Hill v. Director OWCP ( 2009 )

Opinions of the United
2009 Decisions States Court of Appeals
for the Third Circuit
4-9-2009
Hill v. Director OWCP
Precedential or Non-Precedential: Precedential
Docket No. 06-4868
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PRECEDENTIAL
UNITED STATES COURT OF APPEALS
FOR THE THIRD CIRCUIT
_____________
No. 06-4868
_____________
PEGGY HILL, Widow of Charles W. Hill,
Petitioner,
v.
DIRECTOR, OFFICE OF WORKERS’ COMPENSATION
PROGRAMS, UNITED STATES DEPARTMENT OF
LABOR,
Respondent.
On Petition for Review of an Order of
the Benefits Review Board
United States Department of Labor
(BRB No. 06-0266 BLA)
Argued March 24, 2008
Before: McKEE, RENDELL, & TASHIMA * Circuit Judges
*
Honorable A. Wallace Tashima, Senior Judge of the
United States Court of Appeals for the Ninth Circuit, sitting by
designation.
(Opinion Filed: April 9, 2009)
____________
George E. Mehalchick (ARGUED)
Lenahan & Dempsey, P.C.
The Kane Building
116 North Washington Avenue, Suite 400
Scranton, PA 18503
Counsel for Petitioner
Jonathan L. Snare
Allen H. Feldman
Patricia M. Nece
Kristen Lindberg (ARGUED)
United States Department of Labor
Office of the Solicitor
Suite N-2117
200 Constitution Avenue NW
Washington, D.C. 20210
Counsels for Respondent
_____________
OPINION
_____________
2
McKEE, Circuit Judge
The widow of a deceased coal miner petitions for review
of a decision of the Benefits Review Board affirming an
Administrative Law Judge's denial of her claim for survivor's
benefits under the Black Lung Benefits Act, 30 U.S.C. §§
901-945. For the reasons that follow, we will grant the petition
for review, and remand for payment of her claim.
I. FACTS AND PROCEDURAL BACKGROUND
Charles Hill worked in coal mines in Northeastern
Pennsylvania for more than twenty years. During his
employment, he was responsible for physically breaking up coal
with a pick and shovel and loading it into mine cars and shaker
chutes. Hill was also involved in mine drilling, tamping
explosives and blasting operations.
Hill first applied for Black Lung benefits on April 18,
1980. The Department of Labor administratively denied the
3
claim and thereafter denied two additional claims that Hill filed
in June of 1984 and September of 1991. Hill applied for
benefits a fourth time on November 3, 1993 and was denied
once again. That denial was affirmed after a formal hearing, but
the Benefits Review Board reversed the ALJ’s decision denying
benefits. On remand, the ALJ finally awarded benefits dating
back to November 1993, and augmented the benefits to include
Hill’s wife and son who were listed as dependents. In awarding
benefits the ALJ concluded that: (1) the record sufficiently
established the existence of pneumoconiosis, (2) a causal
relationship existed between the pneumoconiosis and 9 ½ years
of documented coal mine employment, and (3) Hill suffered
total disability due to pneumoconiosis.
Hill died on August 7, 2004, and his widow, Peggy Hill,
timely filed for survivor’s benefits under the Black Lung
Benefits Act. That claim was denied by the Department of
4
Labor on February 15, 2005, but Mrs. Hill appealed and
received a hearing before an ALJ.
At the hearing before the ALJ, the parties stipulated that
Hill had contracted pneumoconiosis from working in the mines
based on his receipt of Black Lung benefits during his lifetime.
Accordingly, the only issue facing the ALJ was whether Hill's
death had been caused by pneumoconiosis as required for
survivor's benefits under 20 C.F.R. § 718.250(c). The ALJ
heard testimony from Mrs. Hill and received the deposition of
Dr. Kevin Carey. Dr. Carey had treated Charles Hill at Wilkes-
Barre General Hospital and at Lakeside Nursing Home, where
Mr. Hill had died just a few days after being transferred there
from Wilkes-Barre General.
The ALJ denied Hill’s claim, and that denial was
affirmed by the Benefits Review Board. The Board concluded
that Dr. Carey had not made a finding of clinical
5
pneumoconiosis and “did not state that his finding of chronic
obstructive pulmonary disease/chronic lung disease is related to
coal mine employment (legal pneumoconiosis).” BRB Decision
at 5. Thus, the Board agreed with the ALJ’s conclusion that the
evidence was insufficient to establish death due to
pneumoconiosis.
This petition for review followed.
