Balsavage v. Director, Office of Workers' Compensation Programs

295 F.3d 390, 2002 WL 1402454
Court of Appeals for the Third Circuit·Decided June 28, 2002·No. No. 01-2091·Published·Cited by 8 cases

Opinions

OPINION OF THE COURT

SCHWARZER, Senior Judge.

Evelyn Balsavage petitions for review of a final order of the Benefits Review Board, United States Department of Labor, affirming a final decision of the Administrative Law Judge (“ALJ”) denying survivor’s benefits to appellant, pursuant to 33 U.S.C. § 921(b)(3), as incorporated into [393] the Black Lung Benefits Act, 30 U.S.C. §§ 901-945. Mrs. Balsavage is the widow of Anthony Balsavage (“the Miner”), who died at the age of 73 on November 10, 1998. We must decide whether the ALJ’s decision is supported by substantial evidence. We have jurisdiction under 33 U.S.C. § 921(c), as incorporated by 30 U.S.C. § 932(a), and grant the petition.

FACTUAL AND PROCEDURAL BACKGROUND

In 1991, Dr. Edward W. Cubler diagnosed the Miner with pneumoconiosis1 Category II, severe obstructive lung disease, moderately severe emphysema, low blood oxygen levels at rest, ánd severe wheezes and rales over all lung fields. The Miner could “walk about 50 yards before [getting] winded” and could “not make a flight of stairs because of his shortness of breath.” Dr. Cubler concluded that the Miner had a “severe impairment ... preventing him from performing his last coal mine job,” and certified him totally disabled. Later that year, Dr. Richard F. Feudale, who treated' the Miner from 1963 to 1991, examined him and diagnosed pneumoconiosis, severe obstructive lung disease, bilateral pulmonary emphysema, and other respiratory symptoms. Neither physician noted any cardiac dysfunction.

Seven years later, on September 24, 1998, the Miner was admitted to Ashland Regional Medical Center, suffering from “shortness of breath and syncope” and other cardiac and respiratory symptoms. The principal diagnosis, by attending physician Dr. Houssam Abdul-Al, was “acute congestive heart failure”; other diagnoses were “new onset atrial fibrillation; chronic obstructive pulmonary disease; coronary artery disease; emphysema; pleural effusion; [and] mitral insufficiency.” Chest x-rays showed “moderate left ventricular enlargement increased from previous study with recent changes indicating mild congestive heart failure superimposed on chronic- obstructive pulmonary disease.” EKGs revealed “atrial fibrillation with rapid ventricular response, left axis deviation, [and] left bundle branch block.” He was discharged in stable condition on September 28.

On November 10, 1998, the Miner suffered a “cardio-pulmonary arrest” after “coughing and gagging' prior to arrest,” according to the emergency care registration form. He died within minutes of admission to the hospital.2

Three physicians made written submissions in support of Mrs. Balsavage’s claim, two of them treating physicians, and one also testified on deposition. All concluded [394] that pneumoconiosis hastened or contributed to the Miner’s death.

Dr. Raymond J. Kraynak served as the Miner’s treating physician for roughly sixteen months, seeing him every one to two months until about six weeks before his death.3 On January 11, 1999, Dr. Kraynak wrote a one-page letter to the Department of Labor stating, “I do not have any records concerning the circumstances of his death and [am] unable to give you an updated report.” Six months later, on July 27, 1999, Dr. Kraynak wrote to Mrs. Balsavage’s attorney stating, “[i]t is clear from my taking care of Mr. Balsavage and from his complaints for some time, that coal workers’ pneumoconiosis was a substantial and causative factor in [his] death.” In deposition testimony on October 8, 1999, Dr. Kraynak testified that, after having reviewed the Miner’s medical records, in his opinion the Miner’s death was “due to acute respiratory arrest as well as anthracosilicosis which caused the arrest.” He added that the Miner “had some cardiac difficulties due to his anthracosilicosis.” On cross-examination, during which he was asked whether pneumoconiosis could have caused the Miner’s coronary artery disease or atrial fibrillation, he explained that it could be indirectly responsible by requiring “the heart ... to pump blood through a diseased lung,” lowering blood oxygen and “aggravating] the conductive mechanism of the heart.” Two weeks later, on October 15, 1999, Dr. Kraynak wrote to Mrs. Balsavage’s attorney in response to the opinion letter Dr. Samuel V. Spagnolo gave the Director, stating:

From my review of all the records, my personal care of Mr. Balsavage during his lifetime, as well as interviewing the widow in this matter, it is still my opinion that Mr. Balsavage’s death was due to coal workers’ pneumoconiosis, contracted during his employment in the anthracite coal industry.... He definitely would have survived longer if he did not have coal workers pneumonoconios-is.

On August 18, 1999, Dr. Abdul-Al, who had treated the Miner from September 24 until his death seven weeks later, reported that he “saw [the Miner] at the hospital ... when he had cardiopulmonary arrest and had unsuccessful resuscitation [i.e. death].” He concluded that he had “diffuse fibrotic pulmonary disease due to an-thrasilicosis and pneumoconiosis and because of his condition his heart was getting progressively worse.... I do believe that the number one cause of his death is the anthrasilicosis which was the reason he developed cardiac disease.”

On September 29, 1999, Dr. John P. Simelaro, after reviewing twenty documents from the Miner’s medical records,4 opined that the Miner’s “anthracosilicosis” caused fibrosis in his lungs, interfering with oxygen uptake to the myocardium, which led to “cardiac dysfunction [as evidenced by his] dysrhythmia [and] atrial fibrillation.” This, in turn, caused “a 20% reduction in cardiac output.” He concluded there was diffuse airway destruction [395] from the anthracosilicosis, increasing “overall cardiopulmonary compromise,” “leading to cardiac failure and eventually death ... in this case.”

In opposition to Mrs. Balsavage’s case, the Director offered the medical report of Dr. Spagnolo, dated September 25, 1999, which was based on a review of documents from the Miner’s medical records.5 Dr. Spagnolo’s letter states that

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Balsavage v. Director, Office of Workers' Compensation Programs, 295 F.3d 390, 2002 WL 1402454 (3d Cir. 2002).

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