Inferring Chronic Origin of Terminal ABG Results Under the BLBA: Commentary on Clinchfield Coal Co. v. Mullins (4th Cir. 2025)

Inferring Chronic Origin of Terminal ABG Results Under the BLBA: Commentary on Clinchfield Coal Co. v. Mullins (4th Cir. 2025)

I. Introduction

The Fourth Circuit’s published decision in Clinchfield Coal Company v. Mullins, No. 23‑1644 (4th Cir. Dec. 2, 2025), is a significant Black Lung Benefits Act (“BLBA”) case that clarifies:

  • How strictly adjudicators must read the requirement in 20 C.F.R. § 718.105(d) for arterial blood gas (“ABG”) studies performed during a terminal hospitalization;
  • Whether an Administrative Law Judge (“ALJ”) must use explicit “well-reasoned and well-documented” language when crediting a medical opinion; and
  • The breadth of the “mistake in a determination of fact” ground for modification under 20 C.F.R. § 725.310.

The widow, Geraldine Mullins, sought survivor’s benefits under the BLBA after the death of her husband, Donald Mullins, a coal miner with nearly 28 years of underground coal mine employment. The responsible operator, Clinchfield Coal Company, challenged an award of survivor’s benefits that rested heavily on ABG studies conducted during the miner’s terminal hospitalization and on a record-review report by Dr. Joshua Perper.

A divided panel of the Fourth Circuit (Judge Thacker writing for the majority, joined by Senior Judge Floyd; Judge Quattlebaum dissenting) affirmed the Benefits Review Board’s (“BRB”) decision and denied Clinchfield’s petition for review. The majority adopted a relatively flexible, inference-friendly reading of § 718.105(d), while the dissent insisted on a strict, textual application of the “produced by” language.

II. Factual and Regulatory Background

A. The Miner and the Claim

  • Donald Mullins worked in underground coal mining for approximately 27.92 years.
  • He died on February 3, 2014, after a three-day hospitalization at Clinch Valley Medical Center.
  • On May 23, 2014, his widow filed a survivor’s claim under the BLBA.

Under the BLBA and its implementing regulations:

  • Survivors must show that:
    1. the miner had pneumoconiosis;
    2. the pneumoconiosis arose out of coal mine employment; and
    3. the miner’s death was due to pneumoconiosis.
    See 20 C.F.R. § 718.205(a); Collins v. Pond Creek Mining Co., 751 F.3d 180, 184 (4th Cir. 2014).
  • A rebuttable presumption in 20 C.F.R. § 718.305(b) applies if:
    1. the miner had at least 15 years of qualifying coal mine employment; and
    2. at death, he had a “totally disabling respiratory or pulmonary impairment.”
  • Total disability may be established by qualifying:
    • Pulmonary function tests,
    • Arterial blood gas (“ABG”) tests,
    • Evidence of cor pulmonale with right-sided heart failure, or
    • Medical opinion evidence. See 20 C.F.R. § 718.204(b)(2)(i)–(iv).

B. Special Rule for Terminal Hospital ABGs – § 718.105(d)

Section 718.105(d) imposes a heightened evidentiary requirement for ABG studies performed during a hospitalization that ends in the miner’s death:

“If one or more blood-gas studies producing results which meet the appropriate table in Appendix C is administered during a hospitalization which ends in the miner's death, then any such study must be accompanied by a physician's report establishing that the test results were produced by a chronic respiratory or pulmonary condition. Failure to produce such a report will prevent reliance on the blood-gas study as evidence that the miner was totally disabled at death.”

The purpose, as the Department of Labor (“DOL”) explained in its rulemaking preamble, is to guard against attributing qualifying ABG values solely to acute, non-chronic conditions that often occur during terminal hospitalizations.

C. Procedural History

  1. District Director’s Proposed Award (2015)
    The District Director issued a Proposed Decision and Order awarding survivor’s benefits, identifying Clinchfield as the responsible operator. Clinchfield requested a hearing, and the claim went to the Office of Administrative Law Judges.
  2. ALJ Barto’s Denial of Benefits (2017)
    ALJ William T. Barto found:
    • The 15-year employment requirement for the § 718.305 presumption was satisfied.
    • There were no qualifying pulmonary function tests and no evidence of cor pulmonale.
    • The only potentially qualifying evidence of total disability were two ABG studies performed during Mullins’ terminal hospitalization.
    • Although these ABG studies met Appendix C criteria, they could not be used because they were not accompanied by a physician’s report satisfying § 718.105(d).
    • He treated Dr. Patel’s discharge summary as the only “report provided in connection with the ABGs” and found it insufficient because it did not opine that the respiratory failure or ARDS was due to a chronic respiratory condition rather than an acute infection unrelated to coal dust.