II. THE EVIDENCE BEFORE THE ALJ
During her testimony before the ALJ, Mrs. Hill
confirmed that her husband had been experiencing shortness of
breath and could not go up a flight of stairs without taking a
break. She also testified that Mr. Hill had a severe, productive
cough and that he had difficulty sleeping because of his labored
breathing. Mrs. Hill confirmed that Mr. Hill had these
symptoms before he had been admitted to Wilkes-Barre General
Hospital. Hr’g Tr. at 9-10.
6
Dr. Carey operates a family care practice in Noxen,
Pennsylvania and is board certified in family medicine. His
practice includes patients with pulmonary disease due to
occupational exposures. Dr. Carey began treating Mr. Hill when
Hill was hospitalized at Wilkes-Barre General, and continued
after Hill’s transfer to Lakeside. Although Dr. Carey’s
colleague, Dr. Gwen Galasso, was Hill’s primary physician, Dr.
Carey assumed responsibility for Hill’s care after Hill went to
the nursing home. Dr. Carey’s testimony was based on his own
examinations of Hill, as well as Dr. Galasso’s notes and the
notes of several other specialists at the hospital and the nursing
home. Dep. Tr. at 5-9.
The vast majority of professional observations of Hill,
and the conclusions of a variety of physicians who treated him,
identified symptoms of pneumoconiosis and the effects of
chronic obstructive pulmonary disease (“COPD”). On July 16,
7
2004, the day Hill was admitted to the emergency room at
Wilkes-Barre General, Dr. Galasso noted the presence of
decreased breath sounds and referenced a chest x-ray that
showed bibasilar atelectasis.1 Eight of the ten physicians who
examined Hill during his three-week stay at the hospital made
similar observations. For example, when Hill was admitted to
the hospital, Dr. David Dalessandro noted scattered rhonchi in
Hill’s lungs. Four days later, Dr. Patrick Degennaro observed
“prominent markings” on the lungs and “abnormal opacities in
the bases.” App. at 100. Dr. Wenlin Fan confirmed a reduction
in lung capacity on a chest x-ray completed on August 2, 2004.
Two days later, Dr. Strasser performed a chest x-ray and noted:
1
Atelectasis is the collapse of part or all of a lung. It is
caused by a blockage of the air passages (bronchus or bronchioles)
or by pressure on the lung. U.S. Nat. Library of Medicine and Nat.
Inst. of Health at
http://www.nlm.nih.gov/medlineplus/ency/article/000065.htm.
8
“[h]azy density is present in both mid-lung fields.” App. at 97.
Finally, Dr. Carey testified that upon Hill’s arrival at Lakeside
on August 5, Hill had decreased breath sounds, some chronic
rhonchi, and some coarse rhonchi, all related to a chronic lung
disease.2 Dep. Tr. at 5.
Hill died at 4:15 a.m. on August 7, 2004, two days after
being transferred to the nursing home from Wilkes-Barre
General. Dr. Carey completed the death certificate and listed
the primary cause of death as cardiopulmonary arrest. He also
2
Two physicians, Dr. Sanjeev Garg and Dr. Martin Fried,
indicated that Hill’s lungs were clear to auscultation on July 17,
2004 and July 28, 2004 respectively. Dr. Decker, another
consulting physician, indicated that one of Hill’s chest x-rays was
free of infiltrate, but he observed decreased breath sounds in the
same examination. His notations therefore corroborate that Hill’s
respiratory system was compromised. Moreover, the notations of
these doctors are consistent with observations we have made about
pneumoconiosis. We have explained that it is a persistent and
progressive disease and although “symptoms may, on occasion,
subside, the condition itself does not improve . . . .” Labelle
Processing Co. v. Swarrow, 72 F.3d 308, 314 (3d Cir. 1995).
9
noted other contributing causes of death including: renal failure,
arteriosclerotic cardiovascular disease and anemia. During his
deposition, Dr. Carey explained how Hill’s lung disease
contributed to his death. Dr. Carey indicated that each of the
symptoms listed on Hill’s death certificate—respiratory arrest,
renal failure, arteriosclerotic cardiovascular disease,
anemia—would all be worse because of the lower volumes of
oxygen that resulted from Hill’s pulmonary disease.
On cross-examination, Dr. Carey further explained that
hyponatremia–a deficiency of sodium in the blood–is often seen
in people with chronic lung disease. He also confirmed that no
medical records were available for Hill for the two days prior to
his death on August 7, 2004, after he was transferred to the
nursing home. Dr. Carey last saw Hill on August 5, 2004.
