BIG BRANCH RESOURCES, INCORPORATED, as insured by The West Virginia CWP Fund, Petitioner, v. John A. OGLE; Director, Office of Workers’ Compensation Programs, Respondents.
No. 13-3251.
United States Court of Appeals, Sixth Circuit.
Dec. 17, 2013.
737 F.3d 1063
III. CONCLUSION
We hold that the ALJ did not err by crediting, for the purposes of the fifteen-year presumption, the claimant’s aboveground employment at an underground coal mine without a comparability of conditions determination. Furthermore, both the ALJ’s crediting and discounting of physicians’ opinions and the ALJ’s conclusion that Island Creek did not rebut the fifteen-year presumption were based on substantial evidence and in accordance with applicable law. Finally, because implementing regulations are unnecessary where, as here, the statutory amendments are self-executing, the award of benefits is not premature. For the foregoing reasons, we DENY the petition for review.
Before: BATCHELDER, Chief Judge; GUY and MOORE, Circuit Judges.
OPINION
KAREN NELSON MOORE, Circuit Judge.
In this case, the Benefits Review Board (“the Board“) affirmed the decision of the administrative law judge (“ALJ“) granting John A. Ogle’s claim for federal black lung benefits. The West Virginia Coal Workers’ Pneumoconiosis Fund (“the Fund“) as insurer of the defunct Big Branch Resources, Inc. petitions for review of that decision, claiming that the ALJ erred on several grounds. In particular, the Fund argues that the ALJ improperly restricted the Fund’s ability to rebut the fifteen-year presumption and that the ALJ applied the wrong standard for rebutting the causation presumption. The Fund further alleges that the ALJ’s conclusion that the Fund did not rebut the fifteen-year presumption was erroneous. Finally, the Fund posits that the ALJ wrongly discredited the medical opinions of two experts. Because there is no evidence that the ALJ improperly restricted the Fund’s ability to rebut the fifteen-year presumption or that the ALJ applied the wrong standard, and because the ALJ’s other decisions are supported by substantial evidence, we DENY the petition for review.
I. BACKGROUND
Ogle, born in 1954, worked in various jobs in underground coal mines for twenty-one years. Jt. App’x at 269-70 (ALJ Dec. at 5-6). His last coal mine employment was in 1996 in Kentucky. Jt. App’x at 269 (ALJ Dec. at 5). Ogle has been a long-term smoker, beginning at the age of twelve. Jt. App’x at 270 (ALJ Dec. at 6). He submitted this claim for benefits on November 5, 2007. Jt. App’x at 266 (ALJ Dec. at 2). On May 5, 2009, an ALJ1 conducted a formal hearing at which the parties also submitted exhibits. Jt. App’x at 266, 267-68 (ALJ Dec. at 2, 3-4).
After the record closed but before the ALJ issued a decision, Congress enacted legislation reviving a rebuttable statutory presumption that a coal miner who worked in an underground coal mine for at least fifteen years and suffers from a total respiratory or pulmonary disability is presumed to be totally disabled due to pneumoconiosis. See Patient Protection and Affordable Care Act (“PPACA“), Pub.L. No. 111-148, § 1556, 124 Stat. 119 (2010); see also
Because Ogle’s claim fit the timing criteria for the statutory presumption, the ALJ solicited additional evidence related to the new law and position statements regarding the applicability of the rebuttable presumption to this claim. Jt. App’x at 267 (ALJ Dec. at 3). The Fund submitted supplemental medical reports and a position statement. Id.
