Filed: May 26, 2009
Latest Update: Mar. 02, 2020
Summary: NOT RECOMMENDED FOR FULL-TEXT PUBLICATION File Name: 09a0365n.06 No. 08-3909 FILED UNITED STATES COURT OF APPEALS May 26, 2009 FOR THE SIXTH CIRCUIT LEONARD GREEN, Clerk SAMMY JOE MAYNARD, ) ) Petitioner, ) ON APPEAL FROM THE ) U N ITED STATES v. ) DEPARTMENT OF LABOR ) BENEFITS REVIEW BOARD EASTERN COAL COMPANY; DIRECTOR, ) OFFICE OF WORKERS’ COMPENSATION ) OPINION PROGRAMS; UNITED STATES ) DEPARTMENT OF LABOR, ) ) Respondents. ) BEFORE: BATCHELDER and COLE, Circuit Judges; LAWSON, District Jud
Summary: NOT RECOMMENDED FOR FULL-TEXT PUBLICATION File Name: 09a0365n.06 No. 08-3909 FILED UNITED STATES COURT OF APPEALS May 26, 2009 FOR THE SIXTH CIRCUIT LEONARD GREEN, Clerk SAMMY JOE MAYNARD, ) ) Petitioner, ) ON APPEAL FROM THE ) U N ITED STATES v. ) DEPARTMENT OF LABOR ) BENEFITS REVIEW BOARD EASTERN COAL COMPANY; DIRECTOR, ) OFFICE OF WORKERS’ COMPENSATION ) OPINION PROGRAMS; UNITED STATES ) DEPARTMENT OF LABOR, ) ) Respondents. ) BEFORE: BATCHELDER and COLE, Circuit Judges; LAWSON, District Judg..
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NOT RECOMMENDED FOR FULL-TEXT PUBLICATION
File Name: 09a0365n.06
No. 08-3909
FILED
UNITED STATES COURT OF APPEALS May 26, 2009
FOR THE SIXTH CIRCUIT LEONARD GREEN, Clerk
SAMMY JOE MAYNARD, )
)
Petitioner, ) ON APPEAL FROM THE
) U N ITED STATES
v. ) DEPARTMENT OF LABOR
) BENEFITS REVIEW BOARD
EASTERN COAL COMPANY; DIRECTOR, )
OFFICE OF WORKERS’ COMPENSATION ) OPINION
PROGRAMS; UNITED STATES )
DEPARTMENT OF LABOR, )
)
Respondents. )
BEFORE: BATCHELDER and COLE, Circuit Judges; LAWSON, District Judge.*
COLE, Circuit Judge. Sammy Joe Maynard, a former coal miner employed by Eastern
Coal Company (“Eastern Coal”), petitions for review of a decision by the Benefits Review Board
(“BRB”) of the United States Department of Labor upholding the decision by an administrative law
judge (“ALJ”) denying him benefits under the Federal Coal Mine Health and Safety Act of 1969, as
amended by the Black Lung Benefits Act of 1972 and the Black Lung Benefits Reform Act of 1977,
30 U.S.C. § 901 et seq. (the “Act”). For the following reasons, we DENY Maynard’s petition for
review.
*
The Honorable David M. Lawson, United States District Judge for the Eastern District
of Michigan, sitting by designation.
No. 08-3909
Maynard v. Eastern Coal Co.
I. BACKGROUND
A. Factual and procedural background
This claim has a lengthy procedural history dating back more than twenty years. Maynard
filed his claim for black lung benefits on April 6, 1987. He worked for Eastern Coal in a mine for
at least thirteen-and-one-third years. Maynard was awarded black lung benefits by ALJ Richard E.
Huddleston three separate times; each time, Eastern Coal appealed, and the BRB found fault with
Judge Huddleston’s analysis, vacated the award, and remanded. When the case was remanded the
third time, it was assigned to ALJ Stuart A. Levin, who denied benefits. The BRB affirmed.
