400 F. Supp. 901

James W. BEGLEY, Plaintiff, v. Caspar WEINBERGER, Secretary, Health, Education and Welfare, Defendant. Stephen SPEARS, Plaintiff, v. Caspar WEINBERGER, Secretary, Health, Education and Welfare, Defendant. Harry NUTTER, Plaintiff, v. Caspar WEINBERGER, Secretary, Health, Education and Welfare, Defendant.

Civ. A. Nos. 74-16, 74-622 and 75-58.

United States District Court, S. D. Ohio, E. D.

Aug. 18, 1975.

*902Verrell Dethloff, Dept, of H.E.W., Washington, D. C., William W. Milligan, U. S. Atty., Thomas D. Thompson, Asst. U. S. Atty., Columbus, Ohio, for defendant.

Irwin W. Barkan, Columbus, Ohio, Howdyshell & Dodd, New Lexington, Ohio, for plaintiff in Civ. A. No. 74-16.

Paul A. Pachuta, Reynoldsburg, Ohio, for plaintiff in Civ. A. No. 74-622.

Frederick L. Oremus, Nelsonville, Ohio, for plaintiff in Civ. A. No. 75-58.

OPINION AND ORDER

DUNCAN, District Judge.

These three cases are appeals from final decisions of the Secretary of Health, Education and Welfare under Title IV of the Federal Coal Mine Health and Safety Act of 1969, Pub.L. 91-173, as amended by the Black Lung Benefits Act of 1972, Pub.L. 92-303, now codified at 30 U.S.C. § 901 et seq. [hereinafter, “the statute”]. Mr. Begley, Mr. Spears and Mr. Nutter are' miners who have spent at least fifteen years in under*903ground mines, who filed claims against the United States for black lung benefits, and whose claims have been denied by the Secretary. This Court has jurisdiction to hear these appeals pursuant to 30 U.S.C. § 923(b) and 42 U.S.C. § 405(g).

The common question presented by these appeals concerns the use of evidence of total disability due to pneumoconiosis which becomes available after June 30, 1973, but before final adjudication of a claim by the Secretary. The position of the Secretary of Health, Education and Welfare in these cases is that the requisite total disability must be established as having existed on or before June 30, 1973, and that evidence which shows total disability after that date is relevant only insofar as it can be said to relate back , to June 30, 1973. This Court’s review of the statute leads it to conclude that the Secretary’s position is not in keeping with the mandate of the statutory scheme. For the reasons set forth hereinafter, the Court has concluded that all claims submitted under the statute before July 1, 1973, must be decided by determining whether the claimant is totally disabled due to pneumoconiosis at the time his claim is finally adjudicated by the Secretary. Further, this determination must be made by application of the Part B standards of the statute and the regulations thereunder. Under this construction, the liability of the United States for black lung benefits remains, as Congress intended, a temporary matter. When all claims filed before July 1, 1973, have been finally adjudicated by the Secretary of Health, Education and Welfare, the liability of the United States under the statute will be fixed, and, upon the payment of benefits arising from valid claims, the participation of the United States as an insurer under this statute will cease. The Court will review the statute briefly, and will then turn to the arguments asserted by the parties.

I. AN OVERVIEW OF THE STATUTE

In enacting Title IV of the Federal Coal Mine Health and Safety Act of 1969,1 Congress established a scheme for payment of benefits to miners who are totally disabled due to chronic lung disease arising out of employment in coal mines. The amendments effected by the Black Lung Benefits Act of 1972 left the major themes of the 1969 act untouched, but did modify certain key transition dates.3 Since Congress was concerned about reports that black lung benefits were unduly difficult to obtain,4 *904it also established by the 1972 amendments an additional statutory presumption 5 favoring certain claimants, and it made clear to the Secretary of Health, Education and Welfare its intention that he establish, by regulation, still other such presumptions.6 Congress also provided that the so-called backlog of claims—those which the Social Security Administration had denied during the first three years of the 1969 act’s existence—would be re-examined by the Secretary in light of the 1972 amendments.7

The statute, as originally enacted and as amended, essentially imposes upon the coal mine industry, that is, the operators of coal mines, the burden of providing benefits for worthy claimants. However, Congress believed it was not fitting for the industry to be required to assume financial responsibility, retroactively, so to speak, for the claims of all miners who already had developed pneumoconiosis. Under the statute, then, the United States is liable only for certain claims filed by miners or their survivors, and coal mine operators are liable for all other claims for black lung benefits.