    Without usable ABG evidence, ALJ Barto held total disability was not established; thus the § 718.305 presumption could not be invoked, and the claim was denied.

  3. Modification Request and ALJ Clark’s Award (2021)
    The widow timely sought modification without submitting new evidence. The District Director construed this as a request based on “mistake in a determination of fact” under § 725.310(a), and the case was reassigned to ALJ Richard M. Clark.

    ALJ Clark:

    • Agreed that Dr. Patel’s discharge summary did not satisfy § 718.105(d).
    • But found that ALJ Barto erred in concluding that no other physician’s report addressed the ABG studies.
    • Relied on a 47-page report by Dr. Joshua Perper, who:
      • Discussed the miner’s long history of chronic lung disease symptoms from 1998 onward;
      • Described progressive worsening of symptoms, radiographic findings, and “abnormal respiratory functions,” including “incremental decrease in diffusion of pulmonary gases and hypoxemia, leading to very poor quality of life eventually to death” (J.A. 614–15);
      • Specifically addressed the terminal ABG studies as demonstrating “severe hypoxemia and hypercapnia during the terminal 2014 hospitalization”; and
      • Concluded that the terminal hospitalization records “clearly document respiratory failure complicating coal workers’ pneumoconiosis with bilateral pneumonia and acute respiratory distress syndrome.”
    • ALJ Clark read this as “link[ing] the Miner’s abnormal terminal ABG results … with a chronic lung condition,” thereby satisfying § 718.105(d).
    • He thus found total disability established, triggered the § 718.305 presumption, and (after concluding Clinchfield had not rebutted it) awarded benefits.
  4. BRB Affirmance (2023)
    Clinchfield appealed, arguing principally that the miner was not totally disabled. The BRB:
    • Held that the terminal ABG studies could be used to establish total disability because Dr. Perper’s opinion met § 718.105(d);
    • Agreed that Dr. Perper adequately connected the chronic respiratory diseases (including coal workers’ pneumoconiosis, COPD, chronic bronchitis, and asthma) to the progressively abnormal blood gas values and to the miner’s death;
    • Noted that Clinchfield did not challenge ALJ Clark’s finding on rebuttal of the § 718.305 presumption; and
    • Affirmed the modification and award of benefits.
  5. Fourth Circuit Appeal (2025)
    Clinchfield sought judicial review, arguing:
    • The ABG results could not be used because no physician’s report established they were produced by a chronic respiratory condition as § 718.105(d) requires;
    • The ALJ erred by failing to explicitly find Dr. Perper’s report “well reasoned and well documented” under § 718.104(c); and
    • Any error by ALJ Barto was legal (misinterpretation of § 718.105(d)), not factual, so modification was improper.

III. Summary of the Fourth Circuit’s Decision

The majority denied the petition, holding that the BRB’s affirmance of ALJ Clark was supported by substantial evidence and in accordance with law. The key holdings are:

  1. No Waiver: Clinchfield’s specific arguments about § 718.105(d) and about whether Dr. Perper’s report was “well reasoned and well documented” were not waived, because they were “plainly encompassed” within its broader challenge to the finding of total pulmonary disability presented to the BRB.
  2. § 718.105(d) Satisfied by Inference from the Totality of the Physician’s Report:
    • An ALJ may look to the “totality” of the physician’s report to decide whether it “establish[es] that the test results were produced by a chronic respiratory or pulmonary condition.”
    • A physician need not use the exact words “produced by” in the report; it is enough if the report, reasonably read, links the qualifying ABG values to chronic disease rather than acute conditions.
    • In this case, Dr. Perper’s detailed longitudinal discussion of chronic lung disease progression and his diagnosis of “complicated coal workers’ pneumoconiosis” in close proximity to his discussion of the terminal ABG values sufficed to allow ALJ Clark to draw that inference.
  3. “Link” vs. “Produce”:
    • The ALJ’s use of the word “link” (that Dr. Perper’s report “links” the ABG results to a chronic lung condition) did not misapply § 718.105(d)’s “produced by” language.
    • The DOL itself used the term “linked” in its rulemaking when explaining § 718.105(d); thus “link” is an acceptable way to express the required relationship.
  4. ALJ Need Not Use “Well-Reasoned and Well-Documented” Magic Words:
    • The ALJ is not required to say in so many words that a physician’s report is “well reasoned” or “well documented.”
    • It suffices that the ALJ explains why the report is credible and reliable in light of the entire record.
    • Here, ALJ Clark explained that Dr. Perper’s report was based on extensive review of the miner’s medical records, including multi-year diagnoses and objective testing; that was enough for appellate review.
  5. Modification Properly Based on Mistake of Fact:
    • Modification under § 725.310 permits correction of any “mistake in a determination of fact,” including the ultimate factual issue of entitlement to benefits.
    • ALJ Clark’s conclusion that ALJ Barto failed to fully consider Dr. Perper’s report was a correction of a factual mistake about what the evidence showed and how it related to the ultimate fact of total disability, not a pure legal error.
    • Thus, the broad remedial power to modify awards/denials (as recognized in O’Keeffe, Jessee, and Betty B Coal) was appropriately invoked.