At each stage of the proceedings, the central issue has been whether the large body of medical
evidence—twelve x-rays taken over a span of many years and interpreted by more than thirty doctors
of varying qualifications, a CT scan, pulmonary function studies, arterial blood gas studies, and
physician testimony and reports—establishes that Maynard suffers from complicated coal workers’
pneumoconiosis (“CWP”). We have described CWP as follows:
Coal workers’ pneumoconiosis, known as “black lung disease,” is caused by the
long-term inhalation of coal dust. See, e.g., Usery v. Turner Elkhorn Mining Co.,
428 U.S. 1, 6 [] (1976). It is generally diagnosed by x-rays showing opacities in the
lungs, or by autopsy evidence. See
id. at 7. Pneumoconiosis is classified in two
ways: “simple” and “complicated.” See
id. In its simple form, the disease is not
necessarily disabling. See
id. The complicated form, however, causes significant
pulmonary impairment and respiratory disability. See
id. Complicated
pneumoconiosis is progressive, and often takes years to manifest itself. See
id. at
7-8.
Gray v. SLC Coal Co.,
176 F.3d 382, 386 (6th Cir. 1999). Under the Act, a miner who is totally
disabled as a result of CWP is entitled to payment of benefits. See 30 U.S.C. § 921(a). A miner who
establishes that he has complicated CWP is entitled to an irrebuttable presumption of total disability.
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No. 08-3909
Maynard v. Eastern Coal Co.
See 30 U.S.C. § 921(c)(3). It is undisputed that Maynard cannot independently establish total
disability and therefore must establish complicated CWP in order to receive benefits.
While all of the physicians who opined in this case agreed that Maynard’s x-rays showed
presence of significant abnormalities in his lungs, some believed that this indicated simple CWP
only, some believed it indicated complicated CWP, and some believed it was not CWP at all, but
was the result of scarring from a prior, healed granulomatous disease, such as tuberculosis,
sarcoidosis, or histoplasmosis.
B. The ALJ’s decision
Judge Levin noted that the BRB previously had affirmed Judge Huddleston’s conclusion that,
based on the x-ray evidence, Maynard had established at least simple CWP. Judge Levin reviewed
de novo the voluminous x-ray readings to determine whether they also supported a finding of
complicated CWP. He concluded that they did, but he also noted that x-ray evidence is the “least
accurate method” of diagnosing CWP. (Joint Appendix (“JA”) 506 (quoting
Gray, 176 F.3d at
390).) Judge Levin proceeded to analyze the medical reports of ten physicians opining on Maynard’s
condition, and he also noted that the opinions of eight physicians previously had been found not to
affirmatively support a finding of complicated CWP. After assigning greater or less weight to each
of the ten physicians’ reports based on a number of factors, Judge Levin found that the medical
opinions weighed against a finding of complicated CWP. The doctors’ conclusions in the opinions
were as follows:
• Only Drs. Younes and Nadorra affirmatively opined that Maynard suffers from complicated
CWP.
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Maynard v. Eastern Coal Co.
• Dr. Cooper diagnosed simple CWP, but this was based on Maynard’s unconfirmed lay
statement that he previously had tested negatively for tuberculosis.
• Drs. Abernathy and Lane diagnosed probable CWP without specifying whether it was simple
or complicated, but both noted the possibility of healed granulomatous disease.
• Dr. Harrison opined that he could not definitively rule out CWP but that he believed
Maynard’s abnormal x-rays more likely showed healed granulomatous disease.
• Drs. Vuskovich, Rosenberg, Repsher, and Broudy all opined that Maynard did not have CWP
at all and that the x-rays showed prior granulomatous disease.
Next, Judge Levin considered three physicians’ readings of the CT scan of Maynard’s lungs,
noting that CT scans are “arguably the most sophisticated and sensitive test available.” (JA 509.)
Drs. Rosenberg, Repsher, and Broudy, the only doctors to analyze the CT scan, all read it as negative
for both simple and complicated CWP, consistent with their readings of Maynard’s x-rays.
Balancing all of the foregoing evidence, and noting that, although the x-ray evidence supported a
finding of complicated CWP, “[m]any physicians opined . . . that determining the presence of x-ray
abnormalities is only the first step in analyzing the Claimant’s ailment,” (JA 509), Judge Levin
concluded that Maynard had not established presence of complicated CWP and thus was not entitled
to benefits under the Act. The BRB affirmed.
