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in this regard, as well as to provide initial instructions and direction to personnel involved in handling black lung claims.

At the same time, action was begun to develop the many other administrative, policy and procedural mechanisms necessary for program administration, including the development of internal Social Security Administration claims processing, payment certification and benefit maintenance systems and procedures.

Development of medical evidence

The Administration was limited at the start in what could be done in the way of processing claims to final decisions until a number of basic legal and policy issues were resolved. However, the time during which this was being accomplished was used to good advantage to move forward with a number of case processing activities. An intensive effort was launched to gather available evidence pertinent to these claims. Because most of the claimants for black lung benefits had previously filed claims for social security benefits, a good deal of evidence was available in social security retirement, disability and survivor records. In addition, arrangements were made to tap other valuable sources of evidence, including workmen's compensation claims files and United Mine Workers of America and United Mine Workers of America Welfare and Retirement Fund records.

The inclusion in the Act of widows' benefits requiring the development of evidence with respect to cause of death, with large numbers of claims in which death occurred many years ago, compounded the problem of securing medical evidence. However, thousands of death certificates were secured directly from State vital statistics departments at program expense, resulting in a more orderly and expeditious process with applicants spared much effort and inconvenience.

As a result of these activities, in a large number of allowed claims it was not necessary to go back to the applicant at all for any additional information or evidence after he had filed his claim.

Where payments of fees was involved in obtaining existing evidence, procedures were established for reimbursing the applicant. In some cases, payments were made on his behalf directly to the source. By April 30, 1971, reimbursement totalling almost $200,000 had been made under these procedures, in line with the statutory provision for reimbursement to the applicant of reasonable medical expenses incurred in establishing his claim.

In spite of these efforts to secure all available evidence from existing sources of record, it was clear from the outset that tens of thousands of claims would require current medical examinations and procedures for proper documentation and evaluation. As provided in the law, the Administration enlisted the aid of the State agencies with which it has agreements in the administration of the social security disability insurance program. This action required negotiation of modifications to the present Federal-State agreements under which the State agencies agreed to secure necessary medical examinations, at program expense, for black lung applicants.

Where the evidence obtained from existing sources was insufficient for a proper claims decision, arrangements were made through the State agencies to have claimants examined by qualified physicians and medical facilities as close to the claimant's residence as possible. With

the concentration of so large a volume of claims in areas with very limited medical resources for this purpose, it was necessary to take extraordinary steps to enlarge the available facilities. The State agencies engaged the services of many additional specialists already heavily occupied with the examination and treatment of their regular patients, and in some cases made special arrangements for medical examination units with appropriate equipment and qualified professional and technical staff to be moved between selected locations throughout the States so as to facilitate the examination of large numbers of applicants with a minimum of travel and inconvenience on their part. These and other activities throughout the total operation were carried out wherever feasible on weekends and evenings, in addition to normal working hours, in order to provide the fullest possible capacity for meeting the huge initial workload demands with reasonable promptness.

By the end of April 1971, over 180,000 medical examinations of appplicants (primarily X-rays and pulmonary function tests) had been arranged by State agencies in carrying out this important function of the operation. (Table 1.) Payments totaling over $3 million were made from program funds for these examinations.

CHAPTER III-BASIC ELIGIBILITY REQUIREMENTS-ISSUANCE OF REGULATIONS

The law (Section 411(a) and (b) of Part B of Title IV) directed the Secretary to promulgate the regulations concerning standards for determining total disability and death due to pneumoconiosis and publish them in the Federal Register by the end of the third month following the month of enactment. These regulations were published in the Federal Register on April 7, 1970 (see Appendix A).

Because of the statutory time constraints, these regulations, which cover general definitions and standards for determining total disability and death due to pneumoconiosis, were effective immediately upon publication. However, they were developed in connection with many interested public and private organizations and individuals, including the Public Health Service, the Department of Labor, the United Mine Workers of America, the Social Security Administration Medical Advisory Committee and others. In addition, when the regulations were published, the public was invited to submit data, views, and arguments pertaining to the published regulations for the purpose of suggesting amendments, revisions or modifications. Comments were received and carefully considered, but no changes were determined to be appropriate or necessary.

The regulations were established with full consideration of the remedial nature of the legislation, the expressed intent of Congress in enacting it, and the direction given by the President when he signed the bill.

