Talley v. Mathews, s. 75-2255

• Decision Date: 05 January 1977
• Docket Number: Nos. 75-2255,s. 75-2255
• Citation: 550 F.2d 911
• Parties: James E. TALLEY, Appellant, v. F. David MATHEWS, Secretary of Health, Education and Welfare, Appellee. Aundes F. COLLINS, Appellant, United Mine Workers of America, Amicus Curiae, v. F. David MATHEWS, Secretary of Health, Education and Welfare, Appellee. Sidney G. ADAMS, Appellant, v. F. David MATHEWS, Secretary of Health, Education and Welfare, Appellee. Otis R. TAYLOR, Appellant, v. F. David MATHEWS, Secretary of Health, Education and Welfare, Appellee. to 75-2258.
• Court: U.S. Court of Appeals — Fourth Circuit

Page 911

550 F.2d 911

James E. TALLEY, Appellant, v. F. David MATHEWS, Secretary of Health, Education and Welfare, Appellee.

Aundes F. COLLINS, Appellant, United Mine Workers of America, Amicus Curiae, v. F. David MATHEWS, Secretary of Health, Education and Welfare, Appellee.

Sidney G. ADAMS, Appellant, v. F. David MATHEWS, Secretary of Health, Education and Welfare, Appellee.

Otis R. TAYLOR, Appellant, v. F. David MATHEWS, Secretary of Health, Education and Welfare, Appellee.

Nos. 75-2255 to 75-2258.

United States Court of Appeals, Fourth Circuit.

Argued May 7, 1976.

Decided Jan. 5, 1977.

S. Strother Smith, III, Abingdon, Va. (Robert Austin Vinyard, William H. Robinson, Smith, Robinson & Vinyard, Abingdon, Va., on brief), for appellants.

E. Gail Falk, Charleston, W. Va., for United Mine Workers of America as amicus curiae.

Frederick D. Cohen, Atty., Appellate Section, Civ. Div., Dept. of Justice, Washington, D. C. (Rex E. Lee, Asst. Atty. Gen., Paul R. Thomson, Jr., Roanoke, Va., U. S. Atty., and William Kanter, Atty., Appellate Section, Civ. Div., Dept. of Justice, Washington, D. C., on brief), for appellee.

Before RUSSELL, FIELD and WIDENER, Circuit Judges.

WIDENER, Circuit Judge:

These consolidated appeals raise an administrative jurisdictional issue of some consequence under the Federal Coal Mine Health and Safety Act of 1969, as amended, 30 U.S.C. § 901 et seq. (hereafter the Act).

Plaintiffs are former coal miners who submitted applications for black lung benefits to the Social Security Administration prior to July 1, 1973. ¹ Each, however, continued to work in the mines subsequent to July 1st. ² The issue is whether plaintiffs "filed" their claims within the meaning of the Act prior to July 1, 1973, as is required to invoke the jurisdiction of the Secretary of Health, Education and Welfare (hereafter the Secretary), and consequently to take advantage of more liberal adjudicatory standards established by the Department of Health, Education and Welfare (HEW) regulations.

The Secretary administers only those black lung claims over which the federal government assumes sole responsibility for the payment of benefits. The following statutory sections, read in conjunction, define such claims in terms of when they must be filed:

30 U.S.C. § 924(a)(1): "No claim for benefits under this part (Sub ch. IV, part B) on account of total disability of a miner shall be considered unless it is filed on or before December 31, 1973 . . . ." (emphasis added).

30 U.S.C. § 924(b): "No benefits shall be paid under this part (Sub ch. IV, part B) after December 31, 1973, if the claim therefor was filed after June 30, 1973." (emphasis added).

Thus, as will be discussed in more detail below, the federal government, under the jurisdiction of the Secretary of HEW, pays black lung benefits to claimants who file their claims on or before June 30, 1973. But as crucial to the statutory scheme as the word file is, nowhere in the Act is it defined.

Plaintiffs contend that to file is simply to submit appropriate forms in connection with a claim for benefits; the Secretary's position, sustained by the district court, is that under 20 CFR § 440.226(b) one does not "effectively file (. . .)" a claim until the first month in which all requirements for entitlement to benefits are met. For reasons set forth in this opinion, we conclude that the Secretary's position is in accord with neither the language of the statute nor the intent of Congress, and we vacate the judgment of the district court.