II. ANALYSIS
A. Applicable statutes and regulation
Section 411(c)(3) of the Act provides, in relevant part:
If a miner is suffering or suffered from a chronic dust disease of the lung which (A)
when diagnosed by chest roentgenogram [i.e., x-ray], yields one or more large
opacities (greater than one centimeter in diameter) and would be classified in
category A, B, or C in the International Classification of Radiographs of the
Pneumoconioses by the International Labor Organization, (B) when diagnosed by
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No. 08-3909
Maynard v. Eastern Coal Co.
biopsy or autopsy, yields massive lesions in the lung, or (C) when diagnosis is made
by other means, would be a condition which could reasonably be expected to yield
results described in clause (A) or (B) if diagnosis had been made in the manner
prescribed in clause (A) or (B), then there shall be an irrebuttable presumption that
he is totally disabled due to pneumoconiosis[.]
30 U.S.C. § 921(c)(3). The enabling regulation for section 411(c)(3) similarly provides that the
irrebuttable presumption of total disability, entitling a miner to benefits, may be established through
chest x-ray, biopsy or autopsy, or other means of diagnosis in accordance with acceptable medical
procedures. See 20 C.F.R. § 718.304(a)-(c). Section 413(b) of the Act directs that “in determining
the validity of claims under this part, all relevant evidence shall be considered . . . .” 30 U.S.C.
§ 923(b). We have held that, although the statute and regulation list the three methods of
establishing complicated CWP in the disjunctive, and although any of the three may be sufficient to
support a finding of complicated CWP, an ALJ must take into account all of the relevant evidence
and determine whether the preponderance of the evidence supports a finding of complicated CWP.
Gray, 176 F.3d at 388-90.
B. Standard of review
“[W]e review the Board’s decision to ensure that it ‘did not commit a legal error or exceed
its statutory scope of review of the ALJ’s findings.’” Caney Creek Coal Co. v. Satterfield,
150 F.3d
568, 571 (6th Cir. 1998) (quoting Consolidation Coal Co. v. McMahon,
77 F.3d 898, 901 (6th Cir.
1996). “Our review of the Board’s legal conclusions is plenary; the Board may set aside an ALJ’s
factual findings only if they are not supported by substantial evidence.”
Id. (internal citations
omitted). Therefore, we inquire whether substantial evidence supports the ALJ’s conclusions. See
Gray, 176 F.3d at 387. “We should not re-weigh the evidence or substitute our judgment for that
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No. 08-3909
Maynard v. Eastern Coal Co.
of the ALJ.”
Id. “Substantial evidence is such relevant evidence as a reasonable mind might accept
as adequate to support a conclusion.” Wolf Creek Collieries v. Dir., OWCP,
298 F.3d 511, 519 (6th
Cir. 2002) (internal quotation marks omitted).
C. The ALJ’s decision is supported by substantial evidence
1. The ALJ was entitled to rely on doctors who did not diagnose simple CWP
As mentioned above, in one of its earlier opinions the BRB affirmed Judge Huddleston’s
conclusion that the x-ray evidence supported a finding of, at the very least, simple CWP. On appeal,
Maynard argues that presence of simple CWP became law of the case, making it improper for Judge
Levin to credit the opinions of physicians who had not diagnosed Maynard with simple CWP.
Despite its statement that the x-ray evidence supported a finding of simple CWP, the BRB’s
remand in its May 20, 1998 opinion specifically directed the ALJ to consider the notations and
reports of physicians who believed that the abnormalities in Maynard’s lungs resulted from healed
granulomatous disease. Thus, the BRB’s ruling not only permitted the ALJ to consider such
opinions but required him to do so. Furthermore, Judge Huddleston’s conclusion that simple CWP
was present was based only on x-ray evidence (he purported to rely on blood-gas studies, as well,
but the BRB rejected his conclusions), and the BRB found that Judge Huddleston had erred in failing
to consider other medical-opinion evidence. The BRB clearly did not intend to foreclose Judge
Levin from taking into account the opinions of doctors who believed that granulomatous disease
accounted for the abnormalities on Maynard’s x-rays.
