Consolidation Coal Co. v. Director, Office of Workers' Compensation Programs

732 F.3d 723, 2013 WL 5530986, 2013 U.S. App. LEXIS 20491
Court of Appeals for the Seventh Circuit·Decided October 8, 2013·No. No. 12-1330·Published·Cited by 9 cases

Opinion

ROVNER, Circuit Judge.

James Burris worked in various capacities in coal mines for twenty-three years. He twice sought benefits under the Black Lung Benefits Act, 30 U.S.C. § 901 et seq. (“the Act”), abandoning his first claim in 2001, and then pursuing a second claim in 2006. Following a hearing for the second claim, an Administrative Law Judge (“ALJ”) determined that Burris was totally disabled by pneumoconiosis arising from his coal mining employment and that he [726]*726qualifies for benefits under the Act. The Benefits Review Board (“Board”) affirmed that decision. The employer, Consolidation Coal Company (“Consolidation”), seeks review of that decision, contending that (1) the ALJ erred in finding that Burris established a material change in condition following his first, abandoned claim; (2) the ALJ erred in concluding that Burris proved fifteen years of surface mine employment in conditions substantially similar to those that exist in underground mines; and (3) the ALJ’s review of the employer’s evidence rebutting a presumption of pneumoconiosis was not supported by substantial evidence. We deny the petition for review.

I.

The Act provides federal benefits for coal miners who are totally disabled by pneumoconiosis, “a chronic dust disease of the lung and its sequelae, including respiratory and pulmonary impairments, arising out of coal mine employment.” 30 U.S.C. § 902(b). See also 20 C.F.R. § 718.202 (“Determining the existence of pneumoconiosis”). To establish eligibility for benefits, a coal miner must demonstrate that (1) he or she has pneumoconiosis; (2) the pneumoconiosis arose out of coal mine employment; (3) he or she is totally disabled; and (4) the pneumoconiosis contributes to the total disability. 20 C.F.R. § 725.202(d). Together these are called “the conditions of entitlement.” Because a miner’s physical condition can change over time, a miner whose initial claim for benefits was denied may bring a subsequent claim if he establishes that his condition has changed. See 20 C.F.R. § 718.201(c) (noting that “ ‘pneumoconiosis’ is recognized as a latent and progressive disease which may first become detectable only after the cessation of coal mine dust exposure”). The regulations provide that a subsequent claim “shall be denied unless the claimant demonstrates that one of the applicable conditions of entitlement ... has changed since the date upon which the order denying the prior claim became final.” 20 C.F.R. § 725.309(d). See also Consolidation Coal Co. v. Director, Office of Workers’ Compensation Programs, 721 F.3d 789, 793 (7th Cir.2013); Peabody Coal Co. v. Spese, 117 F.3d 1001, 1008 (7th Cir.1997) (en banc). For the purposes of determining whether to allow a subsequent claim, “a denial by reason of abandonment shall be deemed a finding that the claimant has not established any applicable condition of entitlement.” 20 C.F.R. § 725.409(c).

A coal miner may have either “clinical” or “legal” pneumoconiosis. Consolidation Coal, 721 F.3d at 791; 20 C.F.R. § 718.201(a). Clinical pneumoconiosis “consists of those diseases recognized by the medical community as pneumoconioses, i.e., the conditions characterized by permanent deposition of substantial amounts of particulate matter in the lungs and the fibrotic reaction of the lung tissue to that deposition caused by dust exposure in coal mine employment.” 20 C.F.R. § 718.201(a)(1). Legal pneumoconiosis is a broader category that “includes any chronic lung disease or impairment and its sequelae arising out of coal mine employment.” 20 C.F.R. § 718.201(a)(2). A chronic lung disease can be said to “arise out of coal mine employment” if it is “any chronic pulmonary disease or respiratory or pulmonary impairment significantly related to, or substantially aggravated by, dust exposure in coal mine employment.” 20 C.F.R. § 718.201(b). An earlier version of the Act contained a provision creating a rebuttable presumption that coal miners (1) with fifteen years’ employment in underground mines (or surface mines with similar conditions), and (2) who suffered from a totally disabling respiratory impairment, were totally disabled due to pneumoconiosis. Consolidation Coal, 721 F.3d at [727]*727791; Pub.L. No. 92-303, § 4(c) (1972). In 1981, Congress removed this presumption for new claims, but in 2010, Congress revived the presumption for claims filed after January 1, 2005 that were still pending on or after March 23, 2010. Consolidation Coal, 721 F.3d at 791-92; Keene v. Consolidation Coal Co., 645 F.3d 844, 847 (7th Cir.2011); 30 U.S.C. § 921(c)(4). Burris’s second claim (the one at issue here) fell within this time period.

II.

In April 2001, ten years after stopping coal mine work, Burris first applied for Social Security retirement benefits. The clerk who assisted him in applying for Social Security benefits also prepared a black lung benefits application for him, telling him that it was customary to file these claims for retired miners. The claim was filed pro se and when the Department of Labor (“Department”) requested additional information from Burris, he felt intimidated by the process and let the claim lapse. He did not respond to any requests by the Department’s district director (“Director”) that he submit medical evidence, authorize medical testing and release medical records. The Director considered the claim abandoned after Burris failed to respond to an order to show cause why the claim should not be denied by reason of abandonment, and the claim was dismissed in November 2001.

In February 2006, Burris filed a second claim, the one at issue here. The Director issued a proposed decision awarding benefits in January 2007. Consolidation then requested a hearing before an ALJ, which was held in October 2009. Because this was a “subsequent” claim, before it could be decided on the merits, Burris was required by the regulations we described above to demonstrate that one of the applicable conditions of entitlement had changed since the date upon which the order denying the prior claim became final.

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Consolidation Coal Co. v. Director, Office of Workers' Compensation Programs, 732 F.3d 723, 2013 WL 5530986, 2013 U.S. App. LEXIS 20491 (7th Cir. 2013).

732 F.3d 723 (Consolidation Coal Co. v. Director, Office of Workers' Compensation Programs) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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