Pulmonary Function Tests in Black Lung Claims: Claim-Developed Studies Require Only “Substantial Compliance,” While Treatment-Record Studies Are Weighed for “Reliability”

Precedents Cited

The decision is best understood as an application of entrenched black-lung appellate principles—especially deference to ALJ factfinding—combined with a clarifying emphasis on the regulatory distinction between (i) claim-developed testing and (ii) treatment-record testing.

1) Deferential substantial-evidence review and the ALJ’s factfinding role

• Am. Energy, LLC v. Dir., OWCP — The court relied on this decision for the governing review standard: the appellate court asks whether the ALJ’s findings are supported by substantial evidence and are in accordance with law, and it does not disturb supported findings “even if we disagree with it.” It also supplied the formulation that the APA is satisfied if the ALJ makes clear “what he did and why he did it” (quoting another case).
• Consol. Edison Co. v. N.L.R.B. — Provided the canonical definition of “substantial evidence” as “such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.”
• Extra Energy Inc. v. Lawson — Reiterated that reviewing courts do not reweigh evidence or referee a “battle of the experts,” but instead examine whether the ALJ analyzed relevant evidence and sufficiently explained his rationale.
• Hobet Mining, LLC v. Epling — Cited for the requirement that the ALJ analyze relevant evidence and explain crediting decisions.
• Mingo Logan Coal Co. v. Owens and Doss v. Dir., Off. of Workers' Comp. Programs — Used to emphasize that the ALJ, as factfinder, evaluates credibility and weighs conflicting evidence.
• Lane Hollow Coal Co. v. Dir., OWCP — Quoted for the proposition that an ALJ need not discuss every piece of evidence so long as the decision shows what the ALJ did and why.
• Sterling Smokeless Coal Co. v. Akers — Reinforced that the ALJ must resolve conflicts and articulate a rationale adequate for judicial review.

2) The § 921(c)(4) framework and burden shifting

• W. Va. CWP Fund v. Bender — The court used Bender both for the four-part “default” entitlement framework and for the operation of the fifteen-year presumption: once invoked (by qualifying employment plus total disability), the burden shifts to the employer to rebut in specified ways. Although rebuttal was not contested on appeal, Bender framed why the “total disability” finding was dispositive.

3) Appendix B, the 2000 preamble, and discretion to discount rigid “checklist” approaches

• Harman Min. Co. v. Dir., OWCP — Cited for the principle that the Department’s regulatory preamble explains the scientific and medical basis for Part 718 and can guide evaluation of medical evidence.
• Westmoreland Coal Co. v. Stallard — Supported the proposition that an ALJ may give little weight to medical findings that conflict with the Act’s implementing regulations (and, by extension, with the agency’s expressed medical/scientific premises).
• Extra Energy Inc. v. Lawson (again) — Supported the ALJ’s discretion to credit expert reasoning consistent with the 2000 preamble’s understanding of the quality standards and to reject experts urging an overly rigid approach.
• J.V.S [Stowers] v. Arch of W. Va. — Cited for using a “reliability” approach to treatment-record medical testing.
• Keener v. Peerless Eagle Coal Co. — Cited for the proposition that tests may be admissible if in substantial compliance, even if minor deviations exist.
• Robinette v. Dir., OWCP and Casella v. Kaiser Steel Corp. — Cited for the point that adjudicators consider medical opinions addressing a study’s validity/reliability when weighing non-claim testing.
• S. Ohio Coal Co. v. Dir. OWCP — A Sixth Circuit decision the Fourth Circuit quoted for the proposition that PFT noncompliance with quality standards goes to evidentiary weight, a matter committed to the ALJ’s discretion.
• Cochran — Quoted within an excerpt (via Extra Energy) for the principle that resolving “battle of the experts” disputes is for the ALJ, not the appellate court.

Collectively, these authorities did not create a new test so much as they anchored the court’s central holding: Clinchfield’s arguments invited the Fourth Circuit to treat Appendix B as a rigid admissibility checklist and to reweigh expert disputes—both moves foreclosed by the regulatory text and precedent.

