Court Opinion

ID: 9489258
Source: CourtListenerOpinion
Date Created: 2023-08-05 13:10:12.672566+00
Date Added: 2024-06-11T17:53:25.292828
License: Public Domain

LUTTIG, Circuit Judge,
dissenting:
The majority today is tempted, and ultimately persuaded, by the sympathies of this case, as is evident from the fact that it begins its analysis by “[pjutting aside” the legal question before us, and instead, dwelling on the uncontroverted fact that the claimant today has complicated pneumoconiosis caused by coal mine work. Whether or not, in our judgment, Rutter has complicated pneumoconiosis, or whether he is someone to whom we would award benefits were it our responsibility, are not the questions before us, however. Rather, we have before us a question of law, whether this claimant has proven a “material change in conditions” that would warrant reconsideration of whether he is entitled to black lung benefits. See 20 C.F.R. § 725.309(d) (providing that a successive application for benefits “shall ... be denied” unless there has been a “material change in conditions”).
The Department of Labor promulgated section 725.309(d), the so-called duplicate claims provision, to allow miners who were not disabled at the time they were initially denied benefits an opportunity to establish their entitlement to benefits if they become totally disabled following a denial of benefits. As the Department itself described the regulation, “a miner whose claim has once been finally denied either by the Social Security Administration or the Department should be allowed to file a new claim on the grounds of a progression to total disability.” See Discussion of Comments to Proposed Regulations on Duplicate Claims, 43 Fed.Reg. 36772, 36785 (Aug. 18, 1978) (emphasis add*1366ed). The regulation was never intended to, nor does it, reach a person who was unquestionably disabled at the time of the initial denial, but erroneously held to be not disabled. The law provides avenues of relief— neither of which this claimant pursued — for a person who has been erroneously denied benefits. He may either appeal the erroneous decision, 20 C.F.R. § 725.410(c), or seek modification of that decision, for up to a year after the initial denial, id. at § 725.310. He is not, however, entitled to benefits under the duplicate claim provision.
In order to conclude that this claimant is entitled to benefits under the duplicate claims provision, the majority entirely relieves claimants of their burden of proving a material change in conditions, holding that any miner who is currently entitled to benefits shall receive them, a standard that invites claimants to file claim after claim until they find a pliant ALJ. As the majority unabashedly explains:
[Njothing bars or should bar claimants from filing claims seriatim ....
After today’s decision, an unsuccessful claimant will doubtless schedule a morning appointment with a compliant physician for a year and a day after the denial of his claim. Armed with evidence contrary to an element previously found against him, the claimant will file a new claim that afternoon, and so on, ad infinitum.
Ante at 1362, 1364. This is, of course, precisely the result intended to be avoided under the regulation. Like the now repudiated Spese standard, this standard fails even to examine or consider the claimant’s original conditions, much less to require a determination of whether there has been a “material change” (or for that matter, even an immaterial change) in those conditions — as the Director himself concedes. See Director’s Answer in Support of Respondent’s Petition for Rehearing En Banc at 9 (acknowledging that the “one-element” test “allows an inference of change ” in conditions to support reexamination of a duplicate claim (emphasis added)). Indeed, in its haste to award benefits in this case, the majority does not so much as bother to differentiate between a change and a “material change,” effectively holding that all changes are material.
That the majority’s standard allows recovery of benefits merely upon a showing that the claimant is today eligible for benefits, without any evidence whatever of a change in his condition, is confirmed by the fact that the majority expressly rejects the requirement, from the Sixth Circuit’s decision it purports to adopt, that the ALJ make certain that the evidence presented with the duplicate claim “ ‘differ[s] qualitatively ” from the evidence available at the time of the initial denial. See ante at 1363 n. 11 (quoting Sharondale Corp. v. Ross, 42 F.3d 993, 999 (6th Cir.1994)). The majority, thus, adopts for this circuit the very rule that even the Sixth Circuit recognized was manifestly untenable under the regulation — that the claimant may recover benefits if “the ALJ merely disagree[s] with the previous characterization of the strength of the evidence.” Sharondale, 42 F.3d at 999.
