West Virginia CWP Fund v. Page Bender, Jr.

PUBLISHED

UNITED STATES COURT OF APPEALS
FOR THE FOURTH CIRCUIT

No. 12-2034

WEST VIRGINIA CWP FUND, as insurer for Logan Coals, Inc.,

Petitioner,

v.

PAGE BENDER, JR.; DIRECTOR, OFFICE OF WORKERS’ COMPENSATION
PROGRAMS, UNITED STATES DEPARTMENT OF LABOR,

Respondents.

On Petition for Review of an Order of the Benefits Review Board.
(11-0683-BLA; 10-BLA-5257)

Argued: January 29, 2015 Decided: April 2, 2015

Before KEENAN, FLOYD, and HARRIS, Circuit Judges.

Petition for review denied by published opinion. Judge Keenan
wrote the opinion, in which Judge Floyd and Judge Harris joined.

ARGUED: William Steele Mattingly, JACKSON KELLY PLLC,
Morgantown, West Virginia, for Petitioner. Sean Gregory
Bajkowski, UNITED STATES DEPARTMENT OF LABOR, Washington, D.C.;
Roger Daniel Forman, LAW OFFICE OF ROGER D. FORMAN, Buckeye,
West Virginia, for Respondents. ON BRIEF: M. Patricia Smith,
Solicitor of Labor, Rae Ellen James, Associate Solicitor, Maia
S. Fisher, Deputy Associate Solicitor, Gary K. Stearman, Counsel
for Appellate Litigation, Office of the Solicitor, UNITED STATES
DEPARTMENT OF LABOR, Washington, D.C., for Respondent Director,
Office of Workers' Compensation Programs, United States
Department of Labor.
BARBARA MILANO KEENAN, Circuit Judge:

In this appeal, we consider the validity of an

administrative regulation and its evidentiary standard under

which coal mine operators may rebut a presumption of disability

that otherwise qualifies certain coal miners for benefits under

the Black Lung Benefits Act, 30 U.S.C. §§ 901 through 945.

Logan Coals, Inc. 1 (the operator) seeks review of a decision of

the Benefits Review Board affirming an administrative law

judge’s (ALJ) award of benefits to Page Bender, Jr. under the

Act. Because Bender had worked as an underground coal miner for

21 years and suffered from a totally disabling respiratory

condition, the ALJ applied to Bender’s claim a rebuttable

presumption of total disability due to pneumoconiosis, as

provided by 30 U.S.C. § 921(c)(4) and 20 C.F.R. § 718.305. 2

After considering the medical evidence, the ALJ concluded that

the operator had not rebutted the presumption of total

disability due to pneumoconiosis by “ruling out” any causal

1
The named petitioner in this appeal is the West Virginia
Coal Workers’ Pneumoconiosis Fund, insurer for Logan Coals, Inc.
2
As discussed further below, at the time the ALJ and the
Board rendered their decisions, the current version of Section
718.305 was not yet in effect. The parties agree that the
current version of the regulation applies to this case and is
substantively identical to the standard used by the ALJ. See 20
C.F.R. § 718.305(a) (explaining that the presumption applies to
“all claims filed after January 1, 2005, and pending on or after
March 23, 2010”).

2
relationship between Bender’s pneumoconiosis and his disability.

The ALJ therefore awarded black lung benefits to Bender, and the

Benefits Review Board affirmed the ALJ’s decision.

In its petition for review, the operator argues that the

ALJ erred in applying the “rule-out” rebuttal standard. We

disagree and hold that the Department of Labor acted within its

regulatory authority in requiring coal mine operators to show,

in the case of miners who meet the statutory criteria for the

presumption, that “no part of the miner’s respiratory or

pulmonary total disability was caused by pneumoconiosis.” 20

C.F.R. § 718.305(d). We also hold that the ALJ’s decision is

supported by substantial evidence. Accordingly, we affirm the

award of benefits and deny the operator’s petition for review.

I.

We begin by stating the statutory and regulatory framework,

including certain pertinent history. The Black Lung Benefits

Act (the Act), 30 U.S.C. §§ 901 through 945, was first enacted

in 1969. 3 See Pauley v. BethEnergy Mines, Inc., 501 U.S. 680,

683-84 (1991) (describing history of the Act). The Act is

intended “to provide benefits . . . to coal miners who are

totally disabled due to pneumoconiosis [(black lung disease)]

3
The Act was originally titled the Federal Coal Mine Health
and Safety Act of 1969, 91 Pub. L. No. 173, 83 Stat. 792.

3
and to the surviving dependents of miners whose death was due to

such disease.” 30 U.S.C. § 901(a).

In general, to establish an entitlement to black lung

benefits, a miner must show: “(1) that he has pneumoconiosis, in

either its ‘clinical’ or ‘legal’ form; (2) that the

pneumoconiosis arose out of coal mine employment; (3) that he is

totally disabled by a pulmonary or respiratory impairment; and

(4) that his pneumoconiosis is a substantially contributing

cause of his total disability.” Mingo Logan Coal Co. v. Owens,

724 F.3d 550, 555 (4th Cir. 2013) (citing 20 C.F.R.

§§ 725.202(d)(2), 718.204(c)(1)). Pneumoconiosis is a

“substantially contributing cause” of a miner’s disability if

the pneumoconiosis (1) “[h]as a material adverse effect on the

miner’s respiratory or pulmonary condition” or (2) “[m]aterially

worsens a totally disabling respiratory or pulmonary impairment

which is caused by a disease or exposure unrelated to coal mine

employment.” 20 C.F.R. § 718.204(c)(1).

