Yogi Mining Company v. Fife , 159 F. App'x 441 ( 2005 )


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  •                                UNPUBLISHED
    UNITED STATES COURT OF APPEALS
    FOR THE FOURTH CIRCUIT
    No. 04-2140
    YOGI MINING COMPANY,
    Petitioner,
    versus
    TERRY M. FIFE; DIRECTOR, OFFICE OF WORKERS’
    COMPENSATION    PROGRAMS,   UNITED   STATES
    DEPARTMENT OF LABOR,
    Respondents.
    On Petition for Review of an Order of the Benefits Review Board.
    (02-520-BLA)
    Argued:   September 19, 2005                 Decided:   December 7, 2005
    Before TRAXLER, KING, and GREGORY, Circuit Judges.
    Affirmed by unpublished per curiam opinion.
    ARGUED: Ronald Eugene Gilbertson, BELL, BOYD & LLOYD, Washington,
    D.C., for Petitioner.     Terry Gene Kilgore, WOLFE, WILLIAMS &
    RUTHERFORD, Norton, Virginia, for Respondents. ON BRIEF: Joseph E.
    Wolfe, W. Andrew Delph, Jr., WOLFE, WILLIAMS & RUTHERFORD, Norton,
    Virginia, for Respondents.
    Unpublished opinions are not binding precedent in this circuit.
    See Local Rule 36(c).
    PER CURIAM:
    This    appeal       arises   from    a   claim   for   benefits   made   by
    respondent Terry M. Fife in 1998 under the Black Lung Benefits Act
    (the “Act”).        See 
    30 U.S.C. §§ 901-945
    .            By this proceeding,
    petitioner Yogi Mining Company, Inc., challenges the April 2003
    decision of the Benefits Review Board (the “Board”), which affirmed
    an award of black lung benefits made to Fife by an administrative
    law judge (the “ALJ”).         Yogi Mining maintains on appeal that the
    evidence was insufficient to support the ALJ’s finding that Fife
    was totally disabled due to pneumoconiosis, commonly known as black
    lung disease.      As explained below, we affirm the Board.
    I.
    A.
    Terry Fife worked underground in the coal mines of southwest
    Virginia for seventeen years, most recently as a roof-bolter for
    Yogi Mining.       When he was laid off by Yogi Mining in 1993, Fife’s
    breathing problems were so severe that he was never able to return
    to work.      At the time, Fife lived with his wife and disabled
    dependent child in Buchanan County, Virginia.
    On December 17, 1998, Fife filed a claim for black lung
    benefits    with    the    Department     of   Labor’s   Office   of    Workers’
    2
    Compensation Programs (the “OWCP”).1           By his claim, Fife asserted
    that he was due benefits under the Act because he was totally
    disabled due to pneumoconiosis.         Pneumoconiosis is a chronic dust
    disease of the lungs that arises out of work in the coal mines.
    Under the regulations implementing the Act, pneumoconiosis may be
    diagnosed by X-ray, biopsy, or other medical evidence.                 See 
    20 C.F.R. § 718.202
    . Complicated pneumoconiosis, the more severe form
    of black lung disease, is characterized by large opacities, or
    spots,     on   the   lungs,   and   carries   with   it    the   irrebuttable
    presumption of total respiratory disability.               See 
    id.
     § 718.304.
    Simple pneumoconiosis, a less severe form of the disease presenting
    smaller spots on the lungs, carries no presumption of disability,
    and it requires a miner seeking black lung benefits to make an
    additional showing to establish total respiratory disability and
    receive benefits.       See id. § 718.204.
    In his claim for benefits, Fife explained that he was “unable
    to breathe freely at any time” and asserted that a shortness of
    breath rendered him “unable to perform short or long term tasks.”
    Fife also maintained that “dust in the mines and in and around
    other jobs” made it hard for him to breathe.          In response to Fife’s
    application, the OWCP required Fife to be evaluated by two doctors,
    1
    The OWCP, a party in the proceedings before the ALJ and the
    Board, has not participated in this appeal.
    3
    who were asked to determine whether his claim for black lung
    benefits was substantiated by the medical evidence.
    Fife was first examined for the OWCP on February 12, 1999 by
    Dr. J. Randolph Forehand.            Forehand was a certified “B reader” of
    X-ray       evidence,   that   is,    he   had   passed   a   specially-designed
    proficiency test administered by the Department of Health and Human
    Services for evaluating X-rays for the presence of pneumoconiosis
    and other lung diseases.             See 
    20 C.F.R. § 718.202
    (a)(1)(ii)(E).
