(a) A report of any physical examination conducted in connection
with a claim shall be prepared on a medical report form supplied by the
Office or in a manner containing substantially the same information.
Any such report shall include the following information and test
results:
(1) The miner's medical and employment history;
(2) All manifestations of chronic respiratory disease;
(3) Any pertinent findings not specifically listed on the form;
(4) If heart disease secondary to lung disease is found, all
symptoms and significant findings;
(5) The results of a chest X-ray conducted and interpreted as
required by Sec. 718.102; and
(6) The results of a pulmonary function test conducted and reported
as required by Sec. 718.103. If the miner is physically unable to
perform a pulmonary function test or if the test is medically
contraindicated, in the absence of evidence establishing total
disability pursuant to Sec. 718.304, the report must be based on other
medically acceptable clinical and laboratory diagnostic techniques,
such as a blood gas study.
(b) In addition to the requirements of paragraph (a), a report of
physical examination may be based on any other procedures such as
electrocardiogram, blood-gas studies conducted and reported as required
by Sec. 718.105, and other blood analyses which, in the physician's
opinion, aid in his or her evaluation of the miner.
(c) In the case of a deceased miner, where no report is in
substantial compliance with paragraphs (a) and (b), a report prepared
by a physician who is unavailable may nevertheless form the basis for a
finding if, in the opinion of the adjudication officer, it is
accompanied by sufficient indicia of reliability in light of all
relevant evidence.
(d) Treating physician. In weighing the medical evidence of record
relevant to whether the miner suffers, or suffered, from
pneumoconiosis, whether the pneumoconiosis arose out of coal mine
employment, and whether the miner is, or was, totally disabled by
pneumoconiosis or died due to pneumoconiosis, the adjudication officer
must give consideration to the relationship between the miner and any
treating physician whose report is admitted into the record.
Specifically, the adjudication officer shall take into consideration
the following factors in weighing the opinion of the miner's treating
physician:
(1) Nature of relationship. The opinion of a physician who has
treated the miner for respiratory or pulmonary conditions is entitled
to more weight than a physician who has treated the miner for non-
respiratory conditions;
(2) Duration of relationship. The length of the treatment
relationship demonstrates whether the physician has observed the miner
long enough to obtain a superior understanding of his or her condition;
(3) Frequency of treatment. The frequency of physician-patient
visits demonstrates whether the physician has observed the miner often
enough to obtain a superior understanding of his or her condition; and
(4) Extent of treatment. The types of testing and examinations
conducted during the treatment relationship demonstrate whether the
physician has obtained superior and relevant information concerning the
miner's condition.
(5) In the absence of contrary probative evidence, the adjudication
officer shall accept the statement of a physician with regard to the
factors listed in paragraphs (d)(1) through (4) of this section. In
appropriate cases, the relationship between the miner and his treating
physician may constitute substantial evidence in support of the
adjudication officer's decision to give that physician's opinion
controlling weight, provided that the weight given to the opinion of a
miner's treating physician shall also be based on the credibility of
the physician's opinion in light of its reasoning and documentation,
other relevant evidence and the record as a whole.
