Black Lung:

A Continuing Struggle for Coal Miners in Appalachia

Bennett M. Judkins and Aysha Bodenhamer

Jerry Coleman is a third-generation coal miner. He has worked for thirty-seven years in mostly underground coal mines in the Appalachian Mountains of West Virginia. His lungs are permanently and irreversibly scarred by the inhalation of coal dust. He has coal workers’ pneumoconiosis (CWP), commonly known as black lung. Even though his doctor diagnosed him with the disease, Coleman had to wait seven years to receive the benefits guaranteed to him by the federal government to pay for his medical bills—benefits paid through his own labor in the mines. The company doctor and the lawyers from the coal company fought him in court for each of those seven years.^[1] Coleman is one of the lucky ones; many miners die from black lung before being awarded compensation, while others fight for twenty years or more.

Sadly, Coleman’s struggle is not a new one. Coal workers’ pneumoconiosis was first detected in a Scottish coal miner in 1831.^[2] Yet the disease was not widely recognized and compensated for in Great Britain until the 1940s. It took over 120 years for black lung to be fully recognized in the United States in the 1960s, and even then it was only after several years of organizing efforts. Following the Farmington mine disaster in West Virginia that killed 78 miners in 1968, 40,000 miners went on strike to advocate for health and safety in the mines.^[3] In 1969, Black lung prevention and compensation measures were solidified with the Federal Coal Mine Health and Safety Act, leading leaders to believe the disease would be eradicated.^[4] Cases of black lung initially fell dramatically following the implementation of the Coal Act.^[5] Yet public health officials became aware that the prevalence of black lung was again increasing around the year 2000.^[6] In the 21st century the resurgence of black lung, a preventable disease, is now back with a vengeance, especially in central Appalachia (Virginia, Kentucky, and West Virginia). As a result, the story of black lung in Appalachia goes on, and the efforts of coal miners and their supporters to fight and seek redress from the coal industry, the union, the government, and the occupational health industry also persists.

While black lung may seem like a niche issue, it intersects with myriad institutions and social processes. In case studies, miners with black lung are exposed to issues in the healthcare system, workplace dynamics, government initiatives, and inequalities pertaining to poverty, exploitation, and education. With healthcare specifically, emergent issues include inaccessibility to care, inadequate or nonexistent insurance, and even biased doctors who sympathize with coal employers. Workplaces also develop their own culture—what does it mean to work in a dangerous field? Are government regulations followed or mocked? Are regulatory government agencies such as the Mine Safety and Health Administration (MSHA) and the National Institute for Occupational Safety and Health (NIOSH) effective? How do these dynamics change in a region plagued by persistent poverty, low educational attainment, and a deeply embedded pro-coal culture? The historical and current significance of black lung necessitates the cooperative action of institutions to reform these processes and to improve overall well-being in Appalachia.

The Early Years

Although coal was mined by Indigenous peoples before colonialists arrived and by early settlers in the 18th century, it was the 19th century before that it became a major commercial operation and the largest source of energy in the United States. It has always been a dangerous occupation. Risks include inhaling toxic gases, such as methane, carbon monoxide, and hydrogen sulfide; being crushed by roof falls or mining equipment; drowning when tunnels fill with water; and sustaining injury due to fires and explosions.^[7] In addition, rescuing injured miners often thousands of feet below the surface is a difficult process that sometimes turns into a recovery effort. From 1900 through the first half of the 20th century, the number of miners killed averaged over 2,000 per year until 1930. It was not until around the mid-20th century before the numbers declined to less than 1,000 due to improved safety conditions and the lower number of miners working. In the last ten years, the average number of mine safety fatalities per year has generally been fewer than twenty; however, these figures do not include the long-term, latent effects of black lung.^[8]

While the number of fatalities in the coal mines continued to decline in the 20th century, another malady was slowly being recognized as affecting workers’ health. Miners were experiencing shortness of breath, a chronic cough, and difficulty breathing, and many were dying. The medical term for it was coal workers’ pneumoconiosis. The American Lung Association describes two types of pneumoconiosis—simple, known as coal workers’ pneumoconiosis (CWP), and complicated, known as progressive massive fibrosis (PMF). The miners called the condition “black lung” because it eventually turns lungs from their normal pink color to black. Over time the lungs harden, making it difficult to breathe and often leading to death.^[9]

Black lung is caused by long-term exposure to and inhalation of coal and silica dust into the lungs. Dust exposure has long been a problem in mining but was worsened by the development of more efficient technology, specifically the continuous mining machine in the 1950s. This machine, which at the time accounted for about 45% of underground coal production, has a large, rotating steel drum equipped with teeth that scrape coal from the seam, creating a tremendous amount of dust in the process.