    After conducting a chest X-ray, a pulmonary function study, an
    electrocardiogram, and a physical examination of Fife, Forehand
    concluded that “complicated pneumoconiosis is the sole factor
    contributing to [Fife’s] total pulmonary disability.”                    In his
    report to the OWCP, completed on February 12, 1999, Forehand
    observed that Fife complained of shortness of breath, cough, chest
    pain, and orthopnea (the inability to breathe unless sitting or
    standing straight). Forehand also noted that Fife had been smoking
    a pack of cigarettes per day since the 1970s.                  Forehand did not
    test Fife for tuberculosis, but recommended that such a test be
    conducted in order to exclude tuberculosis as an “additional
    diagnosis.”2
    2
    A diagnosis of tuberculosis does not necessarily exclude the
    possibility that a miner also suffers from pneumoconiosis. A miner
    may be diagnosed with both black lung disease and tuberculosis, or
    tuberculosis may be an alternative explanation for lesions on a
    miner’s lungs. See Wolf Creek Collieries v. Robinson, 
    872 F.2d 1264
    , 1270 (6th Cir. 1989). Here, Dr. Forehand diagnosed Fife as
    suffering from complicated pneumoconiosis (carrying an irrebuttable
    4
    The February 12, 1999 X-ray taken by Dr. Forehand was then
    reviewed by Dr. Nicholas Sargent, who submitted his report dated
    March 1, 1999 to the OWCP.               Sargent was dually qualified — that
    is, he was a B-reader as well as a board-certified radiologist (a
    “B/BCR”).      See 
    20 C.F.R. § 718.202
    (a)(1)(ii)(C).              In his report to
    the OWCP, Sargent opined that the Forehand X-ray showed large
    opacities on Fife’s lungs indicative of simple pneumoconiosis.
    Sargent was unable to conclusively determine, however, whether the
    X-ray showed complicated pneumoconiosis, tuberculosis, or some
    other type of infectious disease.
    On the basis of these two expert opinions, the OWCP, on May
    10,    1999,    made      an   Initial   Finding   of     Entitlement    (the    “OWCP
    Finding”),      granting       Fife’s    claim   and    concluding      that   he    was
    entitled       to    an    award   of    total   disability      benefits      due   to
    complicated         pneumoconiosis.        On    August    5,   1999,   Yogi    Mining
    requested a formal hearing to challenge the OWCP Finding, pursuant
    to 
    20 C.F.R. § 725.421
    (a).3              The matter was then referred to the
    ALJ.
    presumption of total respiratory disability), independent of any
    tuberculosis evaluation.    Forehand explicitly indicated that a
    diagnosis of tuberculosis would only be in addition to his primary
    diagnosis of complicated pneumoconiosis.
    3
    The pertinent regulation provides that “[i]n any claim for
    which a formal hearing is requested or ordered . . . the district
    director [of OWCP] shall refer the claim to the Office of
    Administrative Law Judges for a hearing.” 
    20 C.F.R. § 725.421
    (a).
    5
    B.
    The hearing requested by Yogi Mining was conducted before the
    ALJ on April 12, 2000, in Abingdon, Virginia, where testimony was
    presented by Fife and the written medical opinions of eight doctors
    were received into the record.           These opinions included those of
    Drs. Forehand and Sargent for the OWCP, two doctors’ reports
    submitted by Fife (Drs. Michael S. Alexander and J.P. Sutherland),
    and four doctors’ reports submitted by Yogi Mining (Drs. Abdul
    Dahhan, William W. Scott, Jr., Peter G. Tuteur, and Paul S.
    Wheeler).    The ALJ also received into evidence the depositions of
    two of Yogi Mining’s doctors, Wheeler and Dahhan.                  At the ALJ
    hearing, Yogi Mining was represented by counsel, while Fife was
    assisted by a benefits counselor serving as a lay representative.
    The    issue   before   the   ALJ    was   whether    the   evidence   was
    sufficient to establish that Fife was totally disabled due to
    complicated pneumoconiosis, as had been determined in May 1999 by
    the OWCP Finding.     As a general proposition, the medical evidence
    presented to the ALJ established that there were significant
    abnormalities in Fife’s lungs, but the experts disagreed on whether
    those abnormalities were caused by pneumoconiosis or some other
    disease, such as tuberculosis or emphysema.               The evidence before
    the ALJ is further summarized below.
    6
    1.
