Cedar Coal Company v. Director, DOWCP - Black Lung Benefits Decision

PUBLISHED UNITED STATES COURT OF AP PEALS FOR THE FOURTH CIRCUIT No. 24 - 1063 CEDAR COAL COMPANY, Petitioner, v. DIRECTOR, OFFICE OF WORKERS ’ COMPENSAT ION PROGRAMS, UNITED ST ATES DEPART MENT OF LAB OR; KAREN V ENA MULLIN S, on behalf of the Estate of Roger L. Mullins, Respondents. On Petition for Review of an Order of th e Benefits Review Board. (22 - 0539 - BLA) Argued: January 30, 2026 Decided: March 6, 2026 Before THACKER and RI CHARDSON, Circuit Jud ges, and KEENAN, Senior Circuit Judge. Denied by publis hed opinion. Judge Thacker wrote the opinion, in which Ju dge Richards on and Jud ge Keenan j oined. ARGUED: Michael A. Kawash, ROBINSON & MCELWEE, PLLC, Charleston, West Virginia, for Petitioner. Samu el Brown Petsonk, PETSONK PLLC, Oak Hill, West Virginia; Jeffrey Steven Goldberg, UNITED STATES DEPARTMENT OF LABOR, Washington, D.C., for Respondents. ON BRIEF: Mark J. Grigoraci, ROBINSON & MCELWEE, PLLC, Charleston, West Virginia, for Petitioner. Seema Nanda, Solicitor of Labor, Barry H. Joyner, Associate Solicitor, Jennifer Feldman Jones, Deputy Associate

2 Solicitor, Michael P. Doy le, Office of the Solicitor, UN ITED STATES DEPARTMENT OF LABOR, Washington, D.C., for F ederal Respondent. Bren J. Pomponio, MOUNTAIN STATE JUSTICE, INC., Charleston, West Virginia, for Respond ent Roger L. Mullins.

3 THACKER, Circuit Judge: Roger Mullins filed the instant claim for Black Lung benefits on December 12, 2012, alleging that he was totally disabled due to pulmonary disease caused by coal dust. After his claim was denied, Mullins filed a request for modification in 2019, in which he alleged that the earlier Admin istrative Law Judge (“ALJ”) had made a mistake of fact an d that there had been a chan ge in conditions. After a hearing, the ALJ gran ted Mullins’ request for modification, found him totally disabled due to legal pneumoconio sis, and awarded black lung benefits. Cedar Coal Company (“Petitioner”), Mu llins’ last coal mine employer who was ordered responsible for paying benefits, appealed the ALJ’s order to the Benefits Review Board (“B RB”), which affirmed the award of benefits. In this Petition for Review, Petitio ner argues that the ALJ’s award of benefits should be vacated because Mullins presented affirmativ e evidence in excess of the regulatory limitations, and b ecause the ALJ’s finding of legal pneumoconiosis was not supported by substantial evidence. We disagree with both contentions and deny the petition for review. I. A. For context, we begin with a brief discussion of the statutory and regulatory framework. The Black Lun g Benefits Act creates an adversarial administrative p rocedure designed to determine whether co al miners qualify for compensatory b enefits because they suffer from coal dust related pulmonary injuries, referred to as pneumoconi osis, and are totally disabled as a result. See 30 U.S.C. §§ 901 – 944.