The expanded use of the continuous mining machine was in part the result of an agreement between labor and management in 1950, which created the United Mine Workers Association (UMWA) Welfare and Retirement Fund. Although the fund provided pensions and free medical care for union members, many thought it gave the union a vested interest in increasing production and the possibility of collusion between the UMWA leaders and the coal companies. Because of mechanization, the number of miners dropped from 415,000 in 1950 nationally to fewer than 130,000 in 1969. The continuous miner, with its enhanced speed and motion, also increased the amount of dust circulating in the mines and, consequently, the prevalence of black lung.^[10]

A few years after the coal companies introduced the continuous mining machine, Isodore Buff, a West Virginia cardiologist, became interested in the lung problems of miners. Buff noticed a significant increase in the number of miners with the diagnosis of heart failure, and he knew that heart failure was often the result of excessive tissue development in the lungs. After failing to muster any interest in a proposed study of the relationship between the work environment and lung disorders in 1959, he began a crusade to educate the mining communities about the problem.^[11]

Over the next few years pathologists Donald Rasmussen and Hawley Wells joined Buff’s effort. Their work intensified in 1968 when a major mining disaster in Farmington, West Virginia, killed 78 miners.^[12] This tragedy captured the attention of the public and Congress. In the months following the disaster, a conference on mine safety brought these three physicians together, who then formed the Physicians Committee for Mine Health and Safety to tour West Virginia to speak at rallies organized by concerned miners. Whenever possible, the three physicians appeared together at protest meetings all over West Virginia. Buff would attack the coal industry and the UMWA, Rasmussen would speak about the nature of the disease, and Wells would usually end the meetings with a call to political action.^[13] The efforts of the miners and the Physicians Committee culminated in early 1969 with the formation of the West Virginia Black Lung Association, which was officially introduced at a rally in Beckley, West Virginia, on January 19, 1969. A total of nine black lung bills were introduced into the West Virginia state legislature in February. Several protests later and a massive strike of over 40,000 miners, the legislature and Governor Archie Moore signed the final Black Lung Benefits Act on March 11, 1969.^[14] The act contained a very liberal state workers’ compensation statute and signaled a victory for the miners, as their success in West Virginia made a strong impression in Washington.

From West Virginia to the U.S. Congress

Many miners and their supporters testified in hearings on mine safety and health before the 91st Congress in 1969.^[15] Although much of the reform discussion centered on reducing levels of coal dust to prevent future miners from contracting the disease, an official amendment to establish federal responsibility for a black lung benefits program was eventually introduced. Multiple failures of past political action justified a new amendment, which would establish the first-ever federal compensation program for anyone other than federal workers. The amendment targeted different groups to take more responsibility for the mine workers’ well-being: (1) medical professionals to recognize the disease, (2) states to amend their worker compensation systems, and (3) the federal government to recognize and address the disease as Great Britain had done in the 1940s.^[16] Perhaps the most important factor was the testimony of the miners themselves, whose emotional recitations apparently had a tremendous impact, even on the most conservative legislators.^[17]

The final bill, the Federal Coal Mine Health and Safety Act, was passed in the House and Senate in mid-December. Although President Richard M. Nixon considered vetoing the bill, primarily because of objections to the black lung benefits provision, an unauthorized walkout of West Virginia miners is generally credited for his signature on December 30, 1969. The Coal Act of 1969 introduced sweeping reforms and regulations for the first time in the coal industry.^[18] It mandated four annual inspections for underground mines and two for surface mines, enabled federal agencies to fine coal companies for violations, established a training program, created a respirable dust limit of 2.0 mg/m3, and created a surveillance program for underground miners.^[19] The amended act, the Mine Act of 1977, established a new agency known as the Mine Safety and Health Administration (MSHA).

Black lung benefits were initially administered by the Social Security Administration. Its purpose was to provide benefits to coal miners who were totally disabled by pneumoconiosis and to the surviving dependents of miners who died from the disease. In the first year, the initial claims processed showed approval rates above 90 percent. This success created high expectations in the mining communities of Appalachia. However, when the first major report of claims occurred in the summer of 1970, West Virginia and Kentucky had approval rates of only 32% and 57%, respectively.^[20] By 1971, fourteen chapters of the Black Lung Association (BLA) had been established in Kentucky, Tennessee, Virginia, and West Virginia, with a membership of 4,000 miners and widows. Although many hoped this new legislation would be the final solution to the problem of black lung, inequities in the implementation of the black lung benefits program resulted in a nationwide social movement for retired and disabled coal miners.

