The “Middle Ground” Standard for Medical Rebuttal: Fourth Circuit Upholds ALJ’s Use of the 2000 Preamble as Guidance and Requires Individualized, Literature-Grounded Expert Opinions in Black Lung Cases

Introduction

In Consol of Pa Coal Company, LLC v. Director, OWCP; Seckman (No. 23-2105, 4th Cir. Oct. 28, 2025) (unpublished), the Fourth Circuit denied a coal employer’s petition for review and affirmed an award of federal black lung benefits to miner William J. Seckman. The court held that the Administrative Law Judge (ALJ), as affirmed by the Benefits Review Board (BRB), applied the correct legal standards and supported his findings with substantial evidence when he concluded that the employer failed to rebut the 15-year presumption that the miner is totally disabled due to pneumoconiosis under the Black Lung Benefits Act (BLBA), 30 U.S.C. §§ 901–944.

Although unpublished and not binding precedent in the Fourth Circuit, the opinion provides important guidance on three recurring issues in BLBA litigation:

How an employer may rebut the 15-year presumption under 20 C.F.R. § 718.305, including what it means to prove the “absence” of legal pneumoconiosis;
The permissible use of the Department of Labor’s 2000 regulatory Preamble as guidance when evaluating medical opinions; and
What makes a medical opinion persuasive: neither population-level “statistical averaging” nor unsupported ipse dixit suffices; instead, the court endorses an “obtainable middle ground” that ties individualized clinical assessment to supporting medical literature.

Summary of the Opinion

The parties agreed that Seckman triggered the 15-year presumption of total disability due to pneumoconiosis. The employer argued that the ALJ used the wrong standard in the “pneumoconiosis rebuttal” pathway and improperly gave the 2000 Preamble the force of law—particularly by treating asthma as per se COPD caused by coal dust. The employer also challenged the ALJ’s decision to discount the opinions of its experts, Drs. Zaldivar and Basheda.

The Fourth Circuit rejected those arguments. It held:

The ALJ applied the correct legal standard: to rebut on “pneumoconiosis,” the employer must establish the absence of legal pneumoconiosis, i.e., that the miner’s impairment is not significantly related to or substantially aggravated by coal dust exposure (citing Smith and § 718.305(d)(1)(i)).
The ALJ permissibly used the Preamble as guidance—not as binding law—to evaluate whether the doctors’ reasoning cohered with accepted medical science, including that asthma is a form of COPD that can be linked to coal dust.
The ALJ acted within his discretion in discounting Dr. Zaldivar’s reliance on population averages and Dr. Basheda’s literature-free assertions. The opinion emphasizes a “middle ground” for expert testimony: individualized miner-specific analysis informed by, and tied to, relevant medical literature.

Because the ALJ applied the correct standards and supported the decision with substantial evidence, the court denied the petition without oral argument.

Detailed Analysis

A. Precedents and Authorities Cited

W. Va. CWP Fund v. Bender, 782 F.3d 129 (4th Cir. 2015)
- Articulates the elements of entitlement and the demanding “rule out” standard for causation rebuttal: the employer must affirmatively establish that “no part” of the miner’s total disability is due to pneumoconiosis—that the disability is attributable exclusively to other causes.
W. Va. CWP Fund v. Director, OWCP (“Smith”), 880 F.3d 691 (4th Cir. 2018)
- Explains the 15-year presumption under 30 U.S.C. § 921(c)(4) and 20 C.F.R. § 718.305. When triggered, the burden shifts to the employer to rebut either by proving no pneumoconiosis (legal or clinical) or by satisfying the “no part” causation standard.
- Defines the pneumoconiosis rebuttal: the employer must prove the miner’s impairment is not significantly related to or substantially aggravated by coal mine dust exposure.
Hobet Mining, LLC v. Epling, 783 F.3d 498 (4th Cir. 2015)
- Reiterates substantial-evidence review and the “rule out” causation standard under § 718.305(d)(1)(ii).
Sea “B” Mining Co. v. Addison, 831 F.3d 244 (4th Cir. 2016)
- Affirms the ALJ’s role as factfinder and emphasizes the need for adequate explanation in weighing conflicting medical evidence. Courts do not reweigh evidence or make credibility determinations on appeal but must be able to discern what the ALJ did and why.
American Energy, LLC v. Director, OWCP, 106 F.4th 319 (4th Cir. 2024) and Island Creek Coal Co. v. Blankenship, 123 F.4th 684 (4th Cir. 2024)
- State the substantial evidence standard: more than a scintilla; such relevant evidence as a reasonable mind might accept. Appellate deference is strong but not unbounded.
Extra Energy, Inc. v. Lawson, 140 F.4th 138 (4th Cir. 2025)
- Clarifies the permissible use of the 2000 Preamble: ALJs may consult it as a scientific guide to assess the credibility of medical opinions, but may not treat it as binding law or substitute it for record evidence.
Consolidation Coal Co. v. Director, OWCP, 521 F.3d 723 (7th Cir. 2008)
- Supports discounting an expert opinion that rests on unsupported assertions; medical causation opinions should be grounded in recognized medical literature or data.
Preamble to the 2000 BLBA Regulations, 65 Fed. Reg. 79,920 (Dec. 20, 2000)
- Summarizes the scientific consensus underlying the regulations, including that coal dust exposure can cause COPD (which encompasses chronic bronchitis, emphysema, and asthma-like conditions) and that reliance on “statistical averaging” may obscure effects in individual miners (see 65 Fed. Reg. at 79,941).

