Dwight D. Tomlinson v. Paramont Contura, LLC (Board decision, March 31, 2025)

BRB interlocutory order. The Benefits Review Board affirmed part of the administrative law judge's decision, vacated the denial of black lung benefits, and remanded for further medical review. Entitlement remains unresolved. A final Board decision ordinarily becomes final 60 days after issuance absent timely judicial review or reconsideration under 20 C.F.R. § 802.406; a party may seek Board reconsideration within 30 days under § 802.407.

Plain-English summary

Dwight D. Tomlinson appealed without a representative after a judge denied his black lung benefits claim. The judge credited 37 years of underground mine work but found neither complicated pneumoconiosis nor total respiratory disability. The Board affirmed her reading of the x-ray and certain other testing evidence. A two-judge majority found that she had not adequately evaluated the CT scan evidence and had confused the question of disability with its cause when weighing medical opinions. It vacated the denial and remanded for further findings under the two possible statutory presumptions. One judge disagreed with reopening the complicated pneumoconiosis question but agreed that disability needed further review.

Decision snapshot

• Authority: Complicated pneumoconiosis under 20 C.F.R. § 718.304 and total disability under 20 C.F.R. § 718.204(b)(2).
• Outcome: Benefits denial vacated and remanded in part; one judge dissented in part.
• Key point: The judge must assess CT findings and disability opinions under the distinct standards that govern each issue.

Full text (DOL BRB public release)

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

BRB No. 24-0288 BLA

DWIGHT D. TOMLINSON
)
)
Claimant-Petitioner
)
)
v. )
)
NOT-PUBLISHED
PARAMONT CONTURA, LLC
)
)
Employer-Respondent
) DATE ISSUED: 03/31/2025
)
DIRECTOR, OFFICE OF WORKERS’
)
COMPENSATION PROGRAMS, UNITED
)
STATES DEPARTMENT OF LABOR
)
)
Party-in-Interest
)
DECISION and ORDER
Appeal of the Decision and Order Denying Benefits of Dierdra M. Howard, Administrative Law Judge, United States Department of Labor.

Dwight D. Tomlinson, Duffield, Virginia.

Timothy W. Gresham (Penn, Stuart, & Eskridge) Abingdon, Virginia, for Employer.

Amanda Torres (Jonathan Snare, Deputy Solicitor of Labor; Jennifer Feldman Jones, Acting Associate Solicitor; William M. Bush, Acting Counsel for Administrative Appeals), Washington, D.C., for the Acting Director, Office of Workers’ Compensation Programs, United States Department of Labor.

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

Claimant appeals, without representation,1 Administrative Law Judge (ALJ) Dierdra M. Howard’s Decision and Order Denying Benefits (2022-BLA-05212) rendered on a claim filed on April 19, 2021, pursuant to the Black Lung Benefits Act, as amended, 30 U.S.C. §§901-944 (2018) (Act).

The ALJ found Claimant did not establish complicated pneumoconiosis and thus could not invoke 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. Additionally, she credited Claimant with thirty-seven years of underground coal mine employment but found he does not have a totally disabling respiratory or pulmonary impairment. 20 C.F.R. §718.204(b)(2). She therefore found Claimant did not invoke the presumption of total disability due to pneumoconiosis at Section 411(c)(4) of the Act, 2 30 U.S.C. §921(c)(4) (2018) or establish entitlement to benefits under 20 C.F.R. Part

718. Thus, she denied benefits.

     On appeal, Claimant generally challenges the denial of benefits. Employer responds
     in support of the denial.3 The Acting Director, Office of Workers’ Compensation Programs (the Director), responds, arguing the ALJ conflated the existence of a totally disabling respiratory or pulmonary impairment with disability causation and failed to comply with the Administrative Procedure Act (APA). Employer filed a second response disagreeing with the Director’s contentions.

     In an appeal a claimant files without representation, the Board considers whether
     the Decision and Order below is supported by substantial evidence. Hodges v. BethEnergy

     1
     On Claimant’s behalf, Robin Napier, a benefits counselor with Stone Mountain
     Health Services of St. Charles, Virginia, requested the Benefits Review Board review the ALJ’s decision, but Ms. Napier is not representing Claimant on appeal. See Shelton v. Claude V. Keen Trucking Co., 19 BLR 1-88 (1995) (Order).
     2
     Section 411(c)(4) of the Act provides a rebuttable presumption that a miner is
     totally disabled due to pneumoconiosis if he has at least fifteen years of underground or substantially similar surface coal mine employment and a totally disabling respiratory or pulmonary impairment. 30 U.S.C. §921(c)(4) (2018); 20 C.F.R. §718.305.
     3
     We affirm, as unchallenged on appeal, the ALJ’s finding that Claimant has thirty-
     seven years of qualifying coal mine employment. See Skrack v. Island Creek Coal Co., 6 BLR 1-710, 1-711 (1983); Decision and Order at 4.