The Growth of the Black Lung Movement

The core of the reform efforts, and of the eventual nationwide black lung movement, was rank-and-file miners, often retired and/or disabled, who had filed a claim for compensation with their local office of the Social Security Administration. Most came to the Black Lung Association, at least initially, seeking assistance in obtaining compensation. Barbara Ellen Smith points out that local BLA chapters had three functions: (1) to offer assistance for receiving compensation, (2) to pressure the Social Security Administration and Congress to reform the compensation program, and (3) to organize a network of dissident UMWA members.^[21] Many saw the BLA as a vehicle for union reform as well, responding to the perceived collusion between the union leaders and the coal companies.

An important element to the eventual success of the black lung movement, though, was a group of young activists who came to Appalachia with an ideology of social change, social justice, and a willingness to challenge the prevailing power structure of the region. They came initially as AmeriCorps VISTA volunteers from Community Action Programs, a key component of the war on poverty from the Kennedy/Johnson administrations. However, it was another government program, Designs for Rural Action (DRA), a community action agency responsible for supporting community-related projects in Appalachia, that provided the staff for the BLA. Although direct money or salaries could not be put into a social movement organization, the DRA workers devised a plan to cut their salaries in half to support the early efforts of the Physicians Committee and eventually the Black Lung Association. Known as “The Charleston Office Crew,” they assisted with coordination and communication efforts between all of the BLA chapters. They published the Black Lung Bulletin, released press statements, sent out newsletters, and performed various other activities to help the chapters accomplish what they wanted to see done. The Charleston Office Crew was replaced in 1973 after Arnold Miller, the first president of the BLA, was elected to the presidency of the UMWA, a major victory for the black lung movement. These young staff and volunteers were important to the BLA, not only because of the energy and expertise they brought, but also because the retired and disabled miners were often not physically able to carry out many of the necessary tasks.^[22]

Although most of the efforts of the BLA were initially focused on the local area, it became clear that the battle would have to move to Washington again. Frequent marches and testimonies at Congressional hearings eventually helped change the law and the procedures for implementing the Black Lung Benefits Program. By “offering themselves as evidence,” the passage of amendments to the original black lung law in 1972 liberalized the requirements for obtaining compensation. It was a major victory for the movement and its supporters.^[23]

Another group of retired miners carried on the next phase of the struggle, and in an unlikely location: the city of Chicago. Unemployment caused by new technology and mine shutdowns that began in the 1950s sent many coal miners to Chicago and other cities to work in factories and foundries. Few coalfield migrants found adequate employment, and as time passed, many fell victim to pulmonary problems resulting from their years in the mines. The Chicago BLA was formed in 1976 and joined the BLA chapters in Appalachia to form the National Black Lung Association. The new National BLA was instrumental in the passage of the 1977 amendments, which further liberalized the criteria for benefits and altered the regulations regarding how claims were to be processed and financed. For the next few years, over 80% of claims were approved.^[24]

In 1981, however, President Ronald Reagan's administration dramatically cut eligibility for black lung benefits by ending the fifteen-year presumption. This time limit assumed that miners were disabled from black lung if they had fifteen years in the mines and a disabling lung disease. Ending the presumption made it more difficult for miners and widows to receive benefits. Resistance continued and the BLA realized that without a continual fight against abuses, miners who were then working would not have black lung benefits or would be forced to quit work.^[25] In order to build a stronger coalition, the Black Lung Association combined with two other similar social movement organizations in late 1981—the White Lung Association (WLA) and the Carolina Brown Lung Association (CBLA)—to form the Breath of Life Organizing Campaign (BLOC).

The CBLA emerged as a response to a disease that Southern textile workers were getting called byssinosis, or “brown lung,” a lung affliction caused by the inhalation of cotton dust from working in the textile mills. Because textile workers did not have the benefit of a free medical examination like the coal miners, they began setting up screening clinics, where workers often came together to talk about their disease, creating a strong empowering effect. By 1980, the CBLA had expanded to fifteen cities in five states.^[26]

The White Lung Association addressed illnesses in several different industries that used asbestos, exposure to which can cause either cancer or asbestosis. The workers called it “white lung.” Because of the use of asbestos in shipyards, the first WLA was formed in Los Angeles in 1979 and over the next few years expanded to Maryland, New York, Illinois, and a few other states. However, because workers shared little by way of work experience, culture, or history, and because they were spread out all over the country, the WLA never attained the status of the BLA or the CBLA.

