U.S.DOL - Benefits Review Board

July 5, 2009

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BLACK LUNG DESKBOOK

TABLE OF CONTENTS

PART I	INTRODUCTION
PART II	DEFINITIONS
PART III	PROCEDURAL ISSUES
PART IV	ADMINISTRATIVE PROCESSING OF CLAIMS, POWERS AND DUTIES OF THE ADMINISTRATIVE LAW JUDGE
PART V	BENEFITS REVIEW BOARD POLICIES AND PROCEDURES
PART VI	ESTABLISHING ENTITLEMENT UNDER 20 C.F.R. PART 410
PART VII	ESTABLISHING ENTITLEMENT UNDER 20 C.F.R. PART 718
PART VIII	STATUTORY PRESUMPTIONS IN MINERS' CLAIMS
PART IX	REGULATORY PRESUMPTIONS
PART X	SURVIVORS' CLAIMS
PART XI	ATTORNEY FEES

I. INTRODUCTION

A. General History and Purposes
B. Structure of the Act; Responsibility for Payment of
Benefits; Establishment of Black Lung Disability Trust Fund
C. Structure and Applicability of the Regulations
D. Constitutionality of the Act and Regulations
E. Incorporation of the Provisions of the Longshore and Harbor Workers' Compensation Act (LHWCA) into the Act through Section 422
F. Statute of Limitations, Summary of Prior Law and Reform Act Changes

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2. DEFINITIONS

A. Miner
           1. General
        2. Coal Dust/Coal Mine Dust
        3. Status/Function/Situs & Situs/Function Tests
                a. Status of the Coal
                b. Function Test
                c. Situs Test
        4. Construction/Transportation Workers
B. Survivors/Dependents
        1. Surviving Spouse
        2. Dependent or Surviving Child
C. Coal Mine
D. Pneumoconiosis
E. Total Disability
F. Length of Coal Mine Employment
G. Usual Coal Mine Work
H. Effect of Current Coal Mine Employment or Coal Mine Employment at Time of Death
I. Comparable and Gainful Work
J. Primary Cause
K. Chronic Disease or Respiratory Impairment
L. Responsible Operator
        1. Generally
        2. Successor Operator
M. Benefits
N. Workers' Compensation Law
O. Autopsy

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III. PROCEDURAL ISSUES

          A. Requirement to File State Workers'Compensation Claim; Offset
           B. Consequences of Filing a Part B Claim
               1. Medical Benefits Only Claims (MBO)
           C. Payment of Benefits
               1. Generally; Assessment of Interest On Past Due Benefit Installments
               2. Under the 1981 Amendments to the Act
                   a. General Provisions
                   b. Claim "Denied"
                   c. Approval under Section 435
                   d. Procedural Issues Involving Transfer of Liability
                   e. Overpayments
          D. Parties
          E. Applicable Law
          F. Viability of Claims
              1. Abandonment
              2. Merger of Claims/Duplicate Claims
              3. Merger of Claims/Subsequent Claims
              4. Subsequent Claims/Revised Version of 20 C.F.R. §725.309
          G. Modifications
          H. Commencement of Benefits
              1. Date of Onset of Total Disability Due to Pneumoconiosis
              2. The Effect of Continued Employment
              3. Survivor's Claims
              4. Part B and Transitional Period Claims
          I. Evidence Limitations
          J. Timeliness of Claim Filing

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IV. ADMINISTRATIVE PROCESSING OF CLAIMS, POWERS
    AND DUTIES OF THE ADMINISTRATIVE LAW JUDGE

          A. The Claims Process
              1. Filing of Claims, Withdrawal
              2. The District Director's Role
              3. Formal Hearing
              4. Procedural Issues at the District Director
                 or the Hearing Level
                   a. General Evidentiary Matters
                   b. Hearing Issues
                   c. Burden to Produce Evidence
                   d. Admission of Evidence
                       (1). Generally; Timely Evidence
                       (2). Late Evidence
                   e. Hearsay; Right to Cross-Examination
                   f. Claimants' Rights (Including Criteria for Ordering a Physical
                  Examination)
                   g. Controversion
                   h. Controversion Under Revised 20 C.F.R. §725.412
          B. Jurisdiction; Dismissals
          C. Full and Fair Hearing
              1. Right to a Hearing; Waiver
              2. Conduct of Hearing; Due Process
              3. Right to Counsel; Pro Se Status; Notice to Counsel
          D. Evaluation and Weighing of Evidence
              1. General Principles; Burden of Proof
              2. Elements of Entitlement
                   a. Generally; Interpretation of Medical Data
                   b. Impairment
                   c. Disability
                   d. Existence of Pneumoconiosis
                   e. Cause of Disability and Pneumoconiosis
              3. Specific Evidentiary Principles
                   a. Blevins Test for Admissibility
                   b. Later Evidence
                   c. True Doubt Rule
                   d. Adverse Inferences
              4. Medical Reports
                   a. Documented Opinion
                   b. Reasoned Opinion
                   c. Non-Examining Physician
                   d. Opinions in Conflict with the Spirit of the Act
                   e. Qualifications of Physicians
                   f. Treating Physicians
                   g. Opinions Contrary to the Revised Regulations
              5. Lay Testimony
              6. X-Rays, Readers, Quality Standards
                   a. Generally
                   b. Section 413(b)
              7. Autopsy and Biopsy Evidence, Quality Standards
              8. Ventilatory and Blood Gas Studies, Quality Standards
              9. Vocational Experts and Evidence
             10. Determinations of State Medical Boards and Other Governmental
             Agencies
             11. Contraindication of Continued Employment
             12. Prejudice of Witnesses
             13. CT Scans