I

The provisions of Title IV of the Federal Coal Mine Health and Safety Act of 1969 as amended by the Black Lung Benefits Act of 1972, reveal the significance of the issue under consideration in this case. The Act provided a means of assuring federal benefits to the considerable number of coal miners totally disabled by chronic lung disease as a result of their employment, but who were inadequately compensated under State law. 30 U.S.C. § 901; see generally Statement of House Managers, Conf.Rep. No. 91-761, 91st Cong., 1st Sess. (1969), 1969 U.S.Code Cong. and Admin.News, p. 2578 at 2603. It essentially required a claimant for disability benefits to establish (1) that he was totally disabled within the meaning of HEW regulations to be promulgated; (2) that his disability was due to pneumoconiosis (black lung disease); and (3) that such disability arose out of employment in the nation's coal mines. ³ A series of statutory presumptions was enacted to facilitate proof of the above eligibility criteria. ⁴

Jurisdiction for administering claims for benefits was divided between the Secretary of Labor and the Secretary of Health, Education, and Welfare, and such dual administration continues under the amended Act. Generally, the Secretary of Health, Education, and Welfare administers claims under Part B of Title IV, 30 U.S.C. §§ 921-925, those filed on or before December 31, 1973 and the Secretary of Labor administers claims under Part C, 30 U.S.C. §§ 931, 941, those filed after December 31, 1973. See 30 U.S.C. § 902(c). ⁵ Under the Act as amended in 1972, however, jurisdiction is conferred on the Secretary of Labor over a class of interim Part B claims filed between July 1, 1973 and December 31, 1973. 30 U.S.C. § 925(a)(1). ⁶

The Senate Report indicates Congress was dissatisfied with the results obtained under the statute as originally enacted. See S.Rep. No. 92-743, 92d Cong., 2d Sess. (1972), 1972 U.S.Code Cong. and Admin.News, p. 2307 et seq. It was felt that many miners and survivors of miners for whose benefit the Act had been passed were failing to qualify for benefits under applicable standards. In response to this situation, Congress amended the Act in 1972 in order to facilitate the ability of claimants to qualify for black lung benefits.

While the 1972 amendments left intact the basic thrust of the Act, some significant changes were made. First, the amendments extended the period of federal responsibility for the payment of black lung benefits. ⁷ Under Part C of the amended Act, encompassing claims filed after December 31, 1973, benefits are considered the responsibility of the coal industry. They are paid under applicable State workmen's compensation laws, provided that such laws are deemed to offer adequate coverage for black lung disability, 30 U.S.C. § 931(a), ⁸ or, if not, through self-insurance programs. 30 U.S.C. § 933(a). ⁹ The federal government assumes responsibility for the payment of benefits arising out of certain Part B claims, filed on or before June 30, 1973. Federal coverage extends only to the end of 1973 for claims filed in the interim period between June 30th and December 31st of that year. 30 U.S.C. § 924(a)(1), (b). ¹⁰ Responsibility is upon the coal industry for the payment of benefits with respect to such claims after December 31, 1973.

In addition to altering the transition dates from federal to private responsibility for the payment of benefits, the 1972 amendments added an additional statutory presumption of total disability due to pneumoconiosis to aid in the qualification process. 30 U.S.C. § 921(c)(4). ¹¹ At the same time, Congress indicated its expectation that the Secretary of Health, Education, and Welfare adopt by regulation "such interim evidentiary rules and disability evaluation criteria as will permit prompt and vigorous processing of the large backlog of claims consistent with the language and intent of these amendments." S.Rep. No. 92-743, 92d Cong., 2d Sess. (1972), 1972 U.S.Code Cong. and Admin.News at 2322.

In response to this directive, the Secretary promulgated regulations entitled "Interim adjudicatory rules for certain Part B claims filed by a miner before July 1, 1973, or by a survivor where the miner died before January 1, 1974." 20 CFR § 410.490. ¹² These interim adjudicatory rules establish standards for determining total disability due to pneumoconiosis that are more lenient than the criteria applicable to claimants who filed on or after July 1, 1973. ¹³ Compare 20 CFR 410.490(b) with 20 CFR § 410.426 so far as ventilatory studies are concerned, as well as with 30 U.S.C. § 921(c)(3).

Each of the plaintiffs has been diagnosed as suffering from "simple" pneumoconiosis, see Usery, 428 U.S. at 3-7, 96 S.Ct. at 2887-2888, and is presumptively considered totally disabled due to that disease under the interim adjudicatory standards of 20 CFR § 410.490(b), if those regulations apply to him. Since the plaintiffs wish to avail themselves of the eligibility standards set forth in § 410.490(b), the importance to them of having their claims deemed filed prior to July 1, 1973 is apparent.

II

In asserting his lack of jurisdiction over these cases, the Secretary relies upon the following regulation, 20 CFR § 410.226(b):

"Prospective life of claims. A claim which is filed before the claimant meets all the requirements for entitlement to such benefits will be deemed a valid claim if the claimant meets such requirements for entitlement (1) before the Administration makes a final decision on such claim. . . . If the claimant first meets the requirements for entitlement to benefits in a month after the month of actual filing but before a final administrative or judicial decision is rendered on his claim, his claim will be deemed to have been effectively filed in such first month of entitlement." (emphasis added).

It is from this regulation that the doctrine of effective filing has been adopted. Since the presumption of total disability due to pneumoconiosis found in the interim regulations, 20 CFR § 410.490(b) is made rebuttable if "(t)here is evidence that the individual is, in fact, doing his usual coal mine work or comparable and gainful work," 20 CFR § 410.490(c), the Secretary argues that plaintiffs could not qualify for benefits under those regulations until they stopped working. This, of course, did not occur until "a month after the month of actual filing" as described in 20...