                                         2
     

     Mines, Inc., 18 BLR 1-84, 1-86 (1994). We must affirm the ALJ’s findings of fact and conclusions of law if they are rational, supported by substantial evidence, and in accordance with applicable law.4 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 (1965).

Invocation of the 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 is totally disabled due to pneumoconiosis if he suffers 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. The United States Court of Appeals for the Fourth Circuit holds that because prong (a) sets out an entirely objective scientific standard for diagnosing complicated pneumoconiosis, that is, an x-ray opacity greater than one centimeter in diameter, the ALJ must determine whether a condition which is diagnosed by biopsy or autopsy under prong (b) or by any other means under prong (c) would show as an opacity greater than one centimeter if it were seen on a chest x-ray. See Eastern Associated Coal Corp. v. Director, OWCP [Scarbro], 220 F.3d 250, 256 (4th Cir. 2000); Double B Mining, Inc. v. Blankenship, 177 F.3d 240, 243 (4th Cir. 1999).

    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); Scarbro, 220 F.3d at 255-56; Melnick v. Consolidation Coal Co., 16 BLR 1-31, 1-33 (1991) (en banc).

  The ALJ found the x-rays, computed tomography (CT) scans, and medical opinions

do not support a finding of complicated pneumoconiosis.5 Decision and Order at 7-12.

  4
    This case arises within the jurisdiction of the United States Court of Appeals for

the Fourth Circuit because Claimant performed his coal mine employment in Virginia. See Shupe v. Director, OWCP, 12 BLR 1-200, 1-202 (1989) (en banc); Hearing Transcript at 11; Director’s Exhibit 4.
5
The ALJ accurately noted there is no biopsy evidence and therefore Claimant
cannot establish complicated pneumoconiosis pursuant to 20 C.F.R. §718.304(b). See Decision and Order at 5, 11.

                                        3

Weighing all the evidence together, she concluded Claimant did not establish the disease. Id. at 12.

   20 C.F.R. §718.304(a) – X-rays

    The ALJ considered eight interpretations of three x-rays dated June 29, 2021,

January 26, 2023, and March 7, 2023. Decision and Order at 6-7. She noted that each of the interpreting physicians had similar qualifications as Board-certified radiologists and B readers, and thus she could “discern no reason to give greater or lesser weight to any specific interpretation based solely on qualifications.” Id. at 6.

   Drs. DePonte and Ramakrishnan read the June 29, 2021 x-ray as positive for

complicated pneumoconiosis, Category A, while Dr. Adcock read it as negative for the disease. Director’s Exhibits 16, 22; Claimant’s Exhibit 3. Drs. DePonte and Ramakrishnan interpreted the January 26, 2023 x-ray as positive for complicated pneumoconiosis, Category A, while Drs. Seaman and Tarver read the x-ray as negative for the disease. Claimant’s Exhibits 1, 2; Employer’s Exhibits 3, 4. Dr. Colella read the March 7, 2023 x- ray as negative for complicated pneumoconiosis. Employer’s Exhibit 2 at 35.

   The ALJ permissibly found the June 29, 2021 x-ray positive for complicated

pneumoconiosis because a greater number of dually-qualified physicians read it as positive. 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); Decision and Order at 7. She also permissibly found the readings of the January 26, 2023 x-ray in equipoise because an equal number of dually-qualified physicians read it as positive and negative for complicated pneumoconiosis. See Director, OWCP v. Greenwich Collieries [Ondecko], 512 U.S. 267, 281 (1994); Addison, 831 F.3d at 256; Adkins, 958 F.2d at 52-53; Decision and Order at 7. Finally, she rationally found the March 7, 2003 x-ray negative for complicated pneumoconiosis as the sole physician to provide a reading interpreted it as negative. Id.

