Metro MacHine Corp. v. Director, Office of Workers' Compensation Programs, 846 F.3d 680

Background

Claimant (John Stephenson), a long-time pipefitter with preexisting COPD and extensive smoking history, inhaled welding/epoxy fumes during an 8+ hour workday on Feb. 18, 2008 and was hospitalized the next day for exacerbation of COPD.
Claimant received temporary disability payments, later retired, increased oxygen use, and in 2011 sustained a T7 vertebral fracture that treating surgeons attributed to long-term steroid use for his respiratory condition (steroids tied to COPD treatment).
Claimant sought payment of medical benefits under the Longshore and Harbor Workers’ Compensation Act for both the COPD worsening and the vertebral fracture; employer (Metro) controverted.
ALJ invoked the Section 20(a) presumption for both the COPD aggravation and the fracture, found employer failed to rebut the presumption (discounting equivocal treating opinions), and awarded medical benefits for both conditions.
Benefits Review Board affirmed; employer petitioned the Fourth Circuit. The Fourth Circuit denied review, affirming that substantial evidence supported the ALJ/Board rulings and that remand would be futile.

Issues

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether claimant established a prima facie case for §20(a) presumption as to COPD aggravation	Exposure caused permanent aggravation; hospitalization and post-exposure decline show causation	Employer argued claimant hadn’t proved permanent aggravation and treating opinions were equivocal	Held: Prima facie case satisfied by hospitalization and sustained decline; §20(a) properly invoked
Whether employer rebutted §20(a) as to COPD	N/A (claimant rests on presumption and evidence)	Employer relied on equivocal/toggling opinions of treating physician to show no permanent aggravation	Held: Employer’s evidence was insufficient; treating physician’s shifting views entitled to little weight; presumption not rebutted
Whether §20(a) presumption applies to secondary injuries (T7 fracture)	Presumption applies to any claim within the Act, including secondary injuries that naturally or unavoidably result from a compensable primary injury	Employer argued §20(a) does not apply to secondary injuries (citing Fifth Circuit authority) and the fracture was not listed on the initial claim form	Held: §20(a) applies to secondary-injury claims; claimant’s claim sufficiently encompassed the fracture and employer was not prejudiced by notice
Standard for compensability of secondary injury and whether ALJ erred	Claimant: fracture is compensable as it naturally/unavoidably resulted from work-related COPD (steroid use/coughing)	Employer: ALJ should have applied a "naturally or unavoidably results" standard and employer had evidence (long prior steroid use) that fracture was unrelated	Held: Court says ALJ should have applied the "naturally or unavoidably results" standard but on these facts that omission was harmless; substantial evidence supports finding that fracture could and did naturally/unavoidably result and employer failed to rebut the presumption

Key Cases Cited

Estate of Cowart v. Nicklos Drilling Co., 505 U.S. 469 (1992) (describing the Act’s remedial federal compensation scheme)
U.S. Indus./Fed. Sheet Metal, Inc. v. Director, OWCP, 455 U.S. 608 (1982) (distinguishes "arising out of" from "in the course of" employment)
Director, OWCP v. Greenwich Collieries, 512 U.S. 267 (1994) (explains §20(a) presumption and congressional intent to ease claimant’s initial proof burden)
Universal Maritime Corp. v. Moore, 126 F.3d 256 (4th Cir. 1997) (elements required to invoke §20(a) presumption)
Newport News Shipbuilding & Dry Dock Co. v. Fishel, 694 F.2d 327 (4th Cir. 1982) (aggravation rule: employment injury that aggravates preexisting infirmity renders entire disability compensable)
Jones v. Director, OWCP, 977 F.2d 1106 (7th Cir. 1992) (discusses the "naturally or unavoidably results" standard for secondary injuries)