The statute in operation performs essentially three functions: (1) it imposes liability for payment of black lung benefits upon the United States and/or upon one or more coal mine operators; (2) it provides who is to adjudicate claims; and (3) it establishes standards to be used in determining the eligibility for benefits of miners and certain dependent survivors of miners.

A. Liability for Benefits

The United States is liable, for the life of the claim, for all benefits arising from all claims filed on or before June 30, 1973.8 No coal mine operator shares liability for any such claim.

*905Coal mine operators bear the burden of providing benefits for worthy claimants who file on or after January 1, 1974.9 Operators are to finance such liability through participation in approved state workmen’s compensation programs, or by self-insurance techñiques. If they do not pay benefits through such means, they are liable in a civil action brought by the United States.10 The United States does not share liability for any such claim,

The United States and the coal mine industry do share liability for claims fiied between June 30, 1973 and January i, 1974.11 With respect to such claims, *906the United States pays only benefits accruing on or before December 31, 1973;12 the operators pay all benefits accruing on and after January 1, 1974.13

For most purposes, then, June 30, 1973, is the operative transition date as regards liability for benefits. The United States is liable for the payment of all benefits arising from claims filed on or before that date, and the coal mine industry is liable for all post-December 31, 1973 benefits arising from claims filed after June 30, 1973.

B. Adjudication of Claims

Congress divided the federal government’s adjudicatory role between the Secretary of Labor and the Secretary of Health, Education and Welfare.14 The latter has jurisdiction over claims for which only the United States is potentially liable, that is, claims filed on or before June 30, 1973. The Secretary of Labor has jurisdiction over all claims for which coal mine operators are potentially liable, that is, claims filed after June 30, 1973. However, the Secretary of Labor has no jurisdiction to adjudicate a claim filed after December 31, 1973, if the claim concerns pneumoconiosis arising from employment in a mine located in a state which has a workmen’s compensation plan meeting the federal statutory standards and approved by the Secretary of Labor.15

C. Eligibility Standards

The statute as originally enacted and as amended is divided into three parts. Part A includes Congress’ declaration of purpose, and certain definitions. Part B, entitled “Claims for Benefits Filed on or Before December 31, 1973,” includes 30 U.S.C. §§ 921-925 and concerns claims for which the United States is liable in whole or in part. Part C, entitled “Claims for Benefits After December 31, 1973,” includes 30 U.S.C. §§ 931-941 and concerns claims for which only mine operators are to be liable.

While, as a general rule, the statute provides that eligibility standards for Part B and Part C claims are to be substantially the same,16 several major dif*907ferences do exist. Congress has provided, for example, that one presumption which is applicable to claims filed in whole or in part against the United States is to have limited applicability to claims filed against only coal mine operators. Thus, the statutory rebuttable presumption of disability due to pneumoconiosis, set out at 30 U.S.C. § 921(c)(4),17 is available to all miners who filed claims against the United States on or before December 31, 1973, if the miner had fifteen years experience in underground mines on or before that date. The same provision is available to miners who file post-December 31, 1973 claims payable by mine operators, but the miner must have had the requisite fifteen years experience on or before June 30, 1971,18 and he must file his claim within three years of his last exposed employment in a coal mine.19 *908Those Part C claimants who have the § 921(c)(4) presumption available are therefore a closed class of persons; membership in the class will decrease with the passage of time.