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V. BENEFITS REVIEW BOARD POLICIES AND PROCEDURES

        A. Scope of Review
               1. Generally; Issues Inadequately Raised and Briefed
               2. Timeliness
               3. Finality
               4. Standing
               5. Mootness
               6. Judicial Notice
               7. Administrative Procedure Act
               8. Law of the Case
               9. Issues on Appeal
              10. Stipulations and Conceded Issues
              11. Harmless Error
              12. Disposition as a Matter of Law
          B. Policies and Procedures
               1. Dismissal
               2. Remand
               3. Motions for Reconsideration
               4. Pro Se Claimant
               5. Settlements

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VI. ESTABLISHING ENTITLEMENT UNDER 20 C.F.R. PART 410

          A. In General
          B. Existence of Pneumoconiosis
          C. Total Respiratory Disability
              1. Section 410.412
              2. Section 410.422
              3. Section 410.424
              4. Section 410.426
              5. The Primary Cause Requirement of Section 410.426(a)
          D. Arising Out of Coal Mine Employment
          E. Section 410.414(c)

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VII. ESTABLISHING ENTITLEMENT UNDER 20 C.F.R. PART 718

          A. In General
              1. Applicability
              2. Validity
              3. Entitlement
              4. Quality Standards
          B. Existence of Pneumoconiosis
              1. Generally
              2. Section 718.202(a)(1): X-ray Evidence
              3. Section 718.202(a)(2): Biopsy or Autopsy Evidence
              4. Section 718.202(a)(3): Presumptions
                   a. Section 718.304: Complicated Pneumoconiosis
                   b. Section 718.305
                   c. Section 718.306: "25 Years" Presumption
              5. Section 718.202(a)(4): Medical Reports
              6. Section 718.202(a)(4): Other Medical Evidence
          C. Pneumoconiosis Arising Out of Coal Mine Employment
          D. Total Disability: Section 718.204
              1. Generally
              2. Section 718.204(c)(1)
              3. Section 718.204(c)(2)
              4. Section 718.204(c)(3)
              5. Section 718.204(c)(4)
              6. Section 718.204(c)(5)
          E. Cause of Disability: Section 718.204(b)
              2. Revised Section 718.204(c)
          F. Survivors' Claims Without Benefit of a Presumption: Sections 718.205,
          718.303; Filing
          G. Length of Coal Mine Employment: Section 718.301

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VIII. STATUTORY PRESUMPTIONS IN MINERS' CLAIMS

          A. Section 411(c)(1)
          B. Section 411(c)(3)
          C. Section 411(c)(4)
              1. The 15 Year Presumption (Generally)
              2. Implementation under Part 718 and in Survivors' Claims
              3. Implementation under Part 410
              4. The "Many Years" Presumption

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IX. REGULATORY PRESUMPTIONS

         A. 20 C.F.R. �727.203 Interim Presumption
              1. Invocation of the Interim Presumption Generally
                   a. Section 727.203(a)(1)
                   b. Section 727.203(a)(2)
                   c. Section 727.203(a)(3)
                   d. Section 727.203(a)(4)
                   e. Section 727.203(a)(5)
              2. Rebuttal of the Interim Presumption Generally
                   a. Section 727.203(b)(1)
                   b. Section 727.203(b)(2) [usual coal mine work; comparable and gainful
                   work]
                   c. Section 727.203(b)(3)
                   d. Section 727.203(b)(4)
              3. Reconsideration under Part 410 and Part 718 - Effect of Holdings Under
              Interim Presumption on Entitlement Under Part 410 and Part 718
          B. 20 C.F.R. �410.490 Interim Presumption

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X. SURVIVORS' CLAIMS

          A. Introduction
          B. Derivative Entitlement
          C. Section 411(c)(1)
          D. Section 411(c)(2)
          E. Section 411(c)(3)
          F. Section 411(c)(4)
          G. Section 411(c)(5)
          H. Survivors' Claims Under 20 C.F.R. §§727.203 and 410.490
          I. Survivors' Claims Under 20 C.F.R. Parts 410 and 718

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XI. ATTORNEY FEES

          A. Board Review of Attorney Fee Awards Made Below
              1. General Overview
              2. Standard of Review
              3. Time for Filing Fee Petition
              4. Successful Prosecution of the Claim
              5. Jurisdictional Issues
              6. Requirements for Fee Petition
              7. Issues on Appeal of Attorney Fee Awards
                   a. Opposition to Attorney Fees
                   b. Counsel's Appeal of Substantial Reductions in the Requested Fee
                       (1). The Hourly Rate
                       (2). The Number of Hours
                       (3). Miscellaneous Expenses
                             (a). Travel
                             (b). Overhead Expenses
                   c. Enhancement
              8. Board Modification of Attorney Fees Awards
              9. Liability for Attorney Fees
                   a. Notice of Liability
                   b. Lay Representatives
                   c. Fee Related Issues Which Must Be Raised Sua Sponte by the Board
                   d. Escrow Accounts
                   e. Effect of Continued Coal Mine Employment
                   f. Employer's Ability to Pay
             10. Miscellaneous Issues
          B. Attorney Fees for Services Performed Before the Board
              1. Hourly Rate
              2. Successful Prosecution of Claim Before the Board