4 “The courts have long recognized that pneumoconiosis can take two forms: ‘clinical’ pneumoconiosis and ‘legal’ pn eumoconiosis.” Harman Mining Co. v. Dir., Off. of Workers’ Co mp. Programs, 678 F.3d 305, 30 8 (4th Cir. 2012). While “clinical pneumoconiosis looks for the presence of p articles in the lungs and the lungs’ reaction to those particles, legal pneumoconiosis does not require evidence of particles in the miner’s lungs.” Extra Energy, Inc. v. Lawson, 140 F.4th 138, 1 44 (4th Ci r. 2025) (cleane d up). Relevant here, the Dep artment of Labor (“DOL”) regulations define leg al pneumoconiosis as “any chron ic lung disease or impairment and its sequelae” -- including, but not limited to, “any chro nic restrictive or obstructive pulmonary disease” -- that “aris[es] out of coal mine employment.” 20 C.F.R. § 718.201(a)(2). A disease “ arising out of coal mine employment ” n eed not be solely caused by coal dust. See Extra Energy, 140 F. 4th at 144. Instead, legal pneumoconiosis “includes any chronic pulmonary disease or respiratory o r pulmonary impairment significantly related to, o r substantially aggravated by, dust expo sure in coal mine employment.” 20 C.F. R. § 718.201(b). And, “[b]ecause ‘by definition, legal pneumoconiosis arises o ut of coal mine employment,’ a diagnosis of legal pneumoconiosis automatically satisfies the causal requirement between coal mine employment and the impairment.” Extra Energy, 140 F.4th at 145 (quoting Am. Energy, LLC v. Dir., Off. of Workers’ Comp. P rograms, 106 F.4th 319, 325 (4th C ir. 2024)). In the ordinary case, a miner seeking benefits bears the burden of proof. To be awarded benefits, a miner must prove four elements by a preponderance of the evidence: “(1) that he has [either clinical o r legal] pneumoconiosis; (2) ar ising out of coal mine

5 employment; (3) that he is totally disabled by a pulmonary or respiratory impairment; and (4) that his pneumoconiosis is a substantially contributing cause of that total disability.” Extra Ene rgy, 140 F.4th at 144 – 45. T he DOL regulations set forth ev identiary limits applicable to claims for black lung benefits: The claimant is entitled to submit, in support of his affirmative case, no more than two chest X – ray interpretations, the results of no more th an two pulmonary function tests, the results of no more than two arterial blood gas studies, no more than one report of an autopsy, no mo re than one report of each b iopsy, and no more than two medical reports. 20 C.F.R. § 725.414(a)(2)(i). Importantly, “[n ]otwithstanding the limitations in paragraphs (a)(2) and (a)(3) 1 o f this section, any record of a miner’s hospitalization for a respiratory or pulmonary or related disease, or medical treatment for a resp iratory or pulmonary or related disease, may be received in to evidence.” Id. § 725.414 (a)(4). A nd, relevant here: [A] medical report is a physician’s written assessment of the miner’s respiratory or pulmonary condition. A medical report may be prepared by a physician who examined the miner and/or reviewed the available admissible evidence . . . . A physician’s written assessment of a sin gle objective test, such as a chest X – ray or a pu lmonary function test, is not a medical report for purposes of this section. Id. § 725.414(a)(1). 1 Subsection (a)(3) sets forth the evidence limits applicable to the coal operator’s affirmative case and is no t relevant to this appeal.

6 B. Before the ALJ, Mullins presented evidence t o demonstrate he had totally d isabling legal pne umoconi osis. Mullins presented two affirmative x - ray readings; two rebuttal x - ray readings; two affirmative pulmonary fun ction tests (“PFTs”); med ical reports from Dr. J. Ran dolph Forehand and Dr. Leonard Go; and treatment r ecords from Dr. Sammar Atassi, Mullins’ treating physician. The two PFTs Mullins identified as affirmative evidence were dated September 11, 2019, and Jan uary 21, 2021. In addition, the results of several other PFTs were su bmitted as treatment records, because those PFTs were performed as part of Mullins’ medical treatment and not simply for the purpose of evaluating his claim for benefits. 20 C. F.R. § 725.414(a)(4). Relevant h ere, Dr. G o considered and offered his “interpretation” of all of the PFTs in his medical report -- the two affirmative evidence tests, as well as all those includ ed in Mullins’ admissible treatment records. J.A. 79 – 82. 2 Dr. Go explained, “I provided m y own analys is of the individual test [s] as well as the analysis provided by the original physician.” Id. at 225. Both Dr. Go and Dr. Forehand determined that Mullin s is totally disabled due to legal pneumoc oniosis. Petitioner, as the party opposing Mullins’ request for benefits, offered two x - ray readings; medical reports by Dr. Mohammed Ranavaya, Dr. G eorge Zaldivar, and Dr. Dav id Rosenburg; a transcript of D r. Go’s deposition, and treatment re cords from 2 C itations to the “J.A.” refer to the Joint App endix filed by the parties in t his appeal.