Nor do Part C claimants have available to them the interim presumption set out at 20 C.F.R. § 410.490(b) (1974). Although presumptions established by regulation of the Secretary of Health, Education and Welfare are generally applicable to both Part B and Part C claims,20 the § 410.490(b) rebuttable presumption of total disability due to pneumoconiosis is by its terms an interim presumption, applicable only to claims filed on or before June 30, 1973, which are, as stated in the heading of § 410.490, “certain Part B claims.”

There is also a potential for some variance in eligibility standards when claims are filed with an approved state workmen’s compensation program. The statute provides that the Secretary of Labor may approve such a program, and thereby divest himself of jurisdiction to hear claims which may be filed under the state program, if the eligibility standards are “substantially equivalent to” those of the statute and the regulations promulgated by the Secretary of Health, Education and Welfare.21 Review of the Secretary of Labor’s decisions respecting this substantial equivalency test is vested in the United States Court of Appeals for the appropriate circuit.22

Yet another major difference between Part B claims and Part C claims is that the latter are governed by a three-year statute of limitations, while Part B claims are not.23

The operative transition date for determining the applicable eligibility standards for a particular claim is not the same as the operative transition date which governs liability for claim benefits. Whether a claim is a Part B claim or a Part C claim usually determines the applicable eligibility standards; the operative transition date for determining whether a claim is a Part B claim or a Part C claim is December 31, 1973. The operative transition date concerning liability is, as is discussed hereinabove, June 30, 1973. Claimants filing between June 30 and December 31, 1973, are Part B claimants, even though all benefits arising from such claims after December 31, 1973, are the financial responsibility of the coal mine industry.

II. THE APPLICABILITY OF EVIDENCE ADDUCED AFTER JUNE 30, 1973, TO CLAIMS ADJUDICATED BY THE SECRETARY OF HEALTH, EDUCATION AND WELFARE.

Mr. Begley, Mr. Spears and Mr. Nutter all seek to invoke an interim rebut-table presumption of total disability which is set out at 20 C.F.R. § 410.-490(b) (1974). This section creates, inter alia, a rebuttable presumption of total disability due to pneumoconiosis if certain pulmonary function test values are less than or equal to specified values set out by the Secretary of Health, Edu*909cation and Welfare pursuant to 30 U.S. C. § 921(a) and (b). The heading of § 410.490 is as follows: “Interim adjudicatory rules for miners for certain Part B claims filed by a miner before July 1, 1973 . . . .” Since the interim standards established by the Secretary are considerably lower than his permanent pulmonary function standards, cf. 20 C.F.R. § 410.490(b) with 20 C.F.R. § 410.426(b), the plaintiff miners in the cases before this Court are anxious to establish their entitlement to the interim presumptions.

The Secretary of Health, Education and Welfare stated at 20 C.F.R. § 410.-490(a) that the purpose of the interim presumption was “to permit prompt and vigorous processing of the large backlog of claims” which was generated by restrictive application of the 1969 act. In promulgating such a regulation, the Secretary could have limited it in such a way that the interim standards applied only to pulmonary function test values taken on or before June" 30, 1973. Or he might have provided that the standards would apply to test values taken after that date, if the values were found to relate back to that date. He did neither. The regulation by its terms applies to all claims filed by miners on or before June 30, 1973; it does not establish any date of onset of disability which must be met.

The Secretary argues before this Court, however, that June 30, 1973, is the onset date of disability which is applicable to all miners who filed claims against the United States. Relying upon 30 U.S.C. § 923(b) and 42 U.S.C. § 423(b), he asserts that if a claim was submitted on or before June 30, 1973, and evidence shows the requisite disability as occurring after that date but before final adjudication of the claim by the Secretary, the claim was not “effectively filed” under the black lung statute until after June 30, 1973. In his brief in the Begley case, the Secretary states:

For example, if an individual filed an application for Black Lung benefits in April 1973 and no evidence establishes that he is totally disabled due to pneumoconiosis on or before June 30, 1973, the Social Security Administration must determine that he is not entitled to Part B benefits. Evidence that may show the individual to be totally disabled at a later date, as in October 1973, may not be considered by the Social Security Administration, since a determination that he meets the requirements for entitlement to benefits would render his application effectively filed in October 1973, after expiration of the Administration’s jurisdiction. The individual’s claim thus must be filed with the Department of Labor.