Judge Quattlebaum dissented, concluding that because no physician ever stated that the terminal ABG results were “produced by” a chronic condition, § 718.105(d) was not satisfied, the ABGs were legally unusable to show total disability, and the survivor’s claim should fail.

IV. Detailed Analysis

A. Waiver and Issue Preservation

The widow argued Clinchfield had waived its more granular arguments by presenting only one issue to the BRB: “The ALJ erred in finding the claimant met his burden in proving pulmonary disability.” The majority held there was no waiver, relying on:

  • Armco, Inc. v. Martin, 277 F.3d 468, 476 (4th Cir. 2002) (issues not presented to the BRB are generally waived);
  • 20 C.F.R. § 802.211(a) (petitions for BRB review must list specific issues); and
  • De Simone v. VSL Pharms., Inc., 36 F.4th 518, 528 (4th Cir. 2022) (in the district court context, variations on arguments are allowed if the theory is “plainly encompassed” in the earlier submissions).

The panel analogized to Riley v. Island Creek Coal Co., 688 F. App’x 219 (4th Cir. 2017), where a general challenge to the BRB’s failure to require the ALJ to follow statutory obligations preserved more specific complaints about the ALJ’s analysis.

Here, Clinchfield’s appellate arguments about whether Dr. Perper’s report satisfied § 718.105(d) and whether it was sufficiently reasoned were simply “elaborations” of its core contention that the evidence did not establish total pulmonary disability. The court signaled that:

  • Labeling an issue broadly (“total disability”) but then arguing specific evidentiary/legal subpoints is permissible; but
  • Parties must still give the BRB enough notice of the substance of disputed issues so they can be “potential grounds of decision” in higher courts (citing Wards Corner Beauty Acad.).

This reinforces a practical rule: arguments that refine or detail the same overarching issue (here, entitlement based on total disability) are unlikely to be deemed waived, even if not separately itemized.

B. ABG Studies and § 718.105(d)

1. Majority: The Totality of the Physician’s Opinion Can “Establish” Chronic Origin

The central substantive question is whether Dr. Perper’s report “establish[ed] that the test results were produced by a chronic respiratory or pulmonary condition,” as § 718.105(d) demands for ABGs from a terminal hospitalization.

The majority relied heavily on Trump v. Eastern Assoc. Coal Corp., 737 F. App’x 156 (4th Cir. 2018), where the court faulted an ALJ for parsing a single sentence in a physician’s opinion and failing to consider the “totality” of the report. Applying that approach here, the majority emphasized:

  • Dr. Perper tied the onset of chronic lung disease symptoms back to 1998, with progressive worsening of:
    • Symptoms (shortness of breath, cough),
    • Radiographic findings, and
    • “Abnormal respiratory functions,” including decreasing diffusion capacity and hypoxemia.
  • He described the ABG studies from the terminal hospitalization as showing “severe hypoxemia and hypercapnia.”
  • Within two paragraphs of this ABG discussion, he rendered a final diagnosis that the miner suffered from “complicated coal workers’ pneumoconiosis” at the time of death.
  • He stated that “the arterial blood gases followed a similar pattern of marked progressive worsening,” which “substantiates the worsening of the various respiratory parameters over the years of the chronic pulmonary disease survival.”

From this, the majority concluded that a reasonable ALJ could infer:

  • Dr. Perper’s diagnosis of pneumoconiosis was based in part on the ABG results; and therefore
  • He necessarily regarded the terminal ABG abnormalities as manifestations of the underlying chronic lung disease, not merely of an unrelated acute condition.

