Clark v. Director of Workers' Compensation Programs
Opinion of the Court
Ethyel Clark (Petitioner) appeals a decision made by an Administrative Law Judge (ALJ) and affirmed by the Benefits Review Board, which denied her benefits under the Black Lung Benefits Act (the Act) for the disability of her deceased husband, Walter Clark (miner). The ALJ denied her benefits on the ground that the medical testimony offered to establish a disability due to black lung disease, pneumoconiosis,
Walter Clark filed an application for benefits under the Act on February 14, 1980. The Department of Labor (DOL) denied his claim on July 25, 1980. Clark died on September 29, 1981, from an unrelated colon cancer with metastasis. Petitioner, Clark’s widow, filed a survivor’s claim for benefits on August 6, 1984. On October 12, 1984, the DOL denied her claim as well. Petitioner’s denial letter informed her that if she failed to take any action within sixty days, her claim would be considered abandoned and the decision denying her claim would become final. On April 15, 1985, six months after receiving the denial letter, Petitioner wrote to the DOL and requested a formal hearing.
A formal hearing was held before an ALJ who denied benefits, finding that Petitioner’s claim had been abandoned due to her failure to timely respond to the denial letter. The AU’s finding of abandonment was correct.
For Petitioner’s survivor’s claim to be successful, the miner’s death must be attributable to pneumoconiosis.
In October of 1985, four years after the miner had died, Dr. Rasmussen submitted a second opinion which directly contradicted his first, stating that the miner “did have a
On review, this court is limited to an evaluation of whether the decisions of the AU and the Benefits Review Board are “rational, supported by substantial evidence and consistent with applicable law.” Tonelli v. Director, OWCP, 878 F.2d 1083, 1084 (8th Cir. 1989). We find, after a review of the record as a whole, that the AU’s finding that the evidence was insufficient to invoke the interim presumption is supported by substantial evidence. Dr. Rasmussen’s second medical opinion squarely contradicts his first opinion. While Dr. Rasmussen did reveal the various tests and examination results which led him to his first conclusion in finding no pneumoconiosis, he failed to reveal what his second opinion was based on. The second opinion was submitted more than four years after the miner had died and Dr. Rasmussen never performed a second examination of the miner. Dr. Rasmussen stated in his second opinion letter that he reviewed “some records” and that he read “some of the facts regarding [miner’s] breathing, according to other doctors that took care of him,” yet Dr. Rasmussen never revealed which doctors or what records led him to adopt a totally different conclusion the second time around.
When examining the validity of a medical opinion, the AU must view it “in light of the studies conducted and the objective indications upon which the medical opinion or conclusion is based.” Ware v. Director, OWCP, 814 F.2d 514, 516 (8th Cir. 1987). This court held in Brazzalle v. Director, OWCP, 803 F.2d 934, 936 (8th Cir. 1986), that a physician’s opinion was not based on reasoned medical judgment where the physician failed to adequately explain what his medical opinion was based upon. Brazzalle involved a second medical opinion which directly contradicted the first medical opinion.
We hold that the AU was correct in rejecting Dr. Rasmussen’s second opinion, as it was not sufficiently documented by any new studies or evidence and was not a reasoned medical opinion. We affirm.
. 20 C.F.R. § 727.202 defines pneumoconiosis as "a chronic dust disease of the lung and its sequelae, including respiratory and pulmonary impairments, arising out of coal mine employment."
. Petitioner further argues that her claim was not abandoned because it merged with the miner’s claim under 20 C.F.R. § 725.309. We reject this argument; Petitioner's cited regulation allows only for the merger of duplicate claims filed by a single applicant, i.e., when a miner files a second claim while his first claim is still pending. As the Sixth Circuit reasoned in Earl Patton Coal Co. v. Patton, 848 F.2d 668, 672 (6th Cir. 1988), "The regulations cannot be read as requiring the merging of such claims because the standards of proof and the procedures for processing the claims are different.”
.20 C.F.R. § 727.201 states that: “Benefits are provided under the Act to a miner who is totally disabled due to pneumoconiosis and to certain survivors of a miner who died due to or while totally (or in certain cases, partially) disabled by pneumoconiosis."
. The record indicates that the miner engaged in coal mine employment for sixteen years.
Reference
- Full Case Name
- Ethyel CLARK, Widow of Walter E. Clark v. DIRECTOR, OFFICE OF WORKERS' COMPENSATION PROGRAMS, UNITED STATES DEPARTMENT OF LABOR, as Designee of Elizabeth Dole, Secretary of Labor
- Cited By
- 2 cases
- Status
- Published