Legal Reasoning

1) The court’s core clarification: two standards for two categories of PFTs

The opinion draws a sharp line between two types of PFT evidence:

• Claim-developed PFTs (tests “developed in connection with a claim for benefits”) are assessed under 20 C.F.R. § 718.101(b) and § 718.103(c) for “substantial compliance” with Appendix B. The court emphasized Appendix B’s own introductory instruction that deviations may be considered in assigning weight, not treated as automatic disqualifiers.
• Treatment-record PFTs (tests obtained during medical treatment) are not filtered through Appendix B as a strict gatekeeping regime; rather, consistent with the 2000 preamble (65 Fed. Reg. 79920, 79928 (Dec. 20, 2000)), they are weighed for “reliability”—i.e., whether the adjudicator is persuaded they are sufficiently reliable to establish the fact(s) for which offered.

The practical consequence is significant: Appendix B “maximal effort” criteria are relevant, but they do not function as a rigid invalidity trigger in either category. For claim-developed testing, they inform whether the test substantially complies; for treatment testing, they inform reliability and weight.

2) Application to the October 2014 claim-developed PFT

Clinchfield attacked the October 2014 PFT because the forced expiration time was marginally below seven seconds, and it argued that the ALJ was required to deem the test invalid. The court rejected that framing because:

• Appendix B and the regulatory scheme allow deviations to affect weight, not impose categorical exclusion.
• Dr. Ajjarapu explained the deviation (the claimant came “very close,” maintained effort beyond six seconds, and produced reproducible tracings).
• Critically, the DOL consultant, Dr. Ranavaya, independently validated the study as “acceptable,” which the ALJ could reasonably treat as corroboration.

The Fourth Circuit’s bottom line was not that the seven-second criterion is unimportant; rather, it held that the ALJ permissibly treated a marginal shortfall as a factor in the substantial-compliance analysis, not as an automatic invalidation rule.

3) Application to the February 2018 treatment-record PFT

Clinchfield also argued that the February 2018 PFT should have been rejected for failing Appendix B “maximal effort”/plateau-related criteria. The Fourth Circuit held the ALJ used the correct legal lens: because this was a treatment-record PFT, the ALJ asked whether it was “sufficiently reliable.”

The ALJ considered competing expert critiques (including lack of plateau and expiration concerns) but credited Dr. Ajjarapu’s assessment that effort was “good” and “adequate” and that results were “sufficiently reliable.” The court viewed Clinchfield’s insistence on Appendix B as a strict prerequisite as a mismatch with the governing reliability framework for treatment tests.

4) The APA “explanation” challenge to medical opinion weighing

Clinchfield’s second line of attack was procedural: even if the tests could be credited, the ALJ supposedly failed to adequately explain why he credited Dr. Ajjarapu and discounted Drs. Fino, Sargent, and Renn.

The Fourth Circuit treated this as a classic attempt to repackage disagreement with evidentiary weighing into an APA error. Applying Am. Energy, LLC v. Dir., OWCP and Lane Hollow Coal Co. v. Dir., OWCP, the court held the explanation was adequate because the ALJ:

• Summarized the relevant objective tests and narrative opinions;
• Made threshold determinations on the probative value of each PFT under the correct framework (substantial compliance vs. reliability);
• Explained that certain employer experts’ invalidity criticisms effectively assumed a stricter approach than the regulations require; and
• Explained why Dr. Ajjarapu’s opinion was better supported by the record, including DOL validation and her direct responses to quality objections.

Under the court’s deferential posture, this satisfied the APA requirement to disclose “findings and conclusions” and the “reasons or basis therefor” on material issues.

Impact

The opinion’s likely influence lies in how it arms ALJs (and reviewing bodies) against a common employer strategy in black lung litigation: converting Appendix B quality criteria into bright-line invalidity rules and then using medical expert critiques to argue that qualifying PFTs are legally unusable.

Three practical impacts stand out:

1. Appendix B deviations are primarily weight questions, not automatic disqualifiers. The decision reinforces that “maximal effort” criteria may be important, but they operate within a “substantial compliance”/“rule of reason” structure rather than as rigid gatekeeping.
2. Clear doctrinal separation between claim-developed and treatment-record PFTs. Parties should expect ALJs to explicitly identify which framework applies and to treat “reliability” as the touchstone for treatment tests.
3. Strengthened insulation of ALJ medical-evidence weighing on appeal. By framing the dispute as a “battle of the experts” and emphasizing the limited role of appellate courts, the opinion signals that well-explained credibility and weight determinations will be difficult to overturn.

For future cases, the decision encourages litigants to focus less on technical “gotcha” objections divorced from overall reliability and more on how deviations actually undermine (or do not undermine) a test’s ability to reflect pulmonary capacity—because that is the inquiry the regulations, as read here, demand.