THOMAS A. VARLAN, District Judge.
This civil action is before the Court on plaintiff Kyle Meridieth's Brief in Support
Part E of EEOICPA establishes a compensation program that provides benefits to individuals, or their eligible survivors, with illnesses incurred as a result of exposure to a toxic substance in the performance of the individuals' work for the United States Department of Energy (the "DOE"), its predecessor agencies, or certain of its contractors and subcontractors. See 42 U.S.C. §§ 7385s, 7385s-1. On August 29, 2005, plaintiff filed a claim for benefits under Part E with the Department of Labor's Office of Workers' Compensation Programs ("OWCP"), claiming the condition of "asbestos related lung disease."
On June 24, 2006, OWCP requested additional information from plaintiff, including whether he had filed a tort suit or a state workers' compensation claim related to his claimed condition of asbestos related lung disease [AR, 140]. In response, plaintiff submitted additional medical reports and informed OWCP that he had previously filed a tort suit and received settlement payments totaling $18,532.43 [Id., 92-104].
On November 24, 2006 OWCP issued a recommended decision (the "First Recommended Decision"), accepting plaintiff's Part E claim for the covered illness of asbestosis [AR, 87]. OWCP also concluded that coordination of plaintiff's workers' compensation settlement with his Part E benefits was required [Id.]. See 42 U.S.C. § 7385s-11 (describing coordination of
On February 7, 2007, the Final Adjudication Branch (the "FAB") issued a final decision (the "First Final Decision") disagreeing with plaintiff's objection [AR, 74-78]. The First Final Decision agreed with the First Recommended Decision, accepting plaintiff's Part E claim for the covered illness of asbestosis, agreeing that coordination was required, and agreeing that a surplus of $119,392.18 had been created [Id.]. The First Final Decision also did not discuss plaintiff's settlement payments from his tort suit [Id.]. On March 22, 2007, plaintiff filed a complaint with this Court seeking judicial review of the First Final Decision [Id., 67-70, Doc. 1]. See 42 U.S.C. § 7385s-6 (providing for judicial and administrative review).
On April 30, 2007, the director of OWCP's Division of Energy Employees Occupational Illness Compensation issued an order vacating the First Final Decision because plaintiff's workers' compensation settlement had not been properly coordinated with his Part E benefits and plaintiff's Part E benefits had not been offset to reflect plaintiff's settlement payments from his tort suit [AR, 52-54]. The order to vacate also directed that a new recommended decision be issued [Id., 53-54]. On July 10, 2007, plaintiff and defendants filed a joint stipulation in this Court to hold this case in abeyance pending the issuance of a new final decision on plaintiff's Part E claim [Id., Doc. 8]. The Court issued an Order to that effect [Doc. 9].
On August 15, 2007, OWCP issued a second recommended decision (the "Second Recommended Decision"), again accepting plaintiff's Part E claim for the covered illness of asbestosis and awarding him medical benefits [AR, 33-37]. The Second Recommended Decision again found that coordination was required and a "surplus" had been created, this time, in the amount of $132,065.71 [Id.].
On August 29, 2007, plaintiff objected to the Second Recommended Decision and filed an affidavit supporting his objection by Dr. Ronald Cherry, dated April 20, 2007 [AR, 11-12]. In the objection, plaintiff again contended that there should be no coordination of his Part E benefits with his workers' compensation settlement because
On November 30, 2007, the FAB issued a notice of granted request for reconsideration and final decision on plaintiff's claim (the "Reconsideration and Third Final Decision"), which is the subject of plaintiff's request for judicial review [Id., 3-9].
On January 8, 2008, plaintiff filed a motion to reinstate [Doc. 11] this case on the Court's docket. On January 17, 2008, plaintiff filed his amended complaint [Doc. 12] seeking judicial review of the Reconsideration and Third Final Decision. Pursuant to the Court's scheduling order [Doc. 19], plaintiff filed a brief in support of his request for judicial review [Doc. 23], defendants filed a response in opposition [Doc. 24], and plaintiff filed a reply [Doc. 25].
This Court has jurisdiction to review the Department of Labor's decision regarding plaintiff's claimed benefits under Part E of EEOICPA. Title 42 of the United States Code, section 7385s-6(a) provides that "[a] person adversely affected or aggrieved by a final decision ... under ... [P]art [E] may review that order in the United States district court in the district in which the injury was sustained...." 42 U.S.C. § 7385s-6(a). Section 7385s-6(a) further provides that the district court "shall have jurisdiction over the proceeding and shall have the power to affirm, modify, or set aside, in whole or in part, such decision." Id. The district court "may modify or set aside such decision," however, "only if the court determines that such decision was arbitrary and capricious." Id.
As previously stated, Part E of EEOICPA establishes a compensation program that provides benefits to individuals with illnesses incurred as a result of exposure to a toxic substance in the performance of the individual's work for the DOE or certain or its contractors. See 42 U.S.C. §§ 7385s, 7385s-1, 7385s-8. Benefits under Part E must be coordinated if the individual "has also received benefits from a State workers compensation system by reason of the same covered illness[.]" 42 U.S.C. § 7385s-11. Pursuant to § 7385s-11, the individual "shall receive compensation... reduced by the amount of any workers compensation benefits, other than medical benefits and benefits for vocational rehabilitation, that the individual received under the state workers compensation system by reason of the covered illness...." Id. However, "coordination of benefits will not occur if the [individual] under a state workers' compensation program receives state workers' compensation benefits for both a covered and a non-covered illness arising out of and in the course of the same work-related incident." 20 C.F.R. § 30.626(c)(3).
