Vision Mining, Inc. v. Gardner

Opinion of the Court by

Notwithstanding their 37 and 34 years’ work in underground coal mines, the Workers’ Compensation Board affirmed decisions to dismiss both Appellants’ applications for benefits because the “consensus readings” of their X-rays interpreted them to be negative for coal workers’ pneumoco-niosis (black lung).1 On review, however, two separate Court of Appeals’ panels held the “consensus procedure” required by KRS 342.316 for proving the existence of coal workers’ pneumoconiosis and the “clear and convincing” standard the statute requires to rebut such a consensus unconstitutional.

In so doing, both panels of the Court of Appeals determined that such provisions denied the claimants and other workers who suffer from coal workers’ pneumoconi-osis equal protection under the law by placing a more stringent burden of proof on them than those who suffer from pneu-moconiosis from other sources. Having heard these two cases together and having extensively reviewed their records and histories, we agree with the conclusions of the Court of Appeals.

I. PNEUMOCONIOSIS AND WORKERS’ COMPENSATION

These appeals involve an equal protection challenge to KRS 342.316, which defines the evidentiary procedure and standard for coal workers’ pneumoconiosis claims. As a result, before delving into their background, we believe it prudent to address the distinctions, if any, between coal workers’ pneumoconiosis (contracted from coal dust) and pneumoconiosis contracted from other dusty particulates, as well as to outline the differing statutory treatment of coal workers’ pneumoconiosis versus other pneumoconiosis.

A. Pneumoconiosis

Although the disease is given different names depending upon the source of the dust, there is no “natural” or “real” medical distinction between coal workers’ pneu-moconiosis and other occupational pneu-moconiosis:

“Pneumoconiosis” is simply a generic term for a lung disease evidenced by pigmentation and fibroid induration. The disease is traceable to not only coal dust, but other types of dust particles as well. Some of these include: aluminum (aluminosis), asbestos (asbestosis), cotton dust (byssinosis), iron (siderosis), sandstone (silicosis), tobacco (tabacosis), and ostrich feathers (ptilosis). The fact that these many other environmental sources of particles also cause pneumo-coniosis is the proverbial fly in the ointment for this legislative scheme. There is no medical evidence whatever that any characteristic of disease, itself, sup*458ports a “natural” or “real” distinction in the class of workers who contract it, based on whether the employee was a coal miner or custodian of the ostrich cage at the Louisville Zoo.

Kentucky Harlan Coal Co. v. Holmes, 872 S.W.2d 446, 458 (Ky.1994) (Stephens, C.J., dissenting). Simply put, “pneumoconiosis is pneumoconiosis is pneumoconiosis.” Id. at 456 (quotation marks omitted); see also Stedman’s Medical Dictionary 1522 (28th ed.2006) (describing pneumoconiosis as “[i]nflamation commonly leading to fibrosis of the lungs caused by the inhalation of dust incident to various occupations.... ”).

B. Statutory Treatment

Despite the fact that there is no real distinction between the various forms of pneumoconiosis, Chapter 342 of the Kentucky Revised Statutes treats coal workers differently than those from other occupations with respect to workers’ compensation.2 Specifically, these varying claimants endure different procedures and presumptions and enjoy distinct benefits.

I. Procedure and Presumptions

For coal workers’ pneumoconiosis, KRS 342.316(3) requires a different procedure to establish its existence than it requires for all other types of pneumoconiosis. In addition, KRS 342.316(13) requires “clear and convincing” evidence to rebut a panel consensus for coal workers’ pneumoconio-sis claims, while KRS 342.315(2) — addressing other occupational pneumoconiosis and diseases — requires only “a reasonable basis” to rebut a university evaluator’s clinical findings and opinions, i.e. a standard lower than “clear and convincing.” Magic Coal Co. v. Fox, 19 S.W.3d 88, 95 (Ky. 2000).

a. The Procedure for Coal Miners

In the first instance, KRS 342.316(3) requires a two-step “consensus” procedure for evaluating X-ray evidence of coal workers’ pneumoconiosis. Hunter Excavating v. Bartrum, 168 S.W.3d 381, 382 (2005). Pursuant to this statute, a claimant must submit an X-ray, along with an interpretation of that X-ray. KRS 342.316(3)(b)l. The employer may then submit its own X-ray and interpretation. KRS 342.316(3)(b)4.d. If the two interpretations do not agree, the highest quality X-ray is sent to a panel consisting of three individual “B” readers,3 chosen at random, who issue their own interpretation. KRS 342.316(3)(b)4.e. If a consensus is not reached by the panel,4,5 *459the ALJ renders a decision based on the evidence submitted. Id. If, however, as is often the case, there is a consensus,6 copies of the report are considered as evidence. Id. For all practical purposes, this consensus is the only evidence controlling the result.

