Court Opinion

ID: 9465005
Source: CourtListenerOpinion
Date Created: 2023-08-05 00:33:10.735349+00
Date Added: 2024-06-11T17:38:55.443472
License: Public Domain

HARTMAN,
member, dissenting:
I respectfully dissent from that part of my colleagues’ decision which affirms the hearing officer’s award of benefits to the claimant pursuant to Section 411(c)(4) of the Act, 30 U.S.C. § 921(c)(4).
Let me note first that at the formal hearing below, neither the claimant nor the Director, Office of Workers’ Compensation Programs, presented any medical evidence in support of this claim. The claimant’s subjective testimony was relied upon to demonstrate entitlement to benefits. In addition, the claimant has not participated in this appellate proceeding. It is well settled that a claimant bears the burden of establishing that the requirements for eligibility have been met. Poe v. Weinberger, 403 F.Supp. 312 (N.D.W.Va.1975). In my opinion, in this case the claimant has not even assumed that burden let alone carried it. I strongly disagree with my colleagues’ interpretation of the Act and applicable regulations.
The claimant worked in underground coal mines for over fifteen years and x-ray reports in the record are negative for the existence of any degree of pneumoconiosis. Therefore, the existence of pneumoconiosis and total disability due to pneumoconiosis are determined in accordance with Sections 410.414(b) or (c) of the regulations. 20 C.F.R. §§ 410.414(b), (c). The regulation at 20 C.F.R. § 410.414(b) specifically provides that demonstration of a totally disabling chronic respiratory or pulmonary impairment is to be accomplished in accordance with the regulations at 20 C.F.R. §§ 410.-412, 410.422 and 410.426.
Section 410.412 of the regulations provides a definition relating total disability to inability because of pneumoconiosis to perform “comparable and gainful work”. The statutory basis for that regulation is found in Section 402(f) of the Act. 30 U.S.C. § 902(f). Criteria by which total disability is to be determined are set forth at Sections 410.422, 410.424 and 410.426 of the regulations. In determining whether or not a mirier is totally disabled by pneumoconiosis or by a respiratory or pulmonary impairment which is presumed to be pneumoconio-sis, primary consideration is given to the medical severity of the disease. 20 C.F.R. § 410.422(c).
The only medical evidence in the record was introduced by the employer. It consists of a deposition of Dr. Martin Davis, and his reports of a pulmonary function study, x-ray interpretations and a thorough physical examination of the claimant. Dr. *125Davis examined the claimant on behalf of the Department of Labor on August 30, 1973, performing a pulmonary function study and taking and interpreting an x-ray. On April 18, 1975, Dr. Davis performed a thorough physical examination, including a pulmonary function study and x-ray of the claimant at the request of the employer.
Following these examinations, Dr. Davis prepared a written report which includes his conclusions. He found no evidence of pneumoconiosis. He did find moderate pulmonary emphysema, which he stated is not disabling. He found some evidence of apical pleural thickening bilaterally with some calcification, probably due to an old tuberculosis infection, which he stated is not active at present. He found no evidence of cancer. Results of pulmonary function studies were found to be “generally within the range of normal”. X-rays were negative for pneumoconiosis. Dr. Davis expressed the opinion that the claimant does not have any permanent disability related to his occupation.
The hearing officer recognized that negative x-ray results are not necessarily determinative of the question of whether pneu-moconiosis exists or is disabling. (No claim for benefits shall be denied solely on the basis of the results of a chest x-ray. 30 U.S.C. § 923(b)). He went on to find that the claimant’s long years in the mines and “other evidence” demonstrating an inability to function in other than a sedentary environment, including dyspnea, coughing, weakness,' susceptibility to respiratory infections and recent weight loss, warranted the conclusion that the claimant has a totally disabling respiratory or pulmonary impairment within the meaning of Section 411(c)(4) of the Act. The hearing officer also listed “additional objective medical factors” which “corroborate this evidence”. Substantial weight was given to the subjective aspects of the claimant’s testimony. The hearing officer found that the Section 411(c)(4) presumption “has not been rebutted or controverted” and concluded that the claimant “has pneumoconiosis as defined in the Act and Regulations”.
The hearing officer then found the claimant to be totally disabled within the meaning of 20 C.F.R. § 410.412(a)(1), based on “partial corroboration” of the claimant’s testimony by information contained in the medical reports, the demeanor and appearance of the claimant and the claimant’s credible testimony. He specifically rejected the examining physician’s opinion that the claimant is able to work at the present time, finding that opinion to be overbroad on its face.
I am unable to agree that substantial evidence in the record supports the conclusion that this claimant is totally disabled by a chronic respiratory or pulmonary impairment which would entitle him to the rebut-table presumption that he is totally disabled by pneumoconiosis.
There is no evidence in the record that the claimant has one of the impairments listed in the Appendix to Subpart D of the regulations or a medically equivalent impairment. 20 C.F.R. § 410.424. Section 410.422(c) mandates that primary consideration be given to the medical severity of a claimant’s pneumoconiosis.
Considering the alternative standard for determining total disability, provided by Section 410.426, the^ record reveals that the claimant worked at the employer’s mine until that mine closed in December 1972. There is no evidence that he did not fully perform all duties assigned to him prior to that time. In fact, he continued to work at that mine, retrieving equipment, for a month after mining operations ceased. Results of ventilatory studies exceed the values specified in the table in Section 410.-426(b). Remembering that Dr. Davis examined the claimant on behalf of the Director as well as the employer, his opinion is of no benefit to the claimant within the requirement of Section 410.426(c).
Sections 410.426(d) and 410.414(e) combine to provide a determination of total disability based on an “other relevant evidence” test. “Other relevant evidence” includes a number of factors listed in Section 410.414(c), and “other supportive materials”. The record supports none of the listed *126factors. The claimant’s own testimony, found by the hearing officer to be credible and certainly not questioned here, is the only other “supportive material” available. I cannot conclude in this case that the claimant’s subjective testimony is substantial evidence which establishes that the claimant has a chronic respiratory or pulmonary impairment, the severity of which prevents him from doing his previous coal mine work or other comparable and gainful work.
Moreover, even if there were substantial evidence in the record to support the conclusion that this claimant has a totally disabling respiratory or pulmonary impairment so that he would be entitled to benefit from the rebuttable presumption that he is totally disabled by pneumoconiosis, the record reflects that the employer has overcome the presumption by medical evidence. 30 U.S.C. § 921(c)(4). The only medical evidence in the record, introduced by the employer, clearly states that the claimant does not have pneumoconiosis. That medical opinion was based on the results of a thorough physical examination and not solely on the basis of x-rays, which were interpreted as showing only moderate emphysema, or on the basis of negative pulmonary function test results. I believe that Dr. Davis’ testimony, introduced by the employer, is clearly sufficient to rebut the presumption that this claimant is totally disabled due to pneumoconiosis. See Ansel v. Weinberger, 529 F.2d 304, 310 (6th Cir. 1976).
For these reasons, I conclude that the Decision and Order of the hearing officer is not supported by substantial evidence and is not in accordance with what I believe to be the correct interpretation of the Act and applicable regulations. Therefore, I would reverse.