When all is said and done, therefore, the majority holds that a claimant is entitled to benefits if he comes forward with any additional evidence of his condition “after” the denial of the original claim and shows that he is now entitled to benefits, ante at 1362, whether or not the claimant proves a material change (or a change at all) in his conditions from what they were at the time he was earlier denied benefits. A claimant, for example, who is denied benefits and then files a duplicate claim accompanied by an additional “probative” x-ray taken after the initial denial that is identical to the x-rays presented with the initial claim (that is, that show identical opacities) would receive black lung benefits on his duplicate claim, notwithstanding that his condition has not changed at all. For, he has, according to the majority, “prove[d], under all of the probative medical evidence of his condition after the prior denial, at least one of the elements previously adjudicated against him.” Ante at 1362. Not only is such a holding irreconcilable with the plain language of section 725.309(d), it “makes mincemeat” of the doctrine of res judicata underlying section 725.309(d) by permitting the previous decision to be reevaluated, as the majority itself says, ad infmi*1367turn. Cf. Sahara, 946 F.2d at 556 (similar criticism of the Spese standard).
Because the standard articulated by the Seventh Circuit in Sahara Coal Co. v. OWCP, 946 F.2d 554, 556 (7th Cir.1991), is the only standard which both requires a “material change in conditions” and respects the finality of the initial judgment, I would adopt that test as the law of this circuit. The Sahara standard provides that,
[a] material change in conditions means either that the miner did not have black lung disease at the time of the first application but has since contracted it and become totally disabled by it, or that his disease has progressed to the point of becoming totally disabling although it was not at the time of the first application.
Id. Of the various tests for determining eligibility for duplicate claim benefits, only the Sahara standard focuses upon the miner’s conditions and requires that those conditions change in a way that is material. The majority’s characterization notwithstanding, the Sahara standard does not require that the claimant show a material change “on every element previously decided against him,” ante at 1361,1363. Rather, it requires only that the claimant show, through a comparison of the evidence existing at the time of his original denial of benefits and the evidence currently available, that he was not then, but is now, eligible for benefits. In other words, the focus of the Sahara standard is not on the conclusions reached as to the conditions, but rather on the underlying conditions themselves, which is exactly what section 725.309(d)’s plain language demands. In no other possible way can it be determined whether the claimant’s conditions have materially changed since the earlier denial of benefits.
The majority is critical of the Sahara standard because it believes that any examination of the evidence underlying the prior denial of benefits (that is, examination of the evidence as to the miner’s prior condition) would offend principles of res judicata. A standard that requires denial of a duplicate claim because the claimant’s underlying conditions have not materially changed (for example, because the claimant was disabled then and is disabled now), however, does not undermine the original decision to deny benefits; rather, such a standard fully respects that decision, in stark contrast to the standard adopted by the majority, which continuously allows reopening of that original decision based upon evidence reflecting no change at all in the claimant’s conditions. Instead of “foundering” on principles of res judicata and collateral estoppel, as the majority contends, the Sahara standard actually represents too strict an application of those principles for the majority, because that standard, unlike the majority’s standard, does require faithful adherence to the initial denial, irrespective of whether that denial was correct or incorrect.
The court’s tortured interpretation of the duplicate claims regulation comes about as a result of this one claimant’s refusal either to appeal or to seek modification of an arguably erroneous decision and the court’s unwillingness to accept the result that he may, as a consequence of his insouciance, find himself without remedy. As a court of law, however, we should recognize that this circumstance is an extraordinarily unusual one, not likely to frequently, if ever, repeat itself, and resist the temptation to yield to our collective sense as to what would be “fair” in this most peculiar of circumstances. Doing so, and simply applying the plain language of the regulation, I would vacate and remand to the ALJ for reconsideration of whether Rutter, under the standard adopted by the Seventh Circuit in Sahara, has shown a “material change in conditions.”
Chief Judge WILKINSON and Judges RUSSELL, WILKINS, HAMILTON and WILLIAMS join in this opinion.