To encourage a consensus among the three randomly selected “B” readers, KRS 342.794(4) provides that the “readers” are evaluated not only with respect to the timeliness and completeness of their reports, but also as to “the frequency at which the physician’s classification of X-rays differs from the consensus reading.” In fact, the statute compels removal of a physician “from the ‘B’ reader list ... if the physician’s interpretations of X-rays are not in conformity with the consensus reading fifty percent (50%) of the time.” Id. (emphasis added).

Secondly, once a consensus is reached by at least two of the three chest X-ray interpreters, it is presumptively correct “unless overcome by clear and convincing evidence.” KRS 342.316(13). In Fitch v. Burns, 782 S.W.2d 618, 622 (Ky.1989), this Court concluded that “this approach requires the party with the burden of proof to produce evidence substantially more persuasive than a preponderance of evidence, but not beyond a reasonable doubt.” However, beyond establishing the boundaries (somewhere between preponderance of evidence and beyond a reasonable doubt), the Court asserted that it could provide no definition or guideline as to how a court should apply, this evidentiary standard:

We conclude that where the “burden of persuasion” requires proof by clear and convincing evidence, the concept relates more than anything else to an attitude or approach to weighing the evidence, rather than to a legal formula that can be precisely defined in words. Like “proof beyond a reasonable doubt,” “proof by clear and convincing evidence” is incapable of a definition any more detailed or precise than the words involved.

Id. (emphasis added). Yet, in other instances, we have defined the standard as “proof of a probative and substantial nature carrying the weight of evidence sufficient to convince ordinarily prudent-minded people.” See, e.g., Commonwealth Cabinet for Health and Family Services v. T.N.H., 302 S.W.3d 658, 663 (Ky.2010) (citation omitted); see also Black’s Law DictionaRY 636 (9th ed.2009) (defining “clear and convincing evidence” as “[e]vi-dence indicating that the thing to be proved is highly probable or reasonably certain.”).

In the context of coal workers’ pneumo-coniosis claims, the decision of the ALJ in the Gardner claim demonstrates that additional X-ray evidence, testimonial evidence as to increasing difficulty breathing, and over 37 years’ work in underground mining, did not constitute “clear and convincing evidence” sufficient to rebut the consensus reached by two chest X-ray interpreters. See infra Section II.A. Thus, as indicated, overcoming the presumption *460created by a “B” reader consensus is practically impossible.7,8

b. The Procedure for Other Pneumo-coniosis Claimants

In contrast to coal workers’ pneumoconi-osis, KRS 342.316(3)(b)4.b. and KRS 342.315(1) require workers suffering from non-coal-related pneumoconiosis to only undergo a university evaluation rather than a consensus process. In this regard, KRS 342.316(3)(b)4.b. provides that “[t]he commissioner shall assign the claim to an administrative law judge and, except for coal workers’ pneumoconiosis claims, shall promptly refer the employee to such physician or medical facility as the commissioner may select for examination.” (Emphasis added). And, KRS 342.315(1) states that “[t]he commissioner shall contract with the University of Kentucky and the University of Louisville medical schools to evaluate workers who have had injuries or become affected by occupational diseases covered by this chapter.”9 Thus, it is fair to say in these non-coal cases, it is the total evaluation which is important, not just an X-ray interpretation.

Moreover, workers suffering from non-coal-related pneumoconiosis are not required to produce “clear and convincing evidence” to rebut these evaluations. Upon sufficient grounds, the ALJ may disregard them. KRS 342.315(2) states that “the clinical findings and opinions of the [university] evaluator [are] afforded presumptive weight by administrative law judges and the burden to overcome such findings and opinions ... fall[s] on the opponent of that evidence.” In Fox, 19 S.W.3d at 95, this Court rejected the Workers’ Compensation Board’s determination that this presumption could only be overcome by “clear and convincing evidence.” Based upon KRE 301, the Court instead recognized the discretion afforded an ALJ with respect to non-coal-related pneumoconiosis and held that that KRS 342.315(2) only calls for a reasonable basis to rebut a university evaluator’s clinical findings and opinions:

*461KRS 342.315(2) creates a rebuttable presumption which is governed by KRE 301 and, therefore, does not shift the burden of persuasion. Pursuant to KRS 342.315(2), the clinical findings and opinions of the university evaluator constitute substantial evidence of the worker’s medical condition which may not be disregarded by the fact-finder unless it is rebutted. Where the clinical findings and opinions of the university evaluator are rebutted, KRS 312.315(2) does not restrict the authority of the fact-finder to weigh the conflicting medical evidence. In instances where a fact-finder chooses to disregard the testimony of the university evaluator, a reasonable basis for doing so must be specifically stated.

Id. at 98 (emphasis added). Yet, in coal workers’ pneumoconiosis claims, the authority of the fact-finder to weigh the conflicting medical evidence is restricted.

