in Kirk, supra, and Ross, supra, was harmless[.] Petitioner contends that the BRB exceeded the scope of its review in finding this error was harmless. While the BRB reviews the ALJ’s factual findings under the substantial evidence standard, even the case cited by petitioner recognized that the harmless-error doctrine can apply in this context. Sahara Coal Co. v. OWCP, U.S. Dept. of Labor, 946 F.2d 554, 558 (7th Cir. 1991) (“If the outcome of a remand is foreordained, we need not order one.”). The error in Sahara was not harmless because comparison of the old and new medical evidence presented a factual issue. Similarly, this court remanded for further findings in Ross, but only after comparison of the evidence revealed a factual question on whether there was a material change in condition. There, the ALJ specifically found that new positive x-ray evidence established pneumoconiosis and therefore also a material change in condition, but did not discuss how the evidence differed qualitatively between the new and old claims. That did not end the inquiry, however, as this court then compared the two bodies of evidence. Because the record showed there was evidence of both positive and negative x-ray interpretations accompanying the new as well as the old claims, the court could not discern from the record whether the ALJ had merely reached a different decision on essentially the same evidence No. 04-4297 12 or whether the claimant had shown a material change in his condition since the earlier denial. As a result, the claim was remanded for further findings. In contrast, remand was not required in Kirk, despite the ALJ’s errors in assessing whether there was a material change, because there was substantial evidence in the developed record to support a finding that the claimant had demonstrated a material change in condition as to an element previously adjudicated against him. With respect to the material change, the court explained that: “Although there had been some diagnoses of pneumoconiosis prior to [the denial of his first claim], its presence has become generally acknowledged among his treating physicians after the filing of his fourth claim.” Kirk, 264 F.3d at 609. The court also noted that it was not necessary for there to be a complete absence of evidence of pneumoconiosis at the earlier date; only that there was a substantial difference in the two bodies of evidence. Id. at 609-10. Because both the ALJ and BRB in Kirk relied on the new evidence of pneumoconiosis, a factual record had been developed on the element, albeit not in relation to the material change requirement, that was sufficient to support the BRB’s conclusion that the claimant had proved a material change in condition. Id. at 610. In this case, comparison of the bodies of evidence from the new and old claims does not reveal a factual question that must be remanded to the ALJ. The record shows that while the sum of the evidence submitted with the earlier claim included no findings of pneumoconiosis or disability, the sum of the later evidence included two findings of pneumoconiosis, one validated pulmonary function test showing moderate pulmonary impairment, and the recognition by five out of seven physicians that Spivey had a totally No. 04-4297 13 disabling respiratory impairment.9 We have no trouble finding that substantial evidence in the record supports a finding that the new evidence demonstrates a material change in condition when compared to the evidence on which the first denial was premised with respect to not only the existence of pneumoconiosis but also the element of disability. Therefore, we agree that the ALJ’s failure to compare the new and old evidence was harmless error.
Stepping away from the standard articulated in Kirk, Mountain Clay draws on general principles of finality and res judicata to argue that the change in Spivey’s condition could not have been material absent proof either that he had additional coal dust exposure since the denial of the prior claim, or that he had a type of pneumoconiosis (such as massive fibrosis or silicosis) known to be latent or progressive in the absence of further coal dust exposure. In support of this contention, Mountain Clay suggests that this court has previously relied on the miner’s return to coal mine work in evaluating the material change requirement. On the contrary, none of the cases cited placed importance on continued coal dust exposure in evaluating whether a change in condition had been established. In Ross, the miner’s return to work between the denial of the first and the filing of the second claims was deemed relevant to the statute of limitation issue, but was not mentioned in connection with adoption of the standard for proving a material change in conditions. 42 F.3d at 996. On the other hand, the fact that the miner in Grundy worked until just before filing his second claim for benefits was not mentioned as part of the material change 9 In fact, Dr. Broudy, the only physician to evaluate Spivey in connection with both claims, found no disability at the time of the first claim and total disability at the time of the second. No. 04-4297 14 calculus. Grundy, 353 F.3d at 471. All that is required for materiality is that the new evidence be sufficiently different to warrant a different outcome on one or more elements of entitlement. Id. at 482. Mountain Clay is arguing, at bottom, that there is no proof that legal pneumoconiosis is capable of progression or latent manifestation after the miner’s exposure to coal dust has ended. This is not the first time we have been asked to hold that a miner cannot develop legal pneumoconiosis arising out of coal mine employment without experiencing additional exposure to coal dust. We rejected just such an argument in Odom, reiterating that pneumoconiosis has been recognized as progressive in nature. Peabody Coal Co. v. Odom, 342 F.3d 486, 491 (6th Cir. 2003). It is petitioner’s position that Odom is not controlling because it relied on case law that predated the DOL’s review of the medical literature in revising the regulations to provide that “‘pneumoconiosis’ is recognized as a latent and progressive disease which may first become detectable only after the cessation of coal mine dust exposure.” 20 C.F.R. § 718.201(c). This revision was upheld against a challenge by the National Mining Association (NMA), but only upon the DOL’s concession that, while pneumoconiosis may be latent and progressive, “the most common forms of pneumoconiosis are not latent” and “latent and progressive pneumoconiosis is rare.” Nat’l Mining Ass’n v. Dept. of Labor, 292 F.3d 849, 863 (D.C. Cir. 2002). Although the NMA argued that the revised regulation created an irrebuttable presumption that pneumoconiosis was progressive, the court held that the regulation “simply prevents operators from claiming that pneumoconiosis is never latent and progressive.” Id. (emphasis in original). No. 04-4297 15 The NMA also argued that the regulation was not supported by the scientific studies, two of which reported that pneumoconiosis is latent and progressive in at most 8%, or as many as 24% of cases. Id. at 869. The court construed the regulation narrowly to mean, as counsel for the DOL conceded at oral argument, that pneumoconiosis can be a progressive and latent disease. Id.; see also Midland Coal Co. v. Dir., OWCP (Shores), 358 F.3d 486, 490 (7th Cir. 2004) (holding that DOL’s conclusion that scientific evidence showed pneumoconiosis can be latent and progressive was entitled to deference). Further, the Seventh Circuit in Shores expressly held that the decision in National Mining does not require a miner bringing a second or subsequent claim for benefits to prove that he suffered from a type of pneumoconiosis that has been found in the medical literature to be progressive and/or latent. Shores, 358 F.3d at 491. We agree that proof of a material change in conditions based on a finding of pnemoconiosis does not require the claimant to prove either exposure to coal dust since the denial of his first claim, or that he has a kind of pneumoconiosis known to be latent and progressive.