SSR 75-5: SECTIONS 411(b) and 413(b) (30 U.S.C. 921(b) and 923(b)) -- FEDERAL COAL MINE HEALTH AND SAFETY ACT OF 1969, AS AMENDED -- CLAIM FOR BLACK LUNG BENEFITS -- EVALUATION OF CHEST ROENTGENOGRAPHIC (X-RAY) EVIDENCE
20 CFR 410.414(a), 410.428, and 410.454(a)
SSR 75-5
- Concerning only the issue of whether chest roentgenographic (X-ray) evidence establishes the existence of pneumoconiosis as provided for in Social Security Administration Regulations No. 10, Part 410, Sections 410.414(a), 410.428(a)(1), and 410.454(a); where a chest roentgenogram (X-ray) submitted in support of a claim for Federal Black Lung benefits is of suitable quality for proper classification in accordance with Section 410.428 held, where such roentgenogram (X-ray) is properly classified as category 0 (including subcategories 0/-, 0/0 or 0/1 under the UICC/Cincinnati (1968) classifications), earlier chest roentgenograms (X-rays) would not establish that pneumoconiosis exists as provided for under Sections 410.414(a) and 410.454(a) because the disease process is chronic and irreversible and, for this reason, such earlier roentgenograms (X-rays) will not be obtained and reviewed in making a determination. Further held, such later roentgenogram (X-ray) may be considered as determinative of the issue of roentgenogram (X-ray) evidence of pneumoconiosis unless other roentgenograph (X-ray) evidence proffered by the claimant raises reasonable doubt as to its quality or proper classification.
Illustrative Case:
A question has been raised as to whether the Social Security Administration is required to obtain and review earlier roentgenograms (X-rays) in connection with a claim for Black Lung benefits when later roentgenograms (X-rays) show no evidence of pneumoconiosis. The following guidelines are applicable, if, for example:
G, a living miner claimant, filed an application for black lung benefits in July 1972 at age 58 alleging a disability because of "black lung" resulting from 30 years' coal mine employment. Chest roentgenograms (X-rays) obtained 5/21/73, were found to be of suitable quality for proper classification and to show no roentgenographic (X-ray) evidence of pneumoconiosis (UICC/Cincinnati classification 0/0). Other medical evidence obtained in the development of G's claim included ventilatory function studies showing and FEV1 of 3.6 and MVV of 149 L/Min. and the results of a physical examination which failed to show any other evidence of a totally disabling chronic respiratory or pulmonary impairment. G's claim was denied on the basis that the evidence in his case did not show that he was totally disabled within the meaning of the law due to pneumoconiosis or a chronic respiratory or pulmonary impairment which may be presumed to be due to pneumoconiosis. On appealing his claim, G presented roentgenographic (X-ray) films and a report of X-ray findings by Dr. M in December 1971 which Dr. M concluded were "compatible with silicosis of mild degree."
Social Security Administration Regulations section 410.414(a) and 410.454(a) set forth the evidentiary requirements under which a finding of the existence of pneumoconiosis may be made pursuant to section 410.428 of Regulations No. 10. Under the classification system prescribed in section 410.428 for determining the existence of pneumoconiosis as provided in section 410.414(a) and 410.454(a), a chest roentgenogram (X-ray) of suitable quality for proper classification of pneumoconiosis is a basis for finding the disease exists. (Biopsy and autopsy evidence meeting the specification prescribed under section 410.428 may, of course, also be used for this purpose.) With respect to such chest roentgenogram (X-ray), section 410.428 of the regulations provides that a roentgenogram (X-ray) classified as category 0 (including subcategories 0/-, 0/0 or 0/1) "is not accepted as evidence of pneumoconiosis." (Emphasis supplied.)
Pneumoconiosis as determinable by chest roentgenogram (X-ray) portrays a condition in which the disease process is chronic (that is, persists over a long period of time), progressive and irreversible. In such cases, where a chest roentgenogram (X-ray) of suitable quality for proper classification in accordance with section 410.428 is properly classified thereunder as category 0 (or one of the aforementioned subcategories), earlier chest roentgenograms (X-rays) if properly classified would not result in a different finding being made.
However, where as in the instant case, other roentgenographic (X-ray) evidence is proffered purporting to establish that pneumoconiosis, in fact, exists as provided for in sections 410.414(a) and 410.454(a), such evidence is, of course, considered by the Social Security Administration. If such evidence raises a reasonable doubt as to whether the roentgenogram (X-ray) classified as category 0 (including subcategories) under section 410.428 has been properly classified or is of suitable quality for proper classification, arrangements may be made to have the roentgenographic (X-ray) film (if proffered) reviewed in series with such roentgenogram (X-ray) by physicians expert in classifying pneumoconiosis in accordance with section 410.428, or, where appropriate, to provide the claimant an opportunity for a current chest roentgenographic (X-ray) examination. However, in the subject case, reasonable doubt is not raised by the roentgenographic (X-ray) evidence proffered because the statement of medical findings is ambiguous. The statement also fails to classify such findings by any medically accepted system for such classification, and the roentgenogram (X-ray) described by the findings is several years older than the roentgenogram (X-ray) described by the findings is several years older than the roentgenogram (X-ray) classified as category 0 (including subcategories) under section 410.428. Therefore, the roentgenogram (X-ray) classified as category 0 (including subcategories) under section 410.428 may be considered as determinative of the issue of roentgenograph (X-ray) evidence of pneumoconiosis in G's case.