In 1972, Congress added to the Act a rebuttable presumption

of total disability due to pneumoconiosis (the presumption).

See Black Lung Benefits Act of 1972, 92 Pub. L. No. 303, 86

Stat. 150, 154; 30 U.S.C. § 921(c)(4) (2012). 4 The presumption

4
When referencing prior versions of the Act and certain
regulations, our citations refer to the date of the latest
(Continued)
4
is applicable to a miner’s claim if he worked for at least 15

years in underground coal mines, if a chest x-ray does not show

the presence of complicated pneumoconiosis, 5 and “if other

evidence demonstrates the existence of a totally disabling

respiratory or pulmonary impairment.” § 921(c)(4). Section

921(c)(4) also specifies the manner in which the Secretary of

Labor 6 (the Secretary) can rebut the presumption:

publication of the United States Code or Code of Federal
Regulations in which the relevant language appeared.
5
A miner suffering from complicated pneumoconiosis is
entitled to an irrebuttable presumption that he is totally
disabled due to pneumoconiosis. 30 U.S.C. § 921(c)(3).
6
At the time the presumption first was added to the
statute, the reference in Section 921(c)(4) to the “Secretary”
likely referred to the Secretary of Health, Education, and
Welfare, who was responsible for claims filed until June 30,
1973. Usery v. Turner Elkhorn Mining Co., 428 U.S. 1, 8, 35
(1976).
Such claims filed on or before June 30, 1973 were processed
by the Social Security Administration, and successful claims
were paid by the federal government. Mullins Coal Co. v. Dir.,
Office of Workers’ Comp. Programs, 484 U.S. 135, 138-39 (1987).
Claims filed on or after July 1, 1973 “are paid by private
employers or by a fund to which the employers contribute, and
they are administered by the Director of the Office of Workers’
Compensation Programs pursuant to regulations promulgated by the
Secretary of Labor.” Id. at 139.
Since January 31, 2003, the Department of Labor has been
responsible for administering the entirety of the black lung
benefits program. See Black Lung Consolidation of
Administrative Responsibility Act, 107 Pub. L. No. 275, 116
Stat. 1925 (2002). The current version of the Act specifies
that the term “Secretary” in the Act refers to the Secretary of
Labor. 30 U.S.C. § 902(c). Today, the federal government
through the Black Lung Disability Trust Fund pays black lung
(Continued)
5
 The Secretary may rebut such presumption only by
establishing that (A) such miner does not, or did not,
have pneumoconiosis, or that (B) his respiratory or
pulmonary impairment did not arise out of, or in
connection with, employment in a coal mine.

Four years after the presumption was added to the statute,

the Supreme Court decided Usery v. Turner Elkhorn Mining Co.,

428 U.S. 1, 35-37 (1976), holding that the rebuttal provision in

Section 921(c)(4) applied by its plain terms only to the

Secretary, not to coal mine operators opposing a miner’s claim

for benefits. Later, in 1980, the Department of Labor

promulgated a regulation implementing the statutory presumption

and clarifying the rebuttal standard for both the Secretary and

the coal mine operators (the original regulation). See

Standards for Determining Coal Miners’ Total Disability or Death

Due To Pneumoconiosis, 45 Fed. Reg. 13,678, 13,692 (Feb. 29,

1980); 20 C.F.R. § 718.305 (2012). The original regulation set

forth the rebuttal standard as follows:

Where the cause of death or total disability did not
arise in whole or in part out of dust exposure in the
miner’s coal mine employment or the evidence
establishes that the miner does not or did not have
pneumoconiosis, the presumption will be considered
rebutted. However, in no case shall the presumption
be considered rebutted on the basis of evidence
demonstrating the existence of a totally disabling

benefits to miners when, among other reasons, “there is no
operator who is liable for the payment of such benefits.” 26
U.S.C. § 9501(d)(1)(B).

6
 obstructive respiratory or pulmonary disease of
unknown origin.

§ 718.305(d) (2012) (emphasis added).

In 1981, however, Congress entirely eliminated the

statutory presumption from Section 921(c)(4) for claims filed on

or after January 1, 1982. See Black Lung Benefits Revenue Act

of 1981, 97 Pub. L. No. 119, 95 Stat. 1635. The original

regulation was amended in 1983 to reflect this statutory change,

but remained in effect as originally written for claims filed

before January 1, 1982. 7

The presumption was restored to the statute in March 2010,

as part of the Patient Protection and Affordable Care Act. See

Patient Protection and Affordable Care Act, 111 Pub. L. No. 148,

124 Stat. 119, § 1556 (2010). In reenacting this provision,

Congress used language identical to that employed in the

original statute. See 30 U.S.C. § 921(c)(4) (2012). This

revived statutory presumption remains in effect at the time of

this appeal.

In 2013, the Department of Labor promulgated a revised

regulation (the revised regulation, or the regulation), which is

7
Standards for Determining Coal Miner’s Total Disability or
Death Due to Pneumoconiosis; Claims for Benefits Under Part C of
Title IV of the Federal Mine Safety and Health Act, as Amended,
48 Fed. Reg. 24,272, 24,289 (May 31, 1983); see 20 C.F.R.
§ 718.305(e) (2013). The original regulation otherwise remained
unchanged until 2013.

7
at issue in this case. The revised regulation states the

following evidentiary standard that is required to rebut the

presumption:

In a claim filed by a miner, the party opposing
entitlement may rebut the presumption by--

(i) Establishing both that the miner does not, or
did not, have:

(A) Legal pneumoconiosis . . . ; and

(B) Clinical pneumoconiosis . . . , arising
out of coal mine employment . . . ; or

(ii) Establishing that no part of the miner’s
respiratory or pulmonary total disability was
caused by pneumoconiosis . . . .

