Bonita Y. Ratliff v. R & H Coal Company (Board decision, May 20, 2025)

BRB final decision. The Benefits Review Board affirmed awards on the miner's and survivor's black lung claims. Judge Boggs concurred in the result. Under 20 C.F.R. § 802.406, a Board decision becomes final 60 days after issuance unless a timely petition for judicial review or a timely request for Board reconsideration is filed. A party may request Board reconsideration within 30 days under 20 C.F.R. § 802.407.

Plain-English summary

Bonita Ratliff pursued her late husband's black lung claim and her own survivor's claim. On an earlier appeal, the Board sent the miner's claim back for another look at the evidence of complicated pneumoconiosis. The administrative law judge again awarded benefits, and another judge awarded survivor benefits based on the miner's entitlement at death. The Board upheld the finding of complicated pneumoconiosis after reviewing the x-rays, CT scans, and medical opinions. It affirmed both awards; Judge Boggs concurred in the result.

Decision snapshot

• Authority: Complicated pneumoconiosis under 30 U.S.C. § 921(c)(3) and 20 C.F.R. § 718.304; survivor entitlement under 30 U.S.C. § 932(l).
• Outcome: Miner and survivor benefits awards affirmed.
• Key point: The supported finding of complicated pneumoconiosis established the miner's entitlement, which carried survivor entitlement under § 932(l).

Full text (DOL BRB public release)

U.S. Department of Labor Benefits Review Board 200 Constitution Ave. NW
Washington, DC 20210-0001

BRB Nos. 24-0103 BLA and 24-0263 BLA

BONITA Y. RATLIFF
)
(o/b/o and Widow of RINNIE A. RATLIFF) ) )
Claimant-Respondent
)
)
v. )
NOT-PUBLISHED
)
R & H COAL COMPANY
)
) DATE ISSUED: 05/20/2025
Employer-Petitioner
)
)
DIRECTOR, OFFICE OF WORKERS’
)
COMPENSATION PROGRAMS, UNITED
)
STATES DEPARTMENT OF LABOR
)
)
Party-in-Interest
)
DECISION and ORDER
Appeal of the Decision and Order on Remand Awarding Benefits of Carrie Bland, Associate Chief Administrative Law Judge, United States Department of Labor, and the Decision and Order Awarding Benefits of Theodore W.
Annos, Administrative Law Judge, United States Department of Labor.

Joseph E. Wolfe and Donna E. Sonner (Wolfe Williams & Austin), Norton, Virginia, for Claimant.

Michael A. Pusateri (Greenberg Traurig LLP), Washington, D.C., for Employer and its Carrier.

Before: GRESH, Chief Administrative Appeals Judge, BOGGS and ROLFE, Administrative Appeals Judges.

GRESH, Chief Administrative Appeals Judge, and ROLFE, Administrative Appeals Judge:
 Employer and its Carrier (Employer) appeal Associate Chief Administrative Law Judge (ALJ) Carrie Bland’s Decision and Order on Remand Awarding Benefits (2017- BLA-05714) and ALJ Theodore W. Annos’s Decision and Order Awarding Benefits (2022-BLA-05000) rendered on claims filed pursuant to the Black Lung Benefits Act, as amended, 30 U.S.C. §§901-944 (2018) (Act). This case involves a miner’s claim filed on March 8, 2016, and a survivor’s claim filed on April 22, 2021. The miner’s claim is before the Benefits Review Board for the second time.

In her initial Decision and Order Awarding Benefits in the miner’s claim,1 ALJ Bland (the ALJ) credited the Miner with 10.95 years of coal mine employment and found he established complicated pneumoconiosis. Thus, she found he invoked the irrebuttable presumption of total disability due to pneumoconiosis at Section 411(c)(3) of the Act. 30 U.S.C. §921(c)(3) (2018); 20 C.F.R. §718.304. She further found the Miner’s complicated pneumoconiosis arose out of his coal mine employment, 20 C.F.R. §718.203(b), and awarded benefits.

In consideration of Employer’s appeal, the Board rejected Employer’s Appointments Clause and removal provisions arguments and affirmed the ALJ’s finding regarding the length of the Miner’s coal mine employment. Ratliff v. R & H Coal Co., BRB No. 21-0136 BLA, slip op. at 3-6 (Nov. 29, 2022) (unpub.) However, it held the ALJ erred in weighing the x-ray, computed tomography (CT) scan, and medical opinion evidence on the issue of complicated pneumoconiosis. Id. at 7-10; 20 C.F.R. §718.304(a), (c). The Board thus remanded the case for the ALJ to reconsider all relevant evidence on the issue of complicated pneumoconiosis. Ratliff, BRB No. 21-0136 BLA, slip op. at 10- 11.

