20 C.F.R. § 718.204

Total disability and disability causation defined; criteria for determining total disability and total disability due to pneumoconiosis

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(a) General. Benefits are provided under the Act for or on behalf of miners who are totally disabled due to pneumoconiosis, or who were totally disabled due to pneumoconiosis at the time of death. For purposes of this section, any nonpulmonary or nonrespiratory condition or disease, which causes an independent disability unrelated to the miner's pulmonary or respiratory disability, shall not be considered in determining whether a miner is totally disabled due to pneumoconiosis. If, however, a nonpulmonary or nonrespiratory condition or disease causes a chronic respiratory or pulmonary impairment, that condition or disease shall be considered in determining whether the miner is or was totally disabled due to pneumoconiosis.

(b)(1) Total disability defined. A miner shall be considered totally disabled if the irrebuttable presumption described in § 718.304 applies. If that presumption does not apply, a miner shall be considered totally disabled if the miner has a pulmonary or respiratory impairment which, standing alone, prevents or prevented the miner:

(i) From performing his or her usual coal mine work; and

(ii) From engaging in gainful employment in the immediate area of his or her residence requiring the skills or abilities comparable to those of any employment in a mine or mines in which he or she previously engaged with some regularity over a substantial period of time.

(2) Medical criteria. In the absence of contrary probative evidence, evidence which meets the standards of either paragraphs (b)(2)(i), (ii), (iii), or (iv) of this section shall establish a miner's total disability:

(i) Pulmonary function tests showing values equal to or less than those listed in Table B1 (Males) or Table B2 (Females) in Appendix B to this part for an individual of the miner's age, sex, and height for the FEV1 test; if, in addition, such tests also reveal the values specified in either paragraph (b)(2)(i)(A) or (B) or (C) of this section:

(A) Values equal to or less than those listed in Table B3 (Males) or Table B4 (Females) in Appendix B of this part, for an individual of the miner's age, sex, and height for the FVC test, or

(B) Values equal to or less than those listed in Table B5 (Males) or Table B6 (Females) in Appendix B to this part, for an individual of the miner's age, sex, and height for the MVV test, or

(C) A percentage of 55 or less when the results of the FEV1 test are divided by the results of the FVC test (FEV1/FVC equal to or less than 55%), or

(ii) Arterial blood-gas tests show the values listed in Appendix C to this part, or

(iii) The miner has pneumoconiosis and has been shown by the medical evidence to be suffering from cor pulmonale with right-sided congestive heart failure, or

(iv) Where total disability cannot be shown under paragraphs (b)(2)(i), (ii), or (iii) of this section, or where pulmonary function tests and/or blood gas studies are medically contraindicated, total disability may nevertheless be found if a physician exercising reasoned medical judgment, based on medically acceptable clinical and laboratory diagnostic techniques, concludes that a miner's respiratory or pulmonary condition prevents or prevented the miner from engaging in employment as described in paragraph (b)(1) of this section.

(c)(1) Total disability due to pneumoconiosis defined. A miner shall be considered totally disabled due to pneumoconiosis if pneumoconiosis, as defined in § 718.201, is a substantially contributing cause of the miner's totally disabling respiratory or pulmonary impairment. Pneumoconiosis is a “substantially contributing cause” of the miner's disability if it:

(i) Has a material adverse effect on the miner's respiratory or pulmonary condition; or

(ii) Materially worsens a totally disabling respiratory or pulmonary impairment which is caused by a disease or exposure unrelated to coal mine employment.

(2) Except as provided in § 718.305 and paragraph (b)(2)(iii) of this section, proof that the miner suffers or suffered from a totally disabling respiratory or pulmonary impairment as defined in paragraphs (b)(2)(i), (b)(2)(ii), (b)(2)(iv) and (d) of this section shall not, by itself, be sufficient to establish that the miner's impairment is or was due to pneumoconiosis. Except as provided in paragraph (d), the cause or causes of a miner's total disability shall be established by means of a physician's documented and reasoned medical report.