20 C.F.R. § 718.305(d)(1) (2014) (emphasis added). Although the

language of the revised regulation differs in some respects from

the original regulation, both versions require that any party,

including a coal mine operator, who seeks to rebut the

presumption by disproving disability causation, “rule out” any

connection between a miner’s pneumoconiosis and his disability.

The validity of this “rule-out standard” as applied to coal mine

operators is the primary issue presented in this appeal.

II.

Bender, who was 60 years old at the time of the ALJ’s

decision, was employed in an underground coal mine for 21 years

and ended his work in the mines around 1995. Bender also smoked

8
between one and one half and two packs of cigarettes daily for

over 40 years, and continues to smoke three or four cigarettes

per day. Bender is in poor overall health, and was diagnosed

with lung cancer in 2007. As a result of his lung cancer,

Bender has undergone radiation and chemotherapy treatments, as

well as the removal of a portion of his lung. He also suffers

from diabetes, has undergone several bypass surgeries, and

receives oxygen at night and after physical exertion.

Bender filed a claim for black lung benefits in 2009. 8

After a hearing conducted in August 2010, the ALJ applied the

presumption to Bender’s claim in light of Bender’s 21-year

history of underground coal mine employment and the consensus of

all the medical experts that Bender suffers from a totally

disabling respiratory condition. Under the presumption, the

burden therefore shifted to the operator to disprove Bender’s

entitlement to benefits.

At the time of the ALJ’s decision, the Department of Labor

had not yet promulgated the revised regulation imposing the

current version of the rule-out standard for rebuttal of the

presumption. However, the ALJ applied an analogous rule-out

standard that this Court had used in the context of a previous

8
Bender had filed an earlier claim for benefits in 2003,
which was denied due to his failure to prove that he suffered
from a disability.

9
“interim” presumption, which required the operator to “rule out

any causal relationship between the miner’s disability and his

coal mine employment by a preponderance of the evidence” in

order to rebut the presumption. See Stiltner v. Island Creek

Coal Co., 86 F.3d 337, 339 (4th Cir. 1996); see also infra at

26-27 (discussing the interim presumption).

At the hearing before the ALJ in 2010, the operator offered

the expert opinions of three physicians to rebut the presumption

of Bender’s total disability due to pneumoconiosis. All three

agreed that Bender suffers from simple clinical pneumoconiosis.

The operator thus sought to rebut the presumption by

demonstrating that Bender’s respiratory disability was not

caused by his pneumoconiosis.

The first of the operator’s experts, Dr. Peter Tuteur,

chronicled Bender’s extensive medical history, including a

“multiplicity of cigarette smoke induced health problems.” Dr.

Tuteur opined that Bender’s lung cancer and other medical

conditions, including emphysema and chronic obstructive

pulmonary disease, were not “in any way related to, aggravated

by, or caused by the inhalation of coal mine dust or the

development of coal workers’ pneumoconiosis.” Dr. Tuteur

explained that he would have expected to find “decreased lung

expansion” and “inspiratory crackling sounds” if Bender’s

pneumoconiosis had been advanced enough to “produce

10
abnormalities on physical examination,” but that these

anticipated symptoms were not present. Dr. Tuteur therefore

concluded that Bender’s pneumoconiosis was “present but [had] no

clinical effect.”

Dr. Tuteur also stated that Bender’s disability was “not

caused in whole or in part by coal workers’ pneumoconiosis or

any other chronic lung disease arising out of coal mine

employment,” but instead resulted from Bender’s history of

smoking, lung cancer, and cancer treatments. In applying the

rule-out standard, the ALJ accorded Dr. Tuteur’s opinion little

weight because Dr. Tuteur failed to “explain how he can

determine that none of [Bender’s] impairment is due to coal dust

exposure.”

The operator’s second medical expert, Dr. George Zaldivar,

similarly testified that “all” of Bender’s impairment was

attributable to Bender’s lung surgery, cancer treatments, and

cigarette use. Dr. Zaldivar based his opinion in part on an

examination conducted seven years earlier by another doctor. At

that earlier time, Bender already had stopped working in the

mines and was exhibiting early signs of simple pneumoconiosis,

but had no pulmonary abnormalities. Because Bender had not

worked in a coal mine since that earlier examination, Dr.

Zaldivar attributed Bender’s respiratory deterioration to

smoking and lung cancer. Dr. Zaldivar concluded that “zero

11
percent” of Bender’s respiratory abnormalities were caused by

his coal mine employment. As with Dr. Tuteur, the ALJ accorded

little weight to Dr. Zaldivar’s analysis, because Dr. Zaldivar

did not “adequately explain why the worsened results could not

also be due to coal workers’ pneumoconiosis, which is a

progressive disease.”

And, finally, the operator offered the report of Dr. P.

Raphael Caffrey, who reviewed some surgical pathology slides

that included tissue taken from Bender’s lung in 2008. Dr.

Caffrey noted that lesions caused by pneumoconiosis occupied

less than five percent of Bender’s observed lung tissue. Dr.

Caffrey therefore concluded that Bender’s respiratory disability

was caused by the removal of lung tissue in treatment of his

cancer, not by pneumoconiosis.