   The ALJ properly conducted both a qualitative and quantitative analysis of the

conflicting x-ray readings, taking into consideration the physicians’ radiological qualifications. Addison, 831 F.3d at 256; Adkins, 958 F.2d at 52-53; Decision and Order at 7. Having found one x-ray negative for complicated pneumoconiosis, one x-ray positive, and the readings of one in equipoise, the ALJ permissibly found the x-ray evidence as a whole is in equipoise, and thus neither supports nor refutes a finding of complicated pneumoconiosis, and therefore Claimant did not establish the existence of complicated pneumoconiosis pursuant to 20 C.F.R. §718.304(a). See Ondecko, 512 U.S. at 281; Addison, 831 F.3d at 256-57; Decision and Order at 7. As it is supported by substantial

                                         4

evidence, we affirm the ALJ’s determination that Claimant did not establish complicated pneumoconiosis pursuant to 20 C.F.R. §718.304(a).6

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

   The ALJ also considered whether the CT scans or medical opinions support a

finding of complicated pneumoconiosis. Decision and Order at 9-12.

   CT Scans

    The ALJ considered two interpretations of a February 13, 2023 CT scan. Decision

and Order at 11-12. Dr. DePonte interpreted the scan as showing “findings of coal workers[’] pneumoconiosis with fine interstitial nodularity” and “larger peripheral opacities consistent with pseudoplaques which exceed 1 [centimeter] in greatest dimension. In particular[,] one of the larger pseudoplaque[s] in the right upper lobe has a length exceeding 15 [millimeters].” Claimant’s Exhibit 4 at 1. She did not, however, indicate that the opacities would appear on x-ray as a greater than one centimeter (an equivalency determination).7 Id. Dr. Colella observed “multiple pulmonary nodules bilaterally with reticulonodular pulmonary opacities,” but no pleural plaques, and noted that the “differential would include . . . pneumoconiosis.” Employer’s Exhibit 5 at 1.

    The ALJ found that while the CT scan interpretations support a finding of “lung

abnormalities,” the CT scan evidence is insufficient to support a diagnosis of complicated pneumoconiosis at 20 C.F.R. §718.304(c). Decision and Order at 12. However, although Dr. DePonte did not specifically opine that the opacities she observed on Claimant’s CT scan would appear on x-ray as greater than one centimeter, the Fourth Circuit, within whose jurisdiction this case arises, requires that the ALJ perform equivalency determinations based on the medical evidence of record. Blankenship, 177 F.3d at 243. 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 centimeter 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

   6
    We note the ALJ accurately found all of the interpreting physicians identified

simple pneumoconiosis and, therefore, the x-ray evidence supports a finding of simple pneumoconiosis. Decision and Order at 7.
7
Dr. DePonte noted that Dr. Boyd conducted the initial interpretation of the CT
scan. Claimant’s Exhibit 4.

                                        5

mass characteristic of complicated pneumoconiosis” and satisfies the “statutory ground for application of the presumption”).

   Further, the record contains evidence that could support an equivalency

determination which the ALJ did not consider. Specifically, the ALJ failed to adequately consider the physicians who read x-rays as indicating Category A, or greater than one- centimeter, large opacities.8 See Scarbro, 220 F.3d at 258 (where a physician did not provide an equivalency determination for a lesion seen pathologically, an earlier x-ray showing opacities greater than one centimeter in diameter provided persuasive evidence that the miner’s lesions identified on biopsy did in fact show as opacities of that size); Director’s Exhibit 16; Claimant’s Exhibits 1-3. Consequently, as the ALJ erred in weighing the CT scan evidence, we vacate her finding the CT scan evidence is insufficient to support a diagnosis of complicated pneumoconiosis at 20 C.F.R. §718.304(c) and, therefore, that Claimant did not establish complicated pneumoconiosis at 20 C.F.R.
§718.304.

   Medical Opinions

   The ALJ considered Dr. Harris’s opinion diagnosing complicated pneumoconiosis

and Dr. Sargent’s opinion that Claimant does not have complicated pneumoconiosis.9 Decision and Order at 9-11; Director’s Exhibit 16; Employer’s Exhibits 2, 6. Dr. Harris conducted the Department of Labor-sponsored complete pulmonary evaluation of Claimant on June 29, 2021. Director’s Exhibit 16. He summarized Dr. DePonte’s interpretation of the June 29, 2021 x-ray as revealing small opacities in all lung zones and a Category A opacity, as well as diagnosing atherosclerotic aorta, coalescence of small pneumoconiotic opacities, and calcified non-pneumoconiotic opacities. Id. at 13, 33. Dr. Harris diagnosed Claimant with complicated pneumoconiosis based on “[Claimant’s] occupational history of 45 years in coal mine employment with a heavy exposure to respiratory coal and rock dust, along with [Claimant’s] radiographic findings of small opacities in all lung zones with a 1/1 profusion and large A opacity consistent with
[progressive massive fibrosis].” Id. at 15. Having found Claimant did not establish