(d) Lay evidence. In establishing total disability, lay evidence may be used in the following cases:

(1) In a case involving a deceased miner in which the claim was filed prior to January 1, 1982, affidavits (or equivalent sworn testimony) from persons knowledgeable of the miner's physical condition shall be sufficient to establish total (or under § 718.306 partial) disability due to pneumoconiosis if no medical or other relevant evidence exists which addresses the miner's pulmonary or respiratory condition.

(2) In a case involving a survivor's claim filed on or after January 1, 1982, but prior to June 30, 1982, which is subject to § 718.306, affidavits (or equivalent sworn testimony) from persons knowledgeable of the miner's physical condition shall be sufficient to establish total or partial disability due to pneumoconiosis if no medical or other relevant evidence exists which addresses the miner's pulmonary or respiratory condition; however, such a determination shall not be based solely upon the affidavits or testimony of the claimant and/or his or her dependents who would be eligible for augmentation of the claimant's benefits if the claim were approved.

(3) In a case involving a deceased miner whose claim was filed on or after January 1, 1982, affidavits (or equivalent sworn testimony) from persons knowledgeable of the miner's physical condition shall be sufficient to establish total disability due to pneumoconiosis if no medical or other relevant evidence exists which addresses the miner's pulmonary or respiratory condition; however, such a determination shall not be based solely upon the affidavits or testimony of any person who would be eligible for benefits (including augmented benefits) if the claim were approved.

(4) Statements made before death by a deceased miner about his or her physical condition are relevant and shall be considered in making a determination as to whether the miner was totally disabled at the time of death.

(5) In the case of a living miner's claim, a finding of total disability due to pneumoconiosis shall not be made solely on the miner's statements or testimony.

(e) In determining total disability to perform usual coal mine work, the following shall apply in evaluating the miner's employment activities:

(1) In the case of a deceased miner, employment in a mine at the time of death shall not be conclusive evidence that the miner was not totally disabled. To disprove total disability, it must be shown that at the time the miner died, there were no changed circumstances of employment indicative of his or her reduced ability to perform his or her usual coal mine work.

(2) In the case of a living miner, proof of current employment in a coal mine shall not be conclusive evidence that the miner is not totally disabled unless it can be shown that there are no changed circumstances of employment indicative of his or her reduced ability to perform his or her usual coal mine work.

(3) Changed circumstances of employment indicative of a miner's reduced ability to perform his or her usual coal mine work may include but are not limited to:

(i) The miner's reduced ability to perform his or her customary duties without help; or

(ii) The miner's reduced ability to perform his or her customary duties at his or her usual levels of rapidity, continuity or efficiency; or

(iii) The miner's transfer by request or assignment to less vigorous duties or to duties in a less dusty part of the mine.

Notes of Decisions

Cited in 266 cases (37 in the last 5 years), 1984–2026 · leading case: Milburn Colliery Co. v. Guy Hicks Dir., Off. of Workers' Comp. Programs, United States Dep't of Labor, 138 F.3d 524 (4th Cir. 1998).

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Milburn Colliery Co. v. Guy Hicks Dir., Off. of Workers' Comp. Programs, United States Dep't of Labor, 138 F.3d 524 (4th Cir. 1998). · cites it 12× “2 See 20 C.F.R. § 718.204 (c) (1997). If contrary probative evidence exists,-“the ALJ must assign the contrary evidence appropriate weight - and determine whether it outweighs the evidence that supports a finding of total disability.”

Mabel Samons v. Nat'l Mines Corp., 25 F.4th 455 (6th Cir. 2022). · cites it 9× “20 C.F.R. § 718.204 (b)(2)(i). To establish a miner’s total disability, the results of a test must fall within specified ranges listed in the regulations.”

Island Creek Coal Co. v. Melyndia Bryan, 937 F.3d 738 (6th Cir. 2019). · cites it 3× “The administrative law judge rejected both arguments, and the Board affirmed. Cunningham now challenges both aspects of the judge’s decision.”