Bender presented expert medical evidence from Dr. Donald

Rasmussen, who directly contradicted Dr. Caffrey’s opinion that

the presence of pneumoconiosis was too minimal to cause Bender’s

impairment. Dr. Rasmussen explained that “[a] finding of

limited pneumoconiosis certainly does not exclude Mr. Bender’s

coal mine dust exposure as a contributing cause of his disabling

lung disease. There is no basis for a conclusion that the

extent of pneumoconiosis is related to pulmonary function

impairment induced by coal mine dust exposure.” Dr. Rasmussen

further opined that although multiple factors could have

12
contributed to Bender’s respiratory impairment, including lung

surgery, cancer treatments, and smoking, Bender’s exposure to

coal dust was a “material contributor.”

In considering this conflicting evidence, the ALJ credited

Dr. Rasmussen’s disability causation opinion over Dr. Caffrey’s.

In particular, the ALJ cited Dr. Rasmussen’s explanation that a

finding of limited pneumoconiosis did not exclude coal dust

exposure as a cause of Bender’s disabling respiratory

impairment. The ALJ awarded black lung benefits to Bender,

based on the ALJ’s conclusion that the operator had failed to

rebut the presumption by showing that Bender’s pneumoconiosis

did not in any way contribute to his disability. The Benefits

Review Board affirmed the ALJ’s decision, and this petition for

review followed.

III.

A.

We first address the operator’s legal challenge to the

“rule-out” rebuttal standard. As previously discussed, Section

921(c)(4) sets forth a rebuttable presumption of total

disability due to pneumoconiosis, as well as a rebuttal standard

applicable to the Secretary:

[I]f a miner was employed for fifteen years
or more in one or more underground coal
mines . . . and if other evidence
demonstrates the existence of a totally

13
 disabling respiratory or pulmonary
impairment, then there shall be a rebuttable
presumption that such miner is totally
disabled due to pneumoconiosis. . . . The
Secretary may rebut such presumption only by
establishing that (A) such miner does not,
or did not, have pneumoconiosis, or that (B)
his respiratory or pulmonary impairment did
not arise out of, or in connection with,
employment in a coal mine.

The revised regulation implementing the statutory presumption,

which is at issue in this case, states that “the party opposing

entitlement,” which would include coal mine operators, may rebut

the presumption by

(i) Establishing both that the miner does not, or
did not, have:

(A) Legal pneumoconiosis . . . ; and

(B) Clinical pneumoconiosis . . . , arising
out of coal mine employment . . . ; or

(ii) Establishing that no part of the miner’s
respiratory or pulmonary total disability was
caused by pneumoconiosis . . . .

20 C.F.R. § 718.305(d)(1). 9

In evaluating a regulation promulgated by an executive

agency, we apply the principles of deference articulated in

Chevron v. Natural Resources Defense Council, 467 U.S. 837

9
“Clinical pneumoconiosis” is “a particular set of diseases
recognized by the medical community,” whereas “legal
pneumoconiosis” is “a broader category that includes any chronic
lung disease arising out of coal mine employment.” Collins v.
Pond Creek Mining Co., 751 F.3d 180, 182 (4th Cir. 2014); see
also 30 U.S.C. § 902(b); 20 C.F.R. § 718.201(a).

14
(1984). We first examine “whether Congress has directly spoken

to the precise question at issue.” Elm Grove Coal Co. v. Dir.,

Office of Workers’ Comp. Programs, 480 F.3d 278, 292 (4th Cir.

2007) (quoting Chevron, 467 U.S. at 842). “If the intent of

Congress is clear, that is the end of the matter; for the court,

as well as the agency, must give effect to the unambiguously

expressed intent of Congress.” Chevron, 467 U.S. at 842-43.

However, “if the statute is silent or ambiguous with respect to

the specific issue,” we continue to the second step of the

Chevron analysis, and determine “whether the agency’s answer is

based on a permissible construction of the statute,” according

the agency considerable deference. Id. at 843 (citation

omitted).

i.

The operator argues that our analysis is resolved under the

first step of Chevron. Relying on the Supreme Court’s decision

in Usery, which addressed the plain meaning of Section

921(c)(4), the operator contends that the rebuttal standard in

the statute is unambiguous and applies only to the Secretary.

In light of this plain statutory language, the operator asserts

that the statute does not allow for the same standard to be

applied also to operators by way of an agency regulation. Thus,

the operator argues that this aspect of the agency’s regulation

should be afforded no deference, and that a lesser rebuttal

15
standard should be applicable to operators. In the operator’s

view, the proper rebuttal standard for operators would be one

that would allow the operator to rebut the statutory presumption

by showing that the claimant’s pneumoconiosis is not a

“substantially contributing cause” of his total disability. We

disagree with the operator’s arguments, because we do not think

that the holding in Usery is as broad as the operator maintains.

In applying the first step of the Chevron analysis, we

employ “the traditional tools of statutory construction to

ascertain congressional intent.” Chamber of Commerce of the

U.S. v. NLRB, 721 F.3d 152, 160 (4th Cir. 2013) (quoting

Chevron, 467 U.S. at 842 n.9) (internal quotation marks

omitted). We begin by considering the language of Section

921(c)(4) to determine whether the statute is silent or

ambiguous regarding the manner in which operators can rebut the

presumption. See Chamber of Commerce, 721 F.3d at 160.

We conclude that Section 921(c)(4) is silent regarding the

standard that an operator must meet to rebut the presumption.

The statutory presumption of total disability due to

pneumoconiosis applies both to the Secretary and to operators.

However, in addressing the method for rebutting this

presumption, the statute refers only to the Secretary. Although

operators necessarily must meet some unarticulated standard to

rebut the presumption, the statute specifies none. Thus,

16
because the statute does not speak to the standard operators

must meet to rebut the presumption, Congress has left a “gap”

for the agency to fill by using its delegated regulatory

authority.

