Sea “B” Mining Co. v. Addison
| Decision Date | 29 July 2016 |
| Docket Number | No. 14-2324,14-2324 |
| Citation | 831 F.3d 244 |
| Parties | Sea “B” Mining Company, c/o HealthSmart Casualty Claims Solutions, Petitioner, v. Shirley Addison, widow of Jerry Addison, deceased; Director, Office Of Workers' Compensation Programs, United States Department of Labor, Respondents. |
| Court | U.S. Court of Appeals — Fourth Circuit |
ARGUED: Timothy Ward Gresham, PennStuart, Abingdon, Virginia, for Petitioner. Victoria Susannah Herman, Wolfe Williams & Reynolds, Norton, Virginia, for Respondent Shirley Addison. ON BRIEF: Joseph E. Wolfe, Wolfe Williams & Reynolds, Norton, Virginia, for Respondent Shirley Addison.
Before NIEMEYER, DUNCAN, and AGEE, Circuit Judges.
Petition for review granted; order vacated and remanded by published opinion. Judge Agee
wrote the opinion, in which Judge Niemeyer and Judge Duncan joined.
, Circuit Judge:
Jerry Addison applied for financial assistance under the Black Lung
Benefits Act, 30 U.S.C. §§ 901 -944 (“the Act”), claiming that he suffered from coal-dust induced pneumoconiosis as a result of his prior work as a coal miner. Over conflicting medical evidence, an Administrative Law Judge (“ALJ”) found that Addison was entitled to benefits under the Act because he had established the existence of clinical and legal pneumoconiosis that resulted in a total respiratory disability. Addison's former employer, Sea B Mining Co. (“Sea-B”), filed a petition for review, arguing the ALJ erred in several ways which were not harmless. For the reasons described below, we grant the petition for review, vacate the order awarding benefits, and remand for further proceedings.1
We begin with a brief discussion of the statutory and regulatory framework, which provides context for the events of this case. The Act creates an adversarial administrative procedure designed to determine whether miners (or their surviving dependents) qualify for compensatory benefits because they suffer from coal dust-related pulmonary injuries
, commonly categorized as pneumoconiosis. See 30 U.S.C. §§ 901 -944. The implementing regulations define pneumoconiosis as a “chronic dust disease of the lung and its sequelae, including respiratory and pulmonary impairments, arising out of coal mine employment.” 20 C.F.R. § 718.201(a).
Courts recognize two forms of pneumoconiosis: “clinical” and “legal.” See Clinchfield Coal Co. v. Fuller, 180 F.3d 622, 625 (4th Cir. 1999)
.2 Clinical pneumoconiosis “consists of those diseases recognized by the medical community as pneumoconiosis, i.e., the conditions characterized by permanent deposition of substantial amounts of particulate matter in the lungs and the fibrotic reaction of the lung tissue to that deposition caused by dust exposure in coal mine employment.” 20 C.F.R. § 718.201(a)(1). Legal pneumoconiosis, by contrast, “encompasses a wide variety of conditions ... whose etiology is not the inhalation of coal dust, but whose respiratory and pulmonary symptomatology have nonetheless been made worse by coal dust exposure.” Clinchfield, 180 F.3d at 625. The regulations thus define legal pneumoconiosis as “any chronic lung disease or impairment and its sequelae arising out of coal mine employment.” 20 C.F.R. § 718.201(a)(2).
To obtain black lung
benefits under the Act, a claimant must prove by a preponderance of the evidence that: “(1) he has [either kind of] pneumoconiosis ; (2) the pneumoconiosis arose out of his coal mine employment; (3) he has a totally disabling respiratory or pulmonary condition; and (4) pneumoconiosis is a contributing cause to his total respiratory disability.” Milburn Colliery Co. v. Hicks, 138 F.3d 524, 529 (4th Cir. 1998). The parties agreed that Addison suffered from a disabling respiratory condition that prevented further employment. The issue below, and on review, is whether Addison's disability was the result of pneumoconiosis arising out of his coal mine employment. The dispute centers around the exclusion and consideration of certain medical evidence and the ALJ's conclusions in evaluating the expert medical opinions.
A claimant may establish the existence of pneumoconiosis
by, among other means, chest x-rays and medical opinion evidence. See 20 C.F.R. § 718.202(a). In addition, “[t]he results of any medically acceptable test or procedure ..., which tends to demonstrate the presence or absence of pneumoconiosis ... may be submitted in connection with a claim and shall be given appropriate consideration.” 20 C.F.R. § 718.107(a). Although the regulations group the forms of permissible evidence into discrete categories, an ALJ must weigh all of the evidence together when determining whether the miner has established the presence of pneumoconiosis. See Island Creek Coal Co. v. Compton, 211 F.3d 203, 208–09 (4th Cir. 2000).