Based upon the language of KRS 342.316, along with the relevant subsections of KRS 342.315 and KRS 342.794, we believe that coal workers’ pneumoconiosis claimants are subjected to much more stringent statutory treatment than all other pneumoconiosis claimants. Specifically, a coal workers’ pneumoconiosis claimant must endure a more exacting procedure to prove his claim and is subjected to a much higher rebuttable standard,10 if rebuttable at all (in life, at least).11

2. Benefits

Perhaps in an attempt to justify the disparate treatment between coal workers’ pneumoconiosis and other pneumoconiosis stemming from the two-step “consensus” procedure and the “clear and convincing” evidentiary standard, KRS 342.732 offers different benefits for coal claimants than KRS 342.730, which generally addresses the determination of income benefits for disability. Thus, some of these coal workers’ pneumoconiosis benefits, although they still require a “consensus finding” of *462pneumoconiosis, do not require proof of the impairment. For instance, KRS 342.732(( )(a) 1. entitles those who suffer from Category 1 coal workers’ pneumoco-niosis (as determined by a consensus) to a “retraining incentive benefit” (RIB) without submitting proof that the condition produces a permanent impairment rating:

If an employee has a radiographic classification of category 1/0, 1/1 or 1/2, coal workers’ pneumoconiosis and spirome-tric test values of eighty percent (80%) or more, the employee shall be awarded a one (1) time only retraining incentive benefit which shall be an amount equal to sixty-six and two-thirds percent (66-2/8%) of the employee’s average weekly wage as determined by KRS 342.740, but not more than seventy-five percent (75%) of the state average weekly wage, payable semimonthly for a period riot to exceed one hundred four (104) weeks....

This benefit requires that he or she quit working in the coal mines, KRS 342.732(l)(a)8., and attend school, KRS 342.732(( )(a)2. However, only a de minimis number of coal workers who filed claims received a RIB from 2003 to 2010.12 Furthermore, in lieu of a RIB, KRS 342.732(i )(a)7. entitles workers who are at least 57 years old on the date of the last exposure to elect to receive up to 425 weeks of benefits based on a 25% disability rating without actually proving a permanent impairment rating:

An employee who is age fifty-seven (57) years or older on the date of last exposure and who is awarded retraining incentive benefits under subparagraphs 1. to 4. of this paragraph, may elect to receive in lieu of retraining incentive benefits, an amount equal to sixty-six and two-thirds percent (66-2/3%) of the employee’s average weekly wage, not to exceed seventy-five percent (75%) of the state average weekly wage as determined by KRS 342.740 multiplied by the disability rating of twenty-five percent (25%) for a period not to exceed four hundred twenty-five (425) weeks, or until the employee reaches sixty-five (65) years of age, whichever occurs first....

(Emphasis added).13 We note, however, that these presumptions equate with expected medical findings for coal workers’ pneumoconiosis. Holmes, 872 S.W.2d at 455 (“The presumptions employed in KRS 342.732 bear both a direct and rational connection to the medical realities concerning the seriousness of the degree of coal workers’ pneumoconiosis present in a given worker.”).

In contrast, KRS 342.730 does not offer equivalent benefits for non-coal pneumoco-*463niosis claimants without proof and a finding of an actual impairment. Moreover, coal workers seeking benefits pursuant to KRS 342.732(i )(a)l. or 7. are bound by the unequivocal restrictions enunciated by KRS 342.732(6):

In no event shall income benefits awarded under this section be stacked or added to income benefits awarded under KRS 342.730 to extend the period of disability and in no event shall income or retraining incentive benefits be paid to the employee while the employee is working in the mining industry in the severance or processing of coal as defined in KRS 34.2.0011(23)(a).

(Emphasis added). The essential point, however, is that all coal mining claimants, including those seeking benefits, or even retraining benefits, are subjected to the two-step “consensus” procedure and corresponding “clear and convincing” evidentia-ry standard of KRS 342.316, as well as the statute’s minimum exposure requirement in the processing of their claims:

Income benefits for the disease of pneu-moconiosis resulting from exposure to coal dust or death therefrom shall not be payable unless the employee has been exposed to the hazards of such pneumo-coniosis in the Commonwealth of Kentucky over a continuous period of not less than two (2) years during the ten (10) years immediately preceding the date of his or her last exposure to such hazard, or for any five (5) of the fifteen (15) years immediately preceding the date of such last exposure.

KRS 342.316(4)(b).

With this statutory framework and the delineation of pneumoconiosis in mind, we now turn to the facts of the two cases before us.