A comparable statement may be found in the decision of the Appeals Council in Mr. Begley’s case:

[I]t must be noted that the Social Security Administration has jurisdiction for the payment of black lung benefits in live miner claims only through June 30, 1973. Thereafter, jurisdiction passed to the Department of Labor. Thus, a live miner must not only file a valid application prior to July 1, 1973, but must also establish that he was totally disabled prior to that date.

As has been noted hereinabove, June 30, 1973, is the operative transition date which determines whether the United States or the coal mine industry is responsible for paying the bulk of the benefits arising from a given claim. December 31, 1973, is the transition date which effects the eligibility standards which a claimant must meet to prove a claim. The June 30 date also determines who will adjudicate a claim, but a claim submitted in the second half of 1973 is to be determined by the same eligibility standards which apply to claims filed before July 1, 1973. Congress recognized that the date had jurisdictional importance, and provided, at 30 U.S.C. § 925,24 that claimants desiring to file between June 30 and Decem*910ber 31, 1973, could do so at the district offices of the Social Security Administration even though such a claim would be adjudicated by the Secretary of Labor. It is difficult to read § 925 and conclude that “filing a claim” means anything more than submitting an appropriate piece of paper to the appropriate agency. The only “transfer of jurisdiction” contemplated by the section is that claims might be submitted in writing during the latter half of 1973 to the Secretary of Health, Education and Welfare and thereafter transferred to the Secretary of Labor, who has exclusive jurisdiction pursuant to § 925(a)(1) to decide such Part B claims.

The defendant Secretary’s argument, that a claim is not “filed” for jurisdictional purposes until there is evidence of the requisite total disability, is derived from reliance upon 30 U.S.C. § 923(b), which provides, in pertinent part, that

In carrying out the provisions of this part [i. e., Part B], the Secretary [of Health, Education and Welfare] shall to the maximum extent feasible (and consistent with the provisions of this part) utilize the personnel and procedures he uses in determining entitlement to disability insurance benefit payments under [42 U.S.C. § 423],

The Secretary argues that this incorporation by reference of 42 U.S.C. § 423 [and, in particular, of 42 U.S.C. § 423(b)] in effect establishes June 30, 1973, as the onset date of disability which must be met by black lung claimants who have filed claims against the United States.

It must be borne in mind that 30 U.S. C. § 923(b) incorporates the personnel and procedures utilized by the Secretary under the Social Security Act only to the extent that such procedures are “consistent with the provisions” of Part B of the black lung statute. An examination of 42 U.S.C. § 423(b) reveals that its terms may be applied meaningfully to the Secretary’s administration of Part B claims without the result that the Secretary urges.

Three sentences comprise 42 U.S.C. § 423(b). The first is as follows:

An application for disability insurance benefits filed before the first month in which the applicant satisfies the requirements of such benefits (as prescribed in subsection (a)(1) of this section) shall be deemed a valid application only if the applicant satisfies the requirements for such benefits before the Secretary makes a final decision on the application.

This sentence permits the applicant for disability insurance benefits to introduce evidence of disability until such time as his claim has been finally adjudicated. The provision is remedial rather than restrictive in nature, permitting a claimant the opportunity of proving his disability prior to the Secretary’s final adjudication even if there was no probative evidence of the requisite disability before or at the time of the Secretary’s initial determination of the claim. The similar effect of the sentence upon the Secretary’s adjudication of black lung claims is to require that he receive evidence of disability until final adjudication, even if no evidence exists which tends to show that the miner was disabled at the time he filed his claim.