In this case, the Reconsideration and Third Final Decision concluded that plaintiff was entitled to recover benefits under Part E for the claimed condition of asbestosis [AR, 9]. The Reconsideration and Third Final Decision also concluded that coordination was required because plaintiff recovered for the same condition of asbestosis in both his workers' compensation settlement and his claim under Part E [Id.].
OWCP reviewed the medical evidence submitted by plaintiff and determined that he was entitled to benefits for the covered condition of asbestosis. Then, in accordance
Plaintiff argues that OWCP's interpretation of his workers' compensation settlement is arbitrary and capricious because the settlement order covered two distinct conditions: (1) asbestosis or asbestos related lung disease and (2) any non-malignant respiratory injury, specifically, COPD. Plaintiff acknowledges that the settlement order does not specifically mention COPD, but he contends that the reference in the settlement order to "any non-malignant respiratory injury" was a direct reference to plaintiff's COPD, noted by Dr. Robert Chironna on June 8, 1992 [AR, 869-70],
The Court does not agree that OWCP's interpretation of the settlement agreement was arbitrary and capricious. In the Third Recommended Decision [AR, 36], OWCP noted that plaintiff's workers' compensation complaint sought compensation for only "asbestosis or asbestos-related lung disease," and the workers' compensation complaint contains no mention of any non-malignant respiratory injury or the more specific condition of COPD [Id., 107-08, ¶¶ 3, 6, 7]. OWCP also noted that the settlement order found that plaintiff had contracted a single condition, "asbestos-related lung disease" and that the settlement would relieve the defendants in that case of all liability to plaintiff for "the claimed occupational asbestos-related lung disease and any non-malignant respiratory injury." [Id., 37, 110-15].
The applicable regulations provide that coordination of benefits will not occur if a state workers' compensation suit covers "both a covered and a non-covered illness arising out of and in the course of the same work-related incident." 20 C.F.R. § 30.626(c)(3). Upon the Court's review of plaintiff's workers' compensation complaint, the settlement order, and the applicable regulations, the Court cannot conclude that the Reconsideration and Third Final Decision has no rational basis or involved a clear and prejudicial violation of the applicable statute and regulations. The term "non-malignant respiratory injury," to the extent it even refers to the specific condition of COPD, was never mentioned in the complaint and only mentioned once in the settlement order.
Based on the evidence contained in the administrative record and upon which OWCP based its Reconsideration and Third Final Decision, and because the statutory language and applicable regulation require a clear showing of benefits received for "both a covered and a non-covered illness," the Court finds that the Reconsideration and Third Final Decision was supported by substantial evidence and based on a rational interpretation and a careful consideration of the relevant documents in the administration record and the applicable regulations. Plaintiff's argument that the phrase "any non-malignant respiratory injury" refers specifically to COPD because plaintiff was diagnosed with this condition is not enough to make OWCP's interpretation of the settlement order unreasonable or irrational. Thus, the Court finds that the Reconsideration and Third Final Decision, stating that
OWCP's finding that coordination is required would not be arbitrary and capricious even if the phrase "non-malignant respiratory disease" was interpreted as constituting recovery of benefits based on a second, non-covered condition. Title 20, section 30.626 of the Code of Federal Regulations outlines how OWCP coordinates compensation payable under Part E of EEOICPA with benefits from state workers' compensation programs. See 20 C.F.R. § 30.626. The regulation also explains the situation in which a claimant under Part E may be exempt from coordination. Id. § 30.626(c)(3). "[C]oordination of benefits will not occur if the beneficiary under a state workers' compensation program receives state workers' compensation benefits for both a covered and a non-covered illness arising out of and in the course of the same work-related incident." Id.
OWCP discussed four specific medical opinions in the Reconsideration and Third Recommended Decision: (1) an October 7, 1997 letter by Dr. James Scutero [AR, 867];
In addition to the medical reports, the administrative record also supports the conclusion of the Reconsideration and Third Final Decision that COPD was not a condition arising out of and in the course of plaintiff's employment with a DOE facility. No relief for COPD was sought in the underlying workers' compensation complaint and the settlement order contains no reference to COPD beyond the phrase "any non-malignant respiratory injury." Accordingly, the conclusion of the Reconsideration and Third Final Decision, that plaintiff's COPD did not arise out of and in the course of the same work-related incident or incidents which resulted in the condition of asbestosis, is not arbitrary and capricious. The Court cannot find, based on a review of OWCP's decisions and recommendations, the administrative record—including the medical evidence, reports, and the underlying suit actions— and plaintiff's objections, that plaintiff has established that the Reconsideration and Third Final Decision had no rational basis or involved a clear and prejudicial violation of applicable statutes or regulations.
In sum, the Department of Labor's Reconsideration and Third Recommended Decision, determined by the OWCP, and concluding that plaintiff's Part E benefits under EEOICPA should be coordinated, was not arbitrary and capricious. Contrary to plaintiff's assertions, OWCP properly weighed the evidence, thoroughly considered the administrative record, and properly applied the relevant regulations. Accordingly, plaintiff's Brief in Support of Seeking Judicial Review of the Department of Labor's Determination of Plaintiff's Rights to Benefits Under the Energy Employee's Occupational Illness Compensation Program Act [Doc. 23] is hereby
ORDER ACCORDINGLY.