“CT-Scan Supremacy”: Potomac Coal Co. v. DOWCP and the Fourth Circuit’s Clarification on Establishing Complicated Pneumoconiosis Under 20 C.F.R. § 718.304

1. Introduction

Potomac Coal Company v. Director, Office of Workers’ Compensation Programs (Potomac) is a 2025 unpublished opinion of the U.S. Court of Appeals for the Fourth Circuit denying a petition for review of a Benefits Review Board (BRB) decision in favor of the widow of coal miner Richard D. Strawser. Although unpublished, the opinion delivers a rigorous reaffirmation—if not a subtle expansion—of the evidentiary value of computerized tomography (CT) scans in Black Lung Benefits Act (BLBA) litigation. Specifically, the Fourth Circuit sustains the Administrative Law Judge’s (ALJ) award of benefits by holding that:

The case pits Potomac Coal Company (employer-petitioner) against (i) the Director of OWCP (statutory respondent) and (ii) Virginia Strawser, widow of the deceased miner (claimant-respondent). The crucial controversy centers on whether CT-scan findings showing ≥1 cm opacities can outweigh prior x-rays that failed to exhibit “complicated” lesions, thereby triggering the § 718.304 irrebuttable presumption.

2. Summary of the Judgment

• The ALJ credited a 2021 CT-scan reading by Dr. Kathleen DePonte diagnosing bilateral category-A large opacities (13 mm and 11 mm) consistent with complicated coal workers’ pneumoconiosis.
• Conflicting interpretations: Dr. Fino observed a 14 mm abnormality but was equivocal (“cannot rule out”), while Dr. Tarver saw no pneumoconiosis on the scan despite earlier x-ray readings in which he had diagnosed simple pneumoconiosis.
• Chest x-rays (2014–2020) uniformly showed only simple pneumoconiosis; no physician read them as complicated.
• No biopsy/autopsy evidence was offered.
• The ALJ:
  • Rejected complicated pneumoconiosis under § 718.304(a) (x-ray) and (b) (biopsy/autopsy).
  • Found complicated pneumoconiosis proven under § 718.304(c) (other means) via Dr. DePonte’s CT interpretation.
  • Gave “greater weight” to DePonte and “little” to Tarver; discounted Fino’s equivocal assessment.
• The BRB affirmed, and the Fourth Circuit upheld, holding the ALJ’s analysis was (i) supported by substantial evidence, (ii) sufficiently explained, and (iii) consistent with the disjunctive structure of § 718.304.

3. Analysis

3.1 Precedents Cited

The opinion draws heavily on Fourth Circuit black-lung jurisprudence:

• Eastern Associated Coal Corp. v. DOWCP, 220 F.3d 250 (4th Cir. 2000) – Established that § 718.304’s three prongs are disjunctive: evidence under any one prong may suffice to prove complicated pneumoconiosis. Potomac extends this reasoning by emphasizing CT scans as a viable “other means.”
• W. Va. CWP Fund v. Bender, 782 F.3d 129 (4th Cir. 2015) – Recited basic elements of BLBA entitlement; quoted for the four-part test.
• Sea “B” Mining Co. v. Addison, 831 F.3d 244 (4th Cir. 2016) – Restated appellate limits: courts do not re-weigh medical evidence.
• Mingo Logan Coal Co. v. Owens, 724 F.3d 550 (4th Cir. 2013) and Lane Hollow Coal Co. v. DOWCP, 137 F.3d 799 (4th Cir. 1998) – Provide the “succinct yet adequate” explanation standard for ALJs.
• Island Creek Coal Co. v. Compton, 211 F.3d 203 (4th Cir. 2000) – Clarifies that ALJs assess the reasoning and objective data underpinning medical opinions.

All precedent converges on one principle: the ALJ is the fact-finder whose evidentiary weighing will stand if it is reasoned and supported.