   8
     Again, the ALJ found the x-ray evidence to be in equipoise, and thus merely that

it neither supports nor refutes a finding of complicated pneumoconiosis.
9
Dr. Sargent noted that the CT scan evidence does not show complicated
pneumoconiosis and that Dr. DePonte’s mention of pseudoplaques in the periphery of the lung in her readings is inconsistent with the manifestation of complicated pneumoconiosis. Employer’s Exhibits 2 at 2, 6 at 9-16, 19. Thus, his opinion does not aid Claimant in establishing complicated pneumoconiosis.

                                         6

complicated pneumoconiosis based on the CT scan and x-ray evidence, the ALJ gave little weight to Dr. Harris’s opinion as it is contrary to her determinations. Decision and Order at 12. Thus, the ALJ found the medical opinion evidence does not support a finding of complicated pneumoconiosis. Decision and Order at 9-11.

  However, we vacated the ALJ’s finding that the CT scan evidence is insufficient to

support a diagnosis of complicated pneumoconiosis at 20 C.F.R. §718.304(c). Further, the ALJ merely found the x-ray evidence to be in equipoise and, therefore, that it neither supports nor refutes a finding of complicated pneumoconiosis. See supra. Thus, we also vacate her giving little weight to Dr. Harris’s opinion and her determination that the medical opinion evidence does not support a finding of complicated pneumoconiosis.

    Consequently, we further vacate the ALJ’s finding, based on her consideration of

all the relevant evidence, that Claimant failed to establish complicated pneumoconiosis at 20 C.F.R. §718.304 or invoke the irrebuttable presumption at Section 411(c)(3). Thus, we remand the case for the ALJ to consider all relevant medical evidence to determine whether Claimant affirmatively establishes the presence of complicated pneumoconiosis. 30 U.S.C.
§921(c)(3); 20 C.F.R. §718.304(a)-(c).

    Invocation of the Section 411(c)(4) Presumption – Total Disability

    To invoke the Section 411(c)(4) presumption, Claimant must establish he has a

totally disabling respiratory or pulmonary impairment. 20 C.F.R. §718.305(b)(1)(iii). A miner is considered totally disabled if his pulmonary or respiratory impairment, standing alone, prevents him from performing his usual coal mine work and comparable gainful work. See 20 C.F.R. §718.204(b)(1). A claimant may establish total disability based on qualifying pulmonary function studies, qualifying arterial blood gas studies,10 evidence of pneumoconiosis and cor pulmonale with right-sided congestive heart failure, or medical opinions. 20 C.F.R. §718.204(b)(2)(i)-(iv). The ALJ must weigh all relevant supporting evidence against all relevant contrary evidence. See Rafferty v. Jones & Laughlin Steel Corp., 9 BLR 1-231, 1-232 (1987); Shedlock v. Bethlehem Mines Corp., 9 BLR 1-195, 1- 198 (1986), aff’d on recon., 9 BLR 1-236 (1987) (en banc). The ALJ found the pulmonary

   10
      A “qualifying” pulmonary function study or arterial blood gas study yields results

that are equal to or less than the applicable table values listed in Appendices B and C of 20 C.F.R. Part 718, respectively. A “non-qualifying” study yields results exceeding those values. See 20 C.F.R. §718.204(b)(2)(i), (ii).

                                         7

function studies, blood gas studies, and medical opinions do not support a finding of total disability.11

   Pulmonary Function Studies

    The ALJ considered three pulmonary function studies dated June 29, 2021, January

26, 2023, and March 7, 2023, and accurately noted none of them produced qualifying results. Employer’s Exhibits 1, 2. Therefore, we affirm her finding that the pulmonary function study evidence does not support a finding of total disability. 20 C.F.R.
§718.204(b)(2)(i); see Compton, 211 F.3d at 207-08; Decision and Order at 8, 14.