    First, Fife testified that his coal mine employment had been
    exclusively underground and involved very dusty conditions.                He
    explained to the ALJ that he could not return to work in the mines
    even if a job became available because “he could not breathe enough
    to keep up” and he “could not handle the dust.”                    Fife also
    acknowledged that he had smoked a pack of cigarettes per day since
    the 1970s.
    In addition to the OWCP Finding of complicated pneumoconiosis,
    Fife presented the ALJ with the opinions of Dr. Alexander (B/BCR),
    who had evaluated Fife’s records for the ALJ proceeding, and Dr.
    Sutherland, Fife’s treating physician.             Alexander evaluated an
    X-ray of Fife’s chest taken on December 21, 1999, the most current
    X-ray considered at the hearing.            In his March 4, 2000 report,
    submitted to the ALJ, Alexander observed that the X-ray indicated
    the   presence   of   large    opacities,   and   he   concluded   that   Fife
    suffered from “complicated coal worker’s pneumoconiosis” as a
    result.
    Fife also submitted to the ALJ the March 9, 2000 report of Dr.
    Sutherland, who had been Fife’s treating physician since 1992.
    Sutherland affirmed that Fife was “permanently and totally disabled
    as a result of obstructive and restrictive lung disease associated
    with pneumoconiosis.”         Importantly, Sutherland explained that he
    had evaluated Fife for tuberculosis but had found no sign of the
    7
    disease.   He further observed that he found “no evidence of any
    type of [Ghon] lesions with granulomatous disease except for
    interstitial    changes   which        would   be   consistent         with
    pneumoconiosis.”4   Finally,   Sutherland      related   that   Fife    had
    recurrent shortness of breath and severe wheezing, and that his
    X-rays showed “interstitial scar tissue in all 5 lung fields,”
    indicating “obstructive and restrictive lung disease.”
    2.
    In challenging the OWCP Finding that Fife suffered from
    complicated pneumoconiosis, Yogi Mining presented the ALJ with the
    opinions of its four doctors (Drs. Dahhan, Scott, Tuteur, and
    Wheeler), each of whom ultimately opined that Fife probably did not
    suffer from complicated pneumoconiosis.        They presented no clear
    consensus, however, on how to explain the abnormalities present in
    Fife’s lungs.
    On July 28, 1999, Dr. Dahhan examined Fife for Yogi Mining,
    taking an X-ray and a computer tomography (“CT”) scan of Fife’s
    chest, as well as performing other pulmonary tests.        Dahhan, a B-
    reader, initially found evidence of “large opacities” on Fife’s X-
    ray and concluded that simple pneumoconiosis was indicated.            This
    X-ray of Fife’s chest was later read by both Dr. Wheeler (B/BCR)
    4
    “Ghon lesions” are pulmonary abnormalities indicative of
    tuberculosis. See Dorland’s Illustrated Medical Dictionary, 716,
    766 (30th ed. 2003). “Granulomatous disease” is a type of disease
    characterized by lesions that may be caused by an infection, such
    as tuberculosis. 
    Id. at 795-797, 1962
    .
    8
    and Dr. Scott (B/BCR), who disagreed with Dahhan’s conclusion.        In
    Wheeler’s opinion, the abnormalities shown on the Dahhan X-ray
    “could” be evidence of pneumoconiosis, but it more likely revealed
    tuberculosis or emphysema.    In Scott’s opinion, Dahhan’s X-ray of
    Fife’s chest was “compatible” with tuberculosis. In their reports,
    as filed with the ALJ, Scott and Wheeler opined that they did not
    find conclusive evidence of pneumoconiosis on the CT scan Dahhan
    had taken on July 28, 1999, nor on the X-rays of Fife’s chest taken
    on August 27, 1998, and February 12, 1999.       Both Scott and Wheeler
    acknowledged, however, that pneumoconiosis could account for the
    abnormalities on Fife’s lungs.     Wheeler’s deposition, conducted ex
    parte by Yogi Mining on April 4, 2000, was also submitted by Yogi
    Mining to the ALJ.     In his deposition, Wheeler testified that the
    lung   abnormalities   reflected   on   Fife’s   X-rays   appeared   more
    “compatible” with tuberculosis, although he was “not absolutely
    certain it’s tuberculosis.”
    Upon consideration of the views of Drs. Scott and Wheeler, Dr.