The Breath of Life Organizing Campaign brought these three social movement organizations together, but coordinating their work was difficult because of the physical distance between them and the different industries they represented. Although there was a continuing effort to influence Congressional action, the thrust of BLOC was mainly to educate the public about the needs of diseased and disabled workers and to illustrate the features of a just compensation system.

The Resurgence of Black Lung in the 21st Century

Over the last few decades, the coal industry has changed drastically in Appalachia, including but not limited to declining mining employment, the depletion of coal seams, and the resurgence of black lung. It is important to note that the “resurgence” of black lung is somewhat misleading as the disease was never fully eradicated. However, this phrase is commonly used to discuss the recent increasing prevalence of black lung. The black lung prevention measures put in place by the Coal Act of 1969 for reducing dust exposure in coal mine operations by using mechanical controls (e.g., water sprays and ventilation curtains) and adhering to respiratory dust limit standards were deemed mostly effective for the suppression of black lung. Due to these measures, the prevalence of black lung declined to about 3% in the 1990s.

Even though these methods for controlling dust exposure were mostly effective, some miners continued to get the disease. In 1995, the National Institute for Occupational Safety and Health (NIOSH) recommended reducing the exposure limit for respirable coal mine dust to half of the original amount, but the recommendation was not enacted.^[27] Beginning in the early 2000s, the prevalence of black lung began to increase again.^[28] Using NIOSH Coal Workers’ X-ray Surveillance Program data, a hot spot analysis revealed that the resurgence of black lung was concentrated in central Appalachia, particularly in Kentucky, Virginia, Tennessee, and West Virginia.^[29] Due to the recent resurgence of black lung and after much debate, MSHA lowered the respirable dust standard to 1.5 mg/m3 in 2014.^[30] Other recent MSHA improvements include the use of continuous personal dust monitors in an effort to improve real-time dust reporting.^[31]

It was another mine disaster, however, the worst in four decades, that raised the nation’s attention once again to the problems of both safety and health in the mines. The Upper Big Branch Mine explosion on April 5, 2010, in Raleigh County, West Virginia, killed 29 of the 31 miners at the site. Seventeen of those 29 showed signs of black lung disease on autopsy, many of whom were young miners with only a few years on the job. Massey Energy CEO Don Blankenship spent a year in prison for “conspiring to willfully violate safety standards” due to the number of outstanding violations at the mine.^[32] It was a wake-up call for miners, physicians, and the government that the battle for miner safety and health was far from over.

Technology again played a role in the recent resurgence of the disease, as Anna Allen and Carl Werntz point out that newer mining machines slice through coal and rock much more quickly than older models.^[33] The thin coal seams of Appalachia make this method even more problematic as more rock and hazardous silica dust are churned up in the mining process.^[34] Recent lung pathology studies show that rapidly progressive pneumoconiosis is associated with elevated exposure to respirable silica and silicates found in thin seam mining.^[35] Since 1973, NIOSH has recommended that crystalline silica exposure be limited to 0.05 mg/m3, yet MSHA only recently issued a “Request for Information” about exposure to crystalline silica in 2019.^[36] Despite the recent surge in cases of black lung, silica dust continues to be unregulated in the mines.

Controversy still exists about the nature and prevalence of the disease within the medical profession. Much of this research was conducted by investigative reporters in mainstream media. In 2013, investigative research by ABC News and the Center for Public Integrity revealed that some coal companies were paying off prestigious medical professionals to deny claims of black lung. Dr. Paul Wheeler at Johns Hopkins University reviewed 1,573 cases over a thirteen-year period, including many in which the patients had been approved for benefits by local doctors in Appalachia, but he claims to have never found a single case of black lung.^[37] These reports increased skepticism among many government agencies and persuaded them to investigate the black lung claims process and corporate malfeasance. The Division of Coal Mine Workers’ Compensation (DCMWC) no longer credits the negative readings completed at Johns Hopkins and is reinvestigating many of these denied black lung claims for potential redress.^[38]

In 2016, an investigation by National Public Radio (NPR) found that coal miners were suffering from this most serious form of black lung in numbers more than ten times what federal regulators had reported. The National Institute for Occupational Safety and Health (NIOSH) had reported just 99 cases of “complicated” black lung, or Progressive Massive Fibrosis (PMF), throughout the country in the previous five years. However, NPR obtained data from just eleven black lung clinics in Virginia, West Virginia, Pennsylvania, and Ohio, which reported a total of 962 cases during the same period of time.^[39]

NIOSH finally reported in 2018 that 10% of America’s coal miners with 25 or more years of experience had black lung disease.^[40] Another study published in the American Journal of Public Health found that over 20% of miners with 25 or more years who were tested in Kentucky, Virginia, and West Virginia tested positive for black lung.^[41] A similar report in the Journal of the American Medical Association suggested it was the largest cluster of PMF reported in the scientific literature.^[42] NIOSH had counted only 115 cases of advanced black lung nationwide through its monitoring program from 2010 to 2018. A second investigation by NPR and Frontline identified more than 2,300 cases by contacting health clinics across Appalachia.^[43] The differences in reported cases are stark. Noting the regulatory failures cited by the NPR/Frontline investigation, in 2019, the Chair of the U.S. House Committee on Education and Labor finally scheduled congressional hearings on the epidemic of advanced black lung disease and the government’s regulatory failures. The infamous legacy of black lung continues.