7 Montgomery General Hospital and Dr. Attasi. While Petitioner’s experts agreed that Mullins is totally disabled, they concluded that he d oes not suffer from legal pneumoc oniosis at all. Instead, Drs. Ranavaya, Zaldivar, and Rosenburg concluded that Mullins’ pulmonary impairment was caused by asthma, a coronary bypass surgery, and obesity. 3 Petitioner’s experts were of the opin ion that Mullins’ pulmonary impairment was attributable to asthma based on Mullins’ supp osed “very significant” response to bronchodilators during PFTs. J.A. 776 – 81. But Drs. Forehand and Go disagreed that Mullins’ response to bronchod ilators was significant and instead characterized it a s “minimal” because, even after receiving bronchodilators, Mu llins’ pulmonary function still did not meet the American Thoracic Society definition of “reversibility” 4 and still fell within the DOL stand ard for total disability. Id. at 766 – 67, 76 9 – 71. As to the coronary bypass surgery, Dr. Rosenburg opined that it was a caus e of Mullins’ pulmonary impairment because the surgery was performed by sternotomy. 5 3 But, of note, the record demonstrated that Mullin s’ body mass index did not classify him as obese. 4 R eversibility refers to the reduction in airway obstru ction that results when bronchodilator medications are ad ministered to a person w ith a reversible airway obstruction. 5 A sternotomy is “a procedure to create access to [th e] heart” in which a “surg eon cuts through [the] breastbone or st ernum and spreads the two sides apart to be able to see and operate on [the] heart.” Sternotomy, Clevelan d Clinic, https://my.clevelandclinic.org/health/treatments/24016 - sternoto my [https://perma.cc/DC9J - QKML ].

8 Even still, Dr. Rosenburg acknowledged that “reductions [in pulmonary function] from sternotomy [are] uncommon.” J.A. 780. A s Dr. Forehand explained, “[w]ithout significant surgical complication s, coronary artery bypass graft surgery also w ill not cause a totally disabling restrictive lung disease. [Mullins’] treatment records make no mention of any surgical complication s.” Id. at 766. The ALJ considered all of the evidence, including all of the m edical reports, and concluded that the reports by Dr. Go and D r. R anavaya were entitled to the most weigh t. However, because Dr. Go diagnosed Mullins with legal pneu moconiosis and Dr. Ranavaya did not, the ALJ explained that she was required to “ distinguish between th e two and determine which opinion deserves the greatest weight.” J.A. 785. To make this determination, the ALJ concluded that Dr. Go’s assessment of the effect of bronchodilators was “slightly more persuasi ve.” Id. A nd she concluded that Dr. Go’s “relevant experience in black lung disease outweighs the experience of Dr. Ranavaya,” such that Dr. Go was “better q ualified to evaluate [Mullin s ] for legal pneu moconiosis.” Id. at 785 – 86. Based on these findings, the ALJ awarded benefits, conclud ing that Mullins suffer s from totally disabling legal pneumoconiosis. II. “[O]ur review of the Bo ard’s order is limited and is g overned by the same standard the Board applies when reviewing an ALJ’s decision.” Extra Energy, Inc. v. Lawson, 140 F.4th 13 8, 146 (4th Cir. 2025) (cle aned up). “That standard is de novo for legal conclusi ons but highly deferential for factual findings.” Id.

