Code of Federal Regulations (Last Updated: November 8, 2024) |
Title 20 - Employees' Benefits |
Chapter VI - Office of Workers' Compensation Programs, Department of Labor |
SubChapter B - Federal Coal Mine Health and Safety Act of 1969, as Amended |
Part 727 - REVIEW OF PENDING AND DENIED CLAIMS UNDER THE BLACK LUNG BENEFITS REFORM ACT OF 1977 |
Subpart C - Criteria for Determining Eligibility for Benefits |
§ 727.203 - Interim presumption.
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(a)
Establishing interim presumption. A miner who engaged in coal mine employment for at least 10 years will be presumed to be totally disabled due to pneumoconiosis, or to have been totally disabled due to pneumoconiosis at the time of death, or death will be presumed to be due to pneumoconiosis, arising out of that employment, if one of the following medical requirements is met:(1) A chest roentgenogram (X-ray), biopsy, or autopsy establishes the existence of pneumoconiosis (see § 410.428 of this title);
(2) Ventilatory studies establish the presence of a chronic respiratory or pulmonary disease (which meets the requirements for duration in § 410.412(a)(2) of this title) as demonstrated by values which are equal to or less than the values specified in the following table:
Equal to or less than— FEV 1 MVV 67″ or less 2.3 92 68″ 2.4 96 69″ 2.4 96 70″ 2.5 100 71″ 2.6 104 72″ 2.6 104 73″ or more 2.7 108 (3) Blood gas studies which demonstrate the presence of an impairment in the transfer of oxygen from the lung alveoli to the blood as indicated by values which are equal to or less than the values specified in the following table:
Arterial pO 2 Arterial pCO 2 equal to or less than (mm. Hg.) 30 or below 70. 31 69. 32 68. 33 67. 34 66. 35 65. 36 64. 37 63. 38 62. 39 61. 40-45 60. Above 45 Any value. (4) Other medical evidence, including the documented opinion of a physician exercising reasoned medical judgment, establishes the presence of a totally disabling respiratory or pulmonary impairment;
(5) In the case of a deceased miner where no medical evidence is available, the affidavit of the survivor of such miner or other persons with knowledge
of the miner's physical condition, demonstrates the presence of a totally disabling respiratory or pulmonary impairment. (b)
Rebuttal of interim presumption. In adjudicating a claim under this subpart, all relevant medical evidence shall be considered. The presumption in paragraph (a) of this section shall be rebutted if:(1) The evidence establishes that the individual is, in fact, doing his usual coal mine work or comparable and gainful work (see § 410.412(a)(1) of this title); or
(2) In light of all relevant evidence it is established that the individual is able to do his usual coal mine work or comparable and gainful work (see § 410.412(a)(1) of this title); or
(3) The evidence establishes that the total disability or death of the miner did not arise in whole or in part out of coal mine employment; or
(4) The evidence establishes that the miner does not, or did not, have pneumoconiosis.
(c)
Applicability of part 718. Except as is otherwise provided in this section, the provisions of part 718 of this subchapter as amended from time to time, shall also be applicable to the adjudication of claims under this section.(d)
Failure of miner to qualify under the presumption in paragraph (a) of this section. Where eligibility is not established under this section, such eligibility may be established under part 718 of this subchapter as amended from time to time.