An individual's ventilatory ability may be compromised by many diseases other than coal workers' pneumoconiosis. Emphysema commonly affects this ability; neurological, muscular, infectious, or degenerative disease may do so also. From a medical standpoint, it is impossible in most situations to determine what portion of an individual's reduced ventilatory capacity is due to coal workers' pneumoconiosis and what portion is due to one or more other diseases he has. Nevertheless, to assure fullest equity to claimants under these circumstances, favorable disability determinations have been made where a claimant has a serious breathing impairment and has pneumoconiosis. However, some miners have emphysema or chronic bronchitis, and may be severely disabled as a result, but do not have pneumoconiosis. Under the law, claims from such miners must be denied. Claimants frequently find it difficult to understand the basis for the distinction between these allowed and denied claims, particularly if the miner denied because he does not have pneumoconiosis is severely disabled and worked long years in underground coal mine employment. Some misunderstanding among applicants also results from the fact that it is possible for a miner to have "complicated" pneumoconiosis and therefore meet the statutory presumption of disability, even though he does not have a severe breathing impairment. Death due to pneumoconiosis Widows' claims under the Act presented two special kinds of problems. First, obtaining evidence of the presence of pneumoconiosis in claims where the miner may have died many years in the past and second, the requirement for establishing a causal relationship between the disease and death, unless the miner was entitled to benefits under the Act or had the "complicated" stage of the disease. The first problem was reduced substantially by the statutory provision that if the miner was employed for 10 years or more in underground coal mines and died of a "respirable disease" there is a rebuttable presumption that his death was due to pneumoconiosis. The regulations define "respirable disease" as a chronic lung disease (with certain exceptions), thus permitting the approval of claims where the miner may have had pneumoconiosis, but it was not diagnosed as such. With respect to the second problem, the Social Security Administration has interpreted the requirement that death must have been "due" to the disease to mean that the disease was a significant contributory factor in causing death. Death is usually not due directly to coal workers' pneumoconiosis, but the disease may be a contributory factor. However, when multiple disease processes are present and death occurs, it is frequently not medically possible to distinguish which disease actually "caused" death or how much each contributed. Unless death is due to trauma or clearly results from an acute disease process, the Social Security Administration has ordinarily held that pneumoconiosis or "respirable disease," (under the conditions enumerated in Section 411 (c) (2) of the Act) if present, was a significant contributory factor in causing death. With the application of these liberal rules, claims which have been denied consist largely of those in which either (1) there is no evidence that the miner had chronic lung disease, or (2) the miner died as the result of trauma or clearly from an acute disease unrelated to pneu moconiosis and there is no evidence that he had the "complicated" stage of the disease. The Social Security Administration is making every effort to assist widows in locating any evidence of probative value to support their claims. However, in the absence of any evidence that the miner died of chronic lung disease, or where there is clearly compelling evidence to the contrary, there is no basis under the law for finding that death was due to pneumoconiosis. Public understanding of black lung benefit program As with the regular social security program, it has been the policy of the Social Security Administration to take positive steps to assure that members of the potentially affected public have knowledge of their rights under the black lung benefits provisions and understand the requirements for entitlement. The volume of applications received attests to the extent to which the public has been made aware of the potential benefits under the law. However, efforts to communicate effectively the requirements of the law have been less successful. In some areas, there has been a high degree of misunderstanding of the intent and requirements of the law and regulations among the coal mining population. Some of the reasons for this have been discussed in previous sections of this Chapter. However, even beyond this, and despite sustained efforts by the Social Security Administration and others to clarify the qualifying provisions, many claimants continue to have the strong view that the program is designed to provide supplementary benefits to underground coal miners solely on the basis of long-term mine work or, if simple pneumoconiosis is present, irrespective of the requirement of total disability due to the disease. CHAPTER X-CONCLUSION While very substantial progress has been made in implementing this new and important benefit program, and pending workloads now approximate normal levels, it is recognized that a great deal of effort still lies ahead. From the standpoint of overall claims processing, every effort will continue to be made to give applicants their final decisions and the benefits to which they are entitled as promptly as possible, while maintaining the standard of service that is basic to all social security claims operations-namely, to provide every assistance possible to applicants in establishing their rights to benefits under the law and to give full and fair consideration to each claim. From a broader program perspective, it is apparent that more needs to be known about pneumoconiosis itself as a disease entity-its cause, techniques for diagnosis, its disabling effects, and how to measure them, and its relationship to other diseases of the lung-so that evaluation policies can be refined to advance the objectives of the program. Toward this end, the Administration is closely analyzing its case experience and will continue to seek out new medical knowledge and professional advice and guidance. It is working closely with the Public Health Service to contribute to the planning and conduct of medical research and studies to be carried out under Title V of the Act under the leadership of the Public Health Service. The Administration will be alert to opportunities for applying to the fullest extent possible the added knowledge gained from such studies to improving the administration of the benefit program. Experience gained in administering the black lung benefits program will also be closely watched as it points up a need for possible improvement and refinement in select areas of program operations, as well as for any recommendations for program modifications, to assure full attainment of the objectives of the law. In conclusion, it is fitting to acknowledge that the Social Security Administration has been assisted in implementing the black lung benefit program by members of Congress, the Public Health Service, the Department of Labor, the Department of Interior and other components of the Federal Government, State workmen's compensation and occupational disease agencies, the United Mine Workers of America and other representatives of miner and widow claimants, the United Mine Workers of America Welfare and Retirement Fund, the Social Security Administration Medical Advisory Committee, representatives of the coal mine industry, a wide range of professional and technical specialists in the field, and many others. Such liaison and consultation will continue to be utilized in assuring equitable and effective administration of the program. |