In opposing Mrs. Hill’s claim, the Director offered a
two-page report from Dr. Michael Sherman. His report was
10
based solely on his review of records he had received from the
Department of Labor. Those records included: Hill's death
certificate, records from Lakeside Nursing Home, and records
provided by the Wyoming Valley Health Care System from
Wilkes-Barre General Hospital. The latter included records of
Hill’s three-week stay at Wilkes-Barre General. Based on his
examination of those records, Dr. Sherman stated “[t]here is no
note in the record of any shortness of breath, dyspnea, or
respiratory distress.” App. at 54. He therefore concluded:
1. The cause of death is not clear from the record.
Clearly Mr. Hill was in poor condition. He was severely
malnourished; an albumin of less than 2.0 is associated
with immune compromise and he was thus likely to have
difficulty warding off infection. He had new onset of
atrial fibrillation and thus may have had underlying
coronary artery disease; he was also at risk for
developing systemic emboli from the atrial fibrillation.
There are no records after 8/5/04, so the circumstances
immediately surrounding Mr. Hill's death two days later
are not known.
2. However, I find no evidence that death was
11
caused by pneumoconiosis or that pneumoconiosis
contributed significantly to Mr. Hill's death. There is no
evidence in the record to suggest that Mr. Hill had
dyspnea, respiratory distress, or respiratory failure when
he arrived at the nursing home. Indeed, he was felt to be
stable on the day of admission. Death appears to be
related to a general level of severe impairment from
dementia and malnutrition, and possibly due to his heart
disease. However, I do not find evidence for a
contribution from COPD or from pneumoconiosis.
Id. (emphasis added).
III. THE ALJ’S DECISION
In denying Mrs. Hill’s claim, the ALJ noted the
immediate causes of death listed on the death certificate, which
included COPD, but focused on the relative weight he would
assign to Dr. Sherman’s report as opposed to the deposition
testimony of Dr. Carey. The ALJ offered the following
explanation for completely dismissing Dr. Carey’s testimony:
[Dr. Carey] did not state that pneumoconiosis contributed
to or hastened the miner’s death. Rather he stated only
that the miner’s “chronic lung disease” or “chronic
obstructive pulmonary disease” contributed to his death.
12
Indeed, in neither the death certificate nor his testimony
did Dr. Carey state that pneumoconiosis or a pulmonary
disease related to coal mine employment contributed to
or hastened the miner’s death.
ALJ’s Decision at 5-6.
The ALJ also criticized Dr. Carey for speaking only of
how “‘[s]omeone with a chronic lung disease or chronic
obstructive pulmonary disease’ was affected by such a
condition.” Id. at 6 (emphasis in original). The ALJ’s concern
regarding the implication of Dr. Carey’s testimony is evidenced
by the ALJ’s statement that Dr. Carey’s opinion was
“tantamount to stating that anyone and everyone who suffers
from a chronic lung disease or COPD and dies [could claim that]
those conditions are always substantial contributors to or
hasteners of death.” Id. The ALJ, therefore, gave Dr. Carey’s
opinion no weight.
Rather, the ALJ relied upon Dr. Sherman’s conclusion
13
that there was no evidence of pneumoconiosis contributing to
Hill’s death. The ALJ found the evidence of decreased breath
sounds, scattered rhonchi, and bilateral crackles, after Hill’s
hospital stay and prior to his death, insufficient to support Dr.
Carey’s conclusion. Finally, the ALJ added that even if Dr.
Carey’s opinion were entitled to some consideration, it was
outweighed by the superior opinion and qualifications of Dr.
Sherman. Id.
The Board affirmed the ALJ’s decision, finding that Dr.
Carey did not establish legal or clinical pneumoconiosis and that
his medical opinion was properly discredited. BRB Decision at
5. The Board also emphasized Dr. Sherman’s determination that
the cause of death is unclear due to the absence of records two
days prior to Hill’s death. Id. at 2.
IV. JURISDICTION AND STANDARD OF REVIEW
We have jurisdiction to review the Board's determination
pursuant to 33 U.S.C. § 921(c). The Board is bound by the
ALJ's findings of fact if they are supported by substantial
14
evidence. Our review of the Board's decision is limited to a
“determination of whether an error of law has been committed
and whether the Board has adhered to its scope of review.”
Kowalchick v. Director, OWCP, 893 F.2d 615, 619 (3d Cir.
1990)(citations omitted).
