Black Lung: A Coal Company’s Noose

Coal mining has been a staple of the Appalachian economy since the late 1880s. With it being a dominate resource of energy through the 20th century, it is hard to separate Appalachia from coal. With the production of coal, many unplanned for and unwanted ramifications have been discovered over the years. Problems including the destruction of natural landscapes, environmental pollution and erosion, and a deterioration in miners’ health. While regulation of our national parks and improvement on limiting environmental deterioration, the front that has been neglected the most is the approach to the coal company employees’ health. Similar to how miners fought for better representation and increased pay, miners have had to continuously challenge to have their needs met medically. Specifically, miners have had to fight against the coal companies’ denial of black lung, recognition of the disease, as well as workers compensation for it.

Having Virginia Tech located in Blacksburg, near Virginia’s epicenter of coal mining, peaks the interest of what health benefits are there for Virginia coal miners. Since the beginning of the debate for black lung coverage, Virginia coal miners have struggled to have their needs met. Although coal mining began in the late 19th century, black lung was not recognized by any health insurance until the middle of the 20th century. The coal mining industry has a history of being tyrannical, neglectful, and callous towards its workers. Coal companies have either denied that the coal dust could be at fault or did not claim responsibility, putting the burden on the miners and their families (Hamby). So, what battles have occurred to hold coal companies accountable? What legislation imposes a guarantee that coal miners suffering from black lung are getting compensated for it? And what is the current state of the black lung debate and is there enough being done for the effected coal miner?

To begin, what is black lung? Black lung, also known as coal workers’ pneumoconiosis, is the deposit of coal dust particles in the lungs over time, causing scarring. Normally, when dust particles land in the airway of a healthy individual, the immune response is to dispose of the particle. The immune system does this by catalyzing an inflammatory response (Pathak). As the lung tissue swells repeatedly over time, scarring can accumulate on the tissue. The longer and more often the exposure to the harmful air particles, the more scarring occurs. The inflammation actually causes more problems for the airway because it shrinks the volume of the lungs. When the lungs are scarred from inflammation, this is known as fibrosis. Due to the varying levels of scarring possible, there are two different levels of coal workers’ pneumoconiosis: simple and complicated. Simple, being the better of the two, shows scattered spots of scarring from the coal dust particles. Complicated black lung correlates with increased scarring. This can also be termed progressive massive fibrosis (Pathak).

The disease develops over several years. A person suffering from coal workers’ pneumoconiosis will have tightness in their chest, trouble breathing, and usually a cough. To officially be diagnosed with the condition, a doctor can use x-rays and/or a CT scan to look for scarring. If there is a determination that the patient has black lung, treatment begins by preventing further damage. But, the disease is unfortunately, incurable, and treatment usually focuses on making the patient be able to breathe easier. This can be done with the help of inhaler or oxygen. If the patient is a smoker, it is advised they immediately stop that habit. Virginia coal miners have been at risk of this disease since the state first started coal mining in the 18th century.

Coal mining in Virginia began in 1701 on the banks of the James River. From then, commercial coal mining appeared about mid-18th century. When coal mining first started in Virginia, it mainly was composed of underground mining. Today, around 80% of the coal produced comes from surface mining (Dept. of Mines). There are three different regions in the state of Virginia that hold the black rock utilized by millions: The Eastern Coalfields, Valley Coalfield, and the Southwest Virginia Coalfields. The earliest coal came for the Eastern Coalfields located in the Richmond Basin (Dept. of Mines). As coal continued to be produced, coal companies moved west toward the Blue Ridge, Valley and Ridge, and Appalachian Plateau regions of Virginia. Today, most coal mining in Virginia is produced in the Southwest Virginia Coalfield. Counties like Buchanan, Dickinson, Lee, Russell, Scott, Tazewell, and Wise make up the majority of the region and produce around 13 million short tons in 2016 (Dept. of Mines). Even though mining in Virginia started early, legislation helping the health of miners did not come until the middle of the 20th century.

