880 F.3d 691
4th Cir.2018Background
- Lonnie A. Smith worked at least 31 years in underground coal mines and filed a black‑lung claim in 2010 after retiring for exertional shortness of breath.
- An ALJ found Smith totally disabled based on Dr. Rasmussen’s exercise‑based gas‑transfer testing and invoked the Black Lung Act’s fifteen‑year presumption (30 U.S.C. § 921(c)(4)).
- The presumption shifts to the employer the burden to rebut that Smith has pneumoconiosis arising out of coal‑mine employment or that pneumoconiosis substantially contributed to his disability.
- Employer’s doctors (Drs. Rosenberg and Spagnolo) concluded there was no clinical or legal pneumoconiosis; DOL examiner Dr. Rasmussen diagnosed legal pneumoconiosis in 2011 but, when deposed, revealed a normal 2009 exercise study and said he could not definitively rule coal dust in or out.
- The ALJ excluded Rasmussen’s 2009 report/testimony as an untimely third report under 20 C.F.R. § 725.414(a)(3)(i), credited Rasmussen’s 2011 opinion on disability and causation issues, and concluded the employer failed to rebut the fifteen‑year presumption; the Benefits Review Board affirmed.
Issues
| Issue | Plaintiff's Argument (Smith/WV CWP Fund as petitioner) | Defendant's Argument (Fund) | Held |
|---|---|---|---|
| Whether Smith is totally disabled so as to trigger the 15‑year presumption | ALJ properly credited Rasmussen’s exercise‑based opinion showing gas‑transfer impairment that precludes his last work | Fund argued employer doctors showed no total disability and Rasmussen’s opinion was unreliable | Court: ALJ’s disability finding is supported by substantial evidence; presumption applies |
| Whether employer rebutted the 15‑year presumption (pneumoconiosis rebuttal) | Smith: presumption stands unless employer affirmatively proves impairment not significantly related to coal dust | Fund: absence of any affirmative diagnosis of legal pneumoconiosis (esp. after Rasmussen’s 2009 study) means presumption is rebutted | Court: Employer failed to rebut; Rasmussen could not rule out coal dust and employer experts were insufficient, so presumption stands |
| Whether ALJ erred by excluding Rasmussen’s 2009 report/testimony under the two‑report rule | Smith: ALJ correctly excluded as untimely third report per regulation | Fund: ALJ should have ruled earlier and allowed argument for good cause; admission would have shown Rasmussen withdrew diagnosis | Court: Even if 2009 evidence were considered, Rasmussen still could not rule out coal dust; exclusion issue would not change outcome |
| Whether ALJ properly weighed/conflicted medical opinions | Smith: ALJ reasonably credited the exercise‑based, well‑reasoned Rasmussen report over others | Fund: ALJ should not have given controlling weight to Rasmussen given his equivocation and later testimony | Court: Deferential review; ALJ credibility and weight determinations reasonable and supported by record |
Key Cases Cited
- Hobet Mining, LLC v. Epling, 783 F.3d 498 (4th Cir. 2015) (explaining the fifteen‑year presumption and burden shift)
- Lewis Coal Co. v. Dir., Office of Workers’ Comp. Programs, 373 F.3d 570 (4th Cir. 2004) (standard for appellate review of ALJ factual findings)
- Harman Mining Co. v. Dir., Office of Workers’ Comp. Programs, 678 F.3d 305 (4th Cir. 2012) (deference to ALJ credibility evaluations)
- Westmoreland Coal Co. v. Cochran, 718 F.3d 319 (4th Cir. 2013) (role of ALJ in resolving conflicting medical opinions)
- Sterling Smokeless Coal Co. v. Akers, 131 F.3d 438 (4th Cir. 1997) (appellate limits on reweighing evidence)
- W. Va. CWP Fund v. Bender, 782 F.3d 129 (4th Cir. 2015) (employer’s heavy burden to rule out any connection between pneumoconiosis and disability)