In her Decision and Order on Remand Awarding Benefits (Decision and Order), the ALJ again found the Miner established the existence of complicated pneumoconiosis and invoked the irrebuttable presumption. She therefore awarded benefits.

1 The ALJ issued a Decision and Order Awarding Benefits on May 20, 2020; however, the parties did not receive the decision. Nov. 19, 2020 Order Vacating and Reissuing Decision and Order at 1. In response to Employer’s Motion to Vacate and Set Aside for Lack of Service, the ALJ vacated her May 20, 2020 Decision and Order and reissued it on November 19, 2020. Id. at 1-2. Because the May 20, 2020 Decision and Order and the November 19, 2020 reissued Decision and Order are substantively the same, and to avoid confusion, we will simply refer to that decision as the ALJ’s initial Decision and Order.

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 Claimant 2 filed a claim for survivor’s benefits on April 22, 2021. ALJ Annos issued a Decision and Order Awarding Benefits determining that, because the Miner was entitled to benefits at the time of his death, Claimant is automatically entitled to survivor’s benefits under Section 422(l), 30 U.S.C. §932(l) (2018). Both decisions were appealed, and the Board consolidated them for purposes of decision only.

On appeal, Employer argues the ALJ erred in finding Claimant established complicated pneumoconiosis. Claimant responds in support of the award of benefits. The Acting Director, Office of Workers’ Compensation Programs (the Director), declined to file a response brief. Employer submitted a reply brief reiterating its contentions.

The Board’s scope of review is defined by statute. We must affirm the ALJ’s Decision and Order if it is rational, supported by substantial evidence, and in accordance with applicable law.3 33 U.S.C. §921(b)(3), as incorporated by 30 U.S.C. §932(a); O’Keeffe v. Smith, Hinchman & Grylls Assocs., Inc., 380 U.S. 359, 361-62 (1965).

Section 411(c)(3) Presumption – Complicated Pneumoconiosis

Section 411(c)(3) of the Act, 30 U.S.C. §921(c)(3), provides an irrebuttable presumption that a miner was totally disabled due to pneumoconiosis if he suffered from a chronic dust disease of the lung which: (a) when diagnosed by x-ray, yields one or more opacities greater than one centimeter in diameter that would be classified as Category A, B, or C; (b) when diagnosed by biopsy or autopsy, yields massive lesions in the lung; or (c) when diagnosed by other means, would be a condition that could reasonably be expected to yield a result equivalent to (a) or (b). See 20 C.F.R. §718.304. In determining whether a claimant has invoked the irrebuttable presumption, the ALJ must weigh all evidence relevant to the presence or absence of complicated pneumoconiosis. See Westmoreland Coal Co. v. Cox, 602 F.3d 276, 283 (4th Cir. 2010); E. Assoc. Coal Corp. v. Director, OWCP [Scarbro], 220 F.3d 250, 255-56 (4th Cir. 2000); Melnick v. Consolidation Coal Co., 16 BLR 1-31, 1-33 (1991) (en banc).

2 Claimant is the widow of the Miner, who died on February 8, 2021. Survivor’s Claim (SC) Director’s Exhibit 4. She is pursuing the miner’s claim on her husband’s behalf and her own survivor’s claim. SC Director’s Exhibit 2.
3 This case arises within the jurisdiction of the United States Court of Appeals for

the Fourth Circuit because the Miner performed his coal mine employment in Virginia. See Shupe v. Director, OWCP, 12 BLR 1-200, 1-202 (1989) (en banc); Miner’s Claim (MC) Hearing Tr. at 21.

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 The ALJ found the x-ray and CT scan evidence supports a finding of complicated pneumoconiosis, while the medical opinions do not establish the presence or absence of the disease. 20 C.F.R. §718.304(a), (c); Decision and Order at 3-7. Weighing all the evidence together, he concluded the x-ray and CT scan evidence outweighs the medical opinion evidence and Claimant thus established the existence of complicated pneumoconiosis. Decision and Order at 7.

