Post-Decision Exclusion of Excess Medical-Opinion Testimony Under 20 C.F.R. § 725.414 Does Not Violate Due Process Absent Prejudice

Case: Island Creek Ky. Mining v. OWCPC (6th Cir. Feb. 4, 2026) (not recommended for publication)
Tribunal Reviewed: Benefits Review Board affirmance of an ALJ award under the Black Lung Benefits Act (BLBA)

1. Introduction

This petition for review arose from former underground coal miner Eddie L. Stewart’s fifth attempt to obtain benefits under the Black Lung Benefits Act, 30 U.S.C. § 901 et seq., after four prior denials spanning 1996–2011. Stewart, a roof bolter with just under 15 years of underground coal mine employment, alleged that progressive respiratory impairment requiring supplemental oxygen was caused (at least in part) by pneumoconiosis arising from coal-mine dust exposure.

An Administrative Law Judge (ALJ) awarded benefits, finding Stewart proved clinical and legal pneumoconiosis, total disability, and disability causation, and also proved a “change in condition” required for a subsequent claim. The Benefits Review Board affirmed. Island Creek Kentucky Mining (the employer) petitioned the Sixth Circuit, focusing on: (i) due process and evidentiary-limit issues relating to the ALJ’s partial exclusion of treating physician deposition cross-examination; (ii) the ALJ’s references to the Department of Labor’s 2001 regulatory preamble; and (iii) whether substantial evidence supported findings of clinical pneumoconiosis based on x-rays, CT evidence, and medical opinions notwithstanding a modest smoking history.

2. Summary of the Opinion

The Sixth Circuit denied the petition for review. The court held that:

• The employer was not denied due process by the ALJ’s decision (made in the written Decision and Order) to disregard portions of deposition testimony deemed to exceed evidentiary limits under 20 C.F.R. § 725.414; the employer had adequate notice and failed to demonstrate prejudice.
• The ALJ did not treat the 2001 regulatory preamble as a binding presumption; the ALJ permissibly used it as a scientific reference point when weighing conflicting medical evidence, consistent with Sixth Circuit precedent.
• Substantial evidence supported the ALJ’s clinical pneumoconiosis finding; the ALJ did not “count heads” mechanically on x-ray readings, permissibly assessed CT evidence, and adequately explained credibility and documentation findings concerning medical opinions even where some physicians were unaware of Stewart’s limited smoking history.