The Revitalization of the Black Lung Associations

The recent resurgence of black lung created a need for the revitalization of the black lung movement and many chapters of the Black Lung Association. While the black lung movement exists today, it looks different from the initial movement in the 1960s. A significant change is the number of employed coal miners and, consequently, the number of unionized miners. In 2021, only 43,000 working coal miners remained nationwide.^[44]

Many chapters of the Black Lung Association have grown in recent years. There are currently ten local Black Lung Associations in Appalachia—three in Kentucky, five in West Virginia, and two in Virginia—along with several in other states. Another important organization, the National Coalition of Black Lung and Respiratory Disease Clinics (NCBLARDC), has also become an important part of the black lung movement in recent years. The National Coalition serves as an organizing body for the Health Resources and Services Administration (HRSA)-funded black lung clinics across fourteen states. Like the BLA, the NCBLARDC is dedicated to building a unified national voice for the disease and creating a stronger public voice for respiratory disease issues in general.^[45] Officially, the purpose of the Black Lung Clinics Program is to reduce the morbidity and mortality associated with occupationally-related coal mine dust lung disease through the provision of quality medical care, outreach, education, and benefits counseling services for active, inactive, retired, and disabled U.S. coal miners.^[46] As of 2018, there were 28 black lung clinics located in 15 coal mining states who receive small grants from the Federal Office of Rural Health Policy within HRSA to meet the medical needs of retired and disabled miners.^[47] Getting working miners tested, however, has been difficult. Research indicates that many active miners are fearful of losing their jobs, especially given the unstable coal employment in Appalachia.^[48] The miners also faced continuing opposition from the coal industry, which historically has demonstrated a pattern of externalizing costs by cutting corners on health and safety. It has also shown little effort to address resurgent black lung and continues to contest the disease and to challenge prevention efforts.^[49]

Notably, the industry has seen significant declines in economic productivity over the last several years. More than half of the U.S. coal mines operating in 2008 have now closed.^[50] The volume of coal mined in the U.S. has been consistently dropping since 2010, with coal production in 2020 down almost 18% compared to 2019.^[51] Many of the remaining coal operators are resistant to maintaining the dust levels required by NIOSH. Recent research finds that “hiding evidence from inspectors and falsifying dust samples has become so routinized in the mines . . . that miners are instructed to change practices when inspectors are present.”^[52]

Financial concerns exist for much of the industry and especially the Black Lung Disability Trust Fund and its beneficiaries. The Black Lung Trust Fund is financed by a coal excise tax, which requires coal companies to pay $1.10 per ton of underground-mined coal and $0.55 per ton for surface-mined coal.^[53] This fund was created for miners who could not identify the responsible coal operator for their black lung claim or whose former employers had gone out of business. In 2020, coal operators sought a $220 million cut to the coal excise tax.^[54] Additionally, the coal excise tax was set to expire at the end of 2020. This expiration period meant that money for black lung benefits could dry up quickly. The Black Lung Benefits Disability Trust Fund Solvency Act of 2020, introduced to Congress in late 2020, would extend the black lung excise tax through December 31, 2030. In 2021, the Black Lung Trust Fund was under immense strain as more coal companies filed for bankruptcy and more miners filed for benefits.^[55] Of the 718,123 black lung claims made to the Department of Labor (DOL) between 1973 and 2020, only 2.5% have received compensation, excluding those paid by responsible operators.^[56]

The BLA continues to advocate for miners and black lung benefits. For instance, in 2019 the BLA brought over 150 people to Washington, D.C., to help secure black lung benefits funding through 2020. As a part of the tax extenders package attached to the pandemic relief legislation in late 2020, Congress extended the excise tax, but only for one year, through December 31, 2021.^[57] The solvency of the Black Lung Trust Fund remains questionable. A Government Accounting Office study reported in 2018 that the trust faces financial challenges and that its debt could increase to $15 billion dollars by 2050, due in part to declining coal production and coal company bankruptcies. Expenditures have consistently exceeded revenue.^[58] In 2020, there was a $4 billion dollar debt from the federal government.^[59]