This conclusion is not affected by the Supreme Court’s

decision in Usery, in which the Court evaluated the language of

the original statutory presumption before it was removed from

the statute and later was revived by the Patient Protection and

Affordable Care Act. In Usery, as noted above, the Court held

that it was “clear as a matter of statutory construction that

the . . . limitation on rebuttal evidence is inapplicable to

operators.” 428 U.S. at 35.

As we have explained, however, because Section 921(c)(4)

does not address the standard for rebuttal by operators, that

standard may be set by regulation. The Court in Usery did not

address any regulation implementing the statute and, crucially,

the Court did not consider the evidentiary standard under which

parties other than the Secretary could rebut the statutory

presumption. Instead, the Court merely was required to address

the question whether the statutory rebuttal standard applied

equally to operators, when the plain language of that portion of

the statute referred only to the Secretary. See id. at 37. In

its analysis, moreover, the Court expressly left open the

17
possibility that the Secretary could promulgate regulations

under the statute. 10 Id. at 37 n.40.

We also observe that the premise of the operator’s

argument, namely, that the rule-out standard is the substantive

equivalent of the statutory rebuttal standard at issue in Usery,

is mistaken. The rebuttal provision in the statute does not

address the evidentiary standard required to show that a miner’s

impairment did not “arise out of, or in connection with,

employment in a coal mine.” § 921(c)(4). The statute merely

identifies the elements of a claim that can be rebutted. In

contrast, the rule-out standard prescribes the evidentiary

standard that a party must satisfy to rebut the presumption.

This distinction explains the Court’s analytical focus in

Usery. At the time Usery was decided, coal miners could be

compensated under the Act only if their disability was caused by

what became known as “clinical pneumoconiosis,” which is “a

particular set of diseases recognized by the medical community.”

10
The Court observed that the Secretary of Health,
Education, and Welfare had promulgated regulations imposing on
both operators and the Secretary a rebuttal standard similar to
that set forth in the statute. See Usery, 428 U.S. at 37
(citing 20 C.F.R. §§ 410.414, 410.454 (1975)). The operators in
Usery did not challenge these regulations and, accordingly, the
Court declined to address them. Id. We note that the
regulations in place at the time of Usery mirrored the rebuttal
language in Section 921(c)(4), and did not articulate a rule-out
standard for rebuttal. See 20 C.F.R. §§ 410.414, 410.454
(1975).

18
Collins v. Pine Creek Mining Co., 751 F.3d 180, 182 (4th Cir.

2014) (defining clinical pneumoconiosis); Andersen v. Dir.,

Office of Workers’ Comp. Programs, 455 F.3d 1102, 1105-06 (10th

Cir. 2006) (explaining the original definition of

“pneumoconiosis” under the Act). Therefore, in Usery, the

operators argued that the rebuttal provision in Section

921(c)(4) was unconstitutional because it permitted a miner who

qualified for the statutory presumption, but whose disability

was not caused by a compensable disease under the Act, to

receive an award of benefits. See Usery, 428 U.S. at 34-35.

The Supreme Court avoided the operators’ constitutional

challenge to Section 921(c)(4) by holding that only the

Secretary was bound by the statutory rebuttal limitations. Id.

at 35. Operators thus were permitted to rebut the statutory

presumption by showing that a miner was disabled by a disease

related to coal dust exposure that was not pneumoconiosis. Id.

Following the decision in Usery, Congress amended the Act

in 1978 to define compensable pneumoconiosis to include what is

now known as “legal pneumoconiosis,” as well as clinical

pneumoconiosis. 11 Black Lung Benefits Reform Act of 1977, 95

11
The operator maintains that the 1978 amendments to the
Act “merely codified the existing standard of practice,” under
which miners already could receive benefits for disabling legal
pneumoconiosis at the time of Usery. Even if this assertion is
accurate, however, the Supreme Court in Usery nevertheless
(Continued)
19
Pub. L. No. 239, 92 Stat. 95; see 30 U.S.C. § 902(b) (2012).

Thereafter, the agency promulgated regulations further defining

legal pneumoconiosis as “any chronic lung disease or impairment

and its sequelae arising out of coal mine employment,” including

“any chronic restrictive or obstructive pulmonary disease

arising out of coal mine employment.” 20 C.F.R. § 718.201(a)(2)

(2014). Under this new regime, the concerns animating the

Court’s decision in Usery, namely, concerns about Section

921(c)(4) preventing an operator from rebutting the presumption

by showing that a miner was not disabled due to clinical

pneumoconiosis but due to another respiratory disease caused by

his coal mine employment, are no longer present, because all

totally disabling diseases caused by coal dust exposure now are

compensable under the Act. Accordingly, the Court in Usery did

not consider whether the rule-out standard, as opposed to a more

lenient rebuttal standard, would be a permissible evidentiary

standard for rebuttal under the Act.

We therefore conclude that Usery did not answer either the

question whether Congress left a gap in Section 921(c)(4) that

the agency was permitted to fill by regulation, or the question

focused on the operators’ argument that the rebuttal limitations
in Section 921(c)(4) improperly allowed an award of benefits
even if a miner’s disability was caused by a non-compensable
disease. Usery, 428 U.S. at 34-35.

20
whether application of the rule-out standard to coal mine

operators in a regulation would be a reasonable exercise of

agency authority in filling such a gap in the statute. 12 Thus,

given the different issue before the Court in Usery, the Court’s

holding does not affect our analysis under the first step of the

Chevron standard.

ii.