   Arterial Blood Gas Studies

   The ALJ considered two blood gas studies. Decision and Order at 8-9, 14. The

June 29, 2021 study produced non-qualifying values at rest and after exercise, while the March 7, 2023 study produced qualifying results at rest but nonqualifying results after exercise. Id. As only one of the studies at rest and after exercise yielded qualifying results, we affirm the ALJ’s permissible finding that the preponderance of the blood gas study evidence does not support a finding of total disability. 20 C.F.R. §718.204(b)(2)(ii); see Looney, 678 F.3d at 310; Decision and Order at 8-9, 14.

   Medical Opinions

    The ALJ considered the medical opinions of Drs. Harris and Sargent. Decision and

Order at 14-15. Dr. Harris noted Claimant worked as a roof bolter and opined Claimant “does have a significant impairment due to his pulmonary disease, as evidenced by his symptoms of dyspnea on exertion and his radiographic disease which shows small opacities in all lung zones with 1/1 profusion and [a] large opacity consistent with [progressive massive fibrosis].” Director’s Exhibit 16 at 15 (emphasis omitted). Dr. Sargent acknowledged the “isolated arterial blood gas showing moderate hypoxemia at rest” that “improve[d] significantly with low-level exercise” but concluded the evidence overall did not support that Claimant had a totally disabling respiratory or pulmonary impairment. Employer’s Exhibit 2 at 2; see also Employer’s Exhibit 6 at 17-18.

   11
     The ALJ accurately found there is no evidence of cor pulmonale with right-sided

congestive heart failure. Decision and Order at 9, 14. Thus, we affirm her finding the evidence does not support total disability under 20 C.F.R. §718.304(b)(2)(iii). See id. at 14.

                                          8
   In resolving the conflict in the medical opinions on total disability, the ALJ stated:

          Dr. Harris’ opinion that to a reasonable degree of medical certainty,
   the Claimant’s occupational exposure to coal and rock dust was a significant
   and aggravating factor contributing to his pulmonary diagnosis, was
   presented with clarity; however, his ultimate opinion was inconsistent with
   diagnostic medical evidence including x-ray, [pulmonary function testing]
   PFT, [arterial blood gas studies] ABG and CT studies demonstrating the
   claimant’s diagnosis of simple pneumoconiosis, rather than complex
   pneumoconiosis. Additionally, Dr. Harris offered his opinion regarding the
   etiology of [C]laimant’s impairment, while failing to distinguish between
   coal dust exposure and a history of smoking as the origin for Claimant’s
   condition. Accordingly, Dr. Harris’ opinion was given little weight.

         To the contrary, the opinion of Dr. Sargent [was] given great weight.
   His opinions which supported the Claimant’s diagnosis of simple, yet not
   complex pneumoconiosis was thorough, well-reasoned and supported by
   PFT, ABG and CT studies as well as x-ray interpretations. Additionally, his
   opinion was consistent with clinical observations.

         Based upon a preponderance of the evidence, I find the medical
   opinion reports do not support a finding of total disability.

Decision and Order at 14-15.

The Director asserts that the ALJ erred in conflating the issues of total disability and total disability causation when evaluating whether the evidence is sufficient to invoke the Section 411(c)(4) presumption and failed to critically analyze the medical opinions as the APA requires. Director’s Brief at 1-2. Employer responds, urging the Board to affirm the ALJ’s findings. Employer’s Response to Director’s Brief at 1-5.

As the Director contends, the ALJ improperly conflated the issues of total disability and disability causation in reaching her credibility findings. The relevant inquiry at 20 C.F.R. §718.204(b)(2) is whether Claimant has a totally disabling respiratory or pulmonary impairment; the cause of that impairment is addressed at 20 C.F.R. §§718.202(a)(4), 718.204(c), or in consideration of rebuttal of the Section 411(c)(4) presumption pursuant to 20 C.F.R. §718.305. See 20 C.F.R. §718.204(b), (c); Island Creek Coal Co. v. Blankenship, 123 F.4th 684, 691-92 (4th Cir. 2024); Johnson v. Apogee Coal Co., 26 BLR 1-1, 1-11 (2023), appeal docketed, No. 23-3612 (6th Cir. July 25, 2023); Bosco v. Twin Pines Coal Co., 892 F.2d 1473, 1480-81 (10th Cir. 1989). Further, total disability can be established with a reasoned medical opinion even “[w]here total disability cannot be 9 shown” by qualifying objective testing, as non-qualifying testing may still render a miner incapable of performing his usual coal mine work. 20 C.F.R. §718.204(b)(2)(iv). Even a mild impairment may be totally disabling depending on the exertional requirements of a miner’s usual coal mine employment. See Scott v. Mason Coal Co., 60 F.3d 1138, 1141 (4th Cir. 1995) (explaining physical limitations described in a physician’s report sufficient to establish total disability); Eagle v. Armco Inc., 943 F.2d 509, 512 (4th Cir. 1991); Cornett v. Benham Coal, Inc., 227 F.3d 569, 578 (6th Cir. 2000) (miner is totally disabled if he cannot perform the exertional requirements of his previous job).