On December 8, 2011, the ALJ issued his Decision and Order Awarding Benefits (“ALJ Dec.“). Jt. App’x at 265-99. In the decision, the ALJ first determined that Ogle filed the claim after January 1, 2005, and the claim was pending at the time the rebuttable presumption provision was enacted. Jt. App’x at 267 (ALJ Dec. at 3). The ALJ then found that Ogle suffered from a totally disabling respiratory impairment, a finding with which all medical opinions submitted agreed. Jt. App’x at 289 (ALJ Dec. at 25). Based on this finding of total disability, the filing of the claim after January 1, 2005, and the agreement that the miner had over fifteen years of underground coal mine employment, the ALJ found that the fifteen-year, rebuttable presumption under
Next, the ALJ noted that the rebuttable presumption shifts the burden to the Fund “to demonstrate by a preponderance of the evidence either: (1) the miner’s disability does not, or did not, arise out of coal mine employment; or (2) the miner does not, or did not, suffer from pneumoconiosis.” Jt. App’x at 290 (ALJ Dec. at 26). After reviewing medical opinions regarding x-ray evidence, the ALJ concluded that the Fund did demonstrate by a preponderance of the evidence that Ogle did not suffer from clinical pneumoconiosis. Jt. App’x at 291-93 (ALJ Dec. at 27-29). However, the Fund failed to rebut the presumption that Ogle suffers from legal pneumoconiosis. Jt. App’x at 296 (ALJ Dec. at 32).
The ALJ noted that the medical opinions of Dr. Forehand, Dr. Baker, and Dr. Agarwal all concluded that Ogle’s impairment is due to heavy smoking as well as exposure to coal dust, while the opinions of Dr. Jarboe and Dr. Castle attribute the impairment to smoking alone. Jt. App’x at 293 (ALJ Dec. at 29). The ALJ discredited the opinions of Dr. Jarboe and Dr. Castle because they failed to “adequately address the qualifying FEV1 values on the miner’s pre- and post-bronchodilator testing documenting the presence of obstructive lung disease.”2 Jt. App’x at 295 (ALJ Dec. at 31). Apart from their failure to “adequately explain the cause of the irreversible and totally disabling component of the miner’s lung disease,” id., these two physicians’ opinions “lose probative value” because they “rely on negative chest x-ray findings to preclude a finding of legal pneumoconiosis,” id., which contradicts Department of Labor determinations. The other three doctors diagnosed legal pneumoconiosis. Jt. App’x at 296 (ALJ Dec. at 32). Their opinions were not based on views “inconsistent” with the Department of Labor’s position. Id. Therefore, the ALJ found that the Fund had not rebutted the presumption of legal pneumoconiosis. Id.
In determining whether the Fund had rebutted the causation presumption, the
The Fund appealed the award of benefits to the Board which affirmed the ALJ’s decision as legally sound and based on substantial evidence. Jt. App’x at 307 (Benefits Review Board Decision and Order (“Bd. Dec.“) at 8). In its opinion, the Board first reviewed the ALJ’s findings and the assertions of error made by the Fund. See Jt. App’x at 301-05 (Bd. Dec. at 2-6). The Board analyzed the ALJ’s findings under the same substantial evidence standard that we use. Jt. App’x at 302 (Bd. Dec. at 3) (noting that the Board must affirm the ALJ’s opinion “if it is rational, supported by substantial evidence, and in accordance with applicable law“). The Board rejected the Fund’s arguments that the ALJ “failed to provide valid reasons for discounting the opinions of Drs. Jarboe and Castle.” Jt. App’x at 305 (Bd. Dec. at 6). The Board affirmed the ALJ’s weighing of the evidence and noted that “whether a medical opinion is sufficiently documented and reasoned is a credibility matter within the purview of the [ALJ].” Jt. App’x at 306 (Bd. Dec. at 7). As a result, the Board affirmed the ALJ’s finding that the Fund failed to prove that Ogle did not suffer from legal pneumoconiosis. Id. Turning to disability causation, the Board found that the ALJ “accurately noted that all of the physicians agree that [Ogle]’s disability is due to his pulmonary impairment,” Jt. App’x at 307 (Bd. Dec. at 7), thus leaving only the question whether Ogle’s impairment is due to his coal mine employment. The Board agreed with the ALJ that the physicians’ opinions on this question were closely related to their opinions on the existence of legal pneumoconiosis, and the Board approved of the ALJ discounting the opinions of Dr. Jarboe and Dr. Castle for the same reasons. Id. Consequently, the Board affirmed the ALJ’s conclusion that the Fund had failed to disprove disability causation, that the Fund had not rebutted the presumption, and that benefits ought be awarded. Id.
This petition for review followed.