B. Legal Reasoning

1) Standard of Review and ALJ’s Role

The court reaffirmed the two pillars of BLBA appellate review:

Substantial evidence supports the ALJ’s factfinding when it is the type of evidence a reasonable mind would accept to support a conclusion.
ALJs must analyze all relevant evidence and adequately explain how they resolved conflicts. Appellate courts neither reweigh competing medical opinions nor second-guess credibility determinations if sufficiently explained.

2) The 15-Year Presumption and Employer’s Rebuttal Burden

Once the miner triggered the 15-year presumption, the employer could rebut in either of two ways:

Pneumoconiosis rebuttal (20 C.F.R. § 718.305(d)(1)(i)): Prove that the miner does not have pneumoconiosis, including legal pneumoconiosis. The Fourth Circuit endorsed the ALJ’s articulation that “proving the absence of legal pneumoconiosis” is functionally equivalent to proving the impairment is not significantly related to, or substantially aggravated by, coal dust exposure.
Causation rebuttal (20 C.F.R. § 718.305(d)(1)(ii)): Prove that “no part” of the miner’s total respiratory disability was caused by pneumoconiosis—the rigorous “rule out” standard from Bender and Epling.

Here, the dispute centered on the pneumoconiosis rebuttal, and the court found no legal error in how the ALJ framed and applied that standard.

3) Proper Use of the 2000 Preamble as Guidance

The employer argued the ALJ elevated the Preamble to controlling law by treating asthma as per se COPD caused by coal dust. The court disagreed. Consistent with Extra Energy v. Lawson, the ALJ used the Preamble as a scientific reference point: to recognize that asthma is a form of COPD that can, in appropriate cases, be associated with coal dust exposure. On that premise, the ALJ reasonably expected Dr. Basheda to articulate and support a medically sound basis for excluding coal dust as a contributor to the miner’s “asthma-like” impairment, especially given the miner’s lengthy dust exposure.

4) Evaluating Medical Opinions: The Court’s “Obtainable Middle Ground”

The opinion’s most practically significant passage explains how ALJs may weigh expert testimony:

Dr. Zaldivar’s opinion leaned heavily on population-level statistical averages from epidemiological studies to infer that this particular miner did not have legal pneumoconiosis. Echoing the Preamble’s caution, the court affirmed that “statistical averaging” can mask individual susceptibility or harm; an expert cannot stop at population statistics without connecting them to the miner’s specific clinical picture.
Dr. Basheda’s opinion presented the converse flaw: he offered a list of reasons to attribute impairment solely to smoking but did not anchor those reasons in medical literature and even dismissed the need to do so in deposition testimony. The ALJ reasonably found this insufficient.

Rejecting the employer’s “Catch‑22” argument, the Fourth Circuit described a workable standard for medical causation opinions in BLBA cases: an expert should perform a miner-specific assessment and then apply relevant medical literature to that assessment. That “obtainable middle ground” neither endorses literature-free ipse dixit nor demands mechanistic reliance on population averages untethered to the individual case.

C. Impact and Practical Implications

1) Expert Testimony in BLBA Rebuttal

This opinion elevates the expectations for medical rebuttal evidence in the Fourth Circuit’s black lung docket:

Individualization is essential: Experts must engage with the miner’s specific history, clinical findings, spirometry trends, imaging, and differential diagnoses, and explain how those miner-specific facts align with, or diverge from, the literature.
Literature linkage matters: Opinions should cite medical studies or authoritative sources to justify how the expert distinguishes dust-induced from tobacco-induced COPD, especially when discussing asthma-like phenotypes, chronic bronchitis, or emphysema in miners with long dust exposure.
Killing the “Catch‑22” argument: The court’s “middle ground” language will likely become a touchstone for ALJs. Employers cannot claim unfairness when ALJs discount opinions that are either over-generalized or unsupported by recognized medical science.