    Dahhan changed his diagnosis of Fife and provided Yogi Mining with
    a new opinion, dated March 27, 2000, concluding that Fife did not
    suffer from pneumoconiosis at all.        Yogi Mining also submitted
    Dahhan’s ex parte deposition, taken on April 6, 2000.            Dahhan
    testified that he changed his diagnosis of Fife’s condition after
    considering the reports of Scott and Wheeler, and Dahhan asserted
    that his final opinion was that Fife did not have pneumoconiosis.
    9
    In Dahhan’s revised assessment, the abnormalities that appeared on
    Fife’s X-rays were likely due to some previous infection, such as
    tuberculosis.
    In addition to these three doctors, Yogi Mining submitted to
    the ALJ the report of Dr. Tuteur, a pulmonary specialist, dated
    October 5, 1999.   Tuteur had considered the pulmonary function
    tests performed on Fife by Forehand and Dahhan, as well as the
    reports of Drs. Dahhan, Forehand, Sargent, Scott and Wheeler.
    Tuteur opined that Fife did not suffer from any reduced lung
    capacity, nor from any abnormal blood gas exchange typical of
    pneumoconiosis.    He   also   noted   that   Fife   had   no    history   of
    tuberculosis, and he attributed Fife’s lung abnormalities to a
    “cigarette-smoke induced condition.”
    C.
    On August 30, 2000, after considering the evidence presented
    to him, the ALJ concluded that the X-ray readings and medical
    opinions established by a preponderance of the evidence that Fife
    suffered from complicated pneumoconiosis, and that he was entitled
    to the presumption of total disability, pursuant to 
    20 C.F.R. § 718.304
    .   Fife v. Yogi Mining Co., No. 99-1207, slip op. at 24
    (Aug. 30, 2000) (“ALJ Decision I”).           In ruling that Fife was
    entitled to black lung benefits, the ALJ found that:            (1) Fife had
    been employed for seventeen years in the coal mines; (2) his claim
    10
    for benefits had been timely filed; (3) Yogi Mining was the
    responsible operator; (4) Fife had two dependents for the purposes
    of   augmented          benefits;      and          (5)    Fife’s    benefits         should    have
    commenced as of February 1999, when he was first diagnosed with
    complicated pneumoconiosis by Dr. Forehand.                            
    Id. at 3-6
    .
    Yogi      Mining    then     appealed              ALJ   Decision   I     to    the   Board,
    contending that it was not supported by substantial evidence. More
    specifically, Yogi Mining maintained that the ALJ had improperly
    relied      on    the    opinion       of       Dr.       Sutherland,      had    impermissibly
    discredited the views of the Yogi Mining doctors, and had failed to
    properly weigh the CT scan evidence.                                Fife, who was without
    counsel, did not respond to Yogi Mining’s appeal.
    On October 17, 2001, the Board ruled on Yogi Mining’s appeal,
    affirming        ALJ    Decision       I       in    part,      vacating   it    in     part,    and
    remanding Fife’s claim to the ALJ to: (1) determine whether Dr.
    Sutherland’s opinion was sufficiently reasoned and documented; (2)
    explain more comprehensively his reasons for discounting the views
    of   Yogi     Mining’s      doctors;            and       (3)   reweigh    all    the    relevant
    evidence, including the CT scan evidence, and determine whether
    Fife   had       established      by       a    preponderance         of   the    evidence       the
    existence of complicated pneumoconiosis.                            Fife v. Yogi Mining Co.,
    11
    No. 00-1197, slip op. at 4-6 (B.R.B. Oct. 17, 2001) (“Board
    Decision I”).5
    In response to Board Decision I, the ALJ filed his second
    decision on March 26, 2002 (“ALJ Decision II”), incorporating ALJ
    Decision I by reference, and again awarding black lung benefits to
    Fife.       Fife v. Yogi Mining Co., No. 99-1207, slip op. at 4, 18
    (Mar.       26,   2002).    In    addressing     the   remand     issues,   the    ALJ
    explained that he had not relied on Dr. Sutherland to diagnose
    complicated pneumoconiosis.               
    Id. at 14
    .        Instead, the ALJ had
    relied       on   Sutherland’s     opinion      to   rule   out    a   diagnosis   of
    tuberculosis because his opinion was sufficiently well-reasoned and
    documented on that issue.           
    Id.
        The ALJ further explained that the
    opinions of the Yogi Mining doctors had been discounted because
    they were equivocal and failed to adequately explain contrary data.
    
    Id. at 14-18
    .        Finally, the ALJ again concluded that, on the basis
    of   the     evidence,     Fife   had   established     that      he   suffered   from
    complicated pneumoconiosis.               