3. Analysis

3.1 Precedents Cited (and How They Shaped the Outcome)

• Island Creek Coal Co. v. Maynard ex rel. Maynard, 87 F.4th 802 (6th Cir. 2023)
  Used for the BLBA entitlement framework (miner status; pneumoconiosis; causation; total disability; disability causation) and the handling of subsequent claims. The court relied on it to situate Stewart’s 2019 claim as a subsequent claim requiring proof that an “applicable condition of entitlement” changed since the prior final denial, and then a merits review on the full record.
• Brandywine Explosives & Supply v. Dir., Off. of Workers' Comp. Programs, 790 F.3d 657 (6th Cir. 2015) and Zurich Am. Ins. Grp v. Duncan ex rel. Duncan, 889 F.3d 293 (6th Cir. 2018)
  Cited for the clinical-versus-legal pneumoconiosis distinction. This mattered because the employer attacked the clinical pneumoconiosis finding, while the ALJ also found legal pneumoconiosis; the cited framework underscores that “pneumoconiosis” is broader than classic radiographic disease and includes chronic obstructive diseases arising from coal dust.
• Cumberland River Coal Co. v. Banks, 690 F.3d 477 (6th Cir. 2012)
  Anchored the subsequent-claim rule: proof of change in condition by new evidence is required before reassessing entitlement on the record as a whole. The Sixth Circuit invoked this structure to validate the ALJ’s approach in recognizing changed conditions since the prior denials.
• Glen Coal Co. v. Seals, 147 F.3d 502 (6th Cir. 1998) and York v. Benefits Rev. Bd., 819 F.2d 134 (6th Cir. 1987)
  Provided the appellate posture: review is limited to whether the outcome is supported by substantial evidence and in conformance with law. The opinion repeatedly returned to this limited role to reject invitations to reweigh x-rays, CT interpretations, and expert credibility.
• Big Branch Res., Inc. v. Ogle, 737 F.3d 1063 (6th Cir. 2013)
  Central to the court’s deference: substantial evidence, no reweighing, and the adequacy-of-explanation requirement. The court used it both to define the standard and to uphold the ALJ’s reasoning on x-ray evaluation, CT weighing, and expert-opinion credibility.
• S. Ohio Coal Co. v. Dir., Off. of Workers' Comp. Programs, U.S. Dep't of Lab., 128 F.4th 809 (6th Cir. 2025) (quoting Island Creek Ky. Mining v. Ramage, 737 F.3d 1050 (6th Cir. 2013))
  Reinforced the “no reweighing” rule and the boundary between factfinding (ALJ) and review (Board and court). This was particularly relevant to disputes over which CT interpretation to credit and whether the ALJ “should” have weighed radiological credentials differently.
• Pyro Mining Co. v. Slaton, 879 F.2d 187 (6th Cir. 1989)
  Cited within Glen Coal for the Board’s limited scope. This supported affirmance where the Board did not exceed its review function.
• Apogee Coal Co., LLC v. Dir., Off. of Workers' Comp. Programs, U.S. Dep't of Lab., 112 F.4th 343 (6th Cir. 2024)
  Reinforced de novo review for legal conclusions, which framed the court’s treatment of due process, APA, and preamble-use arguments.
• Incoal, Inc. v. Dir., Off. of Workers' Comp. Programs, U.S. Dep't of Lab., 123 F.4th 808 (6th Cir. 2024) (quoting Grayson Coal & Stone Co., Inc. v. Teague, 688 F. App'x 331 (6th Cir. 2017))
  Used to emphasize that weighing medical evidence for documentation and reasoning is the ALJ’s job and is a credibility determination that appellate bodies must respect. This undergirded the court’s unwillingness to second-guess the ALJ’s CT-scan credibility choices and medical-opinion weighting.
• McCain v. Dir., Off. of Workers Comp. Programs, 58 F. App'x 184 (6th Cir. 2003)
  Provided the remand standard: reversal is appropriate where the ALJ fails to consider all evidence under the proper standard or lacks evidentiary support. The court found neither defect.
• L.P. v. Amherst Coal Co. (Preston), 24 Black Lung Rep. (Juris) 1-55 (Ben. Rev. Bd. 2008) (en banc) (per curiam)
  The employer relied on Preston to argue the ALJ should have issued evidentiary rulings before the final Decision and Order to allow “good cause” arguments. The Sixth Circuit did not treat Preston as creating a constitutional entitlement to pre-decision rulings; rather, it analyzed whether the employer had notice and a fair chance to argue good cause and whether any procedural defect caused prejudice.
• Karst Robbins Coal Co. v. Dir., Off. of Workers' Comp. Programs, 969 F.3d 316 (6th Cir. 2020)
  Supplied the governing due process framework: the Fifth Amendment applies; parties must have notice and opportunity to be heard; and even if a procedural failure occurs, the challenger must show prejudice. This was decisive in rejecting the employer’s due-process challenge to the ALJ’s treatment of deposition testimony.
• Brasher v. Pleasant View Mining Co., 23 Black Lung Reporter (Juris) 1-141 (Ben. Rev. Bd. 2006) (per curiam)
  Supported the proposition that an ALJ is not obligated sua sponte to conduct an independent “good cause” assessment for evidence exceeding 20 C.F.R. § 725.414. This reinforced the Sixth Circuit’s conclusion that the employer bore responsibility to raise good cause at the hearing if it wished to exceed the evidentiary limits.
• Lane Hollow Coal Company v. Director, Office of Workers' Compensation Programs, Department of Labor, 137 F.3d 799 (4th Cir. 1998)
  Invoked by the employer for an APA-based argument that the ALJ failed to specify precisely what deposition testimony was excluded, allegedly making review impossible. The Sixth Circuit rejected the premise, finding the ALJ sufficiently identified the scope (limiting consideration to treatment-note-related testimony) and the record allowed meaningful review.
• Woodward v. Dir., Off. of Workers' Comp. Programs, U.S. Dep't of Lab., 991 F.2d 314 (6th Cir. 1993)
  The leading Sixth Circuit caution against “counting heads” in x-ray conflicts. The court used Woodward to evaluate whether the ALJ performed a qualitative assessment (reader qualifications, etc.) rather than a mere tally. Finding the ALJ considered qualifications (board-certified radiologists and B-readers), the court found no error.
• Wilgar Land Co. v. Dir., Off. of Workers' Comp. Programs, U.S. Dep't of Lab., 85 F.4th 828 (6th Cir. 2023) and Lemarco, Inc. v. Helton, 559 F. App'x 465 (6th Cir. 2014)
  These cases controlled the “preamble” argument. The court applied Wilgar Land to distinguish improper “binding” use of the preamble from permissible uses: clarifying ambiguity and relying on scientific propositions to resolve evidentiary disputes and weigh experts. The court then sustained the ALJ’s preamble references as permissible scientific context.
• Huscoal, Inc. v. Dir., Off. of Workers' Comp. Programs, 48 F.4th 480 (6th Cir. 2022), Wolf Creek Collieries v. Dir., Off. of Workers' Comp. Programs, 298 F.3d 511 (6th Cir. 2002), and Jericol Mining, Inc. v. Napier, 301 F.3d 703 (6th Cir. 2002)
  These cases collectively supported the ALJ’s ability to credit opinions even if based on some imperfect background information (like smoking history), so long as the ALJ acknowledges discrepancies and provides an adequate explanation grounded in the record. The court used them to reject the employer’s claim that unawareness of smoking history required discrediting pro-claimant medical evidence.
• Greene v. King James Coal Mining, Inc., 575 F.3d 628 (6th Cir. 2009)
  Cited to contrast permissible partial reliance on opinions with imperfect premises versus cases where an opinion is properly rejected when its core bases are seriously flawed. Here, the ALJ found the credited evidence supported by imaging and treatment context, so Greene did not compel discrediting.