Thus, even though Dr. Perper never literally wrote “the ABG values were produced by chronic pneumoconiosis,” the majority held the evidentiary requirement was met: the report “established” the requisite causal linkage when viewed in context.

2. Acute vs. Chronic Causes: Addressing the DOL’s Concern

Clinchfield argued—and the dissent agrees—that the DOL’s own explanation of § 718.105(d) shows why a more exacting requirement is needed. In the preamble to the regulation, DOL warned that terminal hospitalization ABG values:

“may be especially susceptible to producing low values unrelated to chronic respiratory or pulmonary disease. Consequently, reliance on such studies should be predicated on an additional showing that the qualifying (or abnormal) test results can be medically linked to chronic lung disease.”
64 Fed. Reg. 54966, 54977 (Oct. 8, 1999) (emphasis added).

The medical record here illustrates that concern. At the time of the ABGs, Mullins had:

  • Pneumonia,
  • Acute respiratory distress syndrome,
  • Hypertension,
  • Type 2 diabetes mellitus,
  • Acute renal insufficiency, and
  • Atrial fibrillation.

Clinchfield’s expert, Dr. Caffrey, opined that these acute conditions, not pneumoconiosis, accounted for the terminal ABG abnormalities. The majority, however, upheld the ALJ’s decision to credit Dr. Perper and the BRB’s reasoning that:

  • Perper treated pneumonia and ARDS as complications of longstanding coal-dust-related lung disease—“often complicated by severe pulmonary infection and pneumonia prior to death” in cases of significant coal workers’ pneumoconiosis;
  • Thus, the acute deterioration was not an independent, unrelated cause, but the final worsening of a chronic respiratory process; and
  • It was reasonable, therefore, for the ALJ to find that the terminal ABG values reflected the chronic disease’s impact on gas exchange, satisfying § 718.105(d).

In other words, the majority accepts that § 718.105(d) requires adjudicators to consider whether low ABG values may be attributable to purely acute conditions, but concludes that:

  • When a reasoned medical opinion attributes the acute events to progression of the chronic pneumoconiosis, the ABGs can still be viewed as “produced by” the chronic condition.

3. “Link” vs. “Produce” – Semantic or Substantive?

Clinchfield argued that ALJ Clark’s statement that Dr. Perper “links” the ABGs to a chronic condition fell short of the regulatory requirement that the values be “produced by” such a condition.

The majority rejected the supposed distinction, emphasizing:

  • The regulation requires that the physician’s report “establish” that ABG results were produced by chronic disease, but does not require the physician to use “produced by” as a magic phrase.
  • The DOL’s own explanatory language uses “linked,” reinforcing that “linkage” is the concept § 718.105(d) is getting at.

The dissent, by contrast, insists on textual precision:

  • “Produced by” implies a causal origin, while “linked” or “connected” may suggest only correlation or consistency.
  • Given the other serious acute conditions, it is speculative to say the ABG values were produced by pneumoconiosis rather than by pneumonia/ARDS.
  • Therefore, in Judge Quattlebaum’s view, the court impermissibly substitutes a looser concept (“connected”) for the regulatory text (“produced by”).

The majority’s key interpretive move is to treat “establish” as the dominant verb in § 718.105(d). So long as the physician’s report, taken as a whole, reasonably supports the inference that pneumoconiosis produced the ABG abnormalities, the requirement is satisfied, even if the report uses different vocabulary.

C. Total Disability and the § 718.305 Fifteen-Year Presumption

Once a claimant shows:

  1. At least 15 years of qualifying coal mine employment; and
  2. Total disabling respiratory/pulmonary impairment at death,

the § 718.305 presumption applies and the miner’s death is presumed due to pneumoconiosis unless the operator rebuts by showing either:

  • The miner did not have pneumoconiosis; or
  • “No part” of his death was caused by pneumoconiosis. 20 C.F.R. § 718.305(d)(2).

The 15-year employment requirement was undisputed; the controversy focused on total disability at death. Since:

  • There were no qualifying pulmonary function tests,
  • No evidence of cor pulmonale, and
  • Other evidence was insufficient,

the ABG studies were critical. Accepting those ABGs as properly supported by a physician’s report effectively decided the total disability issue.

The majority underscores that its review is deferential: if a reasonable mind could conclude that Dr. Perper’s discussion establishes the ABGs as chronic-disease-driven, then under the “substantial evidence” standard it must affirm. Once that premise is accepted, the presumption is invoked, and Clinchfield’s failure to challenge rebuttal findings before the BRB is fatal.