President Truman was a strong voice for the United Mine Workers of America. He famously made a promise, known as The Promise of 1946, to provide mine workers with funds for healthcare and retirement (UMWA). While Truman made these guarantees, and eventually delivered on what he promised, notable legislation was not introduced until 1969. The Federal Coal Mine Health and Safety Act of 1969 outlined the original benefits to be given to miners who had developed black lung as well as the funding for the program by introducing an excise tax on coal companies for every ton of coal they produced. The act gave benefits and compensation to only the miner and to those miners who were in the underground mines (Congress). While this was progress, it was not enough. Miners’ families did not get to continue the coverage if the miner died or if they were not directly involved with the harvesting of coal, they were excluded. This legislation was amended by the Black Lung Amendment of 1977, but not signed into law until February of 1978. This amendment established the Black Lung Disability Trust Fund. Now, instead of paying black lung suffers from public revenues, there would be a supply of money set aside from the excise tax. The new guidelines expanded the term minor to include managers, coal transporters and construction workers who build the mining establishments. The new amendment also expanded the amount of accepted cases. Before, cases were often denied if the worker was still employed and working for the mine, even if their duties have been shifted to an area where direct coal dust exposure was minimized. This allowed many miners to apply for funding and be approved. The expansion of benefits helped miners’ families who had passed away (Congress). If they miner passed and had at least 25 years of mining experience, their family was eligible to apply or benefits. Evidence of the disease standards was also lowered with the new legislation. Before the amendment, disease determination, using x-rays, was left to the radiologists of the Department of Labor. The department often was conservative with approving different cases and resulted in many denials. The Black Lung Amendment of 1977 allowed the interpretation of chest x-rays by board qualified physicians to be suffice for the approval of payment. The only time this did not apply was it there is suspicion of fraud (Congress). This improvement in black lung care was a substantial step to getting healthcare where it needed to be.

While there was improvement in legislation, more was written into law 5 years later by President Reagan. The Black Lung Benefits Revision aimed to provide stability to the program by increasing the funding but make qualification harder. The increase in revenue was done by increasing the coal producers excise tax. The original price per ton of coal produce of surface mining was $0.25 and $0.50 for underground companies. The new revision increased the tax to $0.50 and $1.00, surface and underground mining respectively (Black Lung Benefits Revision). This increase will account for the increased number of cases being approved. The revision did give a little power back to the department of Labor. It allowed them to order a second opinion on cases where before they were not allowed to challenge an approved case, unless fraud was possible. Now, more cases were susceptible to not qualify for not meeting the standard of being “totally disabled by the disease” (Black Lung Benefits Revision). To take away the approval of more cases, two restrictions to survivor benefits were established. Miners families could provide documentation that their late husband was totally medically disabled by the disease if it was presented by a third party that had no intention on financial gain. This means that widows were not allowed to present the information. Additionally, the cause of death had to be strictly and concretely pneumoconiosis. Previously, both cases would have been approved (Black Lung Benefits Revision). While this legislation made qualifying for benefits more difficult, they were still improvements to regulate grey area and provide funding for the program.

While legislation began to make of black lung benefits more regulated and increase monetary support for the trust fund, the problem actually began to disappear. The fact is, even though a miner works for a coal company, black lung is not a guarantee. While it does increase the risk of developing the respiratory condition, only around 16% of coal miners are diagnosed with the lung issues (Pathak). The number reported of black lung cases has even declined from the 1970s till early 2000s (Popovich). This, along with the fact that it takes years for the disease to develop, cited by most people being diagnosed after the age of 50, has given the coal companies and the Black Lung Trust Fund some cushioning. But while this is great, black lung reports took a drastic turn for the worse at the turn of the century.