II. ANALYSIS
A. Standard of Review
In reviewing an appeal from the Board, we review the Board’s legal conclusions de novo. Paducah Marine Ways v. Thompson, 82 F.3d 130, 133 (6th Cir.1996). While we will not vacate the Board’s decision unless the Board has committed legal error or exceeded its scope of review, Jonida Trucking, Inc. v. Hunt, 124 F.3d 739, 742 (6th Cir.1997), we review the ALJ’s decision to determine whether the ALJ applied the applicable law correctly to reach a conclusion supported by substantial evidence. Tenn. Consol. Coal Co. v. Kirk, 264 F.3d 602, 606 (6th Cir.2001). “’Substantial evidence’ means ’such relevant evidence as a reasonable mind might
If the ALJ has adequately explained why he weighed the evidence as he did, then he has satisfied the substantial evidence standard. Morrison v. Tenn. Consol. Coal Co., 644 F.3d 473, 478 (6th Cir.2011). “A remand or reversal is only appropriate when the ALJ fails to consider all of the evidence under the proper legal standard or there is insufficient evidence to support the ALJ’s finding.” McCain v. Director, Office of Workers’ Compensation Programs, 58 Fed.Appx. 184, 201 (6th Cir. 2003).
B. Legal Structure
The Black Lung Benefits Act (“BLBA“) provides benefits to coal miners who have become totally disabled due to their exposure to coal dust and resulting pneumoconiosis. See
Thus, after a showing that the miner (1) was employed for at least fifteen years in underground coal mines and (2) is totally disabled due to a respiratory or pulmonary impairment, then the rest of the elements outlined in
The Fund claims that the ALJ and the Board improperly restricted its ability to rebut the fifteen-year presumption by limiting the Fund to only the two methods through which the Secretary may rebut the presumption. The Fund points to Usery v. Turner Elkhorn Mining Co., 428 U.S. 1, 96 S.Ct. 2882, 49 L.Ed.2d 752 (1976), to argue that the final sentence of
A prior panel of this court has held that to rebut the presumption, the employer must establish that: “(A) such miner does not, or did not, have pneumoconiosis, or that (B) his respiratory or pulmonary
The two rebuttal methods were properly identified and analyzed by the ALJ. The ALJ stated that the Fund can show that the miner does not suffer from pneumoconiosis. Id. Such a showing rebuts the first of the three “presumed” elements—that the individual suffers from pneumoconiosis arising out of his coal mine employment and causing his disability. The ALJ concluded that the Fund failed to show that the miner did not suffer from pneumoconiosis. Jt. App’x at 296 (ALJ Dec. at 32).
The ALJ then explained why the Fund did not rebut what the ALJ labels “disability causation.” Jt. App’x at 296-97 (ALJ Dec. at 32-33). Disability causation rebuttal, according to the ALJ, can be accomplished by proving that the miner’s disability does not arise out of coal mine employment. Jt. App’x at 296 (ALJ Dec. at 32). This formulation encompasses both of the remaining causation elements. The Fund could have proven that the miner’s disability does not arise out of coal mine employment by showing either that the miner’s pneumoconiosis does not arise out of his coal mine employment or that his pneumoconiosis does not cause his disability. The ALJ did not err by collapsing the two-step causal chain—that coal mine employment caused pneumoconiosis which in turn caused total disability—into a single question: did the miner’s disability arise out of his coal mine employment?
Furthermore, proving that there is no causal link between a miner’s coal mine employment and his pneumoconiosis would have shown that the miner does not suffer legal pneumoconiosis. After all, “’legal pneumoconiosis’ includes any chronic lung disease or impairment and its sequelae arising out of coal mine employment.”
The Fund mistakenly argues that there is a third rebuttal method which was denied to the Fund; specifically, the Fund posits that it ought be able to contend that a miner’s pneumoconiosis is mild and that the totally disabling respiratory impairment is the product of another disease. This argument, however, is not a unique third rebuttal method, but merely a specific way to attack the second link in the causal chain—that pneumoconiosis caused total disability. Nothing in the record suggests that the Fund was prevented from making this argument.