D. ALJ’s Evaluation of Medical Opinion Evidence

Clinchfield also argued that the BRB erred by not requiring the ALJ to make an explicit finding that Dr. Perper’s report was “well reasoned and well documented.” It relied on 20 C.F.R. § 718.104(c), which addresses how to weigh medical reports—especially those of treating physicians—and states that a non-examining physician’s report may “form the basis for a finding if, in the opinion of the adjudication officer, it is accompanied by sufficient indicia of reliability in light of all relevant evidence.”

The Fourth Circuit responded:

  • Neither the BLBA nor its regulations require an ALJ to recite the phrases “well reasoned” or “well documented.”
  • What is required is that the ALJ:
    • Analyze all relevant evidence, and
    • Explain why certain medical opinions are credited or discredited.
  • Here, ALJ Clark did so, noting that Dr. Perper:
    • Reviewed medical records from 2000 onward;
    • Considered diagnoses of COPD, coal workers’ pneumoconiosis, asthma, chronic bronchitis, and obstructive airway disease; and
    • Related these to progressive worsening documented by clinical tests, including ABGs.

The court relied on its own precedents emphasizing ALJ discretion:

  • Harman Mining Co. v. Director, OWCP, 678 F.3d 305, 310 (4th Cir. 2012) (courts must not substitute their judgment for that of the ALJ);
  • Westmoreland Coal Co. v. Cochran, 718 F.3d 319, 324 (4th Cir. 2013) (“battle of the experts” is for the ALJ to resolve);
  • Consolidation Coal Co. v. Williams, 453 F.3d 609, 622 (4th Cir. 2006) (a doctor’s opinion is “well reasoned” if supported by objective testing and consistent with the miner’s history);
  • And it cited the Sixth Circuit’s parallel approach in Incoal Inc. v. Director, OWCP, 123 F.4th 808, 818 (6th Cir. 2024) and Big Branch Res., Inc. v. Ogle, 737 F.3d 1063, 1073 (6th Cir. 2013).

The takeaway: appellate courts will not insist on formulaic labels, so long as the ALJ’s written decision shows a reasoned basis for crediting or rejecting medical opinions.

E. Modification as a “Mistake in a Determination of Fact”

The final legal issue concerned whether ALJ Clark properly granted modification under 20 C.F.R. § 725.310(a), which allows reopening within one year based on:

  • a change in condition; or
  • a “mistake in a determination of fact.”

It is well-established that this “mistake of fact” authority is extremely broad:

  • O’Keeffe v. Aerojet-General Shipyards, Inc., 404 U.S. 254, 256 (1971) – the factfinder may correct mistaken factual findings based on new evidence, cumulative evidence, or mere reconsideration of the original record.
  • Jessee v. Director, OWCP, 5 F.3d 723, 724 (4th Cir. 1993) – modification is available to correct mistakes as to the ultimate fact of entitlement.
  • Betty B Coal Co. v. Director, OWCP, 194 F.3d 491, 497 (4th Cir. 1999) – modification is an “extraordinarily broad” procedure, aimed at rendering justice under the Act.

Clinchfield argued that ALJ Barto’s decision involved only an error of law—namely, misinterpreting § 718.105(d) as requiring a contemporaneous, hospitalization-based report (Dr. Patel’s discharge summary) and overlooking Dr. Perper’s later record-review opinion. On that theory, the error could not be corrected by modification.

The majority disagreed, emphasizing:

  • The “ultimate fact” in dispute was whether Mullins was totally disabled at death.
  • ALJ Clark found that the earlier ALJ had erroneously concluded there was no other physician’s report capable of satisfying § 718.105(d).
  • That kind of misapprehension and reassessment of the medical evidence—and its bearing on the existence of total disability—is quintessentially factual, not purely legal.

The court distinguished Donadi v. Director, OWCP, 12 BLR 1‑166 (1989) (BRB), which held that an error or change in law is not a basis for modification. In Donadi,:

  • There was no dispute over the facts; the issue concerned correct application of the law to those facts (commencement date of benefits).

By contrast, in Mullins the question is whether the miner was totally disabled in the first place—a factual determination that can be revisited in light of a reweighing of the existing medical record.

Thus, the panel reaffirmed the breadth of modification as a tool for correcting factual mistakes, including mis-evaluations of medical evidence, even without new evidence.