    Id. at 18
    .    The ALJ’s earlier award
    of black lung benefits to Fife made in ALJ Decision I was thus
    sustained.        
    Id. at 19
    .
    Yogi Mining then appealed ALJ Decision II to the Board,
    contending that the ALJ had not complied with the remand made in
    Board Decision I. Specifically, Yogi Mining contended that the ALJ
    5
    Yogi Mining did not, in its appeal of ALJ Decision I, contest
    the ALJ’s other findings. See Board Decision I at 3.
    12
    had failed to reevaluate the evidence, had failed to adequately
    discuss the CT scan evidence, and had again rendered a decision not
    supported by the evidence.                  Fife, proceeding pro se, did not
    respond to Yogi Mining’s second appeal.
    On April 24, 2003, a panel majority of the Board affirmed ALJ
    Decision II, with one member dissenting.                  Fife v. Yogi Mining Co.,
    No. 02-0520, slip op. at 8-9 (B.R.B. Apr. 24, 2003) (“Board
    Decision II”).          Yogi Mining then moved for reconsideration by the
    Board       en    banc,    which    was   granted    on    July    14,    2004.      On
    reconsideration en banc, the Board reaffirmed the ALJ’s award of
    benefits to Fife by a 2-2 split vote.               Fife v. Yogi Mining Co., No.
    02-0520, slip op. at 4-5 (B.R.B. July 14, 2004).6                   On September 8,
    2004, Yogi Mining filed a timely petition for review by this Court,
    and we possess jurisdiction pursuant to 
    33 U.S.C. § 921
    (c).
    II.
    We review an ALJ decision affirmed by the Board to determine
    whether      it    is     in   accordance    with   the    law    and    supported   by
    substantial evidence.              Island Creek Coal Co. v. Compton, 
    211 F.3d 203
    , 207 (4th Cir. 2000); Piney Mountain Coal Co. v. Mays, 
    176 F.3d 6
    Under the relevant regulations, a decision by a Board panel
    is not disturbed by a grant of reconsideration en banc unless three
    permanent members vote to vacate or modify the original panel
    decision. 
    20 C.F.R. § 802.407
    (d). Here, two members having voted
    to affirm and two others having voted to vacate and remand, Board
    Decision II, rendered by the panel on April 24, 2003, was left
    undisturbed.
    13
    753, 756 (4th Cir. 1999).        Substantial evidence “consists of more
    than   a   mere   scintilla”    and   is    “such   relevant   evidence   as   a
    reasonable mind might accept as adequate to support a conclusion.”
    Island Creek Coal, 
    211 F.3d at 207-208
     (internal quotation marks
    omitted).     In conducting our review, we are not to “reweigh the
    evidence or substitute our views for those of the ALJ,” Lane v.
    Union Carbide Corp., 
    105 F.3d 166
    , 170 (4th Cir. 1997), but we must
    consider “whether all of the relevant evidence has been analyzed
    and whether the ALJ has sufficiently explained his rationale in
    crediting certain evidence,”          Milburn Colliery Co. v. Hicks, 
    138 F.3d 524
    , 528 (4th Cir. 1998).        In our review, we confine ourselves
    to the grounds upon which the Board based its decision.              See Grigg
    v. Dir., OWCP, 
    28 F.3d 416
    , 418 (4th Cir. 1994).                 As always, we
    review the Board’s conclusions of law de novo.             Milburn Colliery,
    
    138 F.3d at 528
    .
    III.
