20 C.F.R. § 725.414

Development of evidence

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(a) Medical evidence. (1) For purposes of this section, a medical report is a physician's written assessment of the miner's respiratory or pulmonary condition. A medical report may be prepared by a physician who examined the miner and/or reviewed the available admissible evidence. Supplemental medical reports prepared by the same physician must be considered part of the physician's original medical report. A physician's written assessment of a single objective test, such as a chest X-ray or a pulmonary function test, is not a medical report for purposes of this section.

(2)(i) The claimant is entitled to submit, in support of his affirmative case, no more than two chest X-ray interpretations, the results of no more than two pulmonary function tests, the results of no more than two arterial blood gas studies, no more than one report of an autopsy, no more than one report of each biopsy, and no more than two medical reports. Any chest X-ray interpretations, pulmonary function test results, blood gas studies, autopsy report, biopsy report, and physicians' opinions that appear in a medical report must each be admissible under this paragraph or paragraph (a)(4) of this section.

(ii) The claimant is entitled to submit, in rebuttal of the case presented by the party opposing entitlement, no more than one physician's interpretation of each chest X-ray, pulmonary function test, arterial blood gas study, autopsy or biopsy submitted by the designated responsible operator or the fund, as appropriate, under paragraph (a)(3)(i) or (a)(3)(iii) of this section and by the Director pursuant to § 725.406. In any case in which the party opposing entitlement has submitted the results of other testing pursuant to § 718.107, the claimant is entitled to submit one physician's assessment of each piece of such evidence in rebuttal. In addition, where the responsible operator or fund has submitted rebuttal evidence under paragraph (a)(3)(ii) or (a)(3)(iii) of this section with respect to medical testing submitted by the claimant, the claimant is entitled to submit an additional statement from the physician who originally interpreted the chest X-ray or administered the objective testing. Where the rebuttal evidence tends to undermine the conclusion of a physician who prepared a medical report submitted by the claimant, the claimant is entitled to submit an additional statement from the physician who prepared the medical report explaining his conclusion in light of the rebuttal evidence.

(3)(i) The responsible operator designated pursuant to § 725.410 is entitled to obtain and submit, in support of its affirmative case, no more than two chest X-ray interpretations, the results of no more than two pulmonary function tests, the results of no more than two arterial blood gas studies, no more than one report of an autopsy, no more than one report of each biopsy, and no more than two medical reports. Any chest X-ray interpretations, pulmonary function test results, blood gas studies, autopsy report, biopsy report, and physicians' opinions that appear in a medical report must each be admissible under this paragraph or paragraph (a)(4) of this section. In obtaining such evidence, the responsible operator may not require the miner to travel more than 100 miles from his or her place of residence, or the distance traveled by the miner in obtaining the complete pulmonary evaluation provided by § 725.406 of this part, whichever is greater, unless a trip of greater distance is authorized in writing by the district director. If a miner unreasonably refuses—

(A) To provide the Office or the designated responsible operator with a complete statement of his or her medical history and/or to authorize access to his or her medical records, or

(B) To submit to an evaluation or test requested by the district director or the designated responsible operator, the miner's claim may be denied by reason of abandonment. (See § 725.409 of this part).

(ii) The responsible operator is entitled to submit, in rebuttal of the case presented by the claimant, no more than one physician's interpretation of each chest X-ray, pulmonary function test, arterial blood gas study, autopsy or biopsy submitted by the claimant under paragraph (a)(2)(i) of this section and by the Director pursuant to § 725.406. In any case in which the claimant has submitted the results of other testing pursuant to § 718.107, the responsible operator is entitled to submit one physician's assessment of each piece of such evidence in rebuttal. In addition, where the claimant has submitted rebuttal evidence under paragraph (a)(2)(ii) of this section, the responsible operator is entitled to submit an additional statement from the physician who originally interpreted the chest X-ray or administered the objective testing. Where the rebuttal evidence tends to undermine the conclusion of a physician who prepared a medical report submitted by the responsible operator, the responsible operator is entitled to submit an additional statement from the physician who prepared the medical report explaining his conclusion in light of the rebuttal evidence.

(iii) In a case in which the district director has not identified any potentially liable operators, or has dismissed all potentially liable operators under § 725.410(a)(3), or has identified a liable operator that ceases to defend the claim on grounds of an inability to provide for payment of continuing benefits, the district director is entitled to exercise the rights of a responsible operator under this section, except that the evidence obtained in connection with the complete pulmonary evaluation performed pursuant to § 725.406 must be considered evidence obtained and submitted by the Director, OWCP, for purposes of paragraph (a)(3)(i) of this section. In a case involving a dispute concerning medical benefits under § 725.708 of this part, the district director is entitled to develop medical evidence to determine whether the medical bill is compensable under the standard set forth in § 725.701 of this part.

(4) Notwithstanding the limitations in paragraphs (a)(2) and (a)(3) of this section, any record of a miner's hospitalization for a respiratory or pulmonary or related disease, or medical treatment for a respiratory or pulmonary or related disease, may be received into evidence.

(5) A copy of any documentary evidence submitted by a party must be served on all other parties to the claim. If the claimant is not represented by an attorney, the district director must mail a copy of all documentary evidence submitted by the claimant to all other parties to the claim. Following the development and submission of affirmative medical evidence, the parties may submit rebuttal evidence in accordance with the schedule issued by the district director.

(b) Evidence pertaining to liability. (1) Except as provided by § 725.408(b)(2), the designated responsible operator may submit evidence to demonstrate that it is not the potentially liable operator that most recently employed the claimant.