Section 20 C.F.R. §718.304(a) – X-rays

The ALJ considered eleven interpretations of five x-rays dated May 10, 2016, August 24, 2016, July 18, 2017, December 23, 2017, and December 29, 2017, noting all the interpreting physicians are dually-qualified B readers and Board-certified radiologists. Decision and Order at 3-4. Further, all the physicians agreed simple pneumoconiosis is present.

Drs. DePonte and Crum read the May 10, 2016 x-ray as positive for complicated pneumoconiosis, Category A, while Dr. Wolfe read the x-ray as negative for the disease.4 MC Director’s Exhibits 9 at 19; 15 at 3; 16 at 2. Dr. Crum also read the August 24, 2016, July 18, 2017, December 23, 2017, and December 29, 2017 x-rays as positive for complicated pneumoconiosis, Category A, whereas Dr. Adcock read all four x-rays as negative for the disease. MC Claimant’s Exhibits 1; 4 at 14 (unpaginated); 5 at 15 (unpaginated); 9; MC Employer’s Exhibits 1; 3; 9; 10.

The ALJ gave determinative weight to Dr. DePonte’s reading of the May 10, 2016 x-ray “because she specifically provides a measurement for the size of the opacity she observed on the x-ray, lending additional credibility to her finding of complicated pneumoconiosis,” and found it is positive for complicated pneumoconiosis based on the “preponderance of the positive interpretations” of the x-ray. Decision and Order at 3. She found the readings of the August 24, 2016, July 18, 2017, December 23, 2017, and December 29, 2017 x-rays in equipoise because equally-qualified radiologists read each x- ray as positive and negative for the disease. Id. Because one x-ray is positive for complicated pneumoconiosis and the readings of the remaining four x-rays are in

4 Employer asserts “[t]he only reason there were two positive readings of the film

and one negative reading was because the limitations on evidence under 20 [C.F.R.]
§725.414 prevented [it] from submitting another reading of this x-ray,” and the evidentiary limitations are thus outcome-determinative and invalid. Employer’s Brief at 18. We disagree. Contrary to Employer’s argument, nothing foreclosed it from submitting another reading of the May 10, 2016 x-ray as affirmative evidence rather than the July 18, 2017 or August 24, 2016 x-ray readings.

4 equipoise, the ALJ concluded the x-ray evidence supports a finding of complicated pneumoconiosis. Id. at 4.

Employer argues the ALJ erred in finding the May 10, 2016 x-ray is positive for complicated pneumoconiosis. Employer’s Brief at 17-18. We disagree.

The ALJ permissibly found the May 10, 2016 x-ray is positive for complicated pneumoconiosis because a greater number of dually-qualified physicians read it as positive for the disease. See Sea “B” Mining Co. v. Addison, 831 F.3d 244, 256 (4th Cir. 2016); Adkins v. Director, OWCP, 958 F.2d 49, 52-53 (4th Cir. 1992); Staton v. Norfolk & Western Ry. Co., 65 F.3d 55, 59-60 (6th Cir. 1995); Decision and Order at 3. Moreover, contrary to Employer’s argument, she permissibly found Dr. DePonte’s reading more persuasive because it is more detailed. See Milburn Colliery Co. v. Hicks, 138 F.3d 524, 533 (4th Cir. 1998); Sterling Smokeless Coal Co. v. Akers, 131 F.3d 438, 441 (4th Cir. 1997); Decision and Order at 3; Employer’s Brief at 18.

Regarding the remaining four x-rays, Employer asserts the ALJ should have given more weight to Dr. Adcock’s readings than Dr. Crum’s readings based on his superior credentials.5 Employer’s Brief at 18-19. We disagree. Credibility determinations are within the ALJ’s discretion. See Westmoreland Coal Co. v. Cochran, 718 F.3d 319, 323- 24 (4th Cir. 2013). The ALJ acknowledged the credentials of Drs. Adcock and Crum and permissibly found they are equally qualified as both are dually-qualified as B readers and Board-certified radiologists. See Adkins, 958 F.2d at 52; Staton, 65 F.3d 55, 59; Decision and Order at 3.

To the extent Employer argues, overall, that the ALJ failed to offer an explanation for her conclusion that the positive x-rays outweigh the negative x-rays, we disagree.