In reviewing the Board’s decision, we must
independently review the record and decide whether the ALJ's
findings are rational, consistent with applicable law and
supported by substantial evidence on the record considered as a
whole. See Mancia v. Director, OWCP, 130 F.3d 579, 584 (3d
Cir.1997) (citing Kowalchick, 893 F.2d at 619). Substantial
evidence has been defined as “such relevant evidence as a
reasonable mind might accept as adequate to support a
conclusion.” Id. We exercise plenary review over the ALJ's
legal conclusions that were adopted by the Board. See Soubik
v. Director, OWCP, 366 F.3d 226, 233 (3d Cir. 2004)(citations
omitted).
V. DISCUSSION
15
“The Black Lung Benefits Act (Act) provides . . . that
benefits are to be provided ‘to the surviving dependents of
miners whose death was due to [pneumoconiosis.]’” Lukosevicz
v. Director, OWCP, 888 F.2d 1001, 1003 (3d Cir. 1989)
(brackets in original) (citing 30 U.S.C. § 901(a)).3 However, the
Act does not define when a miner’s death will be considered
“due to” pneumoconiosis. Rather, Congress left that definition
to the Secretary of Labor who “redelegated all his powers under
the Act to the Director [of the Office of Workers' Compensation
Programs].” Id.
In Lukosevicz, we upheld the Director’s determination
that a miner’s death would be “due to” pneumoconiosis if that
disease “actually hastens death [or] is a substantially
3
“Pneumoconiosis, also known as black lung disease or
anthracosis, is a chronic dust disease of the lung and its sequelae,
including respiratory and pulmonary impairments, arising out of
coal mine employment. ‘Pneumoconiosis’ includes both clinical
and legal pneumoconiosis, which include, but are not limited to
anthracosilicosis, anthracosis, anthrosilicosis ..., [and] any chronic
restrictive or obstructive pulmonary disease arising out of coal
mine employment.’” Balsavage v. Director, OWCP, 295 F.3d 390,
393 n.2 (3d Cir. 2002) (citations omitted).
16
contributing cause of death . . . .” Id. at 1006. There, the ALJ
had denied a claim for survivor’s benefits because the
immediate cause of death was pancreatic carcinoma. The ALJ
concluded that even though the death certificate listed
pulmonary emphysema “as an ‘other significant condition,’” the
survivor had not satisfied her burden of proving that the miner’s
death was “due to,” pneumoconiosis. Id. at 1003. The surviving
spouse and the Director both petitioned for review of the ruling
arguing that survivor benefits were appropriate if the miner’s
pneumoconiosis hastened his death, even if it was not the direct
cause. Id. We agreed.
We held that the fact that the immediate cause of the
miner’s death was pancreatic cancer was irrelevant under 20
C.F.R. § 718.20(c), because the uncontradicted evidence showed
that pneumoconiosis contributed to the miner’s death, “albeit
briefly.” Id. at 1005 (italics in original).4 The miner’s treating
4
Pursuant to the regulation applicable to Mrs. Hill’s claim,
death is considered due to pneumoconiosis if any of the following
criteria is met:
17
physician had testified that the miner’s lungs “show[ed]
pulmonary anthracosis . . . [and in the doctor’s opinion] this
condition shortened [the miner’s] life.” Lukosevicz, 888 F.2d at
1004. We held that that was enough to establish that the miner’s
death was “due to” the underlying pneumoconiosis, and we
therefore remanded for immediate payment of benefits.5 Id. at
1006. Hill’s case is very similar.
As the Director correctly summarizes in its brief, the ALJ
(1) Where competent medical evidence established that the miner's
death was due to pneumoconiosis, or
(2) Where pneumoconiosis was a substantially contributing cause
or factor leading to the miner's death or where the death was
caused by complications of pneumoconiosis, or
(3) Where the presumption [arising from medical evidence of
complicated pneumoconiosis] set forth at § 718.304 is applicable.
4) However, survivors are not eligible for benefits where the miner's
death was caused by a traumatic injury or a principal cause of death
was a medical condition not related to pneumoconiosis, unless the
evidence establishes that pneumoconiosis was a substantially
contributing cause of death.
20 C.F.R. § 718.205(c).
5
We actually remanded to the Board with instructions to
vacate the order denying benefits and instructed that the Board
further remand to the Deputy Commissioner of the Civil Division
of Coal Mine Worker’s Compensation, Office of Workers’
Compensation Programs for immediate payment of benefits.
Lukosevicz, 888 F.2d at 1004.