Helen Hillibush, Widow of Edward Hillibush, Deceased v. U.S. Dep't of Labor, Benefits Review Bd., 853 F.2d 197 (3rd Cir. 1988). · cites it 9× “See 20 C.F.R. § 718.204 (b)(1) (1987). Second, he contends that 20 C.”

Harold Zimmerman v. Dir., Off. of Workers' Comp. Programs, United States Dep't of Labor, 871 F.2d 564 (6th Cir. 1989). · cites it 7× “The AU applied 20 C.F. R. § 718.204 to find that Zimmerman was totally disabled by his respiratory or pulmonary impairment.”

Rockwood Cas. Ins. Co. v. Dir., Off. of Workers' Comp. Programs, 917 F.3d 1198 (10th Cir. 2019). · cites it 9× “" 20 C.F.R. § 718.204 (b)(1). The BLBA regulations provide that a miner can qualify for a total disability determination by submitting evidence from (1) pulmonary function tests, (2) arterial blood gas tests, or (3) medical evidence of right-side congestive heart failure.”

Arch on the Green, Inc. v. Lawrence Groves, 761 F.3d 594 (6th Cir. 2014). · cites it 6× “Simpao’s opinion, to find that claimant established the existence of legal pneumo-coniosis at 20 C.F.R. § 718.204 (c).” The Board cited Tennessee Consolidated Coal Co.”

Island Creek Coal Co. v. Jay Wilkerson, 910 F.3d 254 (6th Cir. 2018). · cites it 2× “20 C.F.R. § 718.204 (b)(1). Once a miner establishes a presumptive entitlement to benefits, the employer may rebut the presumption by showing that the miner does not have pneumoconiosis or that his impairment did not arise out of employment at a coal mine.”

Paramont Coal Co. Virginia, LLC & Brickstreet Mut. Ins. Co. v. Dewey J. McCoy, 819 S.E.2d 831 (Va. Ct. App. 2018). · cites it 4× “2 ; 20 C.F.R. § 718.204 . The relevant federal regulation provides, in pertinent part, that the pulmonary function criteria for total disability of a miner of the claimant's sex, age, and height include an FEV1 of 2.”

Willard M. Toler v. E. Associated Coal Co. Dir., Off. of Workers' Comp. Programs, United States Dep't of Labor, 43 F.3d 109 (4th Cir. 1995). · cites it 6× “Toler argues that the ALJ’s finding that he failed to establish a total disability due to pneumoconiosis, as required by 20 C.F.R. § 718.204 , was not based on substantial evidence.”

Arthur Bonessa v. United States Steel Corp., & Dir., Off. of Workers' Comp. Programs, U.S. Dep't of Labor, Party in Interest, 884 F.2d 726 (3rd Cir. 1989). · cites it 6× “20 C.F.R. § 718.204 (c)(4), applicable here, explains that total disability can be found: If a physician exercising reasonable medical judgment, based on medically acceptable clinical and laboratory and diagnostic techniques, concludes that a miner’s respiratory or pulmonary…”

Consolidation Coal Co. v. OWCP, 911 F.3d 824 (7th Cir. 2018). · cites it 7× “Since the ALJ found the more recent results to be the best indicator of Ross's pulmonary condition, the ALJ concluded that the pulmonary function testing, standing alone, did not support a finding of total disability under 20 C.F.R. § 718.204 (b)(2)(i). Then, the ALJ discussed…”

Show all 266 citing cases →

— 20 C.F.R. § 718.204(a) — 3 cases

Peabody Coal Co. v. Smith, 127 F.3d 504 (6th Cir. 1997).

Dominion Coal Corp v. Vance (4th Cir. 1997).

— 20 C.F.R. § 718.204(b) — 4 cases

Jonida Trucking, Inc. v. Robert F. Hunt Dir., Off. of Workers' Comp. Programs, United States Dep't of Labor, 124 F.3d 739 (6th Cir. 1997).