9 Where a case involves competing medical opinions, “[w ]e defer to the ALJ’s determination regarding the proper weight to be accorded competing medical evidence, and we must be careful not to substitute our judgment for that of the ALJ.” Extra Energy, 14 0 F.4th at 146 (quotin g W. Va. CW P Fund v. Bender, 782 F. 3d 129, 144 (4th Cir. 2015)). “‘[A]s trier of fact, t he ALJ is not bound to accept the opinion or theory o f any medical expert,’ but instead ‘must ev aluate the evidence, weigh it, and draw [her] own concl usions.’” Bender, 782 F.3d at 1 44 (citation omitted). To be sure, “an ALJ may not credit or discredit exp ert testimony for no reason or for the wro ng reason.” Sea “B” Mining Co. v. Addi son, 831 F. 3d 244, 25 7 (4th Cir. 2016) (internal quotation marks and citation omitted). But at bottom, “[i]t is the role of th e ALJ — not the appellate court — to resolve” a “battle of the experts.” Westmoreland Coal Co. v. Cochran, 718 F.3 d 319, 321, 324 (4th Cir. 2013). “Therefore, we will not disrupt the ALJ’s decision to credit the opinion of one expert over another.” Bender, 782 F. 3d at 145. “Rather, the duty to resolve conflicts in the evidence rests with the AL J as factfinder. And when conflicting evidence allows reasonable minds to differ as to whether a claimant is disabled or has pneumoconiosis, the responsibility for that decision falls on the ALJ.” Sea “B” Mini ng, 831 F.3d at 252. “We will not disturb an AL J’s factual finding, ‘even if we d isagree with it, provided the determination is supported by substantial eviden ce.’” Am. Energy, LLC v. Dir., Off. of Wo rkers’ Comp. Programs, 106 F.4th 319, 330 (4th Cir. 2024) (citation omitted). “To evaluate whether substantial ev idence supports an ALJ’s determination, we consider whether all of the relevant evidence h as been analyzed and whether the ALJ

10 has sufficiently explained [h er] rationale in crediting certain evidence.” Extra Ener gy, 140 F.4th at 146 (qu oting Hobe t Minin g, LLC v. Epl ing, 783 F. 3d 498, 504 (4t h Cir. 2015)). “Th e ALJ’s duty of explanation is satisfied if a reviewing court can discern what the ALJ di d and why [she ] did it.” Id. (alterations and intern al quotation marks omitted) (quoting Island Creek Coal Co. v. Blankensh ip, 123 F. 4th 684, 6 95 (4th Cir. 2024)). III. A. Petitioner first argues that the ALJ’s award o f benefits should be reversed becaus e Dr. Go’s medical repo rt violated the evidence limits applicable here. As explained above, the relevant regulations limit claimants to submission of two PFTs as affirmative evidence. 20 C.F.R. § 725.414(a)(2)(i). But “[n]otw ithstanding th[at] limitation[]” any treatment record “may be received into evidence.” Id. § 725.414(a)(4). And medical reports are “prepared by a physician who examined the miner an d/or reviewed the available admissible evidence.” Id. § 725.414(a)(1). Petitioner argues that Dr. Go’s medical report violated these evidentiary limits because Dr. Go “includ e[d] separate, individual interpretations o f numerous [PFTs], which makes those [PFTs] affirmative evidence in excess of the evidence limitations.” Opening Br. at 13. Pet itioner argues that Dr. Go was not permitted to provid e analysis or interpretation of the PFTs in Mu llins’ treatment records that were no t identified as affirmative evidence. And by doing so, Petitioner argu es, Dr. Go converted the trea tment records into affirmative evidence. Petitioner is wrong.

11 The regulations anticipate that the m edical report will analyze more than th e two affirmative PFTs because they specify that “ [a] n y . . . pulmonary function test results . . . that appear in a medical repo rt must each be admissible under [§ 725.414(a)(2) or (a)(4).].” 20 C.F.R. § 725.414(a)(2)(i). And, of course, subsection (a)(2) specifies the limits on affirmative evidence wh ile subsection (a)(4) allows for the ad mission of treatment records “[n]otwithstanding the limitations in p aragraph(2).” Thus, because PFTs included in treatment record s are admissible evidence, a physician may consider them in offering h is medical report “assess[ing] [] the m iner’s respiratory or pulmonary condition,” id. at § 7 25.414(a), without transforming tho se PFTs into affirmative evidence. As the ALJ below explained in rejecting Petitioner’s argument, “this is why you do medical records reviews[.]” J.A. 33. The point is “to have your expert look at a larg e body of medical evidence and to opine on what conclusions they’re d rawing from looking at that large body of medical evidence.” Id. There is no reason why, under t he governing regulations, a physician shou ld be prohibited from considering all of the available admissible evidence in forming an opinion as to the existence of pneumoc oniosi s. Reviewing and interpreting results contained in admissible treatment records to form a medical op inion does not transform those results into affirmative evidence. B. Petitioner next lodges two related ch allenges to the ALJ’s finding of leg al pneumoc oniosis. First, Petitioner argues that the ALJ err ed in crediting Dr. Go’s opinion

