Compensation Department of District Five v. Marshall

667 F.2d 336
Court of Appeals for the Third Circuit·Decided December 9, 1981·No. No. 81-1633·Published·Cited by 3 cases

Opinion

OPINION OF THE COURT

GARTH, Circuit Judge.

This is an appeal from an order of the district court for the Western District of Pennsylvania which dismissed an action brought by the Compensation Department of District Five, United Mine Workers of America (“District Five”) against the Secretary of Labor. District Five sought to enjoin the Secretary from rereading X-rays of black lung claimants, contending that the Secretary’s practice violated § 413(b) of the Black Lung Benefits Act, 30 U.S.C. § 923(b). We agree with the district court’s determination that it lacked subject matter jurisdiction over this action. We therefore affirm its dismissal of District Five’s complaint.

I.

A.

The Black Lung Benefits Act (“BLBA”), 30 U.S.C. §§ 901 et seq., provides that miners who are totally disabled by black lung disease (pneumoconiosis) are entitled to benefits which are paid either by an individual mining company or from the Black Lung Disability Trust Fund, to which mining companies contribute periodically. See 30 U.S.C. §§ 932(b), 934, 934a. The Secretary of Labor processes claims for these benefits filed after December 31, 1973, unless an adequate state workers’ compensation law applies.1 30 U.S.C. §§ 931, 932.

Briefly stated, the processing of black lung claims begins .with an initial determination of the claimant’s eligibility for black lung disability benefits by a deputy commissioner, an official of the Division of Coal Mine Workers’ Compensation Programs within the Office of Workers’ Compensation Programs. The deputy commissioner also determines whether there is a mining company (an “operator”) which is liable for payment of any benefits due the claimant. After the operator has had an opportunity to rebut the claimant’s evidence, the deputy commissioner issues a proposed decision and order. From that order an appeal may be taken to an administrative law judge (“ALJ”), who holds a hearing to which the [338]*338claimant, the operator, and the Office of Workers’ Compensation Programs, among others, are parties. Once the ALJ issues his order, any dissatisfied party may then appeal to the Benefits Review Board (“BRB”), which is “authorized to hear or determine appeals raising a substantial question of law or fact.” 33 U.S.C. § 921(b)(3). See generally 20 C.F.R. §§ 725.350-.483. Finally, any party dissatisfied with the BRB’s disposition of the case “may obtain a review of that order in the United States court of appeals for the circuit in which the injury occurred.” 33 U.S.C. § 921(c).2

B.

In establishing eligibility for black lung benefits, various types of evidence are considered, including

medical tests such as blood gas studies, X-ray examination, electrocardiogram, pulmonary function studies, or physical performance tests, and any medical history, evidence submitted by the claimant’s physician, or his wife’s affidavits, and in the case of a deceased miner, other appropriate affidavits of persons with knowledge of the miner’s physical condition, and other supportive materials.

§ 413(b) of the BLBA, 30 U.S.C. § 923(b).3 The use to which X-rays may be put in passing upon a claim, however, is specifically governed by § 413(b). First, the statute provides that “no claim for benefits .. . shall be denied solely on the basis of the results of a chest roentgenogram.” Id. Second, the statute requires that the Secretary accept the interpretation of the X-ray rendered by a radiologist on behalf of the claimant, so long as (1) there is other evidence of pulmonary or respiratory impairment, (2) the X-ray was taken by a radiologist or qualified technician, and the radiologist interpreting it is board-certified, (3) the X-ray is of adequate quality, and (4) there is no reason to believe that any fraud is being committed.4

It is the meaning of the second restriction — requiring the Secretary to accept the interpretation of the X-ray rendered by the claimant’s radiologist — that has given rise to the underlying dispute between District Five and the Secretary of Labor. District Five contends that § 413(b) forbids the Secretary from engaging in any “substantive” rereading of X-rays whatsoever — that is, reading of X-rays for any purposes other than to verify the quality of the X-ray. The Secretary of Labor, on the other hand, contends that the requirement that the Secretary, under certain circumstances, “accept” the interpretation of a board-certified radiologist binds only the Secretary and his agents, and not the ALJ or the BRB. Further, the Secretary asserts that § 413(b) in no way forbids the substantive rereading of X-rays. See Government’s Brief at 40-46.

Thus, before this suit was filed, it appears that an X-ray submitted by a claimant was [339]*339routinely referred to a “B-reader,” a physician qualified in diagnosing black lung disease from X-rays, see 20 C.F.R. § 718.-202(a)(l)(ii)(E). The B-reader would examine the X-ray not only to ensure that it was “of adequate quality to demonstrate the presence of pneumoconiosis,” 30 U.S.C. § 923(b), but also to arrive at his own independent conclusion as to whether the X-ray indicated the presence of black lung disease. While the B-reader might, of course, agree with the interpretation of the claimant’s radiologist, he might also conclude that an X-ray in fact revealed no black lung disease at all. In those circumstances, while the Secretary of Labor acknowledged that the Office of Workers’ Compensation Programs was bound by the positive interpretation of the X-ray submitted on behalf of the claimant, see 20 C.F.R. §§ 718.202(a)(l)(i), 727.206(b)(1), the Secretary interpreted § 413(b) to bind neither the ALJ nor the BRB. As a result, the B-reader’s negative rereading was made available to the operator for use as rebuttal evidence at the hearing before the ALJ, who could credit the B-reader’s negative interpretation over the positive diagnosis of the claimant’s radiologist.5

Seeking to prevent the Secretary from substantively rereading the X-rays in those circumstances where § 413(b) requires the Secretary to “accept” the interpretation of the claimant’s radiologist, District Five filed a complaint and a motion for a temporary restraining order and a preliminary injunction on December 31,1980.

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Compensation Department of District Five v. Marshall, 667 F.2d 336 (3d Cir. 1981).

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