    In order to be entitled to black lung benefits, Fife was
    obliged to establish four elements: (1) he has pneumoconiosis; (2)
    his pneumoconiosis arose out of his coal mine employment; (3) he
    has a totally disabling respiratory or pulmonary condition; and (4)
    pneumoconiosis is a contributing cause to his total respiratory
    disability.       See   
    20 C.F.R. §§ 718.201-204
    ;   see   also   Milburn
    Colliery Co. v. Hicks, 
    138 F.3d 524
    , 529 (4th Cir. 1998).                 As we
    explained earlier, an irrebuttable presumption of total disability
    14
    arises from a diagnosis of complicated pneumoconiosis.                See 
    20 C.F.R. § 718.304
    .      Under the Act, a miner is deemed to suffer from
    complicated pneumoconiosis if he has satisfied one of the following
    criteria: (A) an x-ray of his lungs shows at least one opacity
    greater than one centimeter in diameter; (B) a biopsy reveals
    “massive lesions” in his lungs; or (C) a diagnosis by other means
    reveals a result equivalent to either (A) or (B).              See 
    30 U.S.C. § 921
    (c)(3); E. Assoc. Coal Corp. v. Dir., OWCP, 
    220 F.3d 250
    , 256
    (4th   Cir.   2000).     If   a   coal    miner    who   is   suffering   from
    pneumoconiosis was employed for ten years or more in the coal
    mines, there is a rebuttable presumption that his pneumoconiosis
    arose out of such employment.        See 
    20 C.F.R. § 718.203
    (b).          As we
    have repeatedly observed, it is within the ALJ’s discretion to
    determine whether a black lung claimant suffers from complicated
    pneumoconiosis, so long as his decision is rational and based on
    substantial evidence. See Underwood v. Elkay Mining, 
    105 F.3d 946
    ,
    949 (4th Cir. 1997); E. Assoc. Coal, 
    220 F.3d at 256
    .             Subject to
    the substantial evidence rule, it is the province of the ALJ to
    make credibility determinations and to resolve inconsistencies or
    conflicts in the evidence.        See Underwood, 
    105 F.3d at 949
    .
    In this appeal, Yogi Mining contends that ALJ Decisions I and
    II were erroneous for three reasons:              First, the ALJ improperly
    relied on the opinion of Dr. Sutherland, Fife’s treating physician;
    second, the ALJ failed to provide valid reasons for discrediting
    15
    the opinions of the Yogi Mining doctors; and, third, the ALJ failed
    to consider the relevant CT scan evidence.                    In response, Fife, now
    represented by counsel, maintains that the ALJ’s findings are
    supported by substantial evidence and that Board Decision II was
    correct in affirming the ALJ’s award of black lung benefits to
    Fife.   We assess Yogi Mining’s contentions in turn.
    A.
    By its first contention, Yogi Mining asserts that the ALJ
    should not have relied upon Dr. Sutherland’s opinion because it did
    not meet the requirement that it be “reasoned,” and it did not
    establish     the    existence     of     complicated          pneumoconiosis.          As
    explained     below,     however,       the       ALJ   did    not    rely    solely    on
    Sutherland’s report to establish complicated pneumoconiosis, and he
    sufficiently        articulated        his    reasons         for    concluding        that
    Sutherland’s opinion constituted a well-reasoned and documented
    opinion.
    First, contrary to Yogi Mining’s characterization, the ALJ did
    not rely exclusively on Dr. Sutherland’s opinion to establish
    complicated       pneumoconiosis.                 Indeed,      the    ALJ     explicitly
    acknowledged      that   Sutherland’s             opinion     was    “insufficient      to
    constitute    a     diagnosis     of    complicated           pneumoconiosis.”          ALJ
    Decision II at 14.        Rather, the ALJ explained that he relied on
    Sutherland’s        “statements        regarding        Mr.     Fife’s       tuberculosis
    16
    evaluation” to rule out tuberculosis as an explanation for the
    abnormalities on Fife’s lungs reflected in his chest X-rays.       Id.7
    Second, Yogi Mining contends that Sutherland’s opinion could
    not be relied upon because it was not sufficiently reasoned and
    documented.    In   fact,   however,   ALJ    Decision   II   carefully
    articulated that the ALJ viewed Sutherland’s medical judgments to
    be well-reasoned and documented because they “follow[ed] logically
    from his observations” and were amply supported by data adequate to
    support his conclusions.    ALJ Decision II at 14.   The ALJ observed
    that Sutherland’s opinion was based on (1) Fife’s medical history;
    (2) Fife’s occupational history; (3) Sutherland’s own readings of
    Fife’s X-rays, as well as the readings of those X-rays by Dr.
    Scott; and (4) Sutherland’s observations, made on the basis of his
    own testing and examination of Fife.    ALJ Decision II at 14.     The
    ALJ concluded that, because “Dr. Sutherland has been the claimant’s
    treating physician for approximately seven years, and because Dr.
    Sutherland is the only physician of record who has evaluated the
    claimant for tuberculosis, I accord great weight to [his] well
    documented and well reasoned opinion.”       
    Id.
    7
    Although not specifically mentioned by the ALJ, the
    administrative record contains Dr. Sutherland’s note indicating
    that, on April 5, 1999, he gave Fife a skin test, known as a
    “tine,” for tuberculosis.     Sutherland also indicated that a
    “negative” result on this test was received on April 8, 1999.
    Sutherland’s note was faxed to the ALJ on October 21, 1999.