Addison worked in the coal industry for approximately 12 years.3 Prior to abandoning this line of work in 1981 due to a neck fracture and arthritis
, his employment consisted of stints as a general laborer, scoop operator, and finally foreman with Sea-B. As often occurs in these cases, Addison was a cigarette smoker, and his smoking history far exceeds the length of his mining career. Addison began his pack-a-day smoking habit in 1956 and stopped sometime between 2001 and 2012. The evidence is clear that Addison suffered from a myriad of ailments during the latter part of his life that, if not caused by smoking, were certainly amplified by this activity. Among other things, he had a history of arthritis, coronary artery disease, hypertension, and diabetes.
In March 2011, Addison filed the present claim for living miner benefits.4 His case was referred to a claims manager, who found that Addison was entitled to benefits due to his prior coal employment. Sea-B disputed the award and sought administrative review before an ALJ.
At the ensuing hearing, Addison testified about his employment history, explaining that he worked in “very thick dust” while at the mines. J.A. 52. He also testified about his decade of breathing problems, for which he had been prescribed oxygen and other pulmonary medications. Apart from Addison's testimony, the parties introduced various medical evidence concerning his condition, including (1) conflicting interpretations of several chest x-rays
; (2) three CT scans which all read negative for pneumoconiosis ; (3) the results from pulmonary function tests and arterial blood gas studies; (4) hospitalization and treatment records; and (5) conflicting medical opinions from three physicians, Dr. J. Randolph Forehand, Dr. Gregory J. Fino, and Dr. James R. Castle, all of whom agreed that Addison was totally disabled by a respiratory impairment but differed as to its cause and type.
Dr. Forehand, who performed the Department of Labor sponsored examination, diagnosed Addison as having both pneumoconiosis
and a non-disabling ventilatory impairment caused by cigarette smoking. His opinion was based on an arterial blood gas study showing impaired gas exchange during exercise, a single 2011 chest x-ray, and Addison's history of coal dust exposure. Had Addison not worked in the mines, Dr. Forehand opined, “his arterial blood gas would no doubt be normal and his chest x-ray clean.” J.A. 104.
Dr. Fino diagnosed Addison with “idiopathic interstitial fibrosis
” that, although disabling, is “unrelated to coal dust inhalation.” J.A. 154. As support for this opinion, Dr. Fino cited the “marked progression” of Addison's lung condition between 2008 and 2011, as evidenced by the photographic progression in the CT scans and x-rays. J.A. 153. He explained that the worsening of Addison's illness “occurred far too rapidly to be consistent with coal-mine-dust inhalation.” J.A. 205. Dr. Fino further testified that although coal workers' pneumoconiosis can cause pulmonary fibrosis, the medical evidence did not support such a diagnosis here. “Coal dust causes nodular fibrosis,” Dr. Fino explained, “[w]hereas this fibrosis [Addison] has is a diffuse type” which is “completely different pathologically and radiographically.” J.A. 213. Dr. Fino also noted that Addison's fibrosis was restrictive in nature, which is not characteristic of pneumoconiosis. Finally, Dr. Fino averred that he was in the best position to assess Addison's condition because he had the benefit of reviewing lung imagery over time, whereas Dr. Forehand had only conducted “a one-time review of a chest x-ray.” J.A. 207.
Dr. Castle reached a similar conclusion as Dr. Fino, opining that Addison suffered from idiopathic pulmonary fibrosis
. After reviewing essentially the same evidence, Dr. Castle explained that these tests revealed “linear, irregular type opacities which are not typical of coal workers' pneumoconiosis.” J.A. 267-68. Dr. Castle further noted that idiopathic pulmonary fibrosis is a disease of unknown cause but is associated with heavy cigarette smoking and not coal dust exposure.
In deciding that Addison established the existence of pneumoconiosis, the ALJ evaluated several items of conflicting medical evidence. He first considered the x-ray evidence, which consisted of three chest images dated January 2009, February 2011, and May 2011. The ALJ found the first two x-rays in equipoise as to the existence of pneumoconiosis
because similarly qualified doctors rendered conflicting interpretations for each. As to the May 2011 x-ray, the ALJ noted that “Dr. Forehand and Dr. Miller interpreted it as positive for pneumoconiosis..., while Dr. Scott interpreted the same x-ray as negative for pneumoconiosis.” J.A. 12.5 Observing that Drs. Miller and Scott were both equally qualified “B-readers and board-certified radiologists,” the ALJ determined that the “May 20, 2011 chest x-ray is overall positive for clinical pneumoconiosis ” because Dr. Miller's positive reading was “supported by Dr. Forehand's opinion.” Id. Dr. Forehand is a certified B-reader but not a radiologist.6
The ALJ next considered the CT scan
evidence and noted such scans do not fall within the...
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