II. BACKGROUND

A. The Gardner Claim

Jesse Gardner was born in 1946. He filed an application for benefits under KRS 342.732 on August 15, 2007, after working as an underground coal miner for 37 years. The application stated that his last exposure to coal dust occurred on January 31, 2005. He did not assert a specific respiratory impairment.14

The parties subsequently submitted the following evidence:

Party “B” reader X-ray Date Quality grade Category15

Claimant Dr. Powell 2/2 07/13/2007 2

Employer Dr. Wiot 0/0 12/27/2007 1

Because the parties’ reports were not in consensus, the Office of Workers’ Claims (now the Department of Workers’ Claims) hired a panel of three randomly-selected “B” readers to whom they submitted the X-rays with directions to choose the better quality X-ray and render a report of that X-ray. The panel reported as follows:

“B” reader X-ray date Quality grade Category

Dr. Anderson 12/27/2007 216 I/O

Dr. Jarboe 12/27/2007 1 0/0

Dr. Pope 12/27/2007 2 0/0

The Office then notified the parties that the panel consensus was category 0/0. *464Gardner then submitted in rebuttal an additional report in which another physician, Dr. Baker, gave the December 27, 2007 X-ray a quality grade of 1 and opined that it revealed parenchymal abnormalities consistent with category 1/0 pneumoconiosis.

Gardner thereafter testified at the hearing concerning the coal mine employers for whom he had worked and the nature of the work that he performed underground. He also testified to experiencing increasing difficulty breathing during the past year, particularly if he walked quickly, climbed steps, or carried something that was heavy. He stated that he began to smoke when was about 16 years old and smoked about a pack a day until quitting many years ago. He also stated that no physician informed him that he suffered from pneumoconiosis until Dr. Powell diagnosed the condition in August 2007.

In spite of his 37 years’ experience in underground coal mining,17 as well as the subsequent X-ray and testimonial evidence of pulmonary dysfunction, the ALJ dismissed Gardner’s claim, finding that he failed to rebut the presumption that the consensus classification was correct with clear and convincing evidence to the contrary. Affirming, the Board noted that, as an administrative tribunal, it lacked jurisdiction to decide Gardner’s constitutional question. See Blue Diamond Coal Company v. Cornett, 300 Ky. 647, 189 S.W.2d 963 (1945). As noted, however, the Court of Appeals panel reversed, holding that both the consensus procedure and the clear and convincing evidentiary standard for rebutting a panel consensus were unconstitutional.18

B. The Martinez Claim

Joe Martinez was born in 1937.19 He filed an application for benefits under KRS 342.732 on October 24, 2002, after working as an underground coal miner for 34 years. His application stated that his last exposure to coal dust occurred on October 1, 2000. He did not assert a specific respiratory impairment.20

The parties subsequently submitted the following evidence:

Party "B” reader X-ray Date Quality grade Category

Claimant Dr. Baker 05/17/2002 3 1/0

Employer Dr. Pope 12/23/2002 2 negative

*465Because the parties’ reports were not in consensus, the Office of Workers’ Claims hired a panel of three randomly-selected “B” readers to whom they submitted the X-rays with directions to choose the better quality X-ray and render a report of that X-ray. The panel reported as follows:

Quality “B” reader X-ray date grade Category

Dr. Rosenberg 12/23/2002 2 0/1

Dr. Ramakrishnan 12/23/2002 2 0/0

Dr. Dineen unknown 1 0/0

The Office then notified the parties that the panel consensus was category 0/0. There is no indication that either party submitted any rebuttal evidence.

In spite of Martinez’s 34 years’ experience in underground coal mining, the ALJ dismissed the claim, finding that he failed to rebut the consensus classification with clear and convincing evidence. As in the Gardner case, the Board noted it lacked jurisdiction to decide the constitutional question that Martinez raised and thus affirmed. The Court of Appeals also reversed, holding that both the consensus procedure and the clear and convincing evidentiary standard for rebutting a panel consensus were unconstitutional.21

To properly assess whether this procedure and the evidentiary standard are unconstitutional, we must now examine the purposes, tests, and precedents with respect to equal protection under the law as recognized by both the United States and Kentucky Constitutions.

III. EQUAL PROTECTION

Citizens of Kentucky enjoy equal protection of the law under the 14th Amendment of the United States Constitution and Sections 1, 2, and 3 of the Kentucky Constitution. D.F. v. Codell, 127 S.W.3d 571, 575 (Ky.2003). Simply put, the 14th Amendment requires persons who are similarly situated to be treated alike. City of Cleburne, Texas v. Cleburne Living Center, 473 U.S. 432, 439, 105 S.Ct. 3249, 87 L.Ed.2d 313 (1985). And Sections 1, 2, and 3 of the Kentucky Constitution also provide that the legislature does not have arbitrary power and shall treat similarly situated persons equally.

In sum, the goal of the 14th Amendment to the United States Constitution, as well as Sections 1,2, and 3 of the Kentucky Constitution, is to “keep[] governmental decision makers from treating differently persons who are in all relevant respects alike.”22 Nordlinger v. Hahn, 505 U.S. 1, 10, 112 S.Ct. 2326, 120 L.Ed.2d 1 (1992). However, because nearly all legislation differentiates in some manner between different classes of persons, neither the federal nor state constitutions forbid such classification per se. Romer v. Evans, 517 U.S. 620, 631, 116 S.Ct. 1620, 134 L.Ed.2d 855 (1996). Accordingly, the level of judicial scrutiny applied to an equal protection challenge depends on the classification made in the statute and the interest affected by it. See Memorial Hospital v. Maricopa County, 415 U.S. 250, 253, 94 S.Ct. 1076, 39 L.Ed.2d 306 (1974).

Currently, there are three levels of review applicable to an equal protection challenge. See, e.g., Steven Lee Enterpris*466es v. Varney, 36 S.W.3d 391, 394-95 (Ky.2000). Strict or intermediate scrutiny applies whenever a statute makes a classification on the basis of a “suspect”23 or “quasi-suspect”24 class, respectively.25 Codell, 127 S.W.3d at 575-576 (discussing strict and intermediate scrutiny). Conversely, “if the statute merely affects social or economic policy, it is subject” to a less searching form of judicial scrutiny, i.e. the “rational basis” test. Id. at 575 (citation omitted).

Workers’ compensation statutes concern matters of social and economic policy. Cain v. Lodestar Energy, Inc., 302 S.W.3d 39, 42 (Ky.2009). As a result, such a statute is not subject to strict or immediate scrutiny and therefore must be upheld if a “rational basis” or “substantial and justifiable reason” supports the classifications that it creates:

Statutes ... concerning social or economic matters generally comply with federal equal protection requirements if the classifications that they create are rationally related to a legitimate state interest.... A statute complies with Kentucky equal protection requirements if a “reasonable basis” or “substantial and justifiable reason” supports the classifications that it creates.

Id. at 42-43 (footnotes omitted).

Although the rational basis standard certainly favors the government, it would be incorrect to state that courts always hold that legislatively-created classifications are rationally related to a legitimate state interest. The United States Supreme Court has made it abundantly clear that the three levels of review constitute guidelines for constitutional inquiry and are not dispositive edicts. See, e.g., Adarand Constructors, Inc. v. Pena, 515 U.S. 200, 237, 115 S.Ct. 2097, 132 L.Ed.2d 158 (1995) (“[W]e wish to dispel the notion that strict scrutiny is strict in theory, but fatal in fact.”).26 Furthermore, both our na*467tion’s highest court and this Court have, in several cases, recognized equal protection violations based upon the rational basis standard.

In Allegheny Pittsburgh Coal Co. v. County Com’n of Webster County, W. Va., 488 U.S. 386, 109 S.Ct. 633, 102 L.Ed.2d 688 (1989) and City of Cleburne, 473 U.S. 432, 105 S.Ct. 3249, the United States Supreme Court unanimously identified equal protection violations based upon the rational basis standard.27,28 In Allegheny, a West Virginia county tax assessor valued the petitioner’s real property on the basis of its recent purchase price, yet made only minor modifications in the assessments of land which had not been recently sold, thereby resulting in gross disparities in the assessed value of generally comparable property,29 488 U.S. at 338, 109 S.Ct. 633. The Supreme Court noted that a tax selection scheme may divide property into classes and assign to each class a different tax burden “[i]f the selection or classification is neither capricious nor arbitrary, and rests upon some reasonable consideration of difference or policy .... ” Id. at 344, 109 S.Ct. 633 (citation and quotation marks omitted) (internal quotation omitted) (emphasis added). However, West Virginia had not drawn such a distinction; rather, the assessor, on her own initiative, *468applied the state tax laws in a manner resulting in the disparity. Id. at 345, 109 S.Ct. 683. Because it had “no doubt that [the] petitioners ha[d] suffered from ... ‘intentional systematical undervaluation by state officials’ of comparable property in” the same county, the court held that the practice “denied [the] petitioners the equal protection of the laws....” Id. at 338, 346, 109 S.Ct. 633.

In City of Cleburne, a Texas city denied a special use permit for the operation of a group home for the mentally retarded pursuant to a municipal zoning ordinance requiring permits for such homes. 473 U.S. at 435, 105 S.Ct. 3249. Our nation’s highest court stated that “where individuals in the group affected by a law have distinguishing characteristics relevant to interests the State has the authority to implement, the courts [should be] very reluctant ... to closely scrutinize legislative choices as to whether, how, and to what extent those interests should be pursued.” Id. at 441^442, 105 S.Ct. 3249. However, the court refused to countenance arbitrary classifications:

The State may not rely on a classification whose relationship to an asserted goal is so attenuated as to render the distinction arbitrary or irrational. Furthermore, some objectives — such as “a bare ... desire to harm a politically unpopular group,” ... are not legitimate state interests.

Id. at 446-447, 105 S.Ct. 3249 (citations omitted). “Because ... the record [did] not reveal any rational basis for believing that the [group] home would pose any special threat to the city’s legitimate interests,” the court deemed the ordinance invalid as applied. Id. at 448, 105 S.Ct. 3249 (emphasis added).

Following in the footsteps of the United States Supreme Court, this Court has also found equal protection violations based upon the rational basis standard.30 For instance, in Commonwealth Natural Resources and Environmental Protection Cabinet v. Kentec Coal Co., Inc., 177 S.W.3d 718, 723 (Ky.2005), the procedure of the Natural Resources and Environmental Protection Cabinet required prepayment before mining permittees could obtain a formal hearing to challenge an assessment. Importantly, the procedure allowed individuals, but not corporations, a means to obtain a waiver from the prepayment requirements. Id. Moreover, it was uncontroverted that Kentec Coal Company could not afford to post the bond requested to contest the assessment on appeal. Id. We could not “discern any rational basis, or legitimate state interest, to explain — much less justify — the arbitrary singling out of a corporation (from individuals) for such disparate treatment.” Id. at 726. Stated succinctly, we found this treatment to be repugnant to our conception of equal protection:

It is just not within our democratic ideas, customs or maxims to grant equal justice and due process only to those who can afford to pay and to deny such rights to those who cannot. Such a *469notion flies in the face of the belief of “equal justice under the law.”

Id. at 725.31

Thus, our precedent, along with that of the United States Supreme Court, demonstrates that the rational basis standard, while deferential, is certainly not demure. This standard encompasses the long held principle that “ [classification ‘must always rest upon some difference which bears a reasonable and just relation to the act in respect to which the classification is proposed, and can never be made arbitrarily, and without any such basis.’ ” McLaughlin v. State of Fla., 379 U.S. 184, 190, 85 S.Ct. 283, 13 L.Ed.2d 222 (1964) (citation omitted) (emphasis added); see also Frontiero v. Richardson, 411 U.S. 677, 683, 93 S.Ct. 1764, 36 L.Ed.2d 583 (1973) (“Under ‘traditional’ equal protection analysis, a legislative classification must be sustained unless it is ‘patently arbitrary’ and bears no rational relationship to a legitimate governmental interest.”) (emphasis added); Elk Horn Coal Corp. v. Cheyenne Resources, Inc., 163 S.W.3d 408, 414 (Ky.2005) (“ ‘[Arbitrary and irrational’ discrimination violates the Equal Protection Clause even under the rational-basis standard of review.”) (footnote omitted) (emphasis added). Simply put, arbitrary selection “ ‘can never be justified by calling it classification.’ ” McLaughlin, 379 U.S. at 190, 85 S.Ct. 283 (citation omitted).32

Having set forth the differing statutory evidentiary treatment of pneumoconiosis claims, the background of the two cases on appeal, and the purposes, tests, and precedents with respect to equal protection, we will now address whether the procedure and evidentiary standard that KRS 342.316 applies only to coal workers’ pneumoconio-sis claimants infringes upon coal workers’ rights to equal protection under the law.

IV. ANALYSIS

Gardner and Martinez assert that both the “consensus procedure” and the “clear and convincing” evidentiary standard KRS 342.316 applies to coal workers’ pneumoconiosis claims violate the rights of coal workers to equal protection under the law. The claimants contend that the statute unfairly and unlawfully discriminates against coal workers who are injured by, and through exposure to coal dust, as opposed to workers who suffer from pneumoconiosis from other sources. According to the claimants, this unfavorable treatment is arbitrary, capricious, and not rationally related to any legitimate state interest. Moreover, they allege there no substantial and justifiable reason to support it exists. Our analysis begins with the presumption that legislative acts are constitutional. United Dry Forces v. Lewis, 619 S.W.2d 489 (Ky.1981); Sims v. Board of Education of Jefferson County, *470290 S.W.2d 491 (Ky.1956); Brooks v. Island Creek Coal Co., 678 S.W.2d 791 (Ky.App.1984).

Although we have considered other equal protection challenges before, this is the first challenge based on the less favorable statutory evidentiary treatment to which coal workers’ pneumoconiosis claimants are subjected compared to all other pneumoconiosis claimants.33 In Holmes, 872 S.W.2d at 448-449, a coal company34 contested the benefits afforded coal workers’ pneumoconiosis claimants pursuant to KRS 842.732. With respect to its equal protection challenge, the coal company essentially argued that the statute’s irre-buttable presumption of total disability discriminated unlawfully between coal companies and businesses in other industries.35 We disagreed, as the statute was designed to deal with the undue burden being placed on other Kentucky industries at the time by the coal industry:

We find that KRS 342.782 ... was a part of a comprehensive revamping of the entire Kentucky Workers’ Compensation Act. This was a dearly demonstrated response to the widely recognized need to deal with the ominous burden placed on all of Kentucky industry, through Special Fund assessments, by the cost of workers’ compensation claims relating to the coal industry. It was a founded fear that because of the burgeoning cost of workers’ compensation, particularly due to the pay-as-you-go method of Special Fund financing, industries would leave the state or fail to locate in Kentucky, thereby increasing unemployment. Approximately 78% of the Special Fund’s overall liability and over 95% of its liability for occupational disease was attributable to the coal industry.[36]

Id. at 452-453 (emphasis added). Thus, there was a rational basis for the disparate treatment we reviewed at the time. Moreover, a classification upheld for one purpose does not ipso facto justify a classification made for another purpose. Compare Kahn v. Shevin, 416 U.S. 351, 94 S.Ct. 1734, 40 L.Ed.2d 189 (1974) (holding that a Florida statute giving widows, but not widowers, a $500 exemption from property taxation did not violate equal protection), with Wengler v. Druggists Mut. Ins. Co., 446 U.S. 142, 100 S.Ct. 1540, 64 L.Ed.2d 107 (1980) (holding that a Missouri law denying a widower workers’ compensation benefits for his wife’s work-related death unless he was either mentally or physically *471incapacitated or could prove dependence on his wife’s earnings, but granting a widow death benefits without proof of dependence, violated equal protection). Each classification must be measured by its relation to the alleged governmental purpose. See 16B C.J.S. Constitutional Law § 1108 (stating that the guarantee of equal protection “prohibit[s] the state from according unequal treatment to persons placed by a statute into classes for reasons wholly unrelated to the purpose of the legislation or a legitimate state purpose.”) (citing Cherokee County v. Greater Atlanta Homebuilders Ass’n, Inc., 255 Ga.App. 764, 566 S.E.2d 470 (2002)). Finally, as we have noted, in Holmes, this Court found the presumptions under attack to equate to the expected medical findings for coal workers’ pneumoconiosis. 872 S.W.2d at 455 (“The presumptions employed in KRS 342.782 bear both a direct and rational connection to the medical realities concerning the seriousness of the degree of coal workers’ pneumoconiosis present in a given worker.”). “[I]t is only essential that there shall be some rational connection between the fact proved and the ultimate fact presumed, and that the inference of one fact from proof of another shall not be so unreasonable as to be a purely arbitrary mandate.” Usery v. Turner Elkhorn Mining Co., 428 U.S. 1, 28, 96 S.Ct. 2882, 49 L.Ed.2d 752 (1976) (quoting Mobile, J. & K.C.R. Co. v. Turnipseed, 219 U.S. 35, 43, 31 S.Ct. 136, 55 L.Ed. 78 (1910)).

In Durham v. Peabody Coal Co., 272 S.W.3d 192, 194 (Ky.2008), coal workers argued that the consensus procedure of KRS 342.316 discriminated unlawfully between workers who are injured by a harmful occupational exposure to coal dust and those who become physically disabled by a traumatic injury. This Court then rejected their argument because “inherent differences between coal workers’ pneumoco-niosis and traumatic injuries provide a reasonable basis or substantial and justifiable reason for different statutory treatment! ]”:

Pneumoconiosis develops gradually and can be difficult to diagnose, as illustrated by the disparity in x-ray interpretations offered in each of these cases. The court noted in Kentucky Harlan Coal Company v. Holmes, 872 S.W.2d 446 (Ky.1994), that when amending KRS 342.316 and enacting KRS 342.732 in 1987, legislators relied on testimony from medical experts that coal workers who suffer from pneumoconiosis should be encouraged to find other employment but that even category 3 simple pneumo-coniosis is not usually associated with any significant decrease in lung function. The court also noted that the 1987 amendments were a legislative attempt to control the cost of coal workers’ pneu-moconiosis claims, particularly by workers with no significant respiratory impairment. The present statutes address those same concerns. As a rule, traumatic injuries occur suddenly and are more easily diagnosed. Workers who sustain traumatic injuries are not, as a rule, advised to change employment to avoid the risk of further injury.

Id. at 195-196 (emphasis added).

Although we rejected equal protection challenges in Holmes and Durham, we found an as-applied equal protection violation with respect to the KRS 342.316 consensus procedure in Cain, 302 S.W.3d 39. In that case, the claimant, seeking a RIB award, submitted a “B” reader’s report that showed the existence of category 2/1 pneumoconiosis while his employer submitted evidence that he suffered only from category 1/1 disease; both submissions supported the claimant’s entitlement to a RIB award. Id. at 43. Nonetheless, because the reports were not in consensus, KRS 342.316(3)(b) 4.e. required the claim *472to be submitted to a consensus panel and the appointed panel subsequently reached a consensus of category 0 and the ALJ thereafter dismissed the claim. Id. at 41, 48. Thus, we unanimously concluded that the statute denied the claimant equal protection because there was “no rational or reasonable basis for such discrimination[37] where the employer’s evidence effectively concedes the worker’s entitlement to a RIB.” Id. at 43.

Here, KRS 342.316(3), along with the relevant subsections of KRS 342.315 and KRS 342.794, treat coal workers’ pneumo-coniosis claimants more stringently than all other pneumoconiosis claimants. However, even though the disease is given different names depending upon the source of dust, there is no “natural” or “real” distinction between coal workers’ pneumoconiosis and other forms of pneu-moconiosis.

As a result, we believe this case significantly differs from Durham and Holmes. Unlike Durham, different names do not justify differing treatment — all forms of pneumoconiosis (whatever type) develop gradually and can be difficult to diagnose. Furthermore, unlike Holmes, we discern no rational basis or substantial and justifiable reason for the singular two-step “consensus procedure” or the “clear and convincing” evidentiary standard, as it is simply counterintuitive to prescribe differing standard of proof requirements for the same disease. Nor can the disparate treatment of coal workers be justified as a cost-saving measure, as it is axiomatic that, if the enhanced procedure saves money, the state would save more money by subjecting all occupational pneumoco-niosis claimants to the more exacting procedure and higher rebuttable standard. Finally, we reject any contention that the two-step procedure promotes prompt and efficient processing of coal mining pneu-moconiosis cases, as an additional step presents nothing more than another formidable hurdle for the coal worker before he or she can receive compensation.

Rather than rely upon Durham and Holmes, we liken this case to those circumstances in which this Court or the United States Supreme Court identified an equal protection violation. Again, whether caused by coal, rock, asbestos, or brick dust, “pneumoconiosis is pneumoconiosis is pneumoconiosis.” Holmes, 872 S.W.2d 446, 456 (Ky.1994) (Stephens, C.J., dissenting) (quotation marks omitted). Therefore, we follow our nation’s highest court’s decisions in Allegheny and City of Cleburne and refuse to countenance an arbitrary classification, i.e. prescribing differing standard of proof requirements for the same disease.

Moreover, we believe any venal element to an initial doctors’ medical diagnosis38 in the context of coal workers’ pneumoconio-sis would apply with equal force to pneu-moconiosis caused by asbestos, rock, or metal dust. To hold otherwise, we must assume that doctors providing the initial diagnosis for all other types of pneumoco-niosis are inherently more trustworthy, and thus the additional consensus panel is only necessary to defend against physicians that testify for coal workers. There is no basis for such an assumption limited *473to physicians from the coal fields of Kentucky and it belies common sense; it encapsulates the very meaning of arbitrariness, irrationality, and unreasonableness.39

Because we consider the classification of coal workers’ pneumoconiosis claimants to be arbitrary in regard to the more stringent proof or procedures required and believe that the disparate treatment afforded such workers lacks a rational basis or substantial justification, we hold that the consensus procedure and the clear and convincing evidentiary standard are unconstitutional.

We pause, though, to address the contention that the preferential treatment afforded coal workers pursuant to KRS 342.732 justifies the more stringent procedural and evidentiary requirements of KRS 342.316.40 Simply put, one type of disparate treatment does not constitute a rational basis or substantial and justifiable reason for another form of disparate treatment.41,42 Although certainly by no means *474equivalent, such an argument brings to mind the United States Supreme Court’s famous proclamation that “[s]eparate educational facilities are inherently unequal.” Brown v. Board of Ed. of Topeka, Shawnee County, Kan., 347 U.S. 483, 495, 74 S.Ct. 686, 98 L.Ed. 873 (1954). In considering an equal protection challenge, a court does not engage in accounting of debits and credits; rather, the court must examine whether similarly situated individuals have been treated differently in that instance and, if so, whether or not such treatment is rationally related to a legitimate state interest. And, as we noted above, a classification upheld for one purpose does not ipso facto justify a classification made for another purpose; each classification must be measured by its relation to the alleged governmental purpose.

V. CONCLUSION

Having carefully reviewed the record and the arguments of the parties, we cannot discern a rational basis or substantial and justifiable reason for the disparate treatment of coal workers in this instance. Pneumoconiosis caused by exposure to coal dust is the same disease as pneumoconiosis caused by exposure to dust particles in other industries, yet coal workers face different, higher standard-of-proof requirements than those other workers. This is an arbitrary distinction between similarly situated individuals, and thus it violates the equal protection guarantees of the Federal and State Constitutions.

For the foregoing reasons, the decisions of the Court of Appeals in these cases are affirmed.