5 To the extent Employer argues the ALJ was required to give more weight to Dr.

Adcock’s credentials because she previously found he “should be entitled to superior weight” in her initial 2020 Decision and Order Awarding Benefits and the Board did not disturb this finding, we disagree. Employer’s Brief at 19; Employer’s Reply Brief at 3 (unpaginated). Employer cites a footnote in the Board’s prior decision stating the ALJ appeared to give Dr. Adcock’s opinion greater weight than Dr. Ramakrishnan’s opinion regarding the CT scan evidence, Ratliff v. R & H Coal Co., BRB No. 21-0136 BLA, slip op. at 9 n.11 (Nov. 29, 2022) (unpub.); ALJ’s 2020 Decision and Order Awarding Benefits at 31, but ignores that the Board recognized, and did not disturb, the ALJ’s finding that “Drs. Crum and Adcock are equally qualified” with regard to the x-ray evidence, Ratliff, BRB No. 21-0136 BLA, slip op. at 8; ALJ’s 2020 Decision and Order Awarding Benefits at 15, 28.

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Employer’s Brief 17-20; Employer’s Reply Brief at 2-3 (unpaginated). Contrary to Employer’s argument, the ALJ considered the number of x-ray interpretations along with the readers’ qualifications and the findings set forth in their interpretations. Decision and Order at 3-4. Having conducted a qualitative and quantitative analysis of the x-ray evidence, she permissibly found the readings of four x-rays are in equipoise and are outweighed by the one x-ray that is positive for complicated pneumoconiosis.6 See Addison, 831 F.3d at 256-57 (ALJ performs a qualitative and quantitative assessment of the x-ray evidence when they take into account the radiological qualifications of each reader and the number of readings by better qualified readers); Adkins, 958 F.2d at 52; Decision and Order at 3-4.

We therefore affirm the ALJ’s finding that the x-ray evidence supports a finding of complicated pneumoconiosis. 20 C.F.R. §718.304(a); Decision and Order at 4.

Other Evidence at 20 C.F.R. §718.304(c)

CT Scans

The ALJ considered four interpretations by Dr. Ramakrishnan of the CT scans dated February 21, 2012, January 21, 2015, August 5, 2015, and January 28, 2016, as well as Dr. Adcock’s interpretation of the January 28, 2016 CT scan. Decision and Order at 4-5. The ALJ found the February 21, 2012 and January 21, 2015 CT scans are negative for complicated pneumoconiosis and the August 5, 2015 CT scan is positive for the disease based on Dr. Ramakrishnan’s readings. Id. at 5. She further found Dr. Ramakrishnan’s reading of the January 28, 2016 CT scan more persuasive than Dr. Adcock’s reading because Dr. Ramakrishnan “specified the size of the nodule he observed whereas Dr. Adcock’s reading is ambiguous regarding the size of the coalescence,” and thus found it is positive for complicated pneumoconiosis. Id. The ALJ gave more weight to the positive August 5, 2015 and January 28, 2016 CT scans based on their recency and thus concluded the CT scan evidence supports a finding of complicated pneumoconiosis. 20 C.F.R.
§718.304(c); Decision and Order at 5.

6 As the ALJ provided valid reasons for finding the May 10, 2016 x-ray is positive

and the x-ray evidence overall supports a finding of complicated pneumoconiosis, we need not address Employer’s argument that the ALJ erred in finding Dr. Crum’s subsequent x- ray readings support these conclusions. See Kozele v. Rochester & Pittsburgh Coal Co., 6 BLR 1-378, 1-382 n.4 (1983); Decision and Order at 3-4; Employer’s Brief at 19-20; Employer’s Reply Brief at 3 (unpaginated).

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 Employer argues the ALJ erred in finding the August 5, 2015 CT scan demonstrates complicated pneumoconiosis.7 Employer’s Brief at 10-13. We disagree.

Dr. Ramakrishnan noted he was comparing the August 5, 2015 CT scan to the February 21, 2012 and January 21, 2015 CT scans. MC Claimant’s Exhibit 6 at 4 (unpaginated). He stated the August 5, 2015 CT scan shows “stable reticular nodular changes of the lung fields bilaterally, consistent with pneumoconiosis” and that there is a stable twelve-millimeter nodule “in the right upper lobe suggesting [a] coalescent fibrotic nodule.” Id.