V. Precedents and Authorities Cited

A. BLBA and Administrative Law Precedents

  • Eastern Assoc. Coal Corp. v. Director, OWCP, 805 F.3d 502 (4th Cir. 2015) – Standards for reviewing BLBA decisions (substantial evidence; rational and in accordance with law).
  • Hobet Mining, LLC v. Epling, 783 F.3d 498 (4th Cir. 2015) – Similar “substantial evidence” standard and ALJ’s duty to analyze relevant evidence.
  • Scott v. Mason Coal Co., 289 F.3d 263 (4th Cir. 2002) – “Reasonable mind” test for substantial evidence.
  • Milburn Colliery Co. v. Hicks, 138 F.3d 524 (4th Cir. 1998) – ALJ must explain which evidence is credited.
  • Frontier-Kemper Constructors, Inc. v. Director, OWCP, 876 F.3d 683 (4th Cir. 2017) – Reiterates need for reasoned explanation by ALJ.
  • Westmoreland Coal Co. v. Cox, 602 F.3d 276 (4th Cir. 2010) – De novo review of legal questions, deference to factual findings.
  • Island Creek Coal Co. v. Blankenship, 123 F.4th 684 (4th Cir. 2024) – Cited for standard of review and ALJ reasoning requirements.

B. Waiver and Preservation Cases

  • Armco, Inc. v. Martin, 277 F.3d 468 (4th Cir. 2002) – Issues not presented to BRB are generally waived.
  • Edd Potter Coal Co., Inc. v. Director, OWCP, 39 F.4th 202 (4th Cir. 2022) – Emphasizes the need for specificity in issues listed for review.
  • De Simone v. VSL Pharms., Inc., 36 F.4th 518 (4th Cir. 2022) – Allows “variations” on arguments if the core theory is disclosed.
  • Wards Corner Beauty Acad. v. NACCAS, 922 F.3d 568 (4th Cir. 2019) – Lower tribunal must be fairly put on notice of contested points.
  • Riley v. Island Creek Coal Co., 688 F. App’x 219 (4th Cir. 2017) (unpublished) – A general attack on the BRB’s analytic framework preserved specific sub-arguments.

C. Medical Evidence and Opinion Weighting

  • Trump v. Eastern Assoc. Coal Corp., 737 F. App’x 156 (4th Cir. 2018) – ALJ must consider the physician’s report as a whole, not parse isolated statements.
  • Consolidation Coal Co. v. Williams, 453 F.3d 609 (4th Cir. 2006) – Explains what makes a medical opinion “well reasoned,” including its foundation in objective tests and miner’s work history.
  • Harman Mining Co. v. Director, OWCP, 678 F.3d 305 (4th Cir. 2012) – Cautions against appellate reweighing of expert testimony.
  • W. Va. CWP Fund v. Bender, 782 F.3d 129 (4th Cir. 2015) – Confirms ALJ’s prerogative to resolve medical expert conflicts.
  • Incoal Inc. v. Director, OWCP, 123 F.4th 808 (6th Cir. 2024) and Big Branch Res., Inc. v. Ogle, 737 F.3d 1063 (6th Cir. 2013) (cited approvingly) – Characterize whether a report is “documented and reasoned” as a credibility determination for the ALJ.

D. Modification and “Mistake of Fact”

  • O’Keeffe v. Aerojet-General Shipyards, Inc., 404 U.S. 254 (1971) – Establishes broad authority to correct factual mistakes on modification.
  • Jessee v. Director, OWCP, 5 F.3d 723 (4th Cir. 1993) – Modification can correct mistakes as to the ultimate fact of entitlement.
  • Betty B Coal Co. v. Director, OWCP, 194 F.3d 491 (4th Cir. 1999) – Emphasizes that modification is an “extraordinarily broad” remedial tool.
  • Donadi v. Director, OWCP, 12 BLR 1‑166 (1989) – Error or change in law alone is not a proper basis for modification; distinguished by the court.

VI. The Dissent: Textual Rigor and Post–Loper Bright Context

Judge Quattlebaum’s dissent is notable for its strict textualist application of § 718.105(d) and for situating the dispute in the post–Loper Bright Enterprises v. Raimondo, 603 U.S. 369 (2024), environment.

A. Emphasis on the Text “Produced By”

The dissent underscores the key regulatory language:

The ABG study “must be accompanied by a physician’s report establishing that the test results were produced by a chronic respiratory or pulmonary condition.” 20 C.F.R. § 718.105(d) (emphasis added).

Judge Quattlebaum argues:

  • “Connecting” or “linking” ABG results to pneumoconiosis is not enough; the regulation demands a physician’s statement that the test results were produced by a chronic condition.
  • Dr. Perper never says that. At best, he indicates that the ABG results are “consistent with” or “substantiate” the worsening of chronic disease, which falls short of a clear causal attribution.
  • Therefore, the regulatory precondition for using these ABGs is unmet, and they “cannot be relied upon as evidence of total disability at death.”