Conclusion

The struggle to protect the health and safety of coal miners in Appalachia continues. After seventy years, we now have a better understanding of black lung disease and its causes; however, disagreement still divides the medical profession, elected politicians, and even government agencies as to how we should identify and respond to the disease. Although the UMWA is working with the Black Lung Association to eradicate the disease and to obtain compensation for miners, the coal industry continues its opposition on multiple levels. From the standpoint of disbursements paid to miners over time, the black lung movement has been immensely successful. From 1973 through 2019, there were 715,565 claims and $166,577,569.00 paid from the Black Lung Trust Fund. These figures do not include benefits paid by responsible coal mine operators and insurers.^[60] Data gathered about all Appalachian states in 2023 indicates that nearly $130 million was paid in black lung benefits.^[61] In 2024, a coal miner with black lung will receive $772.60 per month, which increases to $1,545.20 with three or more children.^[62] Most, if not all, of their medical bills are paid as well.

The movement had other non-monetary benefits as well. Jimmy Moore, the president of a Black Lung Association chapter in Whitesburg, Kentucky, worked in a union mine for 22 years. He filed an initial claim for healthcare benefits in 2019. Participating in the movement was about more than just monetary compensation. He enjoys being with his mining brothers and fighting for what they think is right for medically compromised miners, their widows, and the younger miners, like his own son, who have complicated black lung disease.^[63]

While black lung disease is incurable and fatal, it is preventable, yet we continue to fail to protect our miners. The U.S. Department of Labor estimates that every year, about 1,000 miners die from black lung.^[64] This rate is likely a conservative estimate. Additionally, the impacts of black lung are wide-reaching based on the magnitude of disability, years of life lost, financial strain, depression, and declining quality of life for miners and their families as they watch their loved ones struggle for their next breath. Although not an isolated Appalachian problem, its disproportionate impact on the region has been devastating for many families.

The black lung movement has been, and continues to be, an important part of a broader crusade in the Appalachian Mountains to protect miners and preserve a future for Appalachians historically dependent on coal. Social and environmental injustice issues abound in Appalachia and have for centuries. The continued struggles of miners are many and include their fight for better workplace protections, the continuation of black lung benefits, and healthy employment alternatives. The black lung movement shows the need for sustained focus on occupational health issues across Appalachia and the United States.

Bibliography

Allen, Anna, and Carl Werntz.“Black Lung Disease on the Rise: 5 Questions Answered.” The Conversation, February 16, 2018. https://theconversation.com/black-lung-disease-on-the-rise-5-questions-answered-91637?

Antao, V.C., E.L. Petsonk, and M.D. Attfield. “Advanced Cases of Coal Workers’ Pneumoconiosis—Two Counties, Virginia, 2006.” CDC Morbidity and Mortality Weekly Report 55 (2006): 909-13. https://www.jstor.org/stable/23316864

Antao, V.C, E.L. Petsonk, L.Z. Sokolow, A.L. Wolfe, G.A. Pinheiro, J.M. Hale, and M.D. Attfield. “Rapidly Progressive Coal Workers’ Pneumoconiosis in the United States: Geographic Clustering and Other Factors.” Occupational and Environmental Medicine 62 (2005): 670-74. https://doi.org/10.1136/oem.2004.019679          

Berkes, Howard. “Advanced Black Lung Cases Surge In Appalachia.” Heard on All Things Considered. NPR. December 15, 2016. https://www.npr.org/2016/12/15/505577680/advanced-black-lung-cases-surge-in-appalachia                              

Berkes, Howard. “Calls for Change Follow NPR/Frontline’s Black Lung Investigation.” NPR, January 22, 2019. https://www.npr.org/2019/01/22/685999992/calls-for-change-follow-npr-frontline-black-lung-investigation

“Black Lung Clinics: Support Vital for Retired Miners.” Bluefield Telegraph. June 18, 2017. https://www.bdtonline.com/opinion/editorials/black-lung-clinics/article_fd518aae-d2e5-5767-b0bb-1ccc0d75d69b.html 

“Black Lung Clinics Program.” Health Resources & Services Administration (HRSA). February 15, 2021. https://www.hrsa.gov/get-health-care/conditions/black-lung 

Blackley, David J., Cara N. Halldin, and A. Scott Laney. “Continued Increase in Prevalence of Coal Workers’ Pneumoconiosis in the United States, 1970-2017.” American Journal of Public Health 108 (2018): 1220-222. https://pubmed.ncbi.nlm.nih.gov/30024799/