18
rejected Dr. Carey’s conclusion that Mr. Hill’s death was due to
pneumoconiosis for two reasons. “[F]irst,
the ALJ believed that Dr. Carey “failed to diagnose a coal-mine-
employment-related lung disease; and second, he failed to
adequately explain how the miner’s lung disease contributed to
or hastened death.” Respondent’s Br. at 10 n.6.. Although the
Director only defends the second justification now, both of the
ALJ’s justifications for denying this claim are extremely
troubling and perplexing.
A. Legal and Clinical Definitions of Pneumoconiosis
First, there is absolutely no issue here that Mr. Hill
suffered from pneumoconiosis, nor is there any dispute that that
condition resulted from his employment in mines. The ALJ’s
opinion even notes that “[T]he parties stipulated that the miner,
Charles W. Hill, had a coal mine employment history of 9 ½
years and that Claimant established that the miner had
pneumoconiosis arising out of his coal mine employment.”
App. at 28. Moreover, Mr. Hill’s breathing difficulties and the
changes in his respiratory system were documented by the
testimony of Mrs. Hill, as well as medical records and the
deposition testimony of Dr. Carey as summarized above.
19
For reasons that are neither apparent, nor explainable, the
ALJ stressed that Dr. Carey did not specifically state that
“pneumoconiosis” contributed to or hastened Hill’s death.
Instead, Dr. Carey used the terms “chronic lung disease” or
“chronic obstructive pulmonary disease.” That is a distinction
without a difference; it ignores the definition of
“pneumoconiosis,” codified in the applicable regulations.
As we noted earlier, pneumoconiosis is defined as “a
chronic dust disease of the lung and its sequelae, including
respiratory and pulmonary impairments, arising out of coal mine
employment.” 20 C.F.R. § 718.201(a). “The legal definition of
pneumoconiosis (i.e. any lung disease that is significantly
related to, or substantially aggravated by, dust exposure in coal
mine employment) is much broader than the medical definition,
which only encompasses lung diseases caused by fibrotic
reaction of lung tissue to inhaled dust.” Labelle, 72 F.3d at 312
(emphasis added). The legal definition therefore includes “any
chronic restrictive or obstructive pulmonary disease,” arising out
of coal mine employment. 20 C.F.R. § 718.201(a). Dr. Carey’s
description of the condition that caused Mr. Hill’s death falls
20
squarely within the regulatory definition of pneumoconiosis.6
Rather than seizing upon a semantic technicality to reject Dr.
Carey’s explanation of the causes of Hill’s death, the ALJ
should have recognized that Dr. Carey was stating that
“pneumoconiosis,” as defined under the Black Lung Benefits
Act, was a cause of, and a hastening factor in, his death.
The Board’s order affirming the ALJ’s decision is
equally as puzzling with respect to its treatment of the legal and
clinical definitions of pneumoconiosis. The Board stated the
following in explaining why Dr. Carey’s opinion was properly
dismissed by the ALJ:
Dr. Carey did not make a finding of clinical
pneumoconiosis, and as he did not state that his
finding of chronic obstructive pulmonary
disease/chronic lung disease is related to coal
mine employment (legal pneumoconiosis), the
administrative law judge properly found the
opinion insufficient to establish that the miner’s
death was due to pneumoconiosis.
6
The legal definition of pneumoconiosis is broad and
“includes but is not limited to, coal workers' pneumoconiosis,
anthracosilicosis, anthracosis, anthrosilicosis, massive pulmonary
fibrosis, progressive massive fibrosis, silicosis or
silicotuberculosis, arising out of coal mine employment.” Labelle,
72 F.3d at 315 (citing 20 C.F.R. § 718.201). In fact, even
“[c]hronic bronchitis, as a pulmonary disease, falls within the legal
definition of pneumoconiosis.” Id.
21
BRB Decision at 5. However, there is absolutely no issue here
about whether Hill’s pneumoconiosis “is related to coal mine
employment.” Hill had been receiving benefits under the Black
Lung Benefits Act for nearly ten years before he died, and even
if he had not received those benefits, the causal relationship
between his “coal mine employment” and pneumoconiosis was
stipulated to before the ALJ. Dr. Carey may, or may not, have
been in a position to render an opinion about the cause of Hill’s
pneumoconiosis, but it should have been obvious that he did not
have to. The issue here is what caused Hill’s death, not what
caused his pneumoconiosis.
B. Dr. Carey’s Deposition Testimony
We also find the ALJ's decision to assign no probative
value to Dr. Carey's opinion because of the doctor's conditional
response to a hypothetical question to be severely flawed. The
ALJ was particularly dismissive of the following testimony
during Dr. Carey’s deposition:
Q. Well, how are they affected, in what sense, with
respect to comparing him to someone who didn’t
have the lung disease but with all of those
problems?