Here the ALJ did not consider Dr. Harris’s opinion that Claimant’s symptoms of dyspnea on exertion would preclude him from performing his usual coal mine work, nor otherwise discuss whether there is any record evidence from which to infer that Claimant is totally disabled taking into consideration the exertional requirements of his usual coal mine work.12 See Director’s Exhibit 16. Thus, as the ALJ’s analysis at 20 C.F.R.
§718.204(b)(2)(iv) is incomplete and does not satisfy the APA,13 we vacate her conclusion that Claimant did not establish total disability. 20 C.F.R. §718.204(b)(2); Decision and Order at 15. Thus, we also vacate the ALJ’s conclusion that Claimant failed to invoke the Section 411(c)(4) presumption and the denial of benefits.

Remand Instructions

Initially, the ALJ must reconsider all other relevant evidence at 20 C.F.R.
§718.304(c), including Claimant’s CT scans and medical opinions. She must perform an equivalency determination in evaluating the relevant medical evidence under 20 C.F.R.
§718.304(c). See Scarbro, 220 F.3d at 256; Blankenship, 177 F.3d at 243. The ALJ must then weigh together the evidence at subsections (a)-(c) before determining whether

12
We note that Dr. Harris based his total disability diagnosis in part on x-ray evidence of complicated pneumoconiosis, which the ALJ found was inconsistent with her determination that Claimant did not establish the disease. Although an ALJ may give less weight to a medical opinion that relies upon a misdiagnosis of presumed total disability due to complicated pneumoconiosis, we cannot affirm the ALJ’s findings in this case given her misapplication of the legal standard between disease and causation and her failure to consider the entirety of Dr. Harris’s opinion.
13
The Administrative Procedure Act, 5 U.S.C. §§500-591, requires that every adjudicatory decision include “findings and conclusions and the reasons or basis therefor, on all the material issues of fact, law, or discretion presented . . . .” 5 U.S.C. §557(c)(3)(A), as incorporated into the Act by 30 U.S.C. §932(a); see Wojtowicz v. Duquesne Light Co., 12 BLR 1-162, 1-165 (1989).

10
Claimant has met his burden of proving he has complicated pneumoconiosis by a preponderance of the evidence. See Scarbro, 220 F.3d at 256; Melnick, 16 BLR at 1-3. If Claimant establishes complicated pneumoconiosis, the ALJ must determine whether the complicated pneumoconiosis arose out of Claimant’s coal mine employment at 20 C.F.R.
§718.203 before concluding he is entitled to the irrebuttable presumption.

If the ALJ finds Claimant is not entitled to the irrebuttable presumption at Section 411(c)(3) of the Act, 30 U.S.C. §921(c)(3); 20 C.F.R. §718.304, the ALJ must reconsider whether Claimant invoked the Section 411(c)(4) presumption and the medical opinions of Drs. Harris and Sargent. The ALJ should consider that the regulations permit a physician to offer a reasoned medical opinion diagnosing total disability even though the objective studies are non-qualifying. 20 C.F.R. §718.204(b)(2)(iv); see Killman v. Director, OWCP, 415 F.3d 716, 721-22 (7th Cir. 2005) (claimant can establish total disability despite non- qualifying objective tests); Cornett, 227 F.3d at 587 (“even a ‘mild’ respiratory impairment may preclude the performance of the miner’s usual duties”).

The ALJ must also compare the exertional requirements of Claimant’s usual coal mine employment to the physicians’ descriptions of his pulmonary impairment and physical limitations. Lane v. Union Carbide Corp., 105 F.3d 166, 172 (4th Cir. 1997); Eagle, 943 F.2d at 512 n.4; 20 C.F.R. §718.204(b)(2)(iv). In rendering her credibility findings, she must consider the comparative credentials of the physicians, the explanations for their conclusions, the documentation underlying their medical judgments, and the sophistication of and bases for their diagnoses. See Hicks, 138 F.3d at 533; Sterling Smokeless Coal Co. v. Akers, 131 F.3d 438, 441 (4th Cir. 1997).