Blackley, David J., et al, “Progressive Massive Fibrosis in Coal Miners From 3 Clinics in Virginia.” Journal of the American Medical Association 319 (2018): 500-01. https://jamanetwork.com/journals/jama/fullarticle/2671456

Bodenhamer, Aysha. “'Outlaw Operators': Prevention Failures and the Resurgence of Black Lung in Central Appalachia.” University of New Hampshire, Carsey School of Social Policy. July 28, 2020. https://carsey.unh.edu/publication/black-lung-Central-Appalachia

Bodenhamer, Aysha. “The Resurgence of Black Lung: A Critical Examination of Environmental Illness in Central Appalachia.” PhD diss., North Carolina State University, 2017.

Brown, Matthew. “Amid Pandemic, U.S. Coal Industry Seeks Lower Taxes, Royalties.”  Associated Press. March 20, 2020. https://apnews.com/article/10cdeff2f226892d54cb937fe464706b

Castranova, Vincent, and Val Vallyathan.“Silicosis and Coal Workers' Pneumoconiosis.” Environmental Health Perspectives 108 (2000): 675-84. https://doi.org/10.2307/3454404

“Coal Excise Tax Funding Black Lung Disability Trust Fund Extended for One More Year.” Tax Payers for Common Sense. December 24, 2020. https://www.taxpayer.net/energy-natural-resources/coal-excise-tax-funding-tblack-lung-disability-trust-fund-extended-for-one-more-year/

Cohen, Robert A., Edward L. Petsonk, Cecile Rose, Byron Young, Michael Regier, Asif Najmuddin, Jerrold L. Abraham, Andrew Churg, and Francis H. Y. Green. “Lung Pathology in U.S. Coal Workers with Rapidly Progressive Pneumoconiosis Implicates Silica and Silicates.” American Journal of Respiratory Critical Care Medicine 193 (2016): 673-80. https://www.atsjournals.org/doi/pdf/10.1164/rccm.201505-1014OC 

Denman, William N. “The Black Lung Movement: A Study of Contemporary Agitation.” PhD. diss., Ohio University, 1974, 67-71.                     

Doyle, Henry N. “The Impact of Changing Technology on Health Problems in the Coal Mining Industry.” In Papers and Proceedings of the National Conference on Medicine and the Federal Coal Mine Health and Safety Act of 1969, 195-97. Washington, D.C.: U.S. Government Printing Office, 1970.

Eisenberg, Ann. “As the Coal Industry Shrinks, Miners Deserve a Just Transition.” The Conversation. November 4, 2019. https://theconversation.com/as-the-coal-industry-shrinks-miners-deserve-a-just-transition-heres-what-it-should-include-116340

Gabriel, Trip. “Ex-Executive Donald Blankenship Is Indicted in Disaster at Coal Mine.” New York Times, November 13, 2014. https://www.nytimes.com/2014/11/14/us/ex-executive-donald-blankenship-is-indicted-in-disaster-at-coal-mine.html

Gaffney, Austyn. “These Coal Communities Are Protecting Sick Miners from COVID-19 and Pushing Congress for More Support.” Southerly, April 23, 2020. https://southerlymag.org/2020/04/23/these-coal-communities-are-protecting-sick-miners-from-covid-19-and-pushing-congress-for-more-support/

Hume, Brit. Death and the Mines. New York: Grossman Publishers, 1971.

Judkins, Bennett M. “The Black Lung Association: A Case Study of a Modern Social Movement.” PhD diss., University of Tennessee, 1975.                                            

Judkins, Bennett M. “The People’s Respirator: Coalition Building and the Black Lung Association.” In Fighting Back in Appalachia: Traditions of Resistance and Change. Edited by Stephen Fisher, 227-28. Philadelphia: Temple University Press, 1993.                                                                                                                

Judkins, Bennett M. We Offer Ourselves as Evidence: Toward Workers’ Control of Occupational Health. New York: Greenwood Press, 1986.    

Laney, Scott A., and Michael D. Attfield, “Examination of Potential Sources of Bias in the U.S. Coal Workers’ Health Surveillance Program.” American Journal of Public Health 104 (2014): 165-70. https://doi.org/10.2105/AJPH.2012.301051        

Legislative History of the Federal Coal Mine Health and Safety Act of 1969, U.S. Senate, August 1975 (Washington: U.S. Government Printing Office), 133.        