The ALJ noted Dr. Ramakrishnan did not specifically diagnose complicated pneumoconiosis, but found his identification of a twelve-millimeter nodule consistent with pneumoconiosis would be “of an equivalent size on chest x-ray, that is 1.2 cm,” and therefore constitutes a diagnosis of complicated pneumoconiosis at 20 C.F.R. §718.304(c). Decision and Order at 5. Contrary to Employer’s argument, the Fourth Circuit requires the ALJ to perform equivalency determinations based on her evaluation of all the medical evidence of record. See Scarbro, 220 F.3d at 255; Double B Mining, Inc. v. Blankenship, 177 F.3d 240, 243 (4th Cir. 1999). Thus the absence of a specific statement of equivalency by a physician is not a bar to establishing complicated pneumoconiosis. See Scarbro, 220 F.3d at 258 (while a physician who identified a 1.7 cm lesion on biopsy did not provide an equivalency determination, there was “no reason to believe that nodules of 1.7 centimeters would not produce x-ray opacities greater than one centimeter”); see also Perry v. Mynu Coals, Inc., 469 F.3d 360, 364-65 (4th Cir. 2006) (diagnosis of a “massive” opacity “becomes a proxy for the tissue mass characteristic of complicated pneumoconiosis” and satisfies the “statutory ground for application of the presumption”). Thus the ALJ permissibly concluded the 1.2-centimeter opacity present on the August 5, 2015 CT scan would exceed one centimeter on x-ray and is positive for complicated pneumoconiosis. See Scarbro, 220 F.3d at 258; 20 C.F.R. §718.304(c); Decision and Order at 5.

Employer next asserts the ALJ should have given Dr. Adcock’s negative reading of the January 28, 2016 CT scan more weight than Dr. Ramakrishnan’s positive reading because he reviewed more information, explained his opinion in detail, and is better qualified than Dr. Ramakrishnan. Employer’s Brief at 13-15.

7 Contrary to Employer’s argument the ALJ “violated the APA by transcending and

adding to the record to create proof favoring entitlement that no party offered ,” Claimant offered the August 5, 2015 CT scan into evidence as a part of the Miner’s treatment records. Claimant’s Evidence Summary Form at 8; MC Claimant’s Exhibit 6.

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 In interpreting the January 28, 2016 CT scan, Dr. Ramakrishnan found a “stable upper lobe reticular nodular fibrosis consistent with pneumoconiosis” similar to the August 5, 2015 CT scan. MC Claimant’s Exhibit 6 at 4 (unpaginated). Dr. Adcock opined the CT scan showed “some minor coalescence of small opacities . . . in the apical segment of the right upper lobe,” but that there are no large opacities. MC Employer’s Exhibit 5 at 1.

The ALJ noted both Drs. Ramakrishnan and Adcock identified coalescence of nodules in the right upper lobe. Decision and Order at 5. She then permissibly found Dr. Ramakrishnan’s interpretation more persuasive because it specified the nodule was the same size as the nodule identified on the August 5, 2015 CT scan, 1.2 centimeters, “whereas Dr. Adcock’s reading is ambiguous regarding the size of the coalescence.” 8 See Hicks, 138 F.3d at 533; Akers, 131 F.3d at 441; Decision and Order at 5. Additionally, contrary to Employer’s argument, an ALJ is not required to credit one physician’s opinion over another because they have additional qualifications or considered more evidence. See Harris v. Old Ben Coal Co., 23 BLR 1-98, 1-114 (2006) (en banc), aff’d on recon., 24 BLR 1-13 (2007) (en banc); Worhach v. Director, OWCP, 17 BLR 1-105, 1-108 (1993); Employer’s Brief at 13-14. Thus we affirm her finding the January 28, 2016 CT scan is positive for complicated pneumoconiosis.

Finally, Employer argues the ALJ “failed to account” for the CT scans that were not positive for complicated pneumoconiosis. Employer’s Brief at 16. We disagree.

The ALJ noted Dr. Ramakrishnan found no large opacities on the February 21, 2012 CT scan and that, while he found a ten-millimeter nodule consistent with pneumoconiosis on the January 21, 2015 CT scan, it would not exceed one centimeter on x-ray and is thus negative for complicated pneumoconiosis. Decision and Order at 4-5. She further permissibly found the more recent CT scans are more probative because the August 5, 2015 and January 28, 2016 CT scans demonstrated the nodule grew to twelve millimeters, and the subsequent May 10, 2016 x-ray demonstrated additional growth consistent with the progressive nature of pneumoconiosis.9 See Adkins, 958 F.2d at 51-52 (because

8 Because the August 5, 2015 and January 28, 2016 CT scans are a part of the Miner’s treatment records, we reject Employer’s argument that the treatment records do not contain any diagnoses of complicated pneumoconiosis. Employer’s Brief at 22-23.
9 Contrary to Employer’s argument, the ALJ did not use “the positive x-rays as a yardstick against which she measured” the CT scans. Employer’s Brief at 25-27. Rather, she credited Dr. Ramakrishnan’s readings of the August 5, 2015 and January 28, 2016 CT scans and found the credibility of the readings was “increased” because they are consistent with the May 10, 2016 x-ray, which she credited. Decision and Order at 5.

