Sixth Circuit Holds That ALJs May Discredit Medical Opinions Based on Theory that COPD Caused by Coal-Mine Dust Ends Once Exposure Ends (Sunny Ridge Mining Co. v. Keathley)

Last week, in an important published decision (available here) the U.S. Court of Appeals for the Sixth Circuit affirmed a miner’s award of black lung benefits—holding that an Administrative Law Judge (ALJ) can discredit a physician’s opinion as contrary to the Black Lung Benefits Act when the physician’s opinion is based on the theory that chronic bronchitis caused by coal-mine dust cease once exposure ends.

In Sunny Ridge Mining Co. v. Keathley, 773 F.3d 734, 2014 WL 6805089 (6th Cir. Dec. 4, 2014), Judge Rogers authored a published opinion (joined by Judges Daughtrey & Donald) that should lay to rest a common theory that physicians hired by coal companies use to argue that a coal miner’s disabling breathing impairment was not caused by coal-mine dust.

Facts

Herbert Keathley worked on dusty surface mines in Kentucky for 16 1/2 years.  Mr. Keathley’s results on breathing tests were borderline for proving disability.  On some occasions, he produced values that qualified him as disabled under the black lung benefits regulations; on others, he was slightly above the table values.  His x-rays were generally negative, but his breathing tests showed an obstructive impairment in the form of chronic bronchitis (a form of COPD).

Procedural History

In the ALJ’s initial decision (available here), Judge Stansell-Gamm found that because a majority of Mr. Keathley’s breathing tests proved disability, Mr. Keathley was entitled to the fifteen-year presumption at 30 U.S.C. § 921(c)(4).  Nonetheless, Judge Stansell-Gamm initially concluded that Sunny Ridge Mining rebutted the presumption based on Dr. Broudy’s opinion which explained his theory for why coal-mine dust did not contribute to Mr. Keathley’s obstructive impairment.  Dr. Broudy acknowledged that clinical coal workers’ pneumoconiosis can progress without further exposure, but said “if chronic bronchitis is caused by coal dust exposure, when you remove the exposure it should dissipate.”

The Benefits Review Board reversed (decision here), finding two errors:  First, the ALJ erred by weighing the differing breathing tests by simply counting the number of qualifying vs. nonqualifying results rather than qualitatively analyzing the results.  Second, the ALJ erred by failing to analyze whether Dr. Broudy’s opinion was consistent with the regulations in part because Dr. Broudy’s theory of causation is in tension with 20 C.F.R. § 718.201(c) which says pneumoconiosis “is recognized as a latent and progressive disease which may first become detectable only after the cessation of coal mine dust exposure.”

On remand (decision here), Judge Stansell-Gamm thoroughly analyzed the breathing tests and maintained that the preponderance show that Mr. Keathley was disabled.  However, the judge’s analysis of Dr. Broudy’s opinion changed once he took into account the regulations; on remand, the Dr. Broudy’s opinion was given little weight due to the conflicts between Dr. Broudy’s theories and the regulations.  Accordingly, Judge Stansell-Gamm found that the fifteen-year presumption remained unrebutted and awarded Mr. Keathley benefits.

The Board affirmed the award of benefits (decision here) and Sunny Ridge Mining petitioned the Court of Appeals to review the decision.

Sixth Circuit Decision & Reasoning

The Sixth Circuit first rejected the Sunny Ridge Mining’s argument that the ALJ erred by finding Dr. Broudy’s opinion to be contrary to the regulations.  The court began by stating the legal rule: “When the sole reason given for a medical opinion about the cause of pneumoconiosis conflicts with the Black Lung Benefits Act or its implementing regulations, an ALJ may discount that opinion.”  The court then applied this rule, finding that Dr. Broudy’s statement that “the bronchitis associated with coal dust exposure usually ceases with cessation of exposure” conflicts with § 718.201(c).  Therefore, the court easily concluded that the ALJ properly discounted Dr. Broudy’s opinion.

The court explained that this conclusion was compelled by its previous decision in Cumberland River Coal Co. v. Banks, 690 F.3d 477, 488 (6th Cir. 2012), which discredited Dr. Jarboe’s opinion relying upon the passage of time since the miner stopped working to rule out coal-mine dust as a cause of the miner’s chronic bronchitis.  Further, the court stated that this conclusion was consistent with the plain language of § 718.201(c) which refers simply to “pneumoconiosis” (which by definition includes both clinical and legal pneumoconiosis)—meaning that the latent and progressive nature of pneumoconiosis is not limited to clinical pneumoconiosis.  Finally, the court stated that the agency’s position is entitled to deference.  The court concluded that the Department of Labor’s conclusion that legal pneumoconiosis is latent and progressive, “may seem implausible, since it states a categorical medical claim about a category that is a legal fiction, but it is the conclusion that this court and others have reached.

The Sixth Circuit then rejected Sunny Ridge’s argument regarding the ALJ’s weighing of the breathing tests.  The court held that on remand the ALJ did more than merely count the qualifying vs. nonqualifying tests, but rather considered the qualitative and quantitative aspects of the evidence.  The court explained that although Woodward v. Director, OWCP, 991 F.2d 314 (6th Cir. 1993), held that relying solely on a quantitative approach was improper, there is no problem with considering the quantity of evidence after a qualitative approach is used.  In addition, the court noted that the ALJ’s disability finding was supported not only by his analysis of the pulmonary function tests, but also by his finding that the medical opinion evidence supports a finding of total disability.

Accordingly, the Sixth Circuit rejected Sunny Ridge Mining’s petition for review, affirming Mr. Keathley’s award of benefits.

Analysis

Both of Keathley‘s holdings are important and should be noted by black lung attorneys.

The Sixth Circuit’s first holding clearly discredits a major theory that some doctors use to attempt ruling out coal-mine dust as a cause of a miner’s COPD.  The court did not say that an ALJ must discredit a doctor whose opinion is contrary to § 718.201(c)’s recognition that black lung is latent and progressive. But when combined with the Board’s decision in this case, it will be exceedingly difficult for an ALJ to rely on that medical theory.  An ALJ would have to affirmatively recognize that a doctor’s opinion is contrary to the regulations but then provide other reasons to credit the doctor.  The Board would then likely focus on whether the other reasons were sufficient.  In short, the medical theory that chronic bronchitis caused by coal-mine dust ceases once exposure stops effectively cannot be used to rule out coal-mine dust as a cause of a miner’s COPD.

The Sixth Circuit’s second holding adds a caveat to Woodward.  Once an ALJ qualitatively analyzes the evidence, then a quantitative approach can be used.  This tiebreaker can be useful, but means that it becomes more important to develop a larger quantity of evidence when the evidence is mixed.  Unfortunately, this may increase the cost of developing evidence in close black lung claims.

Congratulations to William Lawrence Roberts & Miller Kent Carter for their success on behalf of Mr. Keathley and to Anne Marie Scarpino & Sean G. Bajkowski of the Department of Labor’s Solicitor’s Office for their success on behalf of the Director.

(Disclosure:  Following law school, I clerked for Judge Rogers.  I had no role in this case and have had no communications with Judge Rogers or his staff about this case.)

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