The Fund also argues that the ALJ applied the incorrect standard for rebutting disability causation. The ALJ applied the Fourth Circuit’s “rule-out” standard. See Bethlehem Mines Corp. v. Massey, 736 F.2d 120, 123 (4th Cir.1984) (holding that “the employer must rule out the causal relationship between the miner’s total disability and his coal mine employment in order to rebut the interim presumption“).4
The regulation implementing the fifteen-year presumption states that “the presumption will be considered rebutted” if the “total disability did not arise in whole or in part out of dust exposure in the miner’s coal mine employment.”
Simply put, the “play no part” or “rule-out” standard and the “contributing cause” standard are two sides of the same coin. Where the burden is on the employer to disprove a presumption, the employer must “rule-out” coal mine employment as a cause of the disability. Where the employee must affirmatively prove causation, he must do so by showing that his occupational coal dust exposure was a contributing cause of his disability. Because the burden here is on the Fund, the Fund must show that the coal mine employment played no part in causing the total disability. See Gibas, 748 F.2d at 1120 (“If an employer is able to prove that pneumoconiosis played no part in causing a miner’s disability, then the employer has satisfied the [rebuttal] requirements.” (emphasis added)). This approach follows and applies the language found in
No meaningful difference exists between this “played no part” standard and the ALJ’s statement that “rebuttal is established by ’ruling out’ the causal nexus between the miner’s totally disabling lung impairment and his coal dust induced lung disease.” Jt. App’x at 296 (ALJ Dec. at 32). Consequently, we hold that the ALJ did not apply an improper standard.5
The Fund does not challenge the ALJ’s determination that Ogle is entitled to the fifteen-year presumption. However, the Fund does challenge the ALJ’s conclusion that it did not rebut that presumption of total disability due to pneumoconiosis. The Fund points to various, specific alleged errors committed by the ALJ. First, the Fund contends that the ALJ erred because he did not account for the failures of Dr. Forehand, Dr. Baker, and Dr. Agarwal to account for Ogle’s elevated or paralyzed left hemidiaphragm. The Fund also argues that the ALJ improperly discredited the medical opinions of Dr. Jarboe and Dr. Castle throughout his decision.
When we review determinations of credibility and the weight afforded to various medical opinions, we defer to the ALJ whenever his conclusions are supported by substantial evidence. Consolidation Coal Co. v. Worrell, 27 F.3d 227, 231 (6th Cir. 1994). This deference extends to whether a medical opinion is well-reasoned—a determination ordinarily left to the ALJ. Director, Office of Workers’ Compensation Programs v. Rowe, 710 F.2d 251, 255 (6th Cir. 1983). In fact, determining whether a “doctor’s report was ’sufficiently documented and reasoned[]’ [is] a credibility decision we have expressly left to the ALJ.” Crisp, 866 F.2d at 185.
1. ALJ’s Assessments of Dr. Forehand, Dr. Baker, and Dr. Agarwal
First, the Fund asserts that the ALJ erred by crediting the opinions of Dr. Forehand, Dr. Baker, and Dr. Agarwal despite these three physicians’ opinions failing to account for Ogle’s elevated or paralyzed left hemidiaphragm. While the Fund is correct that the ALJ did not account for the lack of discussion of Ogle’s potentially elevated or paralyzed left hemidiaphragm in the opinions of these three physicians, we do not require the ALJ to remark on every piece of evidence and every omission by a physician. Our review is whether the ALJ’s decision rests on substantial evidence. See Kirk, 264 F.3d at 606. Here, the ALJ was determining whether the Fund had rebutted the fifteen-year presumption. Nothing in the evidence presented by these three physicians supported rebuttal of that presumption. Furthermore, the ALJ, as required, did consider all relevant evidence, which includes the physicians’ reports in whole and the deposition testimony of Dr. Agar-
2. ALJ’s Assessments of Dr. Jarboe and Dr. Castle
The Fund also argues that the ALJ improperly discredited the medical opinions of Dr. Jarboe and Dr. Castle throughout his decision. The first error, according to the Fund, stems from the ALJ discrediting the opinions of Dr. Jarboe and Dr. Castle as contrary to the preamble to the 2001 amendments to the black lung regulations.6 Second, the Fund contends that despite the two doctors’ opinions adequately explaining the irreversible and totally disabling component of Ogle’s impairment, the ALJ improperly discredited them as inadequate explanations. Third, the Fund posits that the ALJ erred in discrediting the opinions of Dr. Jarboe and Dr. Castle because they did not find legal pneumoconiosis. While an ALJ can discredit an opinion that rules out legal pneumoconiosis when he factually finds that the miner suffers from legal pneumoconiosis, here legal pneumoconiosis was presumed, not found.