Having identified the gap in Section 921(c)(4) that the

agency was permitted to fill by regulation, we proceed to the

second step of the Chevron analysis, under which we ask whether

the agency’s regulation “is a reasonable choice within [the] gap

left open by Congress.” Chevron, 467 U.S. at 866. We defer to

an agency if its “choice represents a reasonable accommodation

of conflicting policies that were committed to the agency’s care

by the statute.” Id. at 845 (citation omitted). We will not

disturb the agency’s choice “unless it appears from the statute

or its legislative history that the accommodation is not one

that Congress would have sanctioned.” Id.

12
This Court recently was presented with the question
whether the rebuttal standard in Section 921(c)(4) applies to
operators, after the presumption was revived by the Patient
Protection and Affordable Care Act. See Mingo Logan Coal Co.,
724 F.3d 550. Although the majority opinion did not address the
question, our colleague Judge Niemeyer considered the language
of the statutory presumption, but did not consider the language
of any regulation, in a concurring opinion, concluding that,
under Usery, the rebuttal standard in the statute does not bind
operators. Id. at 560-61 (Niemeyer, J., concurring).

21
 Additionally, to uphold application of the regulation under

Chevron, we are not required to conclude that the agency’s

construction was the only one that the agency permissibly could

have adopted under the statute, or was the construction a court

would have placed on the statute if presented with the question

in the first instance. Id. at 843 n.11. Instead, we evaluate

only whether the regulation is a reasonable exercise of agency

authority. Id. at 844.

In making this determination, we first observe that the

rule-out standard was made a part of the Act’s regulatory scheme

in 1980, in the original version of 20 C.F.R. § 718.305. See

Standards for Determining Coal Miners’ Total Disability or Death

Due To Pneumoconiosis, 45 Fed. Reg. 13,678, 13,692 (Feb. 29,

1980); 20 C.F.R. § 718.305 (2012) (“Where the cause of death or

total disability did not arise in whole or in part out of dust

exposure . . . the presumption will be considered rebutted.”)

(emphasis added). Although Congress necessarily was aware of

this regulation when reenacting the statutory presumption in

2010, Congress did not insert a different rebuttal standard for

coal mine operators into the statute, or otherwise amend the

statutory language to signal its disagreement with the agency’s

earlier construction of the statute. We therefore may assume,

in the absence of a contrary showing, that Congress intended to

retain the agency’s interpretation of the prior version of the

22
statute. See Lorillard v. Pons, 434 U.S. 575, 580 (1978)

(“Congress is presumed to be aware of an administrative or

judicial interpretation of a statute and to adopt that

interpretation when it re-enacts a statute without change.”).

The rule-out standard unquestionably advances Congress’

purpose in enacting the statutory presumption. Congress

instituted the statutory presumption to make it easier for those

miners most likely to be disabled due to coal dust exposure to

obtain benefits, in response to the high rate of claim denials

that miners experienced without the statutory presumption. See

Pauley, 501 U.S. at 685-86 (discussing the original statutory

presumption as passed in 1972); Regulations Implementing the

Byrd Amendments to the Black Lung Benefits Act: Determining Coal

Miners’ and Survivors’ Entitlement to Benefits, 78 Fed. Reg.

59,102, 59,106-07 (2013) (“Congress adopted the presumption to

relax the often insurmountable burden of proving eligibility

these miners faced.”) (citation, internal quotation marks, and

alteration omitted). The strict nature of the regulatory rule-

out standard furthers this goal by placing a significant burden

on operators seeking to rebut the statutory presumption. 13

13
The operator also contends that the rule-out standard
violates the principle articulated in Director, Office of
Workers’ Comp. Programs v. Greenwich Collieries, 512 U.S. 267
(1994), which held that under the Administrative Procedure Act,
the proponent of a rule or order must meet his burden by a
(Continued)
23
 We further observe that, in practice, operators will be

required to satisfy the rule-out standard only in a clearly

defined class of black lung claims. The rule-out standard

applies only when (1) a miner has worked for 15 years or more in

an underground coal mine, (2) he suffers from a totally

disabling respiratory or pulmonary impairment, and (3) the

operator cannot satisfy the first method of rebuttal under

Section 718.305(d), namely, disproving the presence of

pneumoconiosis. This class of cases is indisputably serious and

encompasses claimants whose disabilities likely are attributable

at least in part to pneumoconiosis.

And, critically, the intent of Congress in enacting the

presumption would be thwarted if the operator’s proposed

“alternative” rebuttal standard were applied. As noted above,

in place of the rule-out standard, the operator asserts that it

should be allowed to rebut the statutory presumption by showing

preponderance of the evidence. Id. at 277-78. However, “the
preponderance standard goes to how convincing the evidence in
favor of a fact must be . . . before that fact may be found, but
does not determine what facts must be proven as a substantive
part of a claim or defense.” Metro. Stevedore Co. v. Rambo, 521
U.S. 121, 139 n.9 (1997). Here, the rule-out standard
articulates “only what facts must be established to rebut the
presumption,” and is therefore consistent with Collieries.
Regulations Implementing the Byrd Amendments to the Black Lung
Benefits Act: Determining Coal Miners’ and Survivors’
Entitlement to Benefits, 78 Fed. Reg. 59,102, 59,107 (Sept. 25,
2013).

24
that the claimant’s pneumoconiosis is not a “substantially

contributing cause” of his total disability.