A. Someone with a chronic lung disease or chronic
obstructive pulmonary disease is going to have
22
lower volumes of oxygen that makes everything
work harder. His heart’s going to work harder. If
this is occupational exposure that has caused this
chronic obstructive pulmonary disease it’s also
going to cause his arteriosclerotic, to an extent,
his arteriosclerotic cardiovascular disease. His
renal failure, if your kidneys aren’t getting enough
oxygen, that tends to push towards renal failure.
The ALJ indicated, as cited above, that this “was tantamount to
stating that with anyone and everyone who suffers from a chonic
lung disease or COPD and dies, those conditions are always
substantial contributors to or hasteners of death.” App. at 32.
However, Dr. Carey was asked by counsel to draw a broader
comparison between Hill and a person without any pulmonary
disease. His response relies upon the chronic lung disease
already stipulated to by both parties and evidenced in chest x-
rays. Dr. Carey connected these facts to the symptoms that Hill
manifested prior to his death. His statement is not a general
characterization; it is directly related to Hill’s condition, and
responsive to the question he was asked.
Moreover, we have previously cautioned that an expert's
testimony with respect to the pulmonary disease of a miner must
be examined in light of the all of the testimony offered, rather
than simply by way of selective quotes. See Balsavage, 295
23
F.3d at 396 ("[S]tatements must be viewed in context–both as
responses on cross-examination to general questions and against
the backdrop of repeated assertions that pneumoconiosis
contributed to the [m]iner's death."); cf. Mancia, 130 F.3d at 590
(noting valid use of a hypothetical question and answer in
assessing whether a miner's death was caused by underlying
lung disease). In Balsavage, the ALJ rejected an expert's
testimony because of his use of the word "could" when
discussing whether pneumoconiosis was a factor in the
development of coronary artery disease and atrial fibrillation.
295 F.3d at 396. We rejected such parsing, especially when
viewed against the expert's unequivocal testimony about the
contributory role of pulmonary disease to his patient's death.
Dr. Carey firmly asserted that the other factors related to
Hill's death would not have been as severe, but for the presence
of pulmonary disease. Nothing on this record, including the
report of Dr. Sherman undermines, Dr. Carey’s testimony about
the effect a compromised respiratory system has on one’s health
and resilience. To the extent that Dr. Carey’s testimony was at
all conditional, the meaning is unmistakable when viewed in
context. See Mancia, 130 F.3d at 593 (“The ALJ was not free
24
to selectively credit testimony merely because it supports a
particular conclusion while ignoring all evidence contrary to that
conclusion.”).
More significantly, however, we are at a loss to
understand why the ALJ was so troubled by Dr. Carey’s
testimony about the effect of a compromised respiratory system
on the human body. One need not be board certified in
pulmonology nor have an advanced degree in anatomy to
appreciate the impact that low oxygen levels in the blood can
have on the human body. Common sense suggests that if the
heart and lungs do not have a sufficient supply of oxygen to
function properly, the result could surely include organ failure
as well as other complications.
Here, Dr. Sherman’s testimony even confirmed that Mr.
Hill was malnourished when admitted to the nursing home. It
is difficult to conclude that an inadequate oxygen supply in the
blood because of a compromised respiratory system would not
hasten the demise of any patient in that condition. That is what
Dr. Carey said, and that is the natural consequence of the simple
biological fact that our bodies need an adequate supply of
oxygen for organs to function properly. If there are concerns
25
that it becomes too easy to establish that a miner’s death was
“due to” pneumoconiosis given that causation, those concerns
must be addressed by amending the Act or the regulations
promulgated under it.7 They can not be addressed by denying
claimants like Mrs. Hill benefits they are entitled to when a
spouse has pneumoconiosis as a result of working in mines, and
that pneumoconiosis hastens his death in some way.
C. Dr. Sherman’s Report
As we have noted, Dr. Sherman’s report does not
contradict Dr. Carey’s testimony about the impact of a
compromised respiratory system. Rather, the ALJ interpreted
Dr. Sherman as concluding that there was “insufficient
[evidence] . . . to support a finding that pneumoconiosis
contributed significantly to the miner’s death.” ALJ’s Decision
at 6. The ALJ’s use of the phrase “contributed significantly”
causes us to wonder if he was aware of our discussion in
Lukosevicz. Under our precedent, the law does not condition
7
Statistics suggest that such a concern by the ALJ is
unwarranted. Miners and their widows who attempt to claim Black
Lung benefits meet with little success. See Office of Workers’
Compensation Programs, Annual Report to Congress, Fiscal Year
2003, at 23 (noting that the approval rate for initial review of
claims for Black Lung benefits is 7.8%).
