Court Opinion

ID: 9478362
Source: CourtListenerOpinion
Date Created: 2023-08-05 06:47:27.264579+00
Date Added: 2024-06-11T17:46:23.766030
License: Public Domain

EASTERBROOK, Circuit Judge,
concurring.
An applicant for black lung benefits may qualify in one of two ways. The applicant (here, the miner’s widow) may establish entitlement to a statutory presumption, throwing on the employer the burden of showing that the employee did not suffer from disabling pneumoconiosis. The miner alternatively may establish by direct evidence that he was disabled by pneumoconi-osis; in this endeavor he carries the burden. Applicants understandably prefer to take advantage of the presumption.
Under the Secretary of Labor’s regulations, an applicant for black lung benefits activates the presumption of disability by presenting specified kinds of medical evidence deemed “qualifying” under the guidelines. 20 C.F.R. § 727.203(a). Although as a rule only ventilatory, blood gas, or x-ray evidence triggers the presumption, 20 C.F.R. § 727.203(a)(5) says that the presumption arises if
In the case of a deceased miner where no medical evidence is available, the affidavit of the survivor of such miner or other persons with knowledge of the miner’s physical condition, demonstrates the presence of a totally disabling respiratory or pulmonary impairment.
“No medical evidence” in this regulation cannot, however, mean exactly what it says. Suppose medical evidence in the record showed that Mr. Collins once had a root canal or was hospitalized after being clobbered by a forklift. Evidence of this sort would be irrelevant to black lung disease and so must be “no medical evidence” for purposes of the regulation. That is to say, “medical” under § 727.203(a)(5) must refer to one of the three kinds of evidence *492(x-ray, ventilatory, or blood gas) that could, if “qualifying”, give rise to the presumption. Even so, if the only medical evidence were a 10-year-old x-ray film, this would not be sufficient to permit a reasoned evaluation of the claimant’s medical condition at the time of death; it would be no different in principle from dental evidence, and under § 727.203(a)(5) the claimant would be allowed to present lay evidence. So much we said in Dempsey v. Director, OWCP, 811 F.2d 1154, 1159-60 (7th Cir.1987).
Dempsey contains a troubling sentence: that § 727.203(a)(5) “enabl[es] a claimant who does not have medical evidence sufficient to invoke the interim presumption under subsections (a)(l)-(a)(4) to rely on [lay] affidavits to establish entitlement.” 811 F.2d at 1160 (emphasis added). My colleagues repeat this statement, maj. op. supra at 490. This language was dictum in Dempsey, is dictum today, and is not right. There is a big difference between evidence “sufficient to permit an evaluation of the claim” and evidence “sufficient to invoke the interim presumption”: the latter is a one-way street in claimants’ favor, and nothing in § 727.203(a)(5) suggests such a bias. Dempsey was concerned that a literal interpretation of § 727.203(a)(5) would put the applicant with just a tiny bit of medical evidence (say, a physician’s report that the miner’s lungs “sound congested”) — evidence useless under subsections (a)(1) to (a)(4) for the purpose of invoking the presumption — at a disadvantage compared with applicants who had no medical evidence. This is a serious concern and a sound reason for treating § 727.203(a)(5) as limited to cases in which the evidence is “medical” (in the sense that it is of the sort that, if “qualifying”, supports the presumption) and “sufficient” (in the sense that it is contemporaneous and reasonably complete). It is not a sound reason for holding that § 727.203(a)(5) allows a claimant to add lay evidence whenever the medical evidence, although of the right quality and quantity, is simply negative for pneumoco-niosis, and therefore does not support invocation of the presumption.
Under the Secretary’s view, if the claimant’s file contains, say, two recent x-ray films and a blood gas study, that is medical evidence sufficient to permit an evaluation of the applicability of the presumption. If the evidence is in the claimant’s favor, then the presumption arises; if the evidence shows no signs of pneumoconiosis, the presumption does not arise; in either ease, lay evidence may not be used to activate the presumption and shift the burden to the employer, but may be used directly to show disability caused by pneumoconiosis, a subject on which the claimant has the burden. If, on the other hand, the record contains only the evidence from a general physical exam (not x-rays, ventilatory, or blood gas studies), or evidence too old or too incomplete to be reliable, then lay evidence would be admissible and relevant. Because the Secretary’s reading is reasonable, we are obliged to accept it. Director, OWCP v. Ball, 826 F.2d 603, 604 (7th Cir.1987); Ensinger v. Director, OWCP, 833 F.2d 678 (7th Cir.1987); Director, OWCP v. Midland Coal Co., 855 F.2d 509, 512 (7th Cir.1988). See also Homemakers North Shore, Inc. v. Bowen, 832 F.2d 408, 411 (7th Cir.1987).