Utah Power & Light Co. v. Dir., Off. Of Workers' Comp. Programs, 13 F.3d 408 (10th Cir. 1993).

Darewood Shreve v. Dir., Off. of Workers' Comp. Programs, United States Dep't of Labor, 864 F.2d 32 (4th Cir. 1988).

Peabody Coal Co. v. DOWCP (4th Cir. 2000).

— 20 C.F.R. § 718.204(b)(1) — 1 case

Bizzack Constr., LLC v. James Fannin (6th Cir. 2019).

— 20 C.F.R. § 718.204(b)(1)(iv) — 1 case

Shannon v. Dir., Off. of Workers' Comp. Programs, 199 F. App'x 469 (6th Cir. 2006).

— 20 C.F.R. § 718.204(c) — 8 cases

Milburn Colliery Co. v. Guy Hicks Dir., Off. of Workers' Comp. Programs, United States Dep't of Labor, 138 F.3d 524 (4th Cir. 1998). “2 See 20 C.F.R. § 718.204 (c) (1997). If contrary probative evidence exists,-“the ALJ must assign the contrary evidence appropriate weight - and determine whether it outweighs the evidence that supports a finding of total disability.”

Arch on the Green, Inc. v. Lawrence Groves, 761 F.3d 594 (6th Cir. 2014). “Simpao’s opinion, to find that claimant established the existence of legal pneumo-coniosis at 20 C.F.R. § 718.204 (c).” The Board cited Tennessee Consolidated Coal Co.”

Dennis Cornett v. Benham Coal, Inc. Kentucky Producers' Self-Ins. Fund & Dir., Off. of Workers' Comp. Programs, United States Dep't of Labor, 227 F.3d 569 (6th Cir. 2000).

Cornett v. Benham Coal, Inc., 227 F.3d 569 (6th Cir. 2000).

Scalia v. Chevron Mining, Inc. (W.D. Ky. 2021).

— 20 C.F.R. § 718.204(c)(1) — 6 cases

Sewell Coal Co. v. Triplett, 253 F. App'x 274 (4th Cir. 2007).

T Coal Co. v. Daniel Cook (4th Cir. 2023).

West Virginia CWP Fund v. DOWCP (4th Cir. 2023).

John Cleary v. United States Steel Corp.: Off. of Workers Comp. Prog., 881 F.2d 1069 (4th Cir. 1989).

Charles Edwin Howard v. Dir., Off. of Workers' Comp. Programs, United States Dep't of Labor, 925 F.2d 1463 (6th Cir. 1991).

— 20 C.F.R. § 718.204(c)(2) — 1 case

Mascarenas v. Dir., Off. of Workers' Comp. Programs, U.S. Dept. of Labor, 52 F.3d 338 (10th Cir. 1995).

— 20 C.F.R. § 718.204(c)(4) — 5 cases

Harold Zimmerman v. Dir., Off. of Workers' Comp. Programs, United States Dep't of Labor, 871 F.2d 564 (6th Cir. 1989). “The AU applied 20 C.F. R. § 718.204 to find that Zimmerman was totally disabled by his respiratory or pulmonary impairment.”

Arthur Muncy v. Dir., Off. of Workers' Comp. Programs, United States Dep't of Labor, 932 F.2d 969 (6th Cir. 1991).

Virginia Jackson v. Grays Knob Coal Co., 917 F.2d 1304 (6th Cir. 1990).

Tolliver v. DOWCP (4th Cir. 1999).

Milburn Colliery Co v. Hicks (4th Cir. 1998).

— 20 C.F.R. § 718.204(c)(5) — 2 cases

Mary Stephens v. Dir., Off. of Workers' Comp. Programs, United States Dep't of Labor, 840 F.2d 11 (4th Cir. 1988).

Okie Conn v. Dir., Off. of Workers' Comp. Programs, 875 F.2d 862 (6th Cir. 1989).

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