The second sentence of 42 U.S.C. § 423(b) is as follows:

If, upon final decision by the Secretary, or decision upon judicial review thereof, such applicant is found to satisfy such requirements, the application shall be deemed to have been filed in such first month.

This provision has applicability to black lung claims insofar as it limits benefits to those benefits accruing from the first month concerning which there is evidence of the requisite disability. Thus, if a miner files a claim on June 30, 1973, and the first evidence of the requisite disability concerns August of 1973, the miner is entitled to benefits begin*911ning in August, not June. So construed, the second sentence of 42 U.S.C. § 423(b) augments the provisions of Part B of the black lung statute without modifying the jurisdictional standards set out, on the face of the statute, at 30 U. S.C. § 925.

The third sentence of 42 U.S.C. § 423(b) is as follows:

An individual who would have been entitled to a disability insurance benefit for any month had he filed application therefor before the end of such month shall be entitled to such benefit for such month if such application is filed before the end of the 12th month immediately succeeding such month.

This sentence establishes a one-year statute of limitations upon the availability of retroactive disability insurance benefits. If, for example, an insured individual suffers the requisite disability on the first day of 1970, but does not file his claim until the first day of 1972, he is entitled only to benefits accruing after the first day of 1971. This provision augments those found in Part B of the black lung statute, and would therefore appear to be applicable- to Part B claims.25

The Secretary’s reliance upon the second sentence of 42 U.S.C. § 423(b) in the context of claims for black lung benefits is, in the judgment of this Court, simply misplaced. The effect of § 423(b) upon Social Security Act claims is, on occasion, to limit the availability of benefits; this is because a section of the Social Security Act which is not incorporated by reference into the black lung statute, 42 U.S.C. § 416,26 establishes an onset of disability deadline which is related to the length of time which has elapsed since the claimant’s last covered employment. See, e. g., Henry v. Gardner, 381 F.2d 191, 195 (6th Cir.), cert. denied 389 U.S. 993, 88 S.Ct. 492, 19 L.Ed.2d 487 (1967); Boles v. Celebrezze, 210 F.Supp. 856, 857 (W.D.Va.1962). No counterpart to the onset of disability provision at 42 U.S.C. § 416 exists in the black lung statute.

*912III. CONCLUSION

The jurisdiction of the Secretary of Health, Education and Welfare to adjudicate claims filed against the United States under the black lung statute, 30 U.S.C. § 901 et seq., does not depend upon the vagaries of proof in each case. He has exclusive jurisdiction to adjudicate all claims submitted before July 1, 1973, and he must consider all probative evidence offered by a claimant prior to final adjudication. In determining the validity of such claims, the Secretary must apply the Part B standards of eligibility in weighing any evidence submitted prior to such final determination.

The interim presumptive criteria promulgated by the Secretary and set out at 20 C.F.R. § 410.490(b) are by the terms of the section applicable to all Part B claims filed before July 1, 1973. There being no onset of disability provision in § 410.490(b), this presumption, like others created by the statute and the regulations, is applicable to evidence submitted before final adjudication by the Secretary of such Part B claims.

Although Mr. Begley, Mr. Spears and Mr. Nutter each had preJune 30, 1973 pulmonary function readings which did not meet the interim criteria at § 410.490(b), each also had readings which did meet these criteria and which were made a part of the record before the Secretary’s final decision was rendered. These miners are therefore entitled to the § 410.490(b) rebut-table presumption of total disability due to pneumoconiosis. Since the Secretary did not afford these plaintiffs this presumption, these cases must be remanded.

For the reasons set forth hereinabove, these cases are remanded to the Secretary of Health, Education and Welfare for proceedings consistent with the views expressed in this opinion.

So ordered.

Begley v. Weinberger
400 F. Supp. 901

Case Details

Name
Begley v. Weinberger
Decision Date
Aug 18, 1975
Citations

400 F. Supp. 901

Jurisdiction
United States

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