    17
    In its review of ALJ Decision II, the Board concluded that the
    ALJ’s reliance on Dr. Sutherland’s observations over a seven-year
    period was rational and within his discretion.              Board Decision II
    at 6.    In these circumstances, we find no error in that conclusion.
    B.
    Yogi Mining next maintains that the ALJ failed to articulate
    sufficient reasons for discrediting the medical opinions of the
    Yogi Mining doctors.       The Board concluded, however, that the ALJ
    had provided valid, rational reasons for according less weight to
    the judgments offered by those doctors, and our review of the
    record reveals no error in that assessment.             See Board Decision II
    at 8.
    The ALJ, in ALJ Decision II, explained that he was according
    less weight to Drs. Scott and Wheeler because their opinions were
    equivocal on the abnormalities shown on Fife’s X-rays, in that they
    could    only   opine   that   such   spots     were    “compatible    with”    or
    “probably” tuberculosis.        ALJ Decision II at 14.        Moreover, Scott
    and Wheeler both acknowledged that Fife’s X-rays could indicate
    pneumoconiosis.     Id. at 15.      As the ALJ explained, “not only were
    the   physicians   unable      to   offer   a   clear    explanation   for     the
    abnormalities revealed by Mr. Fife’s chest x-rays, Drs. Wheeler and
    Scott also were unable to unequivocally conclude that Mr. Fife does
    not suffer from pneumoconiosis.”            Id. at 15.     Although Scott and
    18
    Wheeler were both dually qualified (B/BCR), the ALJ considered
    their opinions to be inconclusive, and he chose to rely instead on
    the unequivocal diagnoses of complicated pneumoconiosis by two
    other experts:         Dr. Alexander, who was also dually qualified
    (B/BCR), and Dr. Forehand, a B reader.              Id. at 15.8
    Next, the ALJ explained that he had discounted Dr. Dahhan’s
    opinion because it was not well-reasoned.                ALJ Decision II at 15-
    17.       Initially, Dahhan read Fife’s July 28, 1999 X-ray to be
    positive for pneumoconiosis, but he altered his view after being
    provided with the readings by Drs. Scott and Wheeler of Fife’s July
    28, 1999 CT scan.          Id. at 16.     In changing his opinion, however,
    Dahhan      failed    to    reconcile     his    view      on    the    absence   of
    pneumoconiosis       with    the   contrary     findings    of   Drs.    Alexander,
    Sargent,      and     Forehand,     who    had    each      found      evidence   of
    pneumoconiosis. Id. at 16-17. Dahhan also failed to reconcile his
    opinion that Fife “retained the respiratory capacity” to work with
    the contrary findings of Drs. Forehand and Sutherland, who opined
    that Fife’s extensive lung injury rendered him totally disabled.
    Id. at 16.9         Moreover, as the ALJ pointed out, although Dahhan
    8
    That the ALJ evenhandedly applied his analysis is further
    revealed by the fact that the ALJ discounted the opinion of Dr.
    Sargent — who examined Fife for the OWCP and found simple
    pneumoconiosis — because his diagnosis was deemed inconclusive.
    ALJ Decision II at 15.
    9
    The ALJ explained that he discounted Dahhan’s second opinion
    because it was a consultative opinion, which is supposed to be “a
    distillation of an array of medical evidence, some produced by the
    19
    opined that any abnormalities suffered by Fife were probably caused
    by tuberculosis, he apparently failed to properly consider that
    Fife’s    sole   evaluation   for   tuberculosis   —   performed   by   Dr.
    Sutherland — found no evidence of the disease.            Id. at 16-17.10
    The ALJ observed that Dahhan’s “failure to address the tension in
    his second opinion between the weight of the contrary evidence and
    his ultimate conclusion is so substantial that his opinion is not
    adequately reasoned.”     Id. at 16.      In these circumstances, the ALJ
    was entitled to discount Dahhan’s opinion.
    Finally, the ALJ discounted the opinion of Dr. Tuteur for Yogi
    Mining because the ALJ found that it was vague and not fully
    reasoned.   ALJ Decision II at 17-18.       In so doing, the ALJ observed
    that Tuteur had failed to explain or support his conclusion that
    the medical evidence “suggest[s] the absence of pneumoconiosis” and
    the presence of an infection.       Id. at 18.   Moreover, Tuteur did not
    independently evaluate Fife’s X-rays or CT scan but was relying on
    opinions of other doctors, into a comprehensive opinion that weighs
    the totality of the evidence. The failure of Dr. Dahhan’s report
    to do just that leads me to accord his opinion little weight.” ALJ
    Decision II at 16.
