20 Cfr 718.101 - .105

1240-0023 20CFR718.101 - 105.pdf

Claim Adjudication Process for the Alleged Presence of Pneumoconiosis

20 CFR 718.101 - .105

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20CFR718.102 - Chest roentgenograms (X-rays).

U.S. Department of Labor
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Content Last Revised: 1/19/01
---DISCLAIMER--CFR Code of Federal Regulations Pertaining to U.S. Department of Labor
Title 20 Employees' Benefits
Chapter VI Employment Standards Administration, Department of Labor
Part 718 Standards for Determining Coal Miners' Total Disability or Death Due to Pneumoconiosis
Subpart B Criteria for the Development of Medical Evidence

20 CFR 718.102 - Chest roentgenograms (X-rays).
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Section Number: 718.102
Section Name: Chest roentgenograms (X-rays).

(a) A chest roentgenogram (X-ray) shall be of suitable quality for
proper classification of pneumoconiosis and shall conform to the
standards for administration and interpretation of chest X-rays as
described in Appendix A.
(b) A chest X-ray to establish the existence of pneumoconiosis
shall be classified as Category 1, 2, 3, A, B, or C, according to the
International Labour Organization Union Internationale Contra Cancer/
Cincinnati (1971) International Classification of Radiographs of the
Pneumoconioses (ILO-U/C 1971), or subsequent revisions thereof. This
document is available from the Division of Coal Mine Workers'
Compensation in the U.S. Department of Labor, Washington, D.C.,
telephone (202) 693-0046, and from the National Institute for
Occupational Safety and Health (NIOSH), located in Cincinnati, Ohio,
telephone (513) 841-4428) and Morgantown, West Virginia, telephone
(304) 285-5749. A chest X-ray classified as Category Z under the ILO
Classification (1958) or Short Form (1968) shall be reclassified as
Category 0 or Category 1 as appropriate, and only the latter accepted
as evidence of pneumoconiosis. A chest X-ray classified under any of
the foregoing classifications as Category 0, including sub-categories
0--, 0/0, or 0/1 under the UICC/Cincinnati (1968) Classification or the
ILO-U/C 1971 Classification does not constitute evidence of
pneumoconiosis.
(c) A description and interpretation of the findings in terms of
the classifications described in paragraph (b) of this section shall be
submitted by the examining physician along with the film. The report
shall specify the name and qualifications of the person who took the
film and the name and qualifications of the physician interpreting the
film. If the physician interpreting the film is a Board-certified or
Board-eligible radiologist or a certified ``B'' reader (see
Sec. 718.202), he or she shall so indicate. The report shall further
specify that the film was interpreted in compliance with this
paragraph.
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20CFR718.102 - Chest roentgenograms (X-rays).

(d) The original film on which the X-ray report is based shall be
supplied to the Office, unless prohibited by law, in which event the
report shall be considered as evidence only if the original film is
otherwise available to the Office and other parties. Where the chest Xray of a deceased miner has been lost, destroyed or is otherwise
unavailable, a report of a chest X-ray submitted by any party shall be
considered in connection with the claim.
(e) Except as provided in this paragraph, no chest X-ray shall
constitute evidence of the presence or absence of pneumoconiosis unless
it is conducted and reported in accordance with the requirements of
this section and Appendix A. In the absence of evidence to the
contrary, compliance with the requirements of Appendix A shall be
presumed. In the case of a deceased miner where the only available Xray does not substantially comply with paragraphs (a) through (d), such
X-ray may form the basis for a finding of the presence or absence of
pneumoconiosis if it is of sufficient quality for determining the
presence or absence of pneumoconiosis and such X-ray was interpreted by
a Board-certified or Board-eligible radiologist or a certified ``B''
reader (see Sec. 718.202).

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20CFR718.103 - Pulmonary function tests.

U.S. Department of Labor
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20 CFR 718.103 - Pulmonary function tests.
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Section Number: 718.103
Section Name: Pulmonary function tests.