(2) Any other party may submit evidence regarding the liability of the designated responsible operator or any other operator.

(3) A copy of any documentary evidence submitted under this paragraph must be mailed to all other parties to the claim. Following the submission of affirmative evidence, the parties may submit rebuttal evidence in accordance with the schedule issued by the district director.

(c) Testimony. A physician who prepared a medical report admitted under this section may testify with respect to the claim at any formal hearing conducted in accordance with subpart F of this part, or by deposition. If a party has submitted fewer than two medical reports as part of that party's affirmative case under this section, a physician who did not prepare a medical report may testify in lieu of such a medical report. The testimony of such a physician will be considered a medical report for purposes of the limitations provided by this section. A party may offer the testimony of no more than two physicians under the provisions of this section unless the adjudication officer finds good cause under paragraph (b)(1) of § 725.456 of this part. In accordance with the schedule issued by the district director, all parties must notify the district director of the name and current address of any potential witness whose testimony pertains to the liability of a potentially liable operator or the designated responsible operator. Absent such notice, the testimony of a witness relevant to the liability of a potentially liable operator or the designated responsible operator will not be admitted in any hearing conducted with respect to the claim unless the administrative law judge finds that the lack of notice should be excused due to extraordinary circumstances.

(d) Except to the extent permitted by §§ 725.456 and 725.310(b), the limitations set forth in this section apply to all proceedings conducted with respect to a claim, and no documentary evidence pertaining to liability may be admitted in any further proceeding conducted with respect to a claim unless it is submitted to the district director in accordance with this section.

[65 FR 80054, Dec. 20, 2000, as amended at 81 FR 24480, Apr. 26, 2016]
Notes of Decisions
Cited in 36 cases (8 in the last 5 years), 1987–2026 · leading case: Gunderson v. United States Dep't of Labor, 601 F.3d 1013 (10th Cir. 2010).
Gunderson v. United States Dep't of Labor, 601 F.3d 1013 (10th Cir. 2010). · cites it 26× “Since the limitations set forth in 20 C.F.R. § 725.414 (2003) are mandatory and cannot be waived, CX10 cannot be considered.”
Lawyer Disciplinary Bd. v. Smoot, 716 S.E.2d 491 (W. Va. 2010). · cites it 6× “Daugherty that the employer was exercising its right, pursuant to 20 C.F.R. § 725.414 (1996), 5 to have Mr.”
West Virginia CWP Fund v. Dir., Off. of Workers' Comp. Programs, United States Dep't of Labor, 880 F.3d 691 (4th Cir. 2018). · cites it 2× “See 20 C.F.R. § 725.414 (a)(3)(i). The ALJ went on to award Smith benefits under the Act.”
Mabel Samons v. Nat'l Mines Corp., 25 F.4th 455 (6th Cir. 2022). · cites it 2× “(Parties may introduce only two opinions per claim, 20 C.F.R. § 725.414 (a)(2)(i), and National Mines used a different opinion for the survivor’s claim.”
Dixie Fuel Co. v. Dir., Off. of Workers' Comp. Programs, 820 F.3d 833 (6th Cir. 2016). “However, because this reading did not comply with the evidentiary limitations of 20 C.F.R. § 725.414 (a)(3), the ALJ, in his pre-re-mand decision, denied admission.”
Edmonds v. Illinois Workers'Comp., 968 N.E.2d 775 (Ill. App. Ct. 2012). · cites it 4× “20 C.F.R. § 725.414 (a). After that evidence is submitted, and we complete any additional processing that we believe may be necessary (which may include an informal conference if all parties are represented and the other requirements of 20 C.”
Appleton & Ratliff Coal Corp. v. Dewey Ratliff, 664 F. App'x 470 (6th Cir. 2016). · cites it 2× “20 C.F.R. § 725.414 (a)(2)(i), (3)(i). Each party may also submit the following evidence in rebuttal: no more than one physician’s interpretation of each chest X-ray, pulmonary function test, arterial blood gas study, autopsy or biopsy submitted by the [other party, as well as] .”
Marfork Coal Co. v. Weis, 251 F. App'x 229 (4th Cir. 2007). · cites it 7× “” 20 C.F.R. § 725.414 (b)(1). Thus, the only “evidence pertaining to liability” that § 725.”
Morrison v. Tennessee Consol. Coal Co., 644 F.3d 473 (6th Cir. 2011). “Any additional evidence submitted must be consistent with the evidentiary limitations imposed by 20 C.F.R. § 725.414 . IV. Next, we review the ALJ’s finding of total disability.”
Darrell A. Doss v. Dir., Off. of Workers' Comp. Programs, United States Dep't of Labor Itmann Coal Co., 53 F.3d 654 (4th Cir. 1995). “414(e)(1) similarly provides: *658 20 C.F.R. § 725.414 (e)(1). The ALJ properly applied the above regulations to exclude the WVOPB report from evidence.”
Elm Grove Coal Co. v. Dir., Off. of Workers' Comp. Programs, 480 F.3d 278 (4th Cir. 2007). · cites it 10× “” 20 C.F.R. § 725.414 (a)(2)®, (3)(i). 6 They further provide that “[a]ny chest X-ray interpretations, pulmonary function test results, blood gas studies, autopsy report, biopsy report, and physicians’ opinions that appear in a medical report must each be admissible under”…”
Old Ben Coal Co. v. Dir., Off. of Workers' Comp. Programs, United States Dep't of Labor, & James E. Hilliard, 292 F.3d 533 (7th Cir. 2002). “” 20 C.F.R. § 725.414 (a)(3)© (2001). 10 According to the regulations, therefore, the requirements of § 725.”
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