26
survivor benefits only upon proof that pneumoconiosis was a
significant or substantial contribution to the miner’s death;
rather, the claimant’s burden is also satisfied by proving that the
underlying pneumoconiosis hastened the miner’s death, even if
only slightly. Thus, pneumoconiosis need not be the sole or
even primary cause of a miner's death; it need only be a
contributing factor.
The ALJ credited Dr. Sherman’s report over Dr. Carey’s
testimony because of Dr. Sherman’s purportedly superior
credentials and qualifications, as well as the ALJ’s belief that
Dr. Carey did not qualify as a treating physician under 20 C.F.R.
§ 718.104. Though both findings are dubious here, Dr.
Sherman’s opinion must still be supported by adequate
evidence. See e.g., Lango v. Director, OWCP, 104 F.3d 573,
577 (3d Cir. 1997) (“The mere statement of a conclusion by a
physician, without any explanation of the basis for that
statement, does not take the place of the required reasoning.”);
Kertesz v. Crescent Hills Coal Co., 788 F.2d 158, 163 (3d Cir.
1986) (holding that an ALJ should reject any medical opinion
that is insufficiently reasoned or reaches a conclusion contrary
to objective clinical evidence). Dr. Sherman’s report falls short
27
of that standard, and does not merit the determinative weight
that the ALJ gave it.
Despite the uncontradicted evidence of Hill’s history of
pneumoconiosis and the uncontradicted evidence of respiratory
problems he was experiencing just days before his death, Dr.
Sherman stated with certainty that “there is no evidence of a
contribution by COPD or pneumoconiosis.” ALJ’s Decision at
5 (emphasis added). That statement is simply inconsistent with
the medical records, Hill’s medical history, and x-rays showing
Mr. Hill’s compromised pulmonary system. Every physician
who examined Hill within a month of his death, and every
medical examination and finding, confirmed his pulmonary
disease, decreased breath sounds, and respiratory difficulties.
Breathing problems, decreased lung sounds and other
complications consistent with COPD were documented during
Hill’s hospitalization immediately preceding his transfer to
Lakeside Nursing Home.8 It is undisputed that a medical
8
We note, as cited in the Director’s brief, that Wilkes-Barre
General indicated that Hill was discharged in stable condition to
Lakeside. App. at 114. However, an indication that a patient is in
stable enough condition to be transferred to another facility does
not show that his medical problems had somehow reversed course
or were resolved entirely.
28
examination on August 5th disclosed decreased breath sounds
and “chronic rhonchi.” 9
It is worth repeating that in Lukosevicz, supra, we held
that the miner’s death was “due to” pneumoconiosis even
though the actual cause of death was pancreatic cancer rather
than pneumoconiosis. We explained that pneumoconiosis need
only have some identifiable effect on the miner’s ability to live.
Despite Dr. Sherman’s report, and the ALJ’s reliance on it, this
record establishes that decreased levels of oxygen in the blood
due at least in part to pneumoconiosis, hastened Hill’s death.
D. Availability of Records Near Time of Death
Dr. Sherman, the ALJ and the Board all highlight the
absence of any medical records for the two days prior to Hill’s
death, and use that to support the conclusion that the record is
inconclusive as to whether Mr. Hill died due to pneumoconiosis.
9
“Rhonchi,” are defined as “added sound[s] occurring
during inspiration or expiration caused by air passing through
bronchi that are narrowed by inflammation or the presence of
mucus in the lumen” and inhere decreased lung capacity.
Stedman's Medical Dictionary 1235 (5th Lawyer's ed. 1982).
Other courts have noted that the presence of rhonchi in the lung
fields is consistent with findings documenting pneumoconiosis.
See, e.g., Peerless Eagle Coal Co. v. Taylor, 107 F.3d 867, 867
(4th Cir. 1997); Freeman United Coal Min. Co. v. Hudson, 105
F.3d 660, 661 (7th Cir. 1997); Thorn v. Itmann Coal Co., 3 F.3d
713, 715 (4th Cir. 1993).