Black lung’s resurgence is staggering to many health professionals. Because mining technology has improved since 1920, the particles that the machinery creates are smaller than ever before (Cashdollar). It is guessed that young miners are suffering more severe cases earlier than before because of the increased silica being released in the mines (Popovich). In the mid-1990s, the average number of complicated cases per 1,000 miners was at 3.7. In 2016, that statistic is at 48.5 complicate cases per 1,000 miners (Popovich). With such a problem, the attention is shifting to making the problem go away by regulating coal dust and silica (Solutions). Starting with the Obama administration, new outlines decreased dust exposure for this first time in four decades. The first they addressed was to adjust particle survey information to today’s standards, not the ones from 1900s, to serve as a basis for new of coal rock dusting regulations (Cashdollar). With increased regulation, and sustaining court appeals, coal mines are becoming safer to work in. Now, healthcare must adjust to deal with this new wave of the disease.

It would make sense to keep the trust fund as full as possible for the youngest miners to develop black lung in the shortest amount of time. This unfortunately is not the case either. While the government has made documentation and regulation of benefits very easy to understand and qualify, Congress has turned its back on Appalachia (Compensation). In 2018, Congress introduced a bill reestablishing the original tax rates for the excise tax; $0.25 and $0.50 respectively. This would cause the trust fund to go bankrupt in less than a year (Solutions). If the fund is depleted, the coal companies will be responsible for dealing out their revenues, causing a cycle of debt to occur. Currently, Virginia coal companies alone are paying $23,329,521.01 to 2,613 claimers as of 2018 (DCMWC). All of these cases would be affected if funding is cut. Many attempts to protest this bill have been attempted. Specifically, in Virginia, Senator Mark Warner is in opposition to the bill. He has even introduced a bipartisan bill to improve detection of black lung and understand southwest Virginia needs a helping hand, not a cold shoulder (Dodson).

While the problem of black lung was not recognized by the healthcare system until 1969, coal miners continue to work toward receiving benefits for their illness. Now more than ever, the disease is on the rise with more aggressive conditions. While it is good coal companies are being held accountable and having to pay worker’s compensation, if the trust fund tax cut is implemented, many suffers will not be able to be compensated. Current efforts are to increase regulation to limit the exposure to coal dust miners have been inhaling, keep the current benefits promised by legislation, and to also maintain funding from the taxes on coal companies to support those who have suffered at the hands of silent bovine killer.

References

Hamby, Chris. “A Century of Denial on Black Lung.” Breathless and Burdened. The Center for Public Integrity May 19, 2014 2013. Web. November 27 2018.

“Black Lung Benefits Revision.” November 1982. 26–28. Vol. 45. Print.

Cashdollar, Kenneth L. Recommendations for a New Rock Dusting Standard to Prevent Coal Dust Explosions in Intake Airways / Kenneth L. Cashdollar [and Six Others]. Report of Investigations (National Institute for Occupational Safety and Health): 9679: Pittsburgh, PA : Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Office of Mine Safety and Health Research, 2010, 2010. Print.

Compensation, Division of Coal Mine Workers’. “Black Lung Medical Benefits: Questions and Answers About the Federal Black Lung Program.” Ed. Labor, U.S. Department of: Office of Workers’ Compensation Programs, 2018. Print.

Congress, 95th United States. “Black Lung Amendments of 1977.” Ed. Administration, Social Security1978. Print.

Distributions of Part C Black Lung Claims and Disbursements, by State Fy 2018. United States Department of Labor, 2018.

Dept. of Mines, Minerals, and Energy (DMME). “Coal Production in Virginia.” Division of Geology and Mineral Resources (2015). Print.

Dodson, Willie. “Black Lung Survivors Take Their Case to Congress.” Front Porch Blog 2018. Web.

Pathak, Neha. “What Is Black Lung Disease?” WebMD. September 25, 2018 2018. Web. 27 November 2018.

Popovich, Nadja. “Black Lung Disease Comes Storming Back in Coal Country.” The New York Times 2018. Print.

Solutions, Athena Information. “Gao Report on Black Lung Benefits Program Shows That Coal Industry Contributions Must Be Maintained at Current Levels.” Article. Targeted News Service 2018/06/05/ 2018. Print.