20 CFR 718.204 - Total disability and disability causation defined; criteria for determining total disability and total disability due to pneumoconiosis.

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§ 718.204 Total disability and disability causation defined; criteria for determining total disability and total disability due to pneumoconiosis.
(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.

Title 20 published on 2012-04-01

The following are only the Rules published in the Federal Register after the published date of Title 20.

For a complete list of all Rules, Proposed Rules, and Notices view the Rulemaking tab.

  • 2014-04-17; vol. 79 # 74 - Thursday, April 17, 2014
    1. 79 FR 21606 - Black Lung Benefits Act: Standards for Chest Radiographs
      GPO FDSys XML | Text
      DEPARTMENT OF LABOR, Office of Workers' Compensation Programs
      Final rule.
      This rule is effective May 19, 2014. The incorporation by reference of certain publications listed in the rule is approved by the Director of the Federal Register as of May 19, 2014.
      20 CFR Parts 718 and 725

This is a list of United States Code sections, Statutes at Large, Public Laws, and Presidential Documents, which provide rulemaking authority for this CFR Part.

This list is taken from the Parallel Table of Authorities and Rules provided by GPO [Government Printing Office].

It is not guaranteed to be accurate or up-to-date, though we do refresh the database weekly. More limitations on accuracy are described at the GPO site.


United States Code
U.S. Code: Title 30 - MINERAL LANDS AND MINING
U.S. Code: Title 33 - NAVIGATION AND NAVIGABLE WATERS

§ 901 - Short title

§ 902 - Definitions

§ 903 - Coverage

§ 904 - Liability for compensation

§ 905 - Exclusiveness of liability

§ 906 - Compensation

§ 907 - Medical services and supplies

§ 908 - Compensation for disability

§ 909 - Compensation for death

§ 910 - Determination of pay

§ 911 - Guardian for minor or incompetent

§ 912 - Notice of injury or death

§ 913 - Filing of claims

§ 914 - Payment of compensation

§ 915 - Invalid agreements

§ 916 - Assignment and exemption from claims of creditors

§ 917 - Lien against compensation

§ 918 - Collection of defaulted payments; special fund

§ 919 - Procedure in respect of claims

§ 920 - Presumptions

§ 921 - Review of compensation orders

§ 921a - Appearance of attorneys for Secretary, deputy commissioner, or Board

§ 922 - Modification of awards

§ 923 - Procedure before deputy commissioner or Board

§ 924 - Witnesses

§ 925 - Witness fees

§ 926 - Costs in proceedings brought without reasonable grounds

§ 927 - Powers of deputy commissioners or Board

§ 928 - Fees for services

§ 929 - Record of injury or death

§ 930 - Reports to Secretary

§ 931 - Penalty for misrepresentation

§ 932 - Security for compensation

§ 933 - Compensation for injuries where third persons are liable

§ 934 - Compensation notice

§ 935 - Substitution of carrier for employer

§ 936 - Insurance policies

§ 937 - Certificate of compliance with chapter

§ 938 - Penalties

§ 939 - Administration by Secretary

§ 940 - Deputy commissioners

§ 941 - Safety rules and regulations

§ 942 - Annual report

§ 943 - Repealed.

§ 944 - Special fund

§ 945 to 947 - Repealed.

§ 948 - Laws inapplicable

§ 948a - Discrimination against employees who bring proceedings; penalties; deposit of payments in special fund; civil actions; entitlement...employer for penalties and payments; insurance policy exemption from liability

§ 949 - Effect of unconstitutionality

§ 950 - Separability

U.S. Code: Title 42 - THE PUBLIC HEALTH AND WELFARE
Presidential Documents

Reorganization ... 1950 Plan No. 6

Title 20 published on 2012-04-01

The following are ALL rules, proposed rules, and notices (chronologically) published in the Federal Register relating to 20 CFR 718 after this date.

  • 2014-04-17; vol. 79 # 74 - Thursday, April 17, 2014
    1. 79 FR 21606 - Black Lung Benefits Act: Standards for Chest Radiographs
      GPO FDSys XML | Text
      DEPARTMENT OF LABOR, Office of Workers' Compensation Programs
      Final rule.
      This rule is effective May 19, 2014. The incorporation by reference of certain publications listed in the rule is approved by the Director of the Federal Register as of May 19, 2014.
      20 CFR Parts 718 and 725