Before: BECKER, SCIRICA and McKEE, Circuit Judges
Petition for Review of an Order of the Benefits Review Board, United States Department of Labor
Argued: September 23, 1997
The widow of a deceased coal miner filed this petition for review of a decision of the Benefits Review Board in which the Board affirmed an Administrative Law Judge's denial of her claim for survivors' benefits under the Black Lung Benefits Act, 30 U.S.C. Section(s) 901-945. For the reasons that follow, we will reverse the Board's affirmance of the Administrative Law Judge's decision and direct that benefits be awarded.
Angelo Mancia filed two applications for Black Lung benefits during his lifetime. The Department of Labor denied the first one on September 3, 1980. Subsequently, Mancia filed a second application, and on April 3, 1984, Administrative Law Judge ("ALJ") Dunau issued a Decision and Order awarding Mancia the requested benefits. The ALJ found that Mancia proved he had pneumoconiosis, *fn1 a causal relationship between that affliction and his eight years of coal mine employment, and total disability due to pneumoconiosis.
On August 5, 1990, Angelo's wife, Josephine, discovered Angelo dead behind the wheel of the parked family car. Dr. Charles Manganiello, Angelo Mancia's family physician, signed the death certificate that stated that the immediate cause of death was cardiopulmonary arrest with underlying causes of anthracosilicosis with emphysema.
Later that same month, Josephine Mancia filed a claim for survivor's benefits with the Department of Labor. The Secretary administratively denied that claim on February 12, 1991. After the Secretary denied the claim a second time, Josephine requested that the matter be referred to an Administrative Law Judge for a hearing, and the claim was referred to ALJ Ainsworth Brown. Since Mancia had been receiving black lung benefits at the time of his death, a stipulation was entered into that the only issue to be decided by the ALJ was whether Mancia's death had been caused by pneumoconiosis as required for survivor's benefits under 20 C.F.R. Section(s) 718.250(c).
The ALJ denied the claim, and Josephine Mancia appealed to the Benefits Review Board. The Board affirmed the ALJ's decision. It concluded that the ALJ, "within a proper exercise of his discretion as a fact finder, . . . discredited the only medical opinion that could support claimant's burden," and, therefore, the widow "failed to establish that pneumoconiosis played any part in the miner's death. . . ." BRB Decision at 4.
This petition for review followed.
II. THE PROCEEDINGS BEFORE THE ALJ
Josephine Mancia, and Armand Mancia (the miner's first cousin), testified before the ALJ. Josephine also offered the deposition testimony of Dr. Charles M. Manganiello, and a letter from Dr. Manganiello, dated August 26, 1991, in support of her claims. The Director's evidence consisted primarily of a report of Dr. Leon Candor whom the Director had retained to render an opinion as to the cause of Mancia's death. The Director also offered two documents that had been written by Dr. Manganiello in an attempt to support Dr. Candor's conclusion, and impeach the contrary conclusion of Dr. Manganiello.
Josephine Mancia testified that her husband had been awarded black lung benefits in 1984 and that his health seemed to worsen on a daily basis prior to his death. He could not breathe well and required assistance doing things around the house. She also testified that he was so short of breath that his bed was moved to the first floor as he could not climb stairs, and he was unable to walk very far before complaining of shortness of breath. Hearing Transcript, at 8-9. Mancia saw Dr. Manganiello for his breathing problems, and was also under the treatment of another physician for an unrelated skin condition. Id. at 10. *fn2 Josephine testified that her husband never complained of any chest or heart pain and he was never treated for a heart condition. Id.
Josephine further testified that Angelo complained that he could not breathe well about one week before he died. Id. at 11. She returned home from a bus trip to Atlantic City, and found him dead in their car. The motor was not running. Id. at 12.
Armand Mancia, testified that he and Angelo were very close and that they spent a lot of time fishing at a lake in the summertime. Id. at 14. The cottage where they stayed was about 200 to 250 feet from a lake. In the year before he died, Angelo had to stop about half-way to the lake to catch his breath. Angelo was able to fish only because the boat was powered by a motor, and Armand did all of the casting. According to Armand, Angelo never complained about chest pain or heart problems, nor did he ever tell Armand he was taking any medication for any heart condition. Armand testified that during the last years of Angelo's life he (Angelo) kept "slowing up," that breathing was a major problem, and that Angelo could not tolerate any physical exertion of any kind because of his problem breathing. Id. at 17.
B. DR. MANGANIELLO'S TESTIMONY
Dr. Manganiello's deposition testimony established that he had been a licensed physician for 15 years, practicing general medicine in a region where coal mining was once the prevalent industry. Approximately 10% of his patients are former coal miners, and he sees those patients primarily for anthracosilicosis and anthracosilicosis-related problems. He is, however, neither board-certified nor board-eligible in cardiology, occupational medicine, pulmonary medicine nor internal medicine. Deposition Transcript, at 7-9.
