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Code of Federal Regulations Pertaining to U.S. Department of Labor |
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Employees' Benefits |
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Employment Standards Administration, Department of Labor |
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Standards for Determining Coal Miners' Total Disability or Death Due to Pneumoconiosis |
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Determining Entitlement to Benefits |
20 CFR 718.202 - Determining the existence of pneumoconiosis.
- Section Number: 718.202
- Section Name: Determining the existence of pneumoconiosis.
(a) A finding of the existence of pneumoconiosis may be made as
follows:
(1) A chest X-ray conducted and classified in accordance with
Sec. 718.102 may form the basis for a finding of the existence of
pneumoconiosis. Except as otherwise provided in this section, where two
or more X-ray reports are in conflict, in evaluating such X-ray reports
consideration shall be given to the radiological qualifications of the
physicians interpreting such X-rays.
(i) In all claims filed before January 1, 1982, where there is
other evidence of pulmonary or respiratory impairment, a Board-
certified or Board-eligible radiologist's interpretation of a chest X-
ray shall be accepted by the Office if the X-ray is in compliance with
the requirements of Sec. 718.102 and if such X-ray has been taken by a
radiologist or qualified radiologic technologist or technician and
there is no evidence that the claim has been fraudulently represented.
However, these limitations shall not apply to any claim filed on or
after January 1, 1982.
(ii) The following definitions shall apply when making a finding in
accordance with this paragraph.
(A) The term other evidence means medical tests such as blood-gas
studies, pulmonary function studies or physical examinations or medical
histories which establish the presence of a chronic pulmonary,
respiratory or cardio-pulmonary condition, and in the case of a
deceased miner, in the absence of medical evidence to the contrary,
affidavits of persons with knowledge of the miner's physical condition.
(B) Pulmonary or respiratory impairment means inability of the
human respiratory apparatus to perform in a normal manner one or more
of the three components of respiration, namely, ventilation, perfusion
and diffusion.
(C) Board-certified means certification in radiology or diagnostic
roentgenology by the American Board of Radiology, Inc. or the American
Osteopathic Association.
(D) Board-eligible means the successful completion of a formal
accredited residency program in radiology or diagnostic roentgenology.
(E) Certified `B' reader or `B' reader means a physician who has
demonstrated proficiency in evaluating chest roentgenograms for
roentgenographic quality and in the use of the ILO-U/C classification
for interpreting chest roentgenograms for pneumoconiosis and other
diseases by taking and passing a specially designed proficiency
examination given on behalf of or by the Appalachian Laboratory for
Occupational Safety and Health. See 42 CFR 37.51(b)(2).
(F) Qualified radiologic technologist or technician means an
individual who is either certified as a registered technologist by the
American Registry of Radiologic Technologists or licensed as a
radiologic technologist by a state licensing board.
(2) A biopsy or autopsy conducted and reported in compliance with
Sec. 718.106 may be the basis for a finding of the existence of
pneumoconiosis. A finding in an autopsy or biopsy of anthracotic
pigmentation, however, shall not be sufficient, by itself, to establish
the existence of pneumoconiosis. A report of autopsy shall be accepted
unless there is evidence that the report is not accurate
or that the claim has been fraudulently represented.
(3) If the presumptions described in Secs. 718.304, 718.305 or
Sec. 718.306 are applicable, it shall be presumed that the miner is or
was suffering from pneumoconiosis.
(4) A determination of the existence of pneumoconiosis may also be
made if a physician, exercising sound medical judgment, notwithstanding
a negative X-ray, finds that the miner suffers or suffered from
pneumoconiosis as defined in Sec. 718.201. Any such finding shall be
based on objective medical evidence such as blood-gas studies,
electrocardiograms, pulmonary function studies, physical performance
tests, physical examination, and medical and work histories. Such a
finding shall be supported by a reasoned medical opinion.
(b) No claim for benefits shall be denied solely on the basis of a
negative chest X-ray.
(c) A determination of the existence of pneumoconiosis shall not be
made solely on the basis of a living miner's statements or testimony.
Nor shall such a determination be made upon a claim involving a
deceased miner filed on or after January 1, 1982, solely based upon the
affidavit(s) (or equivalent sworn testimony) of the claimant and/or his
or her dependents who would be eligible for augmentation of the
claimant's benefits if the claim were approved.
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