2) Preamble as Credibility Guide

Following Extra Energy, this case confirms that ALJs may use the 2000 Preamble to evaluate whether a medical opinion aligns with accepted scientific consensus. Expect continued scrutiny of opinions that:

Assume asthma cannot be COPD or cannot be coal-dust related; or
Dismiss additive or synergistic effects of coal dust and smoking without explanation and support.

3) Reinforcement of Rebuttal Standards

Pneumoconiosis rebuttal: It is not enough to show that smoking is a major cause. The employer must establish that coal dust exposure did not significantly relate to or substantially aggravate the miner’s disease.
Causation rebuttal: The “no part” rule-out standard remains exacting—an employer must demonstrate that pneumoconiosis did not contribute at all to disability.

4) Effects on Case Strategy

For employers:
- Commission reports that synthesize miner-specific data with cited literature; avoid overreliance on population averages.
- Prepare experts to justify biologically plausible mechanisms distinguishing dust- from smoke-related disease, consistent with literature.
- Ensure deposition testimony fortifies, rather than undercuts, the expert’s methodological foundation.
For miners:
- Highlight Preamble-consistent mechanisms linking dust to COPD, including asthma-like impairment, chronic bronchitis, and emphysema.
- Underscore additive effects of dust and smoking where supported by record and literature.
For ALJs:
- Continue to require reasoned medical opinions grounded in both individualized analysis and recognized science.
- Explain credibility determinations with reference to how well each opinion ties miner-specific facts to authoritative sources.

Complex Concepts Simplified

Black Lung Benefits Act (BLBA): A federal program compensating coal miners disabled by pneumoconiosis (black lung disease) and their survivors.
Clinical vs. Legal Pneumoconiosis:
- Clinical: The classic dust disease recognized by medical imaging or pathology (e.g., small rounded opacities).
- Legal: Any chronic lung disease or impairment significantly related to or substantially aggravated by coal dust exposure—including COPD phenotypes such as chronic bronchitis, emphysema, and asthma-like impairment.
15-Year Presumption (§ 921(c)(4); § 718.305): If a miner with 15+ years in underground (or substantially similar) mining has a totally disabling respiratory impairment and no complicated pneumoconiosis on x-ray, he is presumed disabled due to pneumoconiosis. The employer must rebut.
Pneumoconiosis Rebuttal: The employer must prove the miner does not have clinical or legal pneumoconiosis—i.e., the impairment is not significantly related to, or substantially aggravated by, coal dust.
Causation Rebuttal (“Rule Out”): The employer must prove that pneumoconiosis played no part in the miner’s total disability.
Substantial Evidence: Enough relevant evidence that a reasonable person could accept to support a conclusion. Appellate courts defer to well-explained ALJ findings.
2000 Preamble: An explanatory text accompanying the BLBA regulations summarizing medical consensus. It is not binding law, but it is a legitimate scientific reference for evaluating medical opinion credibility.
“Statistical Averaging” Caution: Population averages can obscure effects in individual cases; experts should address the miner’s specific data, not just general trends.

Conclusion

Consol of Pa Coal Co. v. Director, OWCP; Seckman underscores a pragmatic, evidence-grounded approach to rebutting the 15-year presumption. The Fourth Circuit confirms that:

Employers can be required to prove the “absence” of legal pneumoconiosis by showing the impairment is not significantly related to or aggravated by coal dust.
ALJs may consult the 2000 Preamble as scientific guidance—particularly regarding COPD and the limits of statistical averaging—without giving it the force of law.
Medical opinions must occupy the “obtainable middle ground”: a miner-specific analysis anchored in, and coherently supported by, recognized medical literature.

While unpublished and thus nonbinding, the decision adds persuasive weight in the Fourth Circuit to rigorous, transparent evaluation of medical causation evidence in black lung cases. It equips ALJs with a clear articulation for weighing expert testimony and signals to parties that credible rebuttal must be both individualized and scientifically justified. In short, it is not enough to invoke general statistics, nor is it enough to rely on bare assertions; the law demands a reasoned bridge from authoritative science to the miner’s clinical reality.

Note: The opinion is unpublished and not binding precedent in the Fourth Circuit, but it provides influential guidance for ALJs, the BRB, and practitioners litigating BLBA claims.