(a) Any report of pulmonary function tests submitted in connection
with a claim for benefits shall record the results of flow versus
volume (flow-volume loop). The instrument shall simultaneously provide
records of volume versus time (spirometric tracing). The report shall
provide the results of the forced expiratory volume in one second
(FEV1) and the forced vital capacity (FVC). The report shall also
provide the FEV1/FVC ratio, expressed as a percentage. If the maximum
voluntary ventilation (MVV) is reported, the results of such test shall
be obtained independently rather than calculated from the results of
the FEV1.
(b) All pulmonary function test results submitted in connection
with a claim for benefits shall be accompanied by three tracings of the
flow versus volume and the electronically derived volume versus time
tracings. If the MVV is reported, two tracings of the MVV whose values
are within 10% of each other shall be sufficient. Pulmonary function
test results developed in connection with a claim for benefits shall
also include a statement signed by the physician or technician
conducting the test setting forth the following:
(1) Date and time of test;
(2) Name, DOL claim number, age, height, and weight of claimant at
the time of the test;
(3) Name of technician;
(4) Name and signature of physician supervising the test;
(5) Claimant's ability to understand the instructions, ability to
follow directions and degree of cooperation in performing the tests. If
the claimant is unable to complete the test, the person
executing the report shall set forth the reasons for such failure;
(6) Paper speed of the instrument used;
(7) Name of the instrument used;
(8) Whether a bronchodilator was administered. If a bronchodilator
is administered, the physician's report must detail values obtained
both before and after administration of the bronchodilator and explain
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20CFR718.103 - Pulmonary function tests.

the significance of the results obtained; and
(9) That the requirements of paragraphs (b) and (c) of this section
have been complied with.
(c) Except as provided in this paragraph, no results of a pulmonary
function study shall constitute evidence of the presence or absence of
a respiratory or pulmonary impairment unless it is conducted and
reported in accordance with the requirements of this section and
Appendix B to this part. In the absence of evidence to the contrary,
compliance with the requirements of Appendix B shall be presumed. In
the case of a deceased miner, where no pulmonary function tests are in
substantial compliance with paragraphs (a) and (b) and Appendix B,
noncomplying tests may form the basis for a finding if, in the opinion
of the adjudication officer, the tests demonstrate technically valid
results obtained with good cooperation of the miner.

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20CFR718.101 - General.

U.S. Department of Labor
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20 CFR 718.101 - General.
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Section Number: 718.101
Section Name: General.

(a) The Office of Workers' Compensation Programs (hereinafter OWCP
or the Office) shall develop the medical evidence necessary for a
determination with respect to each claimant's entitlement to benefits.
Each miner who files a claim for benefits under the Act shall be
provided an opportunity to substantiate his or her claim by means of a
complete pulmonary evaluation including, but not limited to, a chest
roentgenogram (X-ray), physical examination, pulmonary function tests
and a blood-gas study.
(b) The standards for the administration of clinical tests and
examinations contained in this subpart shall apply to all evidence
developed by any party after January 19, 2001 in connection with a
claim governed by this part (see Secs. 725.406(b), 725.414(a),
725.456(d)). These standards shall also apply to claims governed by
part 727 (see 20 CFR 725.4(d)), but only for clinical tests or
examinations conducted after January 19, 2001. Any clinical test or
examination subject to these standards shall be in substantial
compliance with the applicable standard in order to constitute evidence
of the fact for which it is proffered. Unless otherwise provided, any
evidence which is not in substantial compliance with the applicable
standard is insufficient to establish the fact for which it is
proffered.

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20CFR718.101 - General.

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20CFR718.104 - Report of physical examinations.

U.S. Department of Labor
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20 CFR 718.104 - Report of physical examinations.
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Section Number: 718.104
Section Name: Report of physical examinations.

(a) A report of any physical examination conducted in connection
with a claim shall be prepared on a medical report form supplied by the
Office or in a manner containing substantially the same information.
Any such report shall include the following information and test
results:
(1) The miner's medical and employment history;
(2) All manifestations of chronic respiratory disease;
(3) Any pertinent findings not specifically listed on the form;
(4) If heart disease secondary to lung disease is found, all
symptoms and significant findings;
(5) The results of a chest X-ray conducted and interpreted as
required by Sec. 718.102; and
(6) The results of a pulmonary function test conducted and reported
as required by Sec. 718.103. If the miner is physically unable to
perform a pulmonary function test or if the test is medically
contraindicated, in the absence of evidence establishing total
disability pursuant to Sec. 718.304, the report must be based on other
medically acceptable clinical and laboratory diagnostic techniques,
such as a blood gas study.
(b) In addition to the requirements of paragraph (a), a report of
physical examination may be based on any other procedures such as
electrocardiogram, blood-gas studies conducted and reported as required
by Sec. 718.105, and other blood analyses which, in the physician's
opinion, aid in his or her evaluation of the miner.
(c) In the case of a deceased miner, where no report is in
substantial compliance with paragraphs (a) and (b), a report prepared
by a physician who is unavailable may nevertheless form the basis for a
finding if, in the opinion of the adjudication officer, it is
accompanied by sufficient indicia of reliability in light of all
relevant evidence.
(d) Treating physician. In weighing the medical evidence of record
relevant to whether the miner suffers, or suffered, from
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20CFR718.104 - Report of physical examinations.

