Black lung disease is increasing among miners. Even relatively young miners who've spent their whole careers in mines that were supposed to be under federal dust control standards have been found with advanced disease. At the same time, however, compensation for miners who get black lung disease has been shrinking.
For a miner to convince the federal black lung program that the mining company where he worked owes him compensation for the damage done to his lungs is not an easy task. The miner had better be prepared for mountains of paperwork, and hearings and appeals that can go on for about seven years. Dr. Donald Rasmussen, who does medical examinations of miners for the Department of Labor, says it's not a rare occurrence for there to be 10 to 12 years of appeals, with the mining company usually opposing the claims.
"It takes a long time to succeed," Rasmussen says, "and a miner is not assured of winning anyway."
Fighting For Benefits
At Tug River Clinic in Gary, W.Va., federal caseworkers assist miners like Gerald French. French started applying for black lung benefits when he was 62. He's now 73. Workers at the clinic have counseled him, helped him fill out his paperwork and screened him for the disease. Recently, he was screened a fourth time and was subjected to a series of tests that included X-rays and a fast-paced three minutes on the treadmill to determine how well his lungs are working.
Dr. Randy Forehand listens to his lungs, and he also asks French how well he's sleeping and if there's sputum -- mucus and similar matter expectorated from the lungs -- when he coughs. French says he wheezes at night and that his sputum is grayish. French does not have black lung, but he keeps being tested for it because the disease can be latent and progressive, and it's not always apparent when a worker leaves the mines. Forehand says a miner can develop the disease without further exposure to coal dust.
French worked in the mines for 40 years, most of that time in the preparation plant, where the coal is sorted, crushed and washed. Like most miners he seldom wore a respirator.
"A lot of times you just cannot perform the work you have to do with a respirator over your mouth," says French. "You will suffocate if you do. I don't care what you do, you're going to get that dust, a certain amount of it."
To really understand what conditions were like in the Hobet Mines preparation plant, you should hear the disgust in 57-year-old Robert Schultz's voice when he describes it. He spent 20 years there.
"Nastiest place I've ever been in my life," says Schultz. "Dirtwise, dustwise, mudwise, waterwise. You wore a light in the daytime and I could possibly recognize you from [a distance of four feet], possibly."
That's just how much dust he says was created by crushing, sorting and washing the coal in the nine floors of the prep plant. Schultz left coal mining in 2007 when doctors concluded he was disabled. Both the doctors employed by the Department of Labor and Hobet Mining agree that he is disabled.
But documents provided by doctors who work for the company say that Schultz has emphysema, "from a long history of heavy smoking." There's no evidence, medical or legal, the doctors say, that Schultz has black lung. Schultz says otherwise.
"When you work in a place and I can't tell who you are, and we're four foot away, but it's cigarettes did it," says Schultz, "that's BS. You know it. I know it. Everyone knows it."
The Challenge Of A Clear Diagnosis
The mining company doctors say that if Schultz has black lung, it's not showing up on X-rays. Forehand, of the W.Va. clinic, has been certified by the National Institute of Occupational Safety and Health to distinguish between the impairment caused by smoking and coal mining. Forehand says there's nothing on an X-ray when the patient has emphysema, which makes it really hard to see black lung.
"The [lung] tissue's gone. You don't see the normal lung markings. You don't see the blood vessels," he says. "You don't see the normal markings that you see on a normal X-ray, because the lung tissue has actually been destroyed in smoking."
The doctors from the Department of Labor agree that Schultz has emphysema, but they don't agree that his smoking caused all of it. One department doctor saw no evidence of black lung. But Rasmussen says the X-rays shows that Schultz does have small shadows and scarring in both lungs that are consistent with black lung.
Rasmussen also points out that black lung doesn't always show up on an X-ray, and that a diagnosis is not dependent upon the X-ray. A miner’s work history, where he worked in the mines, how much dust he may have been exposed to, how well his lungs function and other measures are also important.
The district director of the federal black lung program sided with the company doctors and rejected Schultz's disability claim. But he was granted an appeal that will be heard by an administrative law judge. This could go on for years.
Mining Companies Fight Most Cases
At Valley Health Systems in Cedar Grove, W.Va., black lung coordinator Debbie Wills has been helping miners file claims for black lung benefits for 21 years. The first case she assisted in went on for 16 years. She says it’s a rare case that companies will not fight.
"They pretty much fight every claim as long and as hard as they can fight it. They appeal it to every level in fighting miners for their benefits."
Wills says the mining companies will say the miner has cancer, tuberculosis, anything but a work-related disease. She suspects they probably wouldn't fight the miners so hard if the claim was only about paying a monthly disability stipend. There are a lot of other costs they could be liable for. Wills has tracked what the cost of a miner's medical treatment would be if he were diagnosed with black lung at the age of 60.
"We might be talking about a quarter of a million dollars," she says. "The quantity of medication or in-home oxygen, that's where the huge expense to coal companies comes from."
NPR tried to contact several mining companies including Hobet but was unsuccessful. A spokesman for the National Mining Association told NPR they couldn't comment for this story because of their focus on the investigations into the West Virginia mine explosion.
There was a time the federal government paid black lung benefits. During that time, in 1980, nearly a third of claims were approved. Then, under President Ronald Reagan payment became the responsibility of the companies. There were also restrictions to the guidelines under which a miner could claim black lung benefits. The proportion of black lung benefits approved dropped dramatically. New regulations have once again broadened the official definition of black lung, and have limited the amount of evidence companies can submit. Still, just 14 percent of claims are approved.
It's hard to find anyone in the mining industry or the government who will explain why 10,000 miners have died of black lung disease in the past decade, and just about 500 a year are now being approved for black lung benefits. Rasmussen has been seeing miners since he came to West Virginia in the early 1960s and doesn't quite understand it.
"I never get any feedback," he says. "I see people coming back that were denied that shouldn't have been denied."
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