If the ALJ determines total disability is demonstrated by the medical opinions, she must weigh all the relevant evidence together to determine whether Claimant is totally disabled. 20 C.F.R. §718.204(b)(2); Defore v. Ala. By-Products Corp., 12 BLR 1-27, 1- 28-29 (1988); Fields v. Island Creek Coal Co., 10 BLR 1-19, 1-21 (1987); see Shedlock, 9 BLR at 1-198. If Claimant fails to establish total disability, an essential element of entitlement, the ALJ must reinstate the denial of benefits. See Anderson v. Valley Camp of Utah, Inc., 12 BLR 1-111, 1-112 (1989); Trent v. Director, OWCP, 11 BLR 1-26, 1-27 (1987); Perry v. Director, OWCP, 9 BLR 1-1, 1-2 (1986) (en banc).

If Claimant establishes total disability, he will invoke the Section 411(c)(4) presumption, and the ALJ must determine whether Employer has rebutted it. 20 C.F.R.
§718.305(d)(1). In rendering all of her credibility determinations and findings on remand, the ALJ must set forth her findings in detail and explain her rationale in accordance with the APA. 5 U.S.C. §557(c)(3)(A), as incorporated into the Act by 30 U.S.C. §932(a); see Wojtowicz v. Duquesne Light Co., 12 BLR 1-162, 1-165 (1989).

11
Accordingly, the ALJ’s Decision and Order Denying Benefits is affirmed in part and vacated in part, and the case is remanded to the ALJ for further consideration consistent with this decision.

SO ORDERED.

DANIEL T. GRESH, Chief
Administrative Appeals Judge

GREG J. BUZZARD
Administrative Appeals Judge

BOGGS, Administrative Appeals Judge, concurring and dissenting:

I respectfully dissent from the majority’s decision to vacate and remand the ALJ’s finding that the CT scan evidence is insufficient to support a diagnosis of complicated pneumoconiosis at 20 C.F.R. §718.304(c). Contrary to my colleague’s characterization of Dr. DePonte’s interpretation of the February 13, 2023 CT scan, she does not identify the pseudoplaques, whose size she describes, as pneumoconiosis. Claimant’s Exhibit 4. Dr. DePonte indicates that “the patient has findings of coal workers[’] pneumoconiosis with fine interstitial nodularity.” Id. at 1. She then states that “[i]n addition there are larger peripheral opacities consistent with pseudoplaques which exceed 1 [centimeter] in greatest dimension” with one of the large pseudoplaques being in the right upper lobe and having a length exceeding fifteen millimeters. Id. (emphasis added). Dr. Colella does not describe the size of anything he observed in his CT interpretation of the same scan. Thus, the current case is distinguishable from Eastern Associated Coal Corp. v. Director, OWCP [Scarbro], 220 F.3d 250, 256 (4th Cir. 2000) where all of the physicians agreed there was an opacity of the requisite size. As the ALJ permissibly determined she could not reasonably make a complicated pneumoconiosis finding based on the evidence of record, I would affirm her finding that the CT scan evidence does not support a finding of complicated pneumoconiosis at 20 C.F.R. §718.304(c) and therefore also affirm her determination that

12
Claimant failed to establish complicated pneumoconiosis based on a weighing of the evidence as a whole at 20 C.F.R. §718.304 or invoke the Section 411(c)(3) presumption.

I concur with my colleagues’ decision to remand at 20 C.F.R. §718.204(b)(2) because the ALJ conflated the issues of total disability and total disability causation when evaluating whether the evidence is sufficient to invoke the Section 411(c)(4) presumption. However, in evaluating the medical opinions and treatment records, I note that dyspnea, a symptom, is not sufficient to independently establish a totally disabling respiratory impairment. See McMath v. Director, OWCP, 12 BLR 1-6, 1-10 (1988); Clay v. Director, OWCP, 7 BLR 1-82, 1-84 (1984); see also Heaton v. Director, OWCP, 6 BLR 1-1222, 1- 1224 (1984); Parsons v. Director, OWCP, 6 BLR 1-272, 1-277 (1983); Bushilla v. North American Coal Corp., 6 BLR 1-365, 1-367 (1983).

JUDITH S. BOGGS
Administrative Appeals Judge

13