pneumoconiosis, whether the pneumoconiosis arose out of coal mine
employment, and whether the miner is, or was, totally disabled by
pneumoconiosis or died due to pneumoconiosis, the adjudication officer
must give consideration to the relationship between the miner and any
treating physician whose report is admitted into the record.
Specifically, the adjudication officer shall take into consideration
the following factors in weighing the opinion of the miner's treating
physician:
(1) Nature of relationship. The opinion of a physician who has
treated the miner for respiratory or pulmonary conditions is entitled
to more weight than a physician who has treated the miner for nonrespiratory conditions;
(2) Duration of relationship. The length of the treatment
relationship demonstrates whether the physician has observed the miner
long enough to obtain a superior understanding of his or her condition;
(3) Frequency of treatment. The frequency of physician-patient
visits demonstrates whether the physician has observed the miner often
enough to obtain a superior understanding of his or her condition; and
(4) Extent of treatment. The types of testing and examinations
conducted during the treatment relationship demonstrate whether the
physician has obtained superior and relevant information concerning the
miner's condition.
(5) In the absence of contrary probative evidence, the adjudication
officer shall accept the statement of a physician with regard to the
factors listed in paragraphs (d)(1) through (4) of this section. In
appropriate cases, the relationship between the miner and his treating
physician may constitute substantial evidence in support of the
adjudication officer's decision to give that physician's opinion
controlling weight, provided that the weight given to the opinion of a
miner's treating physician shall also be based on the credibility of
the physician's opinion in light of its reasoning and documentation,
other relevant evidence and the record as a whole.

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20CFR718.105 - Arterial blood-gas studies.

U.S. Department of Labor
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20 CFR 718.105 - Arterial blood-gas studies.
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Section Number: 718.105
Section Name: Arterial blood-gas studies.

(a) Blood-gas studies are performed to detect an impairment in the
process of alveolar gas exchange. This defect will manifest itself
primarily as a fall in arterial oxygen tension either at rest or during
exercise. No blood-gas study shall be performed if medically
contraindicated.
(b) A blood-gas study shall initially be administered at rest and
in a sitting position. If the results of the blood-gas test at rest do
not satisfy the requirements of Appendix C to this part, an exercise
blood-gas test shall be offered to the miner unless medically
contraindicated. If an exercise blood-gas test is administered, blood
shall be drawn during exercise.
(c) Any report of a blood-gas study submitted in connection with a
claim shall specify:
(1) Date and time of test;
(2) Altitude and barometric pressure at which the test was
conducted;
(3) Name and DOL claim number of the claimant;
(4) Name of technician;
(5) Name and signature of physician supervising the study;
(6) The recorded values for PC02, P02, and PH, which have been
collected simultaneously (specify values at rest and, if performed,
during exercise);
(7) Duration and type of exercise;
(8) Pulse rate at the time the blood sample was drawn;
(9) Time between drawing of sample and analysis of sample; and
(10) Whether equipment was calibrated before and after each test.
(d) If one or more blood-gas studies producing results which meet
the appropriate table in Appendix C is administered during a
hospitalization which ends in the miner's death, then any such study
must be accompanied by a physician's report establishing that the test
results were produced by a chronic respiratory or pulmonary condition.
Failure to produce such a report will prevent reliance on the blood-gas
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20CFR718.105 - Arterial blood-gas studies.

study as evidence that the miner was totally disabled at death. (e) In
the case of a deceased miner, where no blood gas tests are in
substantial compliance with
paragraphs (a), (b), and (c), noncomplying tests may form the basis for
a finding if, in the opinion of the adjudication officer, the only
available tests demonstrate technically valid results. This provision
shall not excuse compliance with the requirements in paragraph (d) for
any blood gas study administered during a hospitalization which ends in
the miner's death.

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File Type	application/pdf
File Title	20CFR718.102 - Chest roentgenograms (X-rays).
File Modified	2004-10-01
File Created	2004-10-01