Although Judge Levin was not required to discredit doctors who opined that Maynard did
not have CWP, Judge Levin did try to give effect to the BRB’s affirmance of the presence of simple
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No. 08-3909
Maynard v. Eastern Coal Co.
CWP by reducing his reliance on certain doctors who failed to diagnose that condition. The manner
in which he reduced his reliance on certain doctors but not others appears to have been inconsistent.
For example, Judge Levin discredited Dr. Vuskovich’s medical opinion because he had not
diagnosed simple CWP, stating “I give little weight to his opinion . . . because the Board has found
that Claimant does have simple pneumoconiosis, a condition related to coal mine employment which
Dr. Vuskovich was unable to detect.” (JA 507.) However, Judge Levin failed to similarly discount
the medical opinions of other doctors who had also concluded that simple CWP was not present.
Eastern Coal has not provided any explanation for Judge Levin’s apparent inconsistency, and we can
discern none, but any error is harmless, because, as described below, substantial evidence supports
Judge Levin’s ultimate conclusion.
Four doctors opined that the abnormalities on Maynard’s x-rays were healed granulomatous
disease. With respect to Dr. Rosenberg, Judge Levin noted that he is a board-certified internist and
pulmonologist who based his opinion on review of a large volume of medical evidence collected
over a fifteen-year period. Dr. Rosenberg opined that healed granulomatous disease accounted for
the abnormalities in Maynard’s x-rays, stating that “the presence of upper lobe abnormalities without
a background of small nodular opacities made the existence of pneumoconiosis improbable.” (JA
507.) Judge Levin gave the opinion “great weight,” noting that it was based on x-rays, the CT scan,
and the reports of other physicians. (JA 507.)
Similarly, Judge Levin noted that Dr. Harrison had physically examined Maynard, examined
his medical history and x-ray results, and “opined that the Miner’s abnormal x-ray may not be coal
workers’ pneumoconiosis but also could represent tuberculosis or sarcoidosis,” and the “hilar
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No. 08-3909
Maynard v. Eastern Coal Co.
adenopathy seen on the x-ray was more consistent with granulomatous disease than
pneumoconiosis.” (JA 506.) Judge Levin found Dr. Harrison’s report to be well-reasoned.
Dr. Repsher, who performed a review of all of the medical records, opinions, and x-rays,
concluded, like Dr. Rosenberg, that the abnormalities in the x-rays were due to granulomatous
disease, not CWP. Judge Levin stated “[a]lthough Dr. Repsher failed to diagnose even simple
pneumoconiosis, he does discuss the conglomerated lesions in claimant’s lungs, and accordingly I
accord his opinion against a finding of complicated pneumoconiosis moderate weight.” (JA 508.)
Dr. Broudy reached a very similar conclusion, and Judge Levin stated that “[a]lthough Dr. Broudy
failed to diagnose even simple pneumoconiosis, he does discuss the lesions in claimant’s lungs, and
accordingly I accord his opinion against a finding of complicated pneumoconiosis moderate weight.”
(JA 508.)
A number of other physicians in the record recognized prior granulomatous disease as a
possible explanation for Maynard’s abnormal x-rays. Together, these opinions constitute substantial
evidence supporting the ALJ’s ultimate finding that Maynard did not establish presence of
complicated CWP. Only two physicians affirmatively opined that Maynard had complicated CWP.
Judge Levin found that the opinions of the other physicians outweighed that evidence. We may not
re-weigh this evidence or substitute our judgment for that of the ALJ. See
Gray, 176 F.3d at 387.
2. The ALJ properly considered the CT scan evidence
Maynard claims it was error for Judge Levin to consider the CT scan readings by Drs.
Rosenberg, Repsher, and Broudy, which interpreted the CT scan as showing neither simple nor
complicated CWP, since Judge Huddleston’s finding of simple CWP had been affirmed by the BRB.
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No. 08-3909
Maynard v. Eastern Coal Co.
