Edmonds v. Ill. Workers' Comp. Comm'n

• Decision Date: 30 April 2012
• Docket Number: No. 5–11–0118WC.,5–11–0118WC.
• Citation: 360 Ill.Dec. 282,968 N.E.2d 775
• Parties: Donald EDMONDS, Appellant, v. ILLINOIS WORKERS' COMPENSATION COMMISSION et al. (Consolidation Coal Company, Appellee).
• Court: United States Appellate Court of Illinois

968 N.E.2d 775

360 Ill.Dec. 282

Donald EDMONDS, Appellant,

v.ILLINOIS WORKERS' COMPENSATION COMMISSION et al. (Consolidation Coal Company, Appellee).

No. 5–11–0118WC.

Appellate Court of Illinois,

Fifth District.

April 30, 2012.

Bruce R. Wissore, Culley & Wissore, Harrisburg, for appellant.

Cheryl L. Intravaia, Feirich Mager Green Ryan, Carbondale, for appellee.

OPINION

Justice HUDSON delivered the judgment of the court, with opinion.

[360 Ill.Dec. 283]¶ 1 Claimant, Donald Edmonds, had been employed as a coal miner for almost 30 years when he retired on June 30, 1999. On December 31, 2003, claimant filed an application for adjustment of claim pursuant to the Workers' Occupational Diseases Act (Act) (820 ILCS 310/1 et seq. (West 2002)) seeking benefits from respondent, Consolidation Coal Company. In his application, claimant alleged that as a result of inhaling coal mine dust, he experiences shortness of breath and exercise intolerance.Following a hearing, the arbitrator concluded that claimant suffers from coal workers' pneumoconiosis (CWP), that he established his disablement within two years after the date of last exposure to the hazards of the disease (see 820 ILCS 310/1(f) (West 2002)), and that respondent failed to demonstrate that the timing of the notice of the claim caused undue prejudice (see 820 ILCS 310/ 6(c) (West 2002)). The arbitrator awarded claimant permanent partial disability (PPD) benefits of $465.67 per week for 50 weeks, representing 10% of the person as a whole (see 820 ILCS 305/8(d)(2) (West 2002); 820 ILCS 310/ 7 (West 2002)). The Illinois Workers' Compensation Commission (Commission) affirmed and adopted the decision of the arbitrator. On judicial review, the circuit court of Franklin County set aside the decision of the Commission. The court found that the doctrine of collateral estoppel precluded any finding that claimant had CWP within two years after his last date of exposure because the United States Department of Labor had found to the contrary in a proceeding for benefits under the Black Lung Benefits Act (30 U.S.C. § 901 et seq. (2000)). We reverse the judgment of the trial court and reinstate the decision of the Commission.

¶ 2 I. BACKGROUND

¶ 3 Claimant was born on April 18, 1943, and was 64 years old on January 10, 2008, the date of the arbitration hearing. Claimant began working as a coal miner in 1969. During his career, claimant worked predominantly underground and held various job classifications, including shuttle car operator, repairman, and maintenance foreman. Prior to his retirement on June 30, 1999, claimant was working as a long-wall coordinator. Claimant testified that he retired because he had his “time in” and he wanted to have “a few years of quality life when [he] retired.” Claimant also testified that he wanted to “get away from the mines and away from the dust” because, during his last five years of employment, he began experiencing shortness of breath. Claimant testified that since retiring, his breathing problems have worsened and he did not feel that he was physically capable of performing his past mining jobs. Claimant acknowledged that he smoked about a half a pack of cigarettes per day from the time he was a teenager until the age of 45. On cross-examination, claimant stated that he did not inform respondent that he was retiring because of a medical condition. He also acknowledged that none of his treating physicians ever diagnosed him with CWP, advised him to leave the mine, or restricted him from any employment due to a pulmonary condition.

¶ 4 Admitted into evidence were records of claimant's medical care from various treaters for the period from June 30, 1998, through February 8, 2007. Among these records was a referral to Dr. M. Haseeb for a cardiac consultation on August 1, 2001. At that time, claimant reported “staying quite active” since retiring from coal mining. Claimant stated that he swam on almost a daily basis for 30 minutes a day and took care of his yard with a push mower. Dr. Haseeb noted that claimant had no problems carrying out these activities “and in particular does not give any history of exertional chest discomfort, shortness of breath, etc.” Claimant also told Dr. Haseeb that “he can walk as long as he wants to and does not really get any exertional shortness of breath or any chest pain.” Claimant's wife told Dr. Haseeb that during a visit to an amusement park on July 21, 2001, the family could not keep up with claimant because he would keep going from one attraction to another. However, claimant told Dr. Haseeb that he “did not have good intake” that day and passed out for a few seconds. In addition, claimant told Dr. Haseeb that he is overweight and that he gets short of breath while climbing stairs. Dr. Haseeb opined that claimant's symptoms of shortness of breath “are probably related to him being overweight and perhaps [an] underlying diastolic dysfunction,” but added that claimant's “history of working in the coal mines may be contributing and he may have pneumoconiosis.” A stress test performed on August 16, 2001, indicated exertional shortness of breath. However, at a follow-up, claimant denied experiencing any shortness of breath since the stress test. In addition, claimant denied a history of shortness of breath at examinations in April 2001, May 2001, March 2002, May 2002, October 2002, September 2003, October 2003, November 2003, December 2003, April 2004, July 2005, November 2005, February 2006, and July 2006.