This “alternative” rebuttal standard, however, effectively

would nullify the statutory presumption for coal miners such as

Bender whom Congress intended to assist. Instead of shifting

the burden of proof to the operator to rule out pneumoconiosis

as a cause of the miner’s disability, the operator’s proposed

rebuttal standard would track, in the negative, the evidentiary

burden placed on a miner who has not qualified for the statutory

presumption, namely, to show that pneumoconiosis is a

“substantially contributing cause” of his total disability. See

20 C.F.R. § 718.204(c)(1); Mingo Logan Coal Co., 724 F.3d at

555. Thus, to counter an operator’s evidence that

pneumoconiosis was not “a substantially contributing cause” of

the miner’s disability, a miner entitled to the statutory

presumption nevertheless would be placed back at “square one,”

forced to prove the “substantial” impact of pneumoconiosis on

his disability, which is the very situation that Congress

intended to eliminate in enacting the presumption. See Pauley,

501 U.S. at 685-86.

Next, we observe that one of our sister circuits recently

considered the present issue whether the regulatory rule-out

standard lawfully applies to coal mine operators, and reached

the same conclusion that we do. See Big Branch Res., Inc. v.

25
Ogle, 737 F.3d 1063 (6th Cir. 2013). In its decision, the Sixth

Circuit rejected the operator’s argument under Usery and

affirmed application of the regulatory rule-out standard to coal

mine operators. Id. at 1069-71. The court explained that to

rebut the statutory presumption of disability, an employer must

show under the rule-out standard that “the [miner’s] coal mine

employment played no part in causing the [miner’s] total

disability. . . .” Id. at 1071 (emphasis in original).

Our analysis of an earlier regulation in Bethlehem Mines

Corp. v. Massey, 736 F.2d 120 (4th Cir. 1984), further

reinforces our conclusion that the present regulation is a

reasonable exercise of agency authority. We reviewed in Massey

an interim regulation, which established a rebuttable

presumption of total disability due to pneumoconiosis when a

miner had worked for at least 10 years in coal mine employment

and suffered from a chronic respiratory or pulmonary disease.

See id.; see also Stiltner, 86 F.3d at 339 (describing the

interim presumption); Mullins Coal Co. v. Dir., Office of

Workers’ Comp. Programs, 484 U.S. 135, 138-39 (1987) (explaining

the applicability of interim versus permanent regulations to

certain types of claims). The presumption at issue in Massey

could be rebutted under the agency regulation by showing that

the miner’s disability did not “arise in whole or in part out of

26
coal mine employment.” Massey, 736 F.2d at 123 (quoting 20

C.F.R. § 727.203(b)(3)) (emphasis in original).

Similar to the operator’s position here, the coal mine

operator in Massey argued that it should have been allowed to

rebut the interim presumption of disability under Section

727.203(b)(3) by showing that “the claimant’s pneumoconiosis is

but one of several factors contributing to his total

disability.” Id. at 122-23. Rejecting this argument, we

explained in Massey that the rule-out standard reasonably

reflected the reality that the convergence of many medical and

environmental factors often will cause a miner’s disability.

See id. at 124. We observed that the rule-out standard was

consistent with the “letter and spirit” of the Act, by

eliminating the burden of proving causation for miners who

likely suffer from disabling pneumoconiosis. Id. Thus, we

affirmed the rule-out standard in the interim regulation,

concluding that the standard was “within [the Secretary’s]

rulemaking authority and served the broad remedial purposes of

the statute.” Id.

As reflected by our decision in Massey, deference to the

agency’s interpretation is particularly appropriate here because

Congress, through the Act, has “produced a complex and highly

technical regulatory program” in which “[t]he identification and

classification of medical eligibility criteria necessarily

27
require significant expertise and entail the exercise of

judgment grounded in policy concerns” entrusted to the agency.

Pauley, 501 U.S. at 697. Thus, in the absence of explicit

direction from Congress, the procedures under which a claimant

may establish entitlement to benefits are a quintessential

policy judgment best left to the agency. See id. at 696 (“When

Congress, through . . . the introduction of an interpretive gap

in the statutory structure, has delegated policy-making

authority to an administrative agency, the extent of judicial

review of the agency’s policy determinations is limited.”).

Although the rule-out standard undeniably places a

substantial burden on coal mine operators, we cannot say that

the agency acted unreasonably in issuing the regulation

containing the present rule-out standard. 14 Accordingly, we hold

14
The operator also argues that it lacked notice of the
rule-out standard during the administrative proceedings in this
case and, therefore, that its due process rights will be
violated if we affirm the rule-out standard without permitting
the operator to present new rebuttal evidence. The operator,
however, agrees that we should address in this appeal the
validity of the rule-out standard established in Section
718.305(d).
We conclude that the operator’s argument that it lacked
notice of the rule-out standard is without merit. The original
version of Section 718.305(d), which the agency promulgated in
1980, similarly required operators to rule out disability
causation in order to rebut the statutory presumption in Section
921(c)(4). The original regulation, applicable to claims filed
through 1981, remained intact until the 2013 amendments at issue
in this case.
(Continued)
28
that the rule-out standard set forth in Section 718.305(d) is a

reasonable exercise of the agency’s authority under Chevron, and

lawfully applies to coal mine operators as well as to the

Secretary. Therefore, as specifically provided in the

regulation, any “party opposing entitlement” to black lung

benefits, including coal mine operators, may rebut the statutory

presumption of disability under subsection (d)(1)(ii) of the

regulation only by proving that “no part of the miner’s

respiratory or pulmonary total disability was caused by

pneumoconiosis.” 20 C.F.R. § 718.305(d).

B.