Maher, Kris. “Black Lung Disease Makes Comeback, Study Shows.” Wall Street Journal, Sept. 15, 2014. https://www.wsj.com/articles/black-lung-disease-makes-comeback-study-shows-1410789596                                                             

Matta, Allan. “An End to Black Lung Disease: How Close Are We?” (Part 1: The Risk of Coal Dust Inhalation). ThermoFisher Scientific, May 12, 2015. https://www.thermofisher.com/blog/mining/an-end-to-black-lung-disease-how-close-are-we-part-1-the-risk-of-coal-dust-inhalation/

The National Coalition of Black Lung and Respiratory Disease Clinics. Feb. 7, 2021. http://blacklungcoalition.org/                                                                                      

Petsonk, Edward L., Cecile Rose, and Robert Cohen. “Coal Mine Dust Lung Disease. New Lessons from an Old Exposure.” American Journal of Respiratory and Critical Care Medicine 187 (2013): 1178-185. https://doi.org/10.1164/rccm.201301-0042CI                                                

Ridder, Kevin. “The Black Lung Association Responds to the Deadly Disease’s Rise.” Appalachian Voice, October 11, 2019. http://appvoices.org/2019/10/11/the-black-lung-association/                               

Ross, Brian. “Big Money, Black Lung and Doctors for the Coal Companies.” ABC News, October 30, 2013. https://www.youtube.com/watch?v=KSYmJyTiZNQ    

Smith, Barbara E. Digging Our Own Graves: Coal Miners and the Struggle Over Black Lung Disease. Philadelphia: Temple University Press, 1987.                                     

Smith, Barbara E. Digging Our Own Graves: Coal Miners and the Struggle over Black Lung Disease (reprint). Chicago: Haymarket Books, 2020.                                    

Tan, Catlin. “How Miners with Black Lung Disease Are Navigating the Pandemic.” Allegheny Front, September 4, 2020. https://www.alleghenyfront.org/how-miners-with-black-lung-disease-are-navigating-the-pandemic/          

Trupp, Phillip. “Dr. Buff vs. Black Lung.” Reader's Digest, June 1969, 101-05.  

U.S. Department of Labor. “Benefit Rates Under Part B, 1969-2021.” Division of Coal Mine Workers’ Compensation, Office of Workers’ Compensation Programs (OWCP). February 2007, 2021. https://www.dol.gov/agencies/owcp/DCMWC/benefits_part_b.                            

U. S. Department of Labor. “Black Lung Bulletin.” Division of Coal Mine Workers' Compensation. February 1974.                                  

U.S. Department of Labor. “Black Lung Program Statistics: Distributions of Part C Black Lung Claims and Disbursements, by State.” Office of Workers' Compensation Programs (OWCP),  March 23, 2021. https://www.dol.gov/agencies/owcp/dcmwc/statistics/bls2020/DistributionOfClaimsByState2020            

U.S. Department of Labor. “Coal Excise Tax.” Natural Resources Revenue Data. April 21, 2021. https://revenuedata.doi.gov/how-revenue-works/coal-excise-tax/       

U.S. Department of Labor. “Coal Fatalities for 1900 Through 2019.” Mine Safety and Health Administration. January 29, 2021. https://arlweb.msha.gov/stats/centurystats/coalstats.asp          

U.S. Department of Labor. “End Black Lung.” Mine Health and Safety Administration (MHSA). February 20, 2021. https://arlweb.msha.gov/S&HINFO/BlackLung/Videos.asp        

U.S. Department of Labor. “NIOSH-MSHA Respirable Mine Dust Partnership Charter.” Mine Safety and Health Administration. https://www.msha.gov/regulations/niosh-msha-respirable-mine-dust-partnership-charter                              

U.S. Department of Labor. “Respirable Dust Rule: A Historic Step Forward in the Effort to End Black Lung Disease.” Mine Safety Health Administration. December 16, 2016. https://www.msha.gov/news-media/special-initiatives/2016/09/28/respirable-dust-rule-historic-step-forward-effort-end  

U.S. Department of Labor. “Q&As–Impact of OWCP Bulletin 14-09 (Addressing Dr. Wheeler X-Ray Readings) on Previously Denied Claims.” Office of Workers’ Compensation Programs (OWCP), April 22, 2021. https://www.dol.gov/agencies/owcp/negativechestxrays         

U.S. Bureau of Labor Statistics. “Coal Mining Employment.” March 31, 2021. https://data.bls.gov/            

U.S. Government Accountability Office. “Black Lung Benefits Program: Oversight Is Needed to Address Trust Fund Solvency Strained by Bankruptcies.” April 22, 2021 https://www.gao.gov/products/gao-20-438t                                              

Vallyathan, Val, et al, “The Influence of Dust Standards on the Prevalence and Severity of Coal Workers’ Pneumoconiