Sea "B" Mining Company v. Shirley Addison
2016 U.S. App. LEXIS 13796
| 4th Cir. | 2016Background
- Jerry Addison, a former coal miner with ~11.7 years' mining exposure and a long smoking history, filed a subsequent Black Lung claim; ALJ found he had clinical and legal pneumoconiosis causing total respiratory disability and awarded benefits.
- Medical record included three chest x-rays (2009, Feb 2011, May 2011), three CT scans (2008–2012) all read negative, PFT/ABG results, treatment records, and competing medical opinions from Drs. Forehand (diagnoses: clinical and legal pneumoconiosis), Fino, and Castle (diagnosis: idiopathic pulmonary fibrosis unrelated to coal dust).
- ALJ (1) deemed the May 20, 2011 x-ray “overall positive” relying on Dr. Forehand and Dr. Miller despite a contrary Dr. Scott reading, (2) considered only one of Sea-B’s three CT scans (selecting July 2012), and (3) credited Dr. Forehand over Drs. Fino and Castle.
- Benefits Review Board affirmed in a split decision; majority found ALJ erred in excluding CT scans but held Sea-B failed to show prejudice; dissent said exclusion tainted the finding.
- Fourth Circuit granted review, held ALJ erred by excluding CT scans and insufficiently explaining x-ray weighting and medical-opinion credibility; vacated and remanded for reconsideration.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| ALJ excluded two of three CT scans | Addison: error was harmless; Sea-B failed to show prejudice | Sea-B: ALJ must consider all CT readings; exclusion prevents meaningful review | Court: exclusion was error and not harmless because scans bore directly on diagnosis and medical opinions; remand required |
| ALJ relied on x-ray readings (May 20, 2011) — possible headcount | Addison: ALJ properly weighed readings in light of readers’ qualifications | Sea-B: ALJ impermissibly used numerical headcount without adequate reasoning | Court: record lacks sufficient explanation; ALJ must articulate how readers’ qualifications were weighed and avoid mere headcount; remand required |
| Weight given to treating/consulting medical opinions (Forehand v. Fino/Castle) | Addison: ALJ permissibly credited Forehand; consistent with regulatory preamble | Sea-B: ALJ misapplied preamble, ignored physicians’ superior qualifications and CT chronology supporting idiopathic fibrosis | Court: ALJ relied on an inapposite preamble passage and failed to address physicians’ reasoning and qualifications in light of the full imaging record; must reevaluate on remand |
| Harmless error standard for administrative omissions | Addison: Board correctly required showing of prejudice | Sea-B: exclusion of evidence makes appellate review impossible; per se reversal warranted | Court: Harmless-error rule applies; burden on challenger to show prejudice, but here exclusion likely affected outcome; no per se rule; remand warranted |
Key Cases Cited
- Clinchfield Coal Co. v. Fuller, 180 F.3d 622 (4th Cir.) (distinguishing clinical and legal pneumoconiosis)
- Milburn Colliery Co. v. Hicks, 138 F.3d 524 (4th Cir.) (elements required to obtain black lung benefits)
- Island Creek Coal Co. v. Compton, 211 F.3d 203 (4th Cir.) (all relevant evidence must be considered and weighed together)
- Sterling Smokeless Coal Co. v. Akers, 131 F.3d 438 (4th Cir.) (rejecting resolution of medical conflicts by mere numerical superiority)
- Harman Mining Co. v. Dir., OWCP, 678 F.3d 305 (4th Cir.) (standard of review for ALJ factual findings and use of regulatory preamble)
- Consolidation Coal Co. v. Williams, 453 F.3d 609 (4th Cir.) (harmless-error application to agency proceedings)
- Adkins v. Dir., OWCP, 958 F.2d 49 (4th Cir.) (expert qualifications relevant to weight of medical opinion)
- Mullins Coal Co. v. Dir., OWCP, 484 U.S. 135 (1987) (ALJ must weigh quality, not just quantity, of evidence)
- Shinseki v. Sanders, 556 U.S. 396 (2009) (harmless-error principles; burden to show prejudice)