29
However, such analysis is inconsistent with the parallel
regulatory scheme provided by the Social Security
Administration. 20 C.F.R. § 410.462(b) states:
Where the evidence establishes that a deceased
miner suffered from pneumoconiosis or a
respirable disease and death may have been due to
multiple causes, death will be found due to
pneumoconiosis if it is not medically feasible to
distinguish which disease caused death or
specifically how much each disease contributed to
causing death.
Moreover, given the uncontradicted evidence on this record, we
can think of nothing that suggests either that some mysterious
force intervened or that Mr. Hill’s pneumoconiosis underwent
a miraculous reversal and his blood oxygen levels returned to
normal right before he died. Here, medical records from a mere
five days before Hill’s death document the complications of his
pneumoconiosis. Dr. Sherman’s report does not offer a credible
theory that would explain how Mr. Hill would have been
somehow able to shake off the effect of pneumoconiosis in the
two days before he died so that his respiratory arrest, renal
failure, arteriosclerotic cardiovascular disease, and anemia were
somehow not exacerbated by the respiratory disease that he had
suffered from for so many years prior to his death. We are
30
simply unable to imagine anything that could have been revealed
by a medical examination during the final 48 hours of Mr. Hill’s
life that would have undermined the force of Dr. Carey’s
testimony, or the validity his conclusions, and neither the ALJ
nor the Board suggests anything that could have had that effect.
“[C]ourts have long acknowledged that pneumoconiosis
is a progressive irreversible disease .. . .” Labelle, 72 F.3d at
315. Dr. Sherman’s report in no way undermines Dr. Carey’s
opinion that low oxygen levels in the blood associated with
pneumoconiosis or COPD can compromise every system in the
body. Yet, both the ALJ and Dr. Sherman were reluctant to
conclude that Hill’s death was due to pneumoconiosis because
no one saw him on August 7, the day he died, or within the two
days before he passed away. The implication that such records
are mandatory for the receipt of benefits places an unfair and
inappropriate burden on any petitioner or claimant.
Regrettably, the result here is more consistent with an
attempt to justify denying benefits than with a neutral inquiry
into whether the record establishes eligibility for benefits. The
ALJ’s focus on the time immediately preceding death would
raise insurmountable obstacles to an eligible survivor,
31
conditioning determination of benefits not on a miner’s medical
history, but on the timing of doctors’ visits. The law simply
does not require a miner with a respiratory system that has been
ravaged by mine-related pneumoconiosis to hang on until a
physician can document his last moment of life so that the
survivor will be able to document that his impaired respiratory
system hastened his death.10
VI. CONCLUSION
For all the reasons set forth above, we hold that the ALJ’s
denial of Mrs. Hill’s request for survivor’s benefits under the
Black Lung Benefits Act and the Board’s subsequent affirmance
of that decision are not supported by substantial evidence in the
record. In her brief, Mrs. Hill “urges this Court not to remand
the matter for further consideration. Given the foregone
conclusion, based on the proper analysis of the evidence of
record, . . . this Court should issue an Order vacating the denial
of benefits and substituting an award of benefits.” (Petitioner’s
10
Our concern over the denial of benefits here is not
mitigated by Dr. Sherman’s purportedly “superior credentials.”
As we noted above, Dr. Sherman does not contest Dr. Carey’s
assessment of Hill’s respiratory problems, only whether Hill’s
death was due to his pneumoconiosis, and the record raises
concerns about whether he understood what is meant by that
phrase. See Balsavage, 295 F.3d at 397.
32
Br. at 13.) In light of the facts presented, we agree.
There is no issue of credibility here, nor is there any
dispute that Hill suffered from work related pneumoconiosis or
the systemic effect of that progressive disease. The conflicting
inferences introduced by the ALJ are conclusively resolved by
correct application of the regulatory scheme, as well as our
precedent, leaving only one conclusion possible—that
pneumoconiosis hastened Hill’s death. See Mancia, 130 F.3d at
579 (citing Kowalchick, 893 F.2d at 624). Given the medical
evidence on this record, we believe that Mrs. Hill has
established her entitlement to survivor’s benefits as a matter of
law, and there is nothing left to do but award the benefits she is
clearly entitled to.
Accordingly, we will “grant the petition for review,
reverse the decision of the Board and remand for the limited
purpose of awarding survivor’s benefits in accordance with 20
C.F.R. § 725.503(c). We urge the Board to expedite this award
so that survivor’s benefits will begin as soon as possible.”
Mancia, 130 F.3d at 594. “[F]urther administrative review is
unwarranted.” Sulyma v. Director, OWCP, 827 F.2d 922, 924
(3d Cir. 1987).
33