The operator argues, nevertheless, that the ALJ’s decision

awarding benefits is not supported by substantial evidence,

because the ALJ improperly declined to credit the operator’s

medical experts. The operator contends that, by explaining that

Bender’s disability was caused by his history of smoking, lung

surgery, lung cancer, and cancer treatments, the operator’s

medical experts ruled out pneumoconiosis as a cause of Bender’s

We also observe that we applied the rule-out standard to
operators in a case under the original statutory presumption.
See Rose v. Clinchfield Coal Co., 614 F.2d 936, 939 (4th Cir.
1980). As discussed above, we similarly have applied the rule-
out standard over the years to cases involving the interim
presumption. See Stiltner, 86 F.3d at 339; Massey, 736 F.2d at
123. For these reasons, we reject the operator’s due process
argument.

29
disability. Because the ALJ applied the rule-out standard in

his analysis of the evidence from the operator’s experts, we

first explain the type of proof that the rule-out standard

requires from a party opposing a miner’s claim. We later will

address the ALJ’s evaluation of the medical evidence.

i.

To rebut the presumption of disability due to

pneumoconiosis, an operator must establish that “no part of the

miner’s respiratory or pulmonary total disability was caused by

pneumoconiosis.” 20 C.F.R. § 718.305(d). Therefore, the rule-

out standard is not satisfied by showing that pneumoconiosis was

one of several causes of a miner’s disability, or that

pneumoconiosis was a minor or even an incidental cause of the

miner’s respiratory or pulmonary impairment. See Carozza v.

U.S. Steel Corp., 727 F.2d 74, 78 (3d Cir. 1984) (comparing the

interim presumption to Section 921(c)(4), and explaining that

“Congress did not intend to exclude benefits for total

disability resulting from multiple causes, one of which is

pneumoconiosis”); Massey, 736 F.2d at 123 (“Pneumoconiosis . . .

must be a causative factor in the miner’s total disability, but

it need not be the exclusive causative factor rendering the

claimant totally disabled . . . .”).

Instead, an operator opposing an award of black lung

benefits affirmatively must establish that the miner’s

30
disability is attributable exclusively to a cause or causes

other than pneumoconiosis. See Massey, 736 F.2d at 123-24 (to

rebut the interim presumption, an operator must “rule out the

causal relationship between the miner’s total disability and his

coal mine employment”). Thus, to make the required showing when

a miner has qualified for the statutory presumption, a medical

expert testifying in opposition to an award of benefits must

consider pneumoconiosis together with all other possible causes,

and adequately explain why pneumoconiosis was not at least a

partial cause of the miner’s respiratory or pulmonary

disability.

ii.

In reviewing a decision of the Benefits Review Board, we

evaluate “whether substantial evidence supports the factual

findings of the ALJ and whether the legal conclusions of the

Board and ALJ are rational and consistent with applicable law.”

Harman Mining Co. v. Dir., Office of Workers’ Comp. Programs,

678 F.3d 305, 310 (4th Cir. 2012) (citation, internal quotation

marks, and alteration omitted). We 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.” Id.

In the present case, both Drs. Tuteur and Zaldivar opined

that Bender’s disability was caused by his history of smoking

31
and cancer treatments. The ALJ discredited these disability

causation opinions because the doctors did not adequately

explain, as required under the rule-out standard, why Bender’s

disability was not also partially attributable to

pneumoconiosis. The ALJ additionally found that, by emphasizing

Bender’s deteriorating condition after leaving the coal mines,

Dr. Zaldivar did not rule out pneumoconiosis as a cause of

Bender’s disability given the progressive nature of the disease.

It was within the ALJ’s prerogative as fact-finder to weigh

the credibility of the experts and to determine the

persuasiveness of their testimony. See Island Creek Coal Co. v.

Compton, 211 F.3d 203, 211 (4th Cir. 2000). “[A]s trier of

fact, the ALJ is not bound to accept the opinion or theory of

any medical expert,” but instead “must evaluate the evidence,

weigh it, and draw his own conclusions.” Underwood v. Elkay

Mining, Inc., 105 F.3d 946, 949 (4th Cir. 1997). Here, the ALJ

appropriately found that by identifying causes other than

pneumoconiosis, Drs. Tuteur and Zaldivar failed to establish

that pneumoconiosis played “no part” in causing Bender’s

disability. And, although Dr. Tuteur identified reasons for

concluding that Bender’s pneumoconiosis had no clinical effect,

the ALJ was not required to find Dr. Tuteur’s explanation

persuasive. The ALJ also reasonably determined that Dr.

Zaldivar’s causation opinion was inadequately supported.

32
 With respect to Dr. Caffrey’s opinion that Bender’s

pneumoconiosis was insufficiently severe to be disabling, the

ALJ credited the contrary opinion of Bender’s medical expert,

Dr. Rasmussen, who explained that the extent of pneumoconiosis

as reflected on an x-ray has no bearing on whether the disease

was a cause of a miner’s disability. It is the prerogative of

the ALJ, rather than of a reviewing court, to resolve such a

battle of the experts. Westmoreland Coal Co. v. Cochran, 718

F.3d 319, 324 (4th Cir. 2013). Therefore, we will not disrupt

the ALJ’s decision to credit the opinion of one expert over

another.

For these reasons, we conclude that the ALJ acted within

his fact-finding role in weighing the credibility and the

persuasiveness of the medical expert opinions. Accordingly, in

view of our deferential standard of review and the high burden

imposed by the rule-out standard, we hold that the ALJ’s factual

determinations are supported by substantial evidence.

IV.

For these reasons, the operator’s petition for review is

denied.

PETITION FOR REVIEW DENIED

33