8 pneumoconiosis is a latent and progressive disease, more recent evidence may be rationally credited if it shows a miner’s condition has worsened); Thorn v. Itmann Coal Co., 3 F.3d 713, 719 (4th Cir. 1993); Kincaid v. Island Creek Coal Co., 26 BLR 1-43, 1-50-52 (2023); Decision and Order at 5, 7.

As it is supported by substantial evidence, we affirm the ALJ’s finding that the August 5, 2015 and January 28, 2016 CT scans are positive for complicated pneumoconiosis and that the CT scan evidence supports a finding of complicated pneumoconiosis.10 20 C.F.R. §718.304(c); Decision and Order at 5.

Medical Opinions

The ALJ considered the medical opinions of Drs. Silman, Raj, Fino, and Rosenberg.
Decision and Order at 5-7. Drs. Silman and Raj opined the Miner had complicated pneumoconiosis, whereas Drs. Fino and Rosenberg opined he did not. MC Director’s Exhibits 9; 13; MC Claimant’s Exhibits 4; 5; MC Employer’s Exhibits 6; 7; 11; 13. The ALJ discredited the opinions of Drs. Silman and Raj because she found their medical opinions were no more than a restatement of the x-ray evidence they reviewed. Decision and Order at 5, 7. She further discredited the opinions Drs. Fino and Rosenberg as insufficiently reasoned and documented. Id. at 6-7. Having discredited all the medical opinions, the ALJ concluded they provide no probative information on the presence or absence of complicated pneumoconiosis. Id. at 5-7.

Employer argues the ALJ erred in discrediting Dr. Fino’s opinion. Employer’s Brief at 23. We disagree.

In his initial opinion, Dr. Fino noted Dr. DePonte’s reading of the May 10, 2016 x- ray but did not acknowledge Dr. DePonte diagnosed a Category A opacity in rendering his opinion that the miner had simple pneumoconiosis. MC Director’s Exhibit 13 at 8-9. In his supplemental opinion, Dr. Fino reviewed the August 24, 2016, July 18, 2017, December 23, 2017, and December 29, 2017 x-rays as well as all four CT scans and again opined the Miner had only simple pneumoconiosis. MC Employer’s Exhibit 11 at 6. At his deposition, Dr. Fino testified the Miner did not have complicated pneumoconiosis based on “[t]he chest x-ray reading performed on [his] evaluation” and Dr. Adcock’s readings,

10 As the ALJ provided valid reasons for crediting the August 5, 2015 and January

28, 2016 CT scans and for finding the CT scan evidence overall supports a finding of complicated pneumoconiosis, we need not address Employer’s argument that the ALJ erred in finding the December 23, 2017 x-ray “bolsters” her conclusion. See Larioni v. Director, OWCP, 6 BLR 1-1276, 1-1278 (1984); Kozele, 6 BLR at 1-382 n.4; Decision and Order at 4-5, 7; Employer’s Brief at 16.

9 as well as the CT scans, which he opined did not describe any changes consistent with complicated pneumoconiosis. MC Employer’s Exhibit 13 at 18-19.

Contrary to Employer’s argument, the ALJ permissibly discredited Dr. Fino’s opinion because he relied on his own negative reading of the May 10, 2016 x-ray and did not discuss Dr. DePonte’s positive reading that the ALJ credited, and because Dr. DePonte has superior credentials as a B reader and Board-certified radiologist whereas Dr. Fino is only a B reader.11 See Akers, 131 F.3d at 441 (ALJ may discount medical opinions contradicted or unsupported by the underlying objective evidence); Adkins, 958 F.2d at 52; Decision and Order at 6; Employer’s Brief at 25-27. She further permissibly discredited his opinion because he did not address the twelve-millimeter nodule Dr. Ramakrishnan observed on a CT scan. See Akers, 131 F.3d at 441; Clark v. Karst-Robbins Coal Co., 12 BLR 1-149, 1-155 (1989) (en banc); Decision and Order at 6.