As we have already noted, the ALJ was required to consider all of the relevant evidence.
Furthermore, the BRB specifically directed the ALJ to consider the impact of several readings of the
CT scan by doctors who found that it showed neither simple nor complicated CWP. Therefore, we
cannot agree with Maynard that the BRB’s prior findings should have precluded Judge Levin from
considering the CT scan evidence.
Maynard also claims that the ALJ was required to compare the qualifications of the CT scan
readers to the qualifications of the x-ray readers. Only three doctors interpreted the CT scan
evidence, so those were the only three readings on which the ALJ could base his view of the CT scan
evidence. The fact that these three doctors, who were qualified radiographic readers, were not as
highly qualified as some of the other readers who did not view the CT scan evidence does not mean
that the ALJ erred by relying on their CT scan readings.
3. The ALJ’s discounting of Dr. Younes’s opinion because it relied on an incorrect
smoking history was not reversible error
Maynard generally informed the physicians who evaluated him that he had smoked a pack
of cigarettes per day for approximately twenty years. However, Maynard told Dr. Younes that he
had never been a smoker. As a result, the ALJ found Dr. Younes’s opinion that Maynard suffered
from complicated CWP worthy of less weight. Maynard argues that this was error because “[a]
claimant’s smoking history has no relevance to the question of whether clinical pneumoconiosis is
present.” Maynard cites a Third Circuit case, Wisniewski v. Director,
929 F.2d 952, 959 (3d Cir.
1991), which held: “the ALJ erred in considering Mr. Wisniewski’s smoking history as relevant to
causation in this case. Because smoking cannot cause the radiologic impressions characteristic of
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No. 08-3909
Maynard v. Eastern Coal Co.
pneumoconiosis, it is not an alternate exposure capable of contributing to a miner’s clinical
pneumoconiosis.”
Maynard may be correct that smoking history does not affect x-ray images, but he has not
provided any authority—medical or otherwise—stating that smoking history is entirely irrelevant
to a physician’s diagnosis of complicated CWP, which relies on other information about the patient
to aid the doctor’s interpretation of what appears in the x-ray. In any case, even if Judge Levin erred
in discounting Dr. Younes’s opinion, substantial evidence still supports Judge Levin’s ultimate
conclusion. See, e.g.,
Wisniewski, 929 F.2d at 959 (finding ALJ’s conclusion supported by
substantial evidence despite erroneous discounting of opinion that relied on inaccurate smoking
history).
4. The ALJ did not err in his weighing of the opinions of treating physicians
Finally, Maynard argues that Judge Levin failed to give adequate weight to the opinions of
Maynard’s treating physicians, Drs. Nadorra and Younes. Treating physicians are not entitled to
automatic deference in black lung cases but may be given greater deference if their extended
relationship with the patient makes their opinions more persuasive in the context of a given case.
See Eastover Mining Co. v. Williams,
338 F.3d 501, 511-13 (6th Cir. 2003) (holding that there is no
treating-physician rule, but the opinions of treating physicians may be entitled to more deference
based on their power to persuade). Judge Levin noted that Dr. Nadorra, who diagnosed Maynard
with complicated CWP in 2000, offered no basis for that diagnosis, presented no specialty
credentials, and may have relied on an inaccurate smoking history. These are valid reasons for
discounting Dr. Nadorra’s opinion. Judge Levin’s only explanation for discounting Dr. Younes’s
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No. 08-3909
Maynard v. Eastern Coal Co.
opinion was his reliance on an inaccurate smoking history. Although a history of smoking
apparently has no direct relation to the diagnosis of CWP, a mistake as to such a basic historical fact
by a physician treating a pulmonary ailment may cast doubt on the level of Dr. Younes’s familiarity
with Maynard and may be cause to undermine the reliability of his diagnosis. As discussed above,
Maynard has not established that this discounting was erroneous, and even if it had been, Judge
Levin’s ultimate conclusion would still be supported by substantial evidence.
III. CONCLUSION
For the foregoing reasons, we DENY Maynard’s petition for review and AFFIRM the
decision of the BRB.
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