12 and discrediting the opinions of Dr. Rosenberg and Dr. Zaldivar. Petition er argues that the ALJ did not “properly examine[] the logic and ratio nale of the physicians.” Opening Br. at 18. Next, P etitioner as serts that the ALJ’s finding that Mullins is totally disabled due to pne umoconi osis is not supported by substantial evid ence. In our view, these issues amo unt to a question of “whether the ALJ erred in resolving [a] battle of the experts.” Extra Energy, Inc. v. Lawson, 140 F.4th 1 38, 146 (4th Cir. 2025) (cleaned up). A s we have explained, our review in such a situation is only to ensure the ALJ has consid ered “all of the relevant evid ence” and “sufficiently explained [her] rationale.” Id. The ALJ’s “duty of explanation is satisfied i f [we] can discern what the ALJ did and why [sh e] did it.” Id. We have reviewed the ALJ’s thorough explanation of her rationale for crediting Dr. Go’s opinion and discrediting the o pinions of Dr. Rosenberg and Dr. Zaldivar. And w e have no trouble concluding that the AL J adequately consider ed all of th e evidence and explained her reasoning whe n weighing the medical rep orts. In argui ng to the contrary, Petitioner is, in essence, asking us to reweigh the evidence ourselves. That, w e will not and cannot do. As to the ALJ’s finding that Mullins’ legal pneumoconiosis caused his total disability, again the record supports this finding. Indeed, it is Petition er’s position that is not suppor ted. “L ong - standing precedent establishes that a med ical opinion premised on an erroneous finding that a claimant does not suffer from pneumoconiosis is ‘not worthy of much, if any, weight,’ particu larly with respect to whether a claiman t’s disability was caused by that disease. ” Hob et Mining, LLC v. Epling, 783 F.3d 498, 504 (4th Cir. 2015)

13 (quoting Grigg v. Dir., Office of Workers ’ Comp. Programs, 28 F.3d 41 6, 419 (4t h Cir. 1994)). “This is a common - sense rule, for the credib ility of a doctor ’ s judgment as to whether pneumoconiosis is a cause of a miner ’ s disability is necessarily influenced by the accuracy of his underlying diagno sis.” Id. “T hus, opinions that erroneously fail to diagnose pneumoconiosis may not be credited at all, unless an ALJ is able to identify specific and persuasive reasons f or concluding that the doctor’s judgmen t on the question of disability causation does not rest up on the predicate misdiagnosis.” Id. (cleaned up). The ALJ explained that she discredited Dr. Ranavaya, Dr. Rosenberg, and Dr. Zaldivar’s opinions because they “failed to diagnose [Mullins] with legal pneumoc oniosis, and [they] subsequ ently did not attribute his respiratory impairment to legal pneumoconiosis.” J.A. 79 7. And because Dr. Forehan d and Dr. Go offered well reasoned a nd supp orted o pinion s that pne umoconi osis was the cause of Mullins’ total disability, the ALJ credited th eir opinions. H ere, too, the ALJ adequately explained wh at she did and w hy she did it. Therefore, we find th e ALJ’ s opinio n to be supp orted by substantial evidence. IV. Because we conclude that Dr. Go’s medical repo rt did not violate the limitations on affirmative evidence and that the ALJ’s finding of totally disabling legal pneumoconiosis is supported by substan tial evidence, the petition for review is DENIED.