Dr. Manganiello first began treating Angelo Mancia in 1978, primarily for his underlying pneumoconiosis. He saw him at least three times a year thereafter. Mancia's medications consisted of bronchodilator therapy and respiratory treatments, as well as oxygen therapy as needed. Id. at 13. Dr. Manganiello testified he agreed to sign Mancia's death certificate at the coroner's request. Id. at 14. That death certificate states that the immediate cause of death was cardiopulmonary arrest with underlying causes of anthracosilicosis *fn3 with emphysema. Dr. Manganiello was confronted with Dr. Candor's conclusion that Mancia died of a heart attack. Candor based that conclusion partly upon Dr. Manganiello's entry on the death certificate. Manganiello answered as follows:
No where (sic) in my death certificate or in my opinions do I feel that I have ever expressed a myocardial infarction as his cause of death. I'm not sure where [Candor] extrapolated that type of information. And I'm not sure from where he draws his conclusion. Mr. Mancia never had any symptoms related to his heart. And again, the reason for me stating that Mr. Mancia died of a cardiopulmonary arrest is because his heart stopped. Why his heart stopped, in my opinion, was because of his underlying lung condition. The patient had difficulty breathing. He had difficulty oxygenating his heart on the basis of his breathing; and his heart stopped; not because his heart developed a clot, or he damaged his heart. He had no symptoms referable to that. And nowhere could I state that he died of a myocardial infarction. *fn4 And I don't believe that anyone could make that statement. So I am not sure where he extrapolated that information.
Id. at 20-21. Dr. Manganiello was also asked about Dr. Candor's reliance on an April 11, 1991 note written by Dr. Manganiello. As we discuss below, that note is at the heart of the ALJ's rejection of Dr. Manganiello's medical opinion as to the cause of Mancia's death. In that note, Dr. Manganiello wrote that Mancia had suffered a "heart attack" which was a "direct result of his severe anthracosilicosis with emphysema." When asked about that note, Manganiello stated
I believe there was one report that I had made, trying to embellish or trying to explain a cardiopulmonary arrest. And I do believe that that report has been mistaken and misunderstood. I totally negate that report. I do not refer to that in any of my thoughts or any of my opinions in terms of his cardiopulmonary arrest. And again, I believe his heart stopped on the basis of his underlying lung deterioration, and problems relating to his underlying anthracosilicosis.
On cross-examination, the following exchange occurred in response to a question about Manganiello's treatment of diseases related to pneumoconiosis:
Q: Dr., in your testimony this morning, you have talked about treating Mr. Mancia for his pneumoconiosis and related diseases. What are those related diseases?
A: The pneumoconiosis basically; the underlying infections and problems that he would incur as a result of his severe lung disease. Recurrent episodes of bronchitis. Problems such as cor pulmonale, or build-up of some right-sided heart failure, on the basis of severe underlying lung disease; and problems of that nature. But all related to his lung disease.
Manganiello admitted that his reports did not mention the presence of cor pulmonale and explained that it was not mentioned because it was "basically [an] office concern," which was not necessary to note in a report. Id. at 22-23.
You could see that the man had some edema of his legs; some swelling in his abdomen from time to time. He required some diuretic therapy from time to time for the treatment of that problem.
Id. at 23. Dr. Manganiello further explained that he didn't think it was necessary to order objective tests to confirm the presence of cor pulmonale because it can be diagnosed clinically, and because there is really no treatment for the condition once it is diagnosed. Id. "I really don't feel that it was necessary to do that. I believe that a clinical diagnosis can be just as well treated in the office, without any of those studies." Id. at 23.
C. DR. MANCIA'S AUGUST 26, 1991 LETTER
Josephine Mancia also introduced a letter from Dr. Manganiello, dated August 26, 1991, and addressed "TO WHOM IT MAY CONCERN." It reads:
Mr. Angelo Mancia was under my care for anthracosilicosis. I never treated Mr. Mancia for heart disease or coronary artery disease for that matter.
The death certificate states cardiopulmonary arrest secondary to anthracosilicosis and there has never been a statement that his death was related to a myocardial infarction.
It is therefore my opinion that Mr. Mancia's untimely death was a direct result of his anthracosilicosis.
D. THE DIRECTOR'S EVIDENCE BEFORE THE ALJ
The Director's evidence in opposition to the widow's claim consisted of a two-page report of Dr. Leon Candor, *fn5 and the aforementioned April 11, 1991 note from Dr. Manganiello. Dr. Candor never examined the miner. His report was based entirely upon his examination of certain medical records and the results of tests that Dr. Manganiello and other physicians had performed over the years. The Director also introduced the death certificate into evidence. Dr. Manganiello's April 11, 1991 note is addressed "TO WHOM IT MAY CONCERN." The entirety of that note is as follows:
In my opinion Mr. Angelo Mancia (sic) heart attack was a direct result of his severe anthracosilicosis with emphysema which hastened or progressed his underlying coronary artery disease.
Dr. Candor's report details the various medical records he reviewed. They include x-rays and the results of tests that had been performed on Mancia during his lifetime. Based upon his review of those records, Dr. Candor concluded:
1. As noted in Dr. Manganiello's letter of 4/11/91, the immediate cause of Mr. Mancia's death on 8/5/90 was an acute myocardial infarction with resultant cardiopulmonary arrest. The myocardial infarction (heart attack) was caused by underlying coronary artery disease.
2. The patient's coronary artery disease with resultant myocardial infarction were casually unrelated to pneumoconiosis.
3. Despite Dr. Manganiello's statement in his letter of 4/11/91, I know of no scientific evidence which indicates that anthracosilicosis or emphysema hasten the progress of coronary artery disease.
4. The normal arterial oxygen tension at rest and during exercise makes it most unlikely that the patient's chronic lung disease had any effect upon cardiac rhythm and function.
5. The available information provides no evidence that Mr. Mancia's chronic lung disease was a substantially contributing cause to his death caused by acute ...