Each of these arguments once again asks us to ignore the ALJ’s credibility findings and to reweigh the evidence ourselves. We decline to do so. The ALJ stated in each instance why he has discredited the opinions on which the Fund relies. “The ALJ’s conclusion that [one doctor]’s opinion was sufficiently reasoned but that [another doctor’s opinion] was not is a matter of credibility, which we cannot revisit.” A & E Coal Co. v. Adams, 694 F.3d 798, 803 (6th Cir. 2012). Additionally, the ALJ has explained his views clearly, thereby allowing us to discern the opinions on which he relies and the reasons for his reliance. “Thus, the ALJ accurately and specifically referenced the evidence supporting his conclusions.” Id. His determinations to credit or discredit these medical opinions based on whether they are sufficiently documented and reasoned is a credibility matter that we must leave to the ALJ. See Moseley v. Peabody Coal Co., 769 F.2d 357, 360 (6th Cir. 1985); Rowe, 710 F.2d at 255.
On the first asserted error, the Fund argues that its experts did not “rely on negative chest x-ray findings to preclude a
Second, the Fund contends that despite the opinions adequately explaining the irreversible and totally disabling component of Ogle’s impairment, the ALJ improperly discredited them as inadequate explanations. Here, the Fund asks us to “reweigh the evidence [and] substitute our judgment for that of the ALJ.” Kirk, 264 F.3d at 606. We cannot do so. Id. “[E]ven if we would have taken a different view of the evidence were we the trier of facts,” we must affirm the ALJ’s reasonable interpretation. Ramey, 755 F.2d at 486. Here, the ALJ stated precisely what he concluded the Fund’s experts have failed to do—explain adequately the irreversible and totally disabling component of Ogle’s impairment. The Fund cobbles together various statements by the physicians to argue they have done so. “Determinations of whether a physician’s report is sufficiently documented and reasoned is a credibility matter left to the trier of fact.” Moseley, 769 F.2d at 360. We defer to the ALJ’s determination whether the explanations are adequate and will not disturb his reasonable findings.
The Fund’s argument that the ALJ erred by discrediting an opinion that ruled out legal pneumoconiosis where legal pneumoconiosis is only presumed, rather than factually found, is flawed. This argument is based on the view that the ALJ merely presumed legal pneumoconiosis. While the fifteen-year presumption did at first allow the ALJ to presume pneumoconiosis, the Fund challenged this presumption. The Fund fought vigorously to rebut the presumption, while Ogle strived to buttress it. The Fund was able to disprove the existence of clinical pneumoconiosis, but failed to disprove the existence of legal pneumoconiosis, which was its burden. Thus, while pneumoconiosis was first presumed, not found, the ALJ nevertheless concluded that the “[e]mployer has not rebutted the existence of legal coal workers’ pneumoconiosis by a preponderance of the medical evidence.” Jt. App’x at 296 (ALJ Dec. at 32). Thus, the ALJ determined that it was at least as likely as not that Ogle suffered from legal pneumoconiosis. The ALJ did not err in using this determination to discredit the opinions of Dr. Jarboe and Dr. Castle, neither of whom diagnosed legal pneumoconiosis.
In sum, the ALJ did not err in concluding that the Fund failed to rebut the fifteen-year presumption.
We hold that the ALJ did not improperly restrict the Fund’s ability to rebut the fifteen-year presumption. Furthermore, an employer must show that coal mine employment played no part in the claimant’s disability in order to rebut the presumption that coal dust exposure caused the disability. The ALJ’s conclusion that the Fund did not rebut the fifteen-year presumption was based on substantial evidence and in accordance with applicable law. For all of the reasons expressed in this opinion, we DENY the petition for review.