Employer also asserts the ALJ erred in discrediting Dr. Rosenberg’s opinion.
Employer’s Brief at 23-24. We disagree.

Dr. Rosenberg reviewed readings of the May 10, 2016, August 8, 2016, August 24, 2016, and July 18, 2017 x-rays and opined they reveal “a possible small A opacity in the right upper lung zone.” MC Employer’s Exhibit 6 at 1, 4. He also reviewed Dr. Adcock’s reading of the January 28, 2016 CT scan and opined there is coalescence or an early large Category A opacity in the right upper lung zone, and that it is possible the Miner had rheumatoid lung disease. Id. at 1, 4-5. In his supplemental report, Dr. Rosenberg again reviewed the January 28, 2016 CT scan as well as Dr. Adcock’s reading of the July 18, 2017 x-ray, which did not diagnose a large opacity, and opined “it is clear that large opacity formation is not present.” MC Employer’s Exhibit 7.

The ALJ acknowledged Dr. Rosenberg’s opinion that CT scans are more accurate than x-rays, MC Employer’s Exhibit 7, and then permissibly found his opinions are inconsistent because he acknowledged a possible Category A opacity in his first opinion, but opined it is “clear” there is no opacity present in his supplemental opinion, even though both opinions were based on the same CT scan. See Hicks, 138 F.3d at 533; Akers, 131 F.3d at 441; Decision and Order at 6-7. She further permissibly found his opinion is not documented because he did not review Dr. Ramakrishnan’s CT scan readings which the

11 We reject Employer’s argument that “the ALJ confused categories of proof (and

thus misread the evidentiary limitations) when she ‘accorded little weight to Dr. Fino’s ‘reading’ of a May 10 2016 x-ray.’” Employer’s Brief at 23. Contrary to Employer’s argument, the ALJ discredited Dr. Fino’s medical opinion, not his x-ray reading. Decision and Order at 6.

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ALJ found are credible and positive for complicated pneumoconiosis. See Akers, 131 F.3d at 441; Clark, 12 BLR at 1-155; Decision and Order at 6; Employer’s Brief at 25-27.

Consequently, we affirm, as supported by substantial evidence, the ALJ’s discrediting of the medical opinions and her finding the medical opinion evidence does not support or refute the existence of complicated pneumoconiosis at 20 C.F.R. §718.304(c). 12 Decision and Order at 7.

The ALJ weighed the evidence as a whole and found it supports a finding of complicated pneumoconiosis. Decision and Order at 7. Having rejected Employer’s arguments regarding the ALJ’s weighing of the x-ray, CT scan, and medical opinion evidence, and because it is supported by substantial evidence, we affirm the ALJ’s conclusion that Claimant invoked the irrebuttable presumption. See Melnick, 16 BLR at 1-33; 20 C.F.R. §718.304; Decision and Order at 7. The Board previously affirmed the ALJ’s finding that the Miner’s pneumoconiosis arose out of his coal mine employment. Ratliff, BRB No. 21-0136 BLA, slip op. at 6. Thus, we affirm the award of benefits.

Survivor’s Claim

Because we have affirmed the award of benefits in the miner’s claim and Employer raises no specific challenge to the award of benefits in the survivor’s claim, we affirm the ALJ Annos’s determination that Claimant is derivatively entitled to survivor’s benefits because the Miner was entitled to benefits at the time of his death. 30 U.S.C. §932(l); see Thorne v. Eastover Mining Co., 25 BLR 1-121, 1-126 (2013); SC Decision and Order Awarding Benefits at 4.

12 We reject Employer’s argument that the ALJ erred in failing to consider the Miner’s lack of pulmonary or respiratory disability in weighing the evidence of complicated pneumoconiosis, Employer’s Brief at 21-22, as no physician opined the Miner did not have complicated pneumoconiosis because he has no disability. Further, Claimant need not establish total disability to invoke the presumption at Section 411(c)(3) of the Act, 30 U.S.C. §921(c)(3).

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 Accordingly, the Decision and Order on Remand Awarding Benefits in the miner’s claim and Decision and Order Awarding Benefits in the survivor’s claim are affirmed.

SO ORDERED.

DANIEL T. GRESH, Chief
Administrative Appeals Judge

JONATHAN ROLFE
Administrative Appeals Judge

BOGGS, Administrative Appeals Judge, concurring:

I concur in the result.

JUDITH S. BOGGS
Administrative Appeals Judge