B. Acute Co-morbidities as Alternative Explanations

The dissent emphasizes the multiple serious acute conditions at the time of the ABG testing and notes that Dr. Perper explicitly acknowledged the tests were taken “when Mr. Mullins had contracted pneumonia and respiratory distress syndrome.”

Against this background, the dissent contends:

  • The record does not tell us whether the ABG abnormalities stem from chronic pneumoconiosis or from these acute conditions; that is precisely why § 718.105(d) exists.
  • Because no physician explicitly attributes the ABG results to the chronic disease, the statutory presumption of total disability cannot be invoked.

C. Loper Bright and Deference

In a footnote, Judge Quattlebaum discusses Loper Bright, which eliminated Chevron deference to agency interpretations of statutes but recognized that Congress can still expressly delegate definitional power to agencies. He notes:

  • The BLBA explicitly directs the Secretary of Labor to define terms like “total disability” by regulation (30 U.S.C. § 902(f); § 921(b)).
  • Thus, the regulations here are authoritative and must be applied according to their text, not loosened through agency commentary or judicial gloss.

He also flags—but does not decide because the issue was not raised—an additional textual question: whether a report written over two years after the ABG studies for litigation purposes can truly be said to “accompany” the tests as § 718.105(d) requires.

The dissent ultimately concludes that the court is improperly diluting a clear regulatory requirement in the name of remedial purposes, and insists that even pro-claimant statutes do not justify ignoring binding regulatory text.

VII. Practical and Doctrinal Impact

A. For Claimants and Their Counsel

  • Use of Record-Review Reports to Satisfy § 718.105(d):
    • Mullins confirms that a retrospective, record-review opinion—like Dr. Perper’s—can “accompany” terminal ABG tests and satisfy § 718.105(d), so long as it reasonably establishes a chronic origin for the abnormal results.
    • There is no requirement that the report be authored at the time of hospitalization or by a treating physician.
  • Language Need Not Be Formulaic:
    • Physicians do not need to parrot the phrase “produced by.” Detailed narrative tying ABG abnormalities to the course of chronic lung disease can suffice.
    • However, in light of the dissent’s critique, prudent counsel will likely continue to ask physicians to explicitly state that the ABG findings are caused or “produced by” the chronic disease, to avoid future litigation risk.
  • Modification as a Safety Valve:
    • Mullins reinforces the broad availability of modification to correct prior denials based on misapprehension or misweighing of medical evidence.
    • Claimants should be alert to filing modification requests within one year whenever prior adjudicators have arguably overlooked or misinterpreted medical opinions.

B. For Operators and Insurers

  • Heightened Need to Address All Medical Opinions:
    • Operators must proactively address all physician opinions in the record—including record-review reports that discuss ABG tests—when challenging total disability.
    • Failure to specifically rebut a physician’s linking of ABG results to chronic disease may be fatal, especially if the 15-year presumption is in play.
  • Preservation of Rebuttal Issues:
    • Clinchfield’s failure to challenge the ALJ’s finding on rebuttal of the § 718.305 presumption before the BRB meant that once the presumption was found invoked, the litigation was effectively over.
    • Operators should clearly articulate both:
      • Challenges to entitlement (e.g., total disability, pneumoconiosis); and
      • Alternative rebuttal theories (no pneumoconiosis; or no contribution to death), at every stage.
  • Limits on “Error of Law” Shield Against Modification:
    • Arguments that a prior decision rested on legal error will often be recast as factual mistakes about what the medical evidence shows.
    • Operators should recognize that once a claim is within the modification window, factual findings—including ultimate disability findings—are vulnerable to reconsideration.

C. For ALJs and the BRB

  • Holistic Reading of Medical Opinions:
    • Mullins affirms that ALJs should read physicians’ reports as a whole, avoiding hyper-technical parsing of isolated sentences.
    • But they should also clearly explain how they infer the causal relationship between ABG abnormalities and chronic disease.
  • No Need for “Magic Words,” But Explanation is Crucial:
    • ALJs are not required to declare that an opinion is “well reasoned and well documented,” but must describe the basis for crediting it:
    • e.g., scope of record review, objective tests relied upon, consistency with longitudinal course of disease, etc.
  • Application of § 718.105(d):
    • ALJs must:
      • Identify whether ABGs were performed during a terminal hospitalization;
      • Determine if they are qualifying under Appendix C; and
      • Explicitly analyze whether a physician’s report establishes they were produced by chronic disease rather than solely acute conditions.
    • Mullins permits ALJs to find this requirement satisfied through reasonable inference from the physician’s narrative, not just explicit phrases.
  • Modification Decisions:
    • ALJs have wide latitude to revisit earlier factual conclusions on modification, including by reweighing existing evidence, to “render justice under the Act.”
    • They should, however, clearly identify which prior findings are being revised and why.