3.2 Legal Reasoning

1. Disjunctive Evidence Structure
   The court reiterates that § 718.304 allows a claimant to prove complicated pneumoconiosis via x-ray, biopsy/autopsy, or “other means.” The ALJ, therefore, could accept CT-scan evidence under prong (c) despite negative x-ray readings.
2. Comparative Diagnostic Reliability
   Both Drs. DePonte and Tarver acknowledged that CT scans are more sensitive in detecting large opacities than standard radiographs. This medical concession undercut Potomac’s argument that x-ray silence should trump CT findings.
3. Credibility & Persuasiveness Analysis
   Using Compton’s framework, the ALJ examined each physician’s reasoning:
   • DePonte: Specific measurements, bilateral findings, clinical correlation ⇒ “well-reasoned.”
   • Tarver: Failure to address left-lobe lesion, internally inconsistent with prior x-rays ⇒ “incomplete.”
   • Fino: Equivocal on complication ⇒ limited weight only on that question.
4. Substantial Evidence Standard
   The appellate panel declined to second-guess the ALJ’s choice between two board-certified radiologists. The record contained “such relevant evidence as a reasonable mind might accept.”
5. Explanation Requirement
   The opinion applies the forgiving Lane Hollow test: if we understand what and why, it satisfies the Administrative Procedure Act. The ALJ’s short but pointed criticism of Tarver and endorsement of DePonte sufficed.

3.3 Impact on Future Litigation

While unpublished (and thus not precedential under Fourth Circuit Rule 32.1), Potomac will carry persuasive weight and practical consequences:

• Elevated Status of CT Scans – The decision underscores that CT evidence can be alone dispositive under § 718.304(c). Parties will likely invest more in high-resolution imaging and expert radiology testimony.
• Strategic Emphasis on Opinion Quality – ALJs may give primacy to reports containing quantitative measurements, bilateral analysis, and pathology-based explanations. Mere conclusory statements risk exclusion.
• Clarified “Adequate Explanation” Threshold – The Fourth Circuit signals an ALJ need not write treatises; concise rationales survive appellate scrutiny.
• Employer Litigation Tactics – Employers may seek to impeach CT scans by insisting on volumetric or serial imaging or by demanding consistency checks between historical x-rays and scans.
• Claimant Burden in Subsequent Claims – The holding illustrates how the “change in condition” requirement under 20 C.F.R. § 725.309(c) can be met via a single CT scan showing progression to complication.

4. Complex Concepts Simplified

• Black Lung Benefits Act (BLBA) – Federal statute granting monthly benefits to coal miners (or their survivors) disabled by pneumoconiosis (“black lung”), a lung disease caused by inhaling coal dust.
• Simple vs. Complicated Pneumoconiosis – “Simple” involves small nodular opacities; “complicated” shows large opacities ≥1 cm, triggering an irrebuttable presumption of total disability.
• 20 C.F.R. § 718.304 Irrebuttable Presumption – If any single diagnostic method confirms ≥1 cm lesions, the miner is conclusively deemed totally disabled due to pneumoconiosis; the employer cannot disprove disability causation.
• B-Reader – Physician certified by NIOSH to classify chest radiographs for pneumoconiosis using the ILO system; denotes specialized radiology competence.
• Substantial Evidence – Legal standard on review: “such relevant evidence as a reasonable mind might accept as adequate.” It is less than a preponderance but more than a scintilla.
• Disjunctive Prongs – Means “any one will do.” Proof under A or B or C satisfies the statute, without reconciling inconsistencies across prongs unless necessary to evaluate reliability.

5. Conclusion

Potomac Coal Company v. DOWCP strengthens the evidentiary legitimacy of CT scans in black-lung proceedings and illustrates the deference appellate courts grant to ALJ credibility determinations. The decision conveys that:

1. CT-scan findings alone can establish complicated pneumoconiosis under § 718.304(c).
2. ALJs must provide a rational—but not exhaustive—explanation for preferring one medical opinion over another.
3. Employers face formidable challenges once a well-documented CT scan reveals ≥1 cm lesions, given the statute’s irrebuttable presumption.

While technically non-precedential, the Fourth Circuit’s reasoning offers persuasive guidance within and beyond the circuit, likely influencing both litigation strategy and ALJ adjudication in future BLBA claims. In practical terms, the opinion heralds a “CT-Scan Supremacy” era: sophisticated imaging, robust measurement, and methodical medical reasoning will increasingly decide black-lung disputes.