The requirements reflected in these regulations are summarized in the discussions which follow.

Standards for determining total disability due to pneumoconiosis

The Act prescribes that the term "total disability" shall have the meaning given it by regulations of the Secretary of Health, Education, and Welfare, but such regulations shall not provide more restrictive criteria than those applicable under the Social Security Act (with respect to the disability insurance benefits program). There is clearly expressed Congressional intent that, initially, the criteria should be those now applied under the Social Security Act. Also, the President, in signing the Act into law, directed such application.

Accordingly, in addition to incorporating the specific presumptions provided by law, the regulations reflect adaptation of the basic evaluation principles and criteria followed under the social security disability insurance benefits program to the extent that they are applicable to cases in which pneumoconiosis is the disabling impairment.

It should be noted, however, that there are differences in the concepts underlying these coal workers' pneumoconiosis benefits and those provided under the social security disability insurance program. Social security disability insurance benefits are payable to insured workers

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who are disabled within the meaning of the law, regardless of the nature of the medically determinable impairment or disease that causes the disability, and regardless of whether there was a causal connection with employment. All impairments are covered. On the other hand, under the Federal Coal Mine Health and Safety Act, benefits may be paid to an applicant only if he is totally disabled due to pneumoconiosis and if his pneumoconiosis arose out of underground coal mine employment. These two requirements disability that must be due to the specific disease, pneumoconiosis, and the requirement of "causal” connection with underground coal mine employment-are quite different from anything in the social security disability insurance benefits

program.

Fortunately, the problem of establishing "causality" is facilitated by the provision in the law which permits a rebuttable presumption that pneumoconiosis was due to employment in the mine when the miner was employed for 10 or more years in an underground coal mine. However, the problem of causal connection remains if the applicant is disabled by pneumoconiosis and was not employed in an underground coal mine for at least 10 years. In this event, the evidence must show affirmatively that the disease was due to emploment in an underground coal mine.

The regulations reflect a broad interpretation that employment in an underground coal mine includes not only work performed under the surface in extracting the coal, but also work above the surface at the mine preparing the coal so extracted. (20 CFR 410.110 (j))

With respect to the requirement that the miner be totally disabled due to pneumoconiosis, it was necessary to establish diagnostic criteria for determining the presence of the disease, criteria for measuring its severity in terms of its effect on an applicant's ability to work, and criteria establishing the level of severity that would be considered totally disabling within the meaning of the law.

Under published regulations (20 CFR 410.402 (a)) a miner is found to be totally disabled if he meets a presumptive test described in the law (X-ray or pathological findings show that he has what is commonly referred to as "complicated" pneumoconiosis).

Alternatively, he can be found to be totally disabled if he meets certain medical criteria showing severe breathing impairment due to pneumoconiosis or has another serious condition resulting from pneumoconiosis, e.g., cor pulmonale (20 CFR 410.403 (a)). If he is not disabled by any of these prescribed medical criteria, he may nevertheless be found to be totally disabled if he has pneumoconiosis and such functional breathing limitation as to prevent him from doing coal mining work and from engaging in any other type of substantial gainful activity consistent with his vocational competence (20 CFR 410.403(b)). (Under this evaluation guide the older, long-term miner with minimal education and skills, who is shown to be unable to do heavy work because of pneumoconiosis, will ordinarily be found to be totally disabled.)

The criteria described in the foregoing paragraph follow closely the evaluation guides under the social security disability insurance benefits program.

Standards for determining death due to pneumoconiosis

For a widow to qualify for benefits under the program, her husband must have been entitled to benefits under Part B of the Act or it must be established that his death was due to pneumoconiosis arising out of his underground coal mine employment.

The law provides an irrebuttable presumption that death was due to pneumoconiosis if the miner had "complicated" pneumoconiosis. It provides a rebuttable presumption that a miner's death was due to pneumoconiosis if he had at least 10 years of employment in an underground coal mine and died of a "respirable disease". These provisions are covered in the regulations in 20 CFR 410.415.

In line with statutory intent, the regulations provide that death will be found due to pneumoconiosis, in the absence of evidence to the contrary, when death is ascribed to chronic dust disease or other chronic disease of the lung (with certain exceptions) and the miner was employed for 10 years or more in the Nation's underground coal mines. (20 CFR 410.415 (b))

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