VIII. Complex Concepts Explained

A. Pneumoconiosis (Black Lung)

  • Definition: A “chronic dust disease of the lung and its sequelae” caused by coal mine employment. 30 U.S.C. § 902(b).
  • Clinical pneumoconiosis refers to the classic radiographic and pathological disease.
  • Legal pneumoconiosis includes any chronic lung disease or impairment significantly related to, or substantially aggravated by, dust exposure in coal mine employment.

B. Total Disability in BLBA Context

  • Not simply whether the miner stopped working, but whether he had a respiratory or pulmonary impairment that, standing alone, precluded him from performing his usual coal mine work or comparable gainful work.
  • Can be proven through:
    • Pulmonary function tests (PFTs),
    • ABG tests,
    • Evidence of cor pulmonale with right-sided heart failure, or
    • Reasoned medical opinion.

C. Arterial Blood-Gas (ABG) Tests

  • Measure levels of oxygen and carbon dioxide in arterial blood.
  • Abnormal (qualifying) values at rest or on exercise can demonstrate impairment in gas exchange in the lungs.
  • Appendix C to Part 718 prescribes tables of values at or below which ABG results are deemed qualifying for total disability purposes.
  • Section 718.105(d) adds the special requirement for tests taken during a terminal hospitalization.

D. 15-Year Presumption – 20 C.F.R. § 718.305

  • If a miner has:
    • 15 or more years of underground (or substantially similar) coal mine employment, and
    • At death, a totally disabling respiratory or pulmonary impairment,
  • Then it is presumed that:
    • The miner’s death was due to pneumoconiosis,
    • Unless the employer proves either:
      • No pneumoconiosis; or
      • Pneumoconiosis played no role at all (“no part”) in the miner’s death.

E. Modification – 20 C.F.R. § 725.310

  • Allows any party to request reconsideration of an award or denial of benefits within one year of:
    • the last payment of benefits; or
    • the denial of a claim.
  • Grounds:
    • Change in condition; or
    • Mistake in a determination of fact—including the ultimate question of entitlement.
  • Permits reliance on new evidence, cumulative evidence, or re-evaluation of existing evidence.

IX. Conclusion: The Significance of Clinchfield Coal Co. v. Mullins

Clinchfield Coal Co. v. Mullins establishes important, claimant-friendly doctrinal points in Fourth Circuit BLBA jurisprudence:

  • Section 718.105(d) does not require a physician to use particular magic words (“produced by”), so long as a reasoned, holistic reading of the report allows the ALJ to conclude that terminal ABG abnormalities are attributable to chronic pneumoconiosis.
  • The court is willing to treat acute conditions at death as complications of chronic coal-dust-induced disease when a credible physician so explains, thereby preserving ABGs as valid evidence of total disability.
  • ALJs are not bound to formulaic labels like “well reasoned and well documented”; their credibility findings will be upheld if adequately explained.
  • The modification mechanism retains its “extraordinarily broad” character, enabling correction of prior denials based on factual misinterpretations of medical evidence.
  • Issue preservation is applied flexibly: specific arguments that elaborate an earlier, broadly framed contention (here, lack of total disability) generally are not deemed waived.

At the same time, the vigorous dissent underscores an emerging tension in post–Loper Bright administrative law: to what extent may courts soften or elaborate clear regulatory text in the interest of remedial purposes? While the majority adopts a pragmatic, inference-based approach, the dissent insists on a stricter adherence to the regulatory command that ABG values from a terminal hospitalization be expressly attributed to chronic disease.

In practical terms, Mullins will make it easier for survivors to rely on terminal ABG tests, so long as a credible physician’s narrative—taken as a whole—ties those values to the miner’s longstanding lung disease. It also reinforces the centrality of detailed, longitudinal medical analysis in BLBA cases and the deference courts will afford to ALJ factfinding so long as it is adequately reasoned and supported by substantial evidence.

Case Details

Year: 2025
Court: Court of Appeals for the Fourth Circuit

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