¶ 5 On April 16, 2002, claimant, unrepresented by an attorney, applied for benefits under the federal Black Lung Benefits Act (30 U.S.C. § 901 et seq. (2000)). In conjunction with his application, claimant was referred to Dr. Parviz Sanjabi for an evaluation of his lungs. Dr. Sanjabi examined claimant on June 18, 2002. Claimant provided Dr. Sanjabi with a history of cough and sputum in the morning with an onset more than three years earlier. Claimant also reported dyspnea upon exertion after climbing one or two flights of stairs, but stated that he does not experience dyspnea when walking. As part of the evaluation, claimant underwent a chest X ray on June 17, 2002, and a pulmonary function study. Dr. Sanjabi interpreted the X ray as showing some granulomas in the left mid-lung field and para hilar and supra hilar areas on the right side. The pulmonary function study was normal. Dr. Sanjabi diagnosed CWP and bronchitis by history. Dr. Sanjabi attributed the diagnoses to smoking and exposure to coal but did not expect any impairment. Dr. Gatla, a radiologist and B-reader, also read the chest X ray taken on June 17, 2002, and interpreted it as negative. Dr. Gatla did not grade the quality of the film.

¶ 6 On August 20, 2002, a claims examiner for the United States Department of Labor (Department) issued a “Schedule for the Submission of Additional Evidence” (Schedule) and a “Summary of Employment Evidence.” The Department determined that respondent would be the “responsible operator” liable for the payment of benefits. However, based on a review of the medical evidence presented, the Department concluded that claimant would not be entitled to benefits if it were to issue a decision at that time. The Department noted that in order to qualify for federal black lung benefits, the claimant must prove that: (1) he worked as a coal miner; (2) he has CWP; (3) his CWP was caused at least in part by exposure to coal mine dust; (4) he has a totally disabling respiratory or pulmonary impairment; and (5) his totally disabling impairment is caused at least in part by CWP. The Department found, inter alia, that claimant failed to establish that he had CWP or that he had a totally disabling respiratory or pulmonary impairment. The Department noted that the chest X ray dated June 17, 2002, was negative for black lung disease and that claimant's pulmonary function study was normal. Further, while Dr. Sanjabi diagnosed CWP, the Department found that he “gave no medical rationale for this diagnosis,” and he did not expect any breathing impairment. As such, the Department concluded that the medical evidence was insufficient to establish the presence of CWP.

¶ 7 The Schedule additionally provided:

“The claimant and the designated responsible operator listed above may now submit to this office additional medical evidence as to the claimant's entitlement. 20 C.F.R. § 725.414(a). After that evidence is submitted, and we complete any additional processing that we believe may be necessary (which may include an informal conference if all parties are represented and the other requirements of 20 C.F.R. § 725.416 are met), we will issue a proposed decision and order awarding or denying benefits. Any party dissatisfied with that decision and order may request a hearing before the Office of Administrative Law Judges at that time.”

The Schedule noted that if no party submits additional medical evidence on entitlement, a proposed decision and order would be based on the preliminary conclusions stated in the Schedule. There is no indication that either party presented additional medical evidence.

¶ 8 Although not included in the record on appeal, a proposed decision and order denying claimant benefits under the Black Lung Benefits Act was apparently issued on November 18, 2002. On November 25, 2002, a “district director” for the Department issued a revised proposed decision and order. The November 25, 2002, decision states that the earlier proposed decision was revised because a quality reading of claimant's June 17, 2002, chest X ray by Dr. Dominic Gaziano, a B-reader, was not included on the list of medical evidence attached to the November 18, 2002, decision. Dr. Gaziano opined that the June 17, 2002, film was of “acceptable quality.” The district director's review of Dr. Gaziano's quality reading “d[id] not demonstrate any basis for revision of the proposed decision and order issued on November 18, 2002.” The revised...