Dempsey did not discuss the Secretary’s interpretation of his own regulation. The language I have quoted from Dempsey was not essential to the court’s judgment — indeed, none of the discussion of § 727.203(a)(5) was essential to the judgment or even influential — because the court went on to hold that even taking the lay testimony for all it could be worth, the record lacked substantial evidence of disabling pneumoconiosis. 811 F.2d at 1161-63. Dempsey’s treatment of § 727.203(a)(5) does not mention the difference between medical evidence “sufficient to invoke the presumption” and evidence “sufficient to permit an evaluation of the miner’s medical condition at the time of death”. The parties to this case filed supplemental briefs at our request to discuss the problem in light of Dempsey, and we should give the problem the attention it requires instead of repeating dictum from an opinion that did not discuss the point. The scope for lay evidence in § 727.203(a)(5) is supposed to be narrow— *493if not, the difference between proving the case directly and proving enough to set up the interim presumption collapses. Unlimited use of lay evidence enables the claimant to obtain the benefit of the presumption (and shift a heavy burden to the employer) without any of the kinds of medical evidence that justify burden shifting. The Secretary’s position distinguishes the presumption from the direct method of proof in a permissible way.
One additional regulation requires comment. The court’s opinion refers to 20 C.F.R. § 718.206, which says:
Decisions, statements, reports, opinions, or the like, of agencies, organizations, physicians or other individuals, about the existence, cause, and extent of a miner’s disability, or the cause of a miner’s death, are admissible. If properly submitted, such evidence shall be considered and given the weight to which it is entitled as evidence under all the facts before the adjudication officer in the claim.
The first sentence of § 718.206 simply abolishes the hearsay rule for medical and similar reports, like the Social Security statute and regulations sustained in Richardson v. Perales, 402 U.S. 389, 399-408, 91 S.Ct. 1420, 1426-31, 28 L.Ed.2d 842 (1971), without attributing any particular consequence to evidence. The second sentence makes this clear: the evidence shall be given “the weight to which it is entitled” under substantive law. Section 727.-203(a)(5) establishes the “weight to which [lay evidence] is entitled” with respect to the interim presumption — none, if there is medical evidence sufficient to permit a reasoned assessment of the claimant’s condition. The lay evidence is relevant if the claimant seeks to prove her case without resort to the presumption, or if she seeks to fend off the employer’s effort to overcome the presumption; it is not properly used to activate the presumption except under the terms laid down in § 727.203(a)(5).
Things would be otherwise if § 727.203(a)(5) were inconsistent with the statute. One requirement, 30 U.S.C. § 902(f)(2), says that the regulations of the Secretary of Labor “shall be no more restrictive” than the regulations applicable to claims filed before June 30, 1973, with the Secretary of Health and Human Services. These regulations implement a presumption of disability without the evidentiary limits of § 727.203(a)(5). See 20 C.F.R. §§ 410.414, 410.454. We concluded in Strike v. Director, OWCP, 817 F.2d 395 (7th Cir.1987), that the language of § 902(f)(2) refers to substantive but not evidentiary rules of eligibility. See also Taylor v. Peabody Coal Co., 838 F.2d 227 (7th Cir.1988). The Supreme Court has granted certiorari in a case that presents the question whether Strike was correctly decided, see Pittston Coal Group v. Sebben, — U.S.-, 108 S.Ct. 1011, 98 L.Ed. 2d 977 (1988). If Strike is right, § 727.203(a)(5), as an evidentiary rule only, comports with § 902(f)(2).
The statute also provides that “all relevant evidence shall be considered”, 30 U.S. C. § 923(b). The Supreme Court said in Mullins Coal Co. v. Director, OWCP, — U.S. -, 108 S.Ct. 427, 430, 98 L.Ed.2d 450 (1987), that the Secretary’s regulations comply with this all-relevant-evidence requirement. Section 923(b) does not specify what evidence is relevant, though. Section 727.203(a)(5) tells us that lay evidence is not relevant for a particular purpose (activating the presumption), even though it is relevant if the claimant seeks to prove her case directly to undercut the employer’s defense. The regulation is consistent with the statute and must be respected — unless this circuit Strikes out.