Black lung is a serious, and sometimes fatal, disease caused by exposure to coal mine dust. Black lung causes permanent lung damage, which can affect breathing and normal heart function. Coal miners who develop black lung can file claims under state and federal workers’ compensation laws, which provide benefits for workers with occupational lung diseases.
Black lung (also called coal workers’ pneumoconiosis) is a disease that is caused by inhaling coal mine dust. Although most people think of coal dust exposure as occurring underground only, 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 strip mining.
Black lung causes permanent scarring in the lungs over time. On average it takes at least ten years to develop black lung, though it can appear sooner. Although any coal miner is at risk for developing black lung disease, the majority of coal miners will never get black lung disease. Only a small portion of miners are susceptible hosts for black lung and will eventually develop the disease. In these individuals, the coal dust triggers an immune system response, which causes a negative reaction in the lungs and leads to scarring.
Black lung begins when the body’s immune system tries to rid itself of the inhaled coal dust particles. For a susceptible worker, the body views the dust particles as foreign objects that must be eliminated. Unfortunately, the body has no way of expelling the dust particles from the lungs. The immune system doesn’t know this and sends out cells to attack the dust particles. The cells die while trying to destroy the dust particles and release certain irritating substances in the process, causing scar tissue to form around the dust particles.
There are two types of black lung: simple and complicated. Most coal miners who get black lung disease have what’s called “simple black lung.” In simple black lung, the x-ray opacities are smaller and less numerous than in complicated black lung. The severe stage of black lung called “complicated black lung” requires the presence of larger opacities.
Fortunately, for most workers with black lung, the disease never progresses to complicated black lung. However, for the minority of workers who develop complicated black lung, the results are serious and can be deadly. The more lung tissue that is replaced by scar tissue, the harder it is to breathe. For that reason, people with complicated black lung are at risk of respiratory failure and heart failure.
Because of the threat of progression, any coal miner diagnosed with simple black lung should be carefully monitored through periodic chest x-rays.
In its early stages, black lung may not cause any symptoms at all. When simple black lung does cause symptoms, they are usually limited to shortness of breath or a dry cough. The onset of these symptoms usually happens very slowly, and miners may blame their symptoms on getting older or being out of shape. To be on the safe side, any such symptom in a coal miner should always prompt a trip to the doctor. It’s possible that the symptoms are caused by other medical problems, such as heart disease, asthma, or emphysema (which can be caused by smoking, coal dust, or both). However, it’s also possible that black lung is the culprit.
When seeking treatment, make sure your doctor knows that you are a coal miner. It’s also important to tell your doctor about all of the irritating exposures you have experienced in the mines. In addition to coal dust, irritating exposures in the mines can include rock dust, as well as fumes from glues and adhesives used in the mines. Any substance that causes an immediate breathing reaction, such as coughing or shortness of breath, should be reported to your doctor.
A black lung diagnosis is usually made by identifying abnormalities called "opacities" on a chest x-ray. A doctor can classify the degree of the disease based on the amount and size of the opacities. There are other methods of diagnosing black lung. For example, federal law allows a black lung diagnosis to be made based on a doctor’s opinion along or based on other types of lung testing. However, as a practical matter, a workers’ comp claim is not likely to succeed without a positive chest x-ray.
A positive x-ray will prompt a doctor to order pulmonary function tests and arterial blood gas tests to find out how badly your lungs have been damaged. For a pulmonary function test, you’ll have to breathe into a tube. For the arterial blood gas test, you’ll have your blood taken, probably twice – once while resting and once while exercising. The blood gas test will measure how well your lung is functioning by showing whether your blood is carrying enough oxygen.
These pulmonary tests help to show whether you have an obstructive or a restrictive breathing defect. An obstructive defect means you have trouble exhaling, which is a common indicator of other lung diseases such as emphysema. A restrictive defect means you have difficulty inhaling, which is an indicator of black lung.
Unfortunately, there is no real cure for black lung. The lung tissue affected by black lung is permanently damaged and cannot be repaired. The only way to keep black lung from progressing is to stop coal dust exposure altogether. While this can be difficult for someone who works as a coal miner, there are options for reassignment. For example, under federal law, a miner diagnosed with black lung can ask to be moved to a less dusty area of the coal mine.
Other than reducing exposure to coal dust, treatment options for black lung are limited and 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.
Workers who have developed black lung on the job may file claims through their states’ workers’ compensation programs. For an explanation of the different types of benefits available, see Nolo’s article, Types of Workers' Compensation Benefits.
You should notify your employer immediately once you learn that you have black lung. Most states have strict time limits for providing notice, often between 30-90 days. Each state also has strict time limits in which a worker with black lung must file a workers' comp claim. The clock usually starts running on one of the following: the date the employee was last exposed to coal mine dust, the date when symptoms began, or the date when the black lung diagnosis is made. Each state has its own laws on these time limits, which are usually around three years.
A worker with black lung may also have a separate claim under the Federal Black Lung Benefits Act. Under federal law, a worker can recover for black lung only if he or she is “totally disabled” by it. This means that the worker is no longer able to perform the work of a coal miner because his or her ability to breathe normally is permanently impaired. While you may file claims under both state and federal law, there will likely be an offset of benefits to prevent a double recovery.
It’s important to consult with a lawyer who is familiar with occupational diseases of coal miners. An attorney who represents coal miners will be familiar with black lung disease and can usually refer the miner to a doctor who has expertise is diagnosing and treating the disease. For advice on how to find the right lawyer, see Nolo’s article on how to find and choose a workers’ comp lawyer.