    10
    While Dr. Sutherland’s report was listed by Dr. Dahhan as one
    that he had considered, the ALJ explained, in that regard, that
    “the mere listing of a report does not demonstrate adequate
    consideration alone and, more importantly, a doctor’s failure to
    explicitly discuss the lone piece of evidence available to him that
    explicitly contradicts his opinion is demonstrative of an opinion
    that is poorly reasoned.” ALJ Decision II at 17.
    20
    the reports of Scott and Wheeler, which the ALJ deemed inconclusive
    and, therefore, less probative.          Id. at 17-18.
    In contrast to his rejection of the equivocal opinions of Yogi
    Mining’s doctors, the ALJ explained that he accorded “great weight”
    to the views of Dr. Forehand, who had examined Fife for the OWCP
    and unequivocally opined that “complicated pneumoconiosis is the
    sole factor contributing to his total pulmonary disability.”                     ALJ
    Decision II at 7, 18.           Forehand’s opinion was “supported by
    specific physical examination findings, the miner’s employment and
    smoking histories, and a chest X-ray” taken by Forehand on February
    12, 1999.    Id. at 18.     While Forehand suggested that Fife be tested
    for tuberculosis, he made clear his view that any such resulting
    diagnosis    would   have    been   in   addition    to       his   diagnosis     of
    pneumoconiosis. See 
    20 C.F.R. § 718.201
    (b) (including within legal
    definition of pneumoconiosis “any chronic pulmonary disease .                     .
    . substantially aggravated by” coal dust).              The ALJ also accorded
    weight to Dr. Alexander’s interpretation of Fife’s most recent X-
    ray as positive for complicated pneumoconiosis. ALJ Decision II at
    18.
    The Board, in reviewing ALJ Decision II, concluded that the
    ALJ   was   within   his    discretion    in   ruling    as    he   did   and,   in
    particular, in deeming the opinions of Drs. Forehand and Alexander
    as the more probative evidence presented.           Board Decision II at 8.
    Because it is the province of the ALJ to determine the weight to be
    21
    accorded   such     evidence,    we     also    conclude     that,      in   these
    circumstances, the ALJ and the Board did not err.
    C.
    Finally, Yogi Mining contends that the ALJ failed to consider
    the relevant CT scan evidence relating to Fife’s claim.                 The Board
    concluded, however, that the ALJ had properly considered all the
    relevant   evidence,    and     that    he   had    satisfied     his    duty   of
    explanation.   The Board’s conclusion on this point is confirmed by
    our review.    Board Decision II at 3.             Contrary to Yogi Mining’s
    contentions, an ALJ is not required to give determinative weight to
    CT scan readings; he is only obliged to weigh such readings against
    the other relevant evidence.          See Consol. Coal Co. v. Dir., OWCP,
    
    294 F.3d 885
    , 893 (7th Cir. 2002) (recognizing the “absence of any
    regulatory requirement that a negative CT scan must trump all other
    evidence”).    Furthermore, ALJ Decision I, which is explicitly
    incorporated   by   reference     in   ALJ     Decision    II,   satisfactorily
    explained that the ALJ was according “little evidentiary weight” to
    the CT scan readings of Drs. Wheeler and Scott because both had
    interpreted the scans as showing evidence of tuberculosis, while
    Fife had, in fact, tested negative for the disease.               ALJ Decision
    I at 22.   The ALJ also explained that he gave little weight to Dr.
    Dahhan’s evaluation of Fife’s CT scan of July 28, 1999, because
    22
    Dahhan   had   not   adequately   explained   why   he   had   rejected   the
    contrary evidence of the other doctors.        ALJ Decision II at 16.
    An ALJ’s duty of explanation is fully satisfied “[i]f a
    reviewing court can discern what the ALJ did and why he did it.”
    Piney Mountain Coal Co. v. Mays, 
    176 F.3d 753
    , 762 n.10 (4th Cir.
    1999) (internal quotation marks omitted). The Board concluded that
    this test was satisfied, i.e., that the ALJ had properly considered
    the CT scan evidence and fulfilled his duty of explanation.           Board
    Decision II at 4.     In these circumstances, we find no error in that
    assessment.
    IV.
    Pursuant to the foregoing, we affirm the decision of the Board
    affirming the ALJ’s award of black lung benefits to Fife.
    AFFIRMED
    23