3.2 Legal Reasoning

A. Evidentiary limits, deposition cross-examination, and due process

The employer’s lead procedural argument was that the ALJ’s post-hearing, in-decision exclusion of portions of treating physician Dr. Chavda’s deposition cross-examination denied due process because it prevented a “good cause” request under 20 C.F.R. § 725.456(b)(1) or other corrective steps.

The Sixth Circuit’s reasoning followed a stepped analysis:

• Due process standard: Under Karst Robbins Coal Co. v. Dir., Off. of Workers' Comp. Programs, the employer needed to show lack of adequate notice and a fair opportunity to be heard, and—critically—prejudice.
• Notice and opportunity: The court emphasized that the employer used the agency’s “Evidence Summary Form,” which warned that physician testimony from a doctor who did not prepare a prior medical report would be treated as the submitting party’s “medical report.” The court treated this as substantial notice that adding deposition testimony could implicate the two-opinion limit under 20 C.F.R. § 725.414.
• Burden to raise good cause: Relying on Brasher v. Pleasant View Mining Co., the court stressed that ALJs are not obliged sua sponte to evaluate good cause for excess evidence; parties must timely raise and develop those arguments.
• Scope of cross-examination: The ALJ characterized certain cross-examination questions as seeking a new medical opinion based on evidence outside the treating physician’s notes—functionally an additional medical report—thus exceeding evidentiary limits. The Sixth Circuit accepted that framing as within the ALJ’s discretion to police the record.
• Reviewability / APA concerns: The employer’s “Lane Hollow” argument (framed around the APA’s requirement of reasoned decisionmaking) failed because the ALJ’s limitation—to treatment-note-related testimony—was sufficiently specific to permit appellate review.

B. Preamble to the 2001 regulations: permissible “scientific fact,” not a binding presumption

The employer argued the ALJ treated the regulatory preamble as binding. The Sixth Circuit, applying Wilgar Land Co. v. Dir., Off. of Workers' Comp. Programs, U.S. Dep't of Lab., reaffirmed:

• The preamble cannot “bind” private parties or add substantive duties beyond the regulations.
• But ALJs may consult the preamble to clarify ambiguity and to use its scientific propositions when resolving evidentiary conflicts—e.g., when weighing whether coal dust and smoking effects are additive and whether coal dust can cause obstructive impairment even absent certain radiographic patterns.

The court then examined how the ALJ actually used the preamble: to explain why physicians’ failure to account for a minimal smoking history did not necessarily undermine their coal-dust causation views, and to support giving greater weight to opinions consistent with Department-accepted medical principles. That use fit squarely within Wilgar Land and Lemarco, Inc. v. Helton.

C. Substantial evidence review of clinical pneumoconiosis: x-rays, CT, and medical opinions

The remainder of the opinion is a model of substantial-evidence deference:

• X-ray conflicts and “counting heads”: Applying Woodward v. Dir., Off. of Workers' Comp. Programs, U.S. Dep't of Lab., the court held the ALJ did not merely tally positive versus negative readings. The ALJ also addressed reader qualifications, noting they were “equally qualified” (board-certified radiologists and B-readers). That qualitative component insulated the decision from the “counting heads” critique.
• “Inconclusive” x-rays and the APA: The employer argued the APA only permits descriptors like “reliable,” “probative,” or “substantial.” The Sixth Circuit rejected the formalism: calling an x-ray “inconclusive” is a statement about probative value and does not violate 5 U.S.C. § 556.
• CT-scan weighing under 20 C.F.R. § 718.107: The court upheld the ALJ’s reliance on the treating-context CT report and a supportive expert interpretation, while discounting the employer’s interpretation as insufficiently explained (particularly where it attributed findings to etiologies not identified by the clinical reader and failed to explain why coal dust was excluded as an etiology).
• Qualifications and CT evidence: The court emphasized that, unlike x-rays (which have specific regulatory provisions concerning readings and qualifications), CT evidence under 20 C.F.R. § 718.107 does not impose the same credential-weighing requirement. Thus, the ALJ was not required to decide CT credibility by comparing radiological experience.
• Imperfect smoking history in physician opinions: Relying on Huscoal, Inc. v. Dir., Off. of Workers' Comp. Programs and Wolf Creek Collieries v. Dir., Off. of Workers' Comp. Programs, the court accepted that an ALJ may credit an opinion despite some imprecision in background assumptions, so long as the discrepancy is acknowledged and the ALJ explains why the opinion remains persuasive in light of other evidence (here, imaging and treatment history).

3.3 Impact

A. Litigation conduct under the BLBA’s evidentiary limits

This decision underscores a pragmatic risk for employers (and, by symmetry, claimants): deposition testimony can become an “additional medical report” for evidentiary-limit purposes when cross-examination pushes the witness into offering new medical judgments based on evidence outside the witness’s own treatment records. Parties should assume that:

• ALJs may later cabin testimony to avoid exceeding 20 C.F.R. § 725.414; and
• Failure to raise a timely “good cause” argument under 20 C.F.R. § 725.456(b)(1) can be outcome-determinative because appellate courts will require a showing of prejudice under Karst Robbins.

B. Continued Sixth Circuit acceptance of the preamble as an evidentiary touchstone

The opinion reinforces the post-Wilgar Land equilibrium: the preamble is not a presumption, but it remains a powerful “scientific baseline” against which ALJs may evaluate expert reasoning. Experts who do not engage with widely accepted propositions recited in the preamble (e.g., additive risks of smoking and coal dust; coal-dust-related obstructive disease) risk being found less persuasive.

C. Deference to ALJ medical-evidence synthesis

On clinical pneumoconiosis, the decision continues the Sixth Circuit’s emphasis that appellate review is not a second medical board. When an ALJ articulates a qualitative imaging assessment and a coherent credibility rationale, challenges framed as “the ALJ should have believed Dr. X instead of Dr. Y” will predictably fail under Big Branch Res., Inc. v. Ogle and Incoal, Inc. v. Dir., Off. of Workers' Comp. Programs, U.S. Dep't of Lab..

4. Complex Concepts Simplified

• Clinical vs. legal pneumoconiosis: Clinical pneumoconiosis refers to classic dust-disease patterns (often seen on x-rays). Legal pneumoconiosis is broader and includes chronic lung diseases (like COPD) caused or aggravated by coal-mine dust, even if x-rays are not definitive.
• Subsequent claims and “change in condition” (20 C.F.R. § 725.309): A miner whose earlier claim was finally denied may file again, but must prove—using new evidence—that at least one entitlement element changed since the earlier denial.
• Evidentiary limitations (20 C.F.R. § 725.414): BLBA litigation limits how many medical reports/opinions each side can submit. Testimony can be treated like an additional “report” if it introduces new medical opinions rather than explaining existing treatment records.
• “Good cause” (20 C.F.R. § 725.456(b)(1)): A safety valve allowing additional evidence beyond the limits if a party justifies the need. But the party must raise it; the ALJ need not do it for them.
• Preamble use: The preamble is not itself a regulation. It can, however, be used as an accepted summary of medical/scientific understandings that helps an ALJ decide which expert is more persuasive.
• “Counting heads” in x-ray evidence: An ALJ cannot resolve x-ray conflicts by simply counting how many readings are positive versus negative. The ALJ must also consider quality—such as reader qualifications and reasoning.
• Substantial evidence: Not “the best evidence,” but enough that a reasonable person could agree with the ALJ. If substantial evidence exists, appellate courts will not reweigh or substitute their judgment.

5. Conclusion

Island Creek Ky. Mining v. OWCPC is a deferential, procedure-and-proof decision that strengthens practical expectations in Sixth Circuit BLBA litigation: (1) evidentiary-limit enforcement—especially where deposition questioning morphs into new expert opinion—will be upheld absent concrete prejudice; (2) ALJs may cite the 2001 preamble as a scientific reference without converting it into a binding presumption; and (3) well-explained imaging and expert-opinion weighing will survive substantial-evidence review. In the broader context, the opinion reinforces the ALJ’s “gatekeeper of the record” role and confirms that appellate review remains tightly constrained to legal error and evidentiary sufficiency.