Black lung is a serious, and sometimes fatal, disease caused inhaling coal dust. If you’ve developed black lung disease as a result of your work mining coal—or you’re the surviving dependent of a miner who died from the condition—you may file a claim and get benefits through your state’s workers’ compensation system or a special federal black lung program. Miners may also receive free screening for the disease through a federal program.
Black lung disease may sound like something out of the past. And it's true that it declined from the 1970s until the early 2000s. But then the rate of new—and more serious—cases rose dramatically, to the point where some researchers are calling it a renewed epidemic in Appalachia.
Also called coal workers’ pneumoconiosis, black lung disease begins when the body’s immune system tries to rid itself of small particles of coal dust lodged in the lungs. It’s a complex process, but essentially the scavenger white blood cells (called macrophages) get overwhelmed, releasing enzymes that damage the lungs and create scar tissue. As the scarring builds up, it can shrink the volume of the lungs, resulting in even more damage to surrounding tissue. The name of the disease comes from the appearance of its sufferers’ lungs, which develop dark spots and eventually turn black.
Although most people think of coal dust exposure as occurring only underground, it can also happen above ground when the coal is being processed or when coal is being mined just below the earth’s surface, such as during strip mining.
Black lung disease can be stealthy. In its early stages, the condition may not cause any symptoms at all. And the first symptoms, like shortness of breath or a chronic cough, could be the result of smoking or other medical problems like heart disease or asthma. To confuse matters even more, people with black lung have a higher risk of developing chronic bronchitis or emphysema, and the disease often appears alongside silicosis (a similar lung disease caused by inhaling silica dust). Eventually, if simple black lung progresses to what’s known as “complicated black lung” (or “progressive massive fibrosis”), it becomes more and more difficult to breathe—which can lead to respiratory or heart failure.
Historically, it took at least 10 or 20 years of exposure to develop black lung disease. But researchers are finding that miners are now getting the disease after fewer years of working with coal, and they’re dying at a younger age. Not only that, but the disease appears to be making a huge comeback after nearly disappearing by the end of the 1990s (largely as a result of federal laws and regulations from the early 1970s that limited miners’ exposure to coal dust). As reported by the National Institutes of Health, cases of progressive massive fibrosis jumped 900% between 2000 and 2012; in 2018, government researchers identified the largest reported cluster of cases with this severe form of the disease. Some scientists believe the increase is due to longer work days and different mining techniques that expose miners to more silica.
If you are or have been a coal miner and you experience any breathing problems or chronic coughing, it’s critical that you seek medical care as soon as possible. Even if you don’t yet have symptoms, it’s a good idea to get your lungs checked out periodically. The National Institute for Occupational Safety and Health (NIOSH) operates a Coal Workers’ Health Surveillance Program in coal country, which provides free screenings—including chest x-rays, pulmonary function testing (known as spirometry), and other health assessments for coal miners.
Early detection is particularly important for black lung, because the only way to keep the disease from progressing is to stop the exposure to coal dust. Under federal law, any miner diagnosed with black lung must be allowed to transfer (with no cut in pay) to another position in the mining operation where the dust is below a certain concentration (30 U.S.C. § 843(b)).
Other than reducing exposure to coal dust, treatment options for black lung are limited and generally focused on helping the patient breathe. Doctors may try to treat breathing problems with inhalers and may recommend an oxygen tank in severe cases where blood oxygen levels are too low. A lung transplant may be an option, but only if the patient is healthy enough to withstand the procedure.
If you’ve been diagnosed with black lung disease, you should immediately notify your employer (or former employer). You should also promptly file a claim through your state’s workers’ compensation system. There are tight time limits for reporting work-related injuries or illnesses and for filing workers’ comp claims. While the deadlines vary from state to state, the clock usually starts running when you were last exposed to coal mine dust, when symptoms began, or when you were diagnosed with the disease. (For more information on the rules where you live, see our state-specific articles on filing workers’ comp claims and on workers’ comp benefits.)
You may also have a separate claim under the federal Black Lung Program. In order to qualify for these benefits (including monthly checks and payment for medical expenses), miners must be “totally disabled” due to black lung, meaning that the disease keeps them from doing work that requires skills similar to those they used in their previous mining job. Surviving spouses and children of miners who died from black lung may also be entitled to monthly benefits. (30 U.S.C. §§ 901, 902(f).) If a miner or surviving spouse is also receiving workers’ comp or other disability payments under state law, the monthly benefits from the federal black lung program will be reduced to offset those state benefits.
Unfortunately, it’s often an uphill battle to qualify for benefits under either the federal program or state workers’ compensation. The mining industry fights these claims vigorously, leading to lengthy legal battles. Although it has generally been easier to get compensation under state workers’ comp, that could be changing—at least in some states. In 2018, Kentucky passed a law that limits diagnosis of black lung (for purposes of workers' comp) to a few certified pulmonologists in the state, most of whom typically work for coal companies.
This is why it’s so important to consult with an experienced workers’ comp lawyer who’s familiar with occupational diseases of coal miners. An attorney who represents coal miners will understand black lung disease, can usually refer you to a doctor with expertise in diagnosing and treating the disease, and can fight for your rights through the complicated process of getting benefits. For advice on how to find the right lawyer, see our article on how to find and choose a workers’ comp lawyer.