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A coal miner is entitled to black lung benefits under a provision of the Patient Protection and Affordable Care Act, the 7th U.S. Circuit Court of Appeals has ruled.
The court in Consolidation Coal Co. v. Director, Office of Workers' Compensation Programs, United States Department of Labor addressed a 15-year presumption on causation of black lung that was reinstated as part of the PPACA.
Congress first adopted the presumption in 1972 as part of the Black Lung Benefits Act. It held that for workers who toiled in coal mines for at least 15 years, their totally disabling pulmonary or respiratory impairment is caused by pneumoconiosis under the law. Pneumoconiosis is commonly called black lung.
While Congress removed that presumption in 1981, it was later revived under the PPACA for claims filed after Jan. 1, 2005, that were still pending on or after March 23, 2010.
In the case decided Thursday, Consolidation Coal employed George Bailey at a surface mine in Illinois for 26 years, where he primarily operated bulldozers, the opinion states. He suffers from obstructive pulmonary disease.
Over the years, he filed four claims for black lung benefits. Three were considered when the 15-year presumption was withdrawn from the Black Lung Benefits Act. Two of those claims were denied, and Mr. Bailey withdrew the third, according to the opinion.
He filed the most recent claim in 2007 and, because he filed previously rejected claims, he had to show that there had been a “change in condition.” While his claim was under consideration, Congress restored the presumption under PPACA and an administrative law judge awarded benefits for total pulmonary impairment.
The judge determined that Mr. Bailey's medical condition had worsened, making him totally disabled. Applying the 15-year presumption, the judge held that Mr. Bailey could establish pneumoconiosis caused in part by exposure to coal dust.
A federal Benefits Review Board upheld the finding and Consolidation Coal appealed, arguing that the judge incorrectly applied the 15-year presumption to find a change in Mr. Bailey's medical condition. The employer also argued that Mr. Bailey was a longtime smoker.
“Consolidation Coal's primary argument is that the 15-year presumption cannot be used to establish an element of entitlement for purposes of demonstrating a change in medical condition,” a three-judge panel of the appeals court ruled unanimously.
But the Chicago-based appeals court said relevant statutory language does not support Consolidation's contention. It said the judge correctly determined that the 15-year presumption applied to Mr. Bailey's subsequent claim inquiry.
“The (administrative law judge) addressed evidence relating to Bailey's health and his smoking history, and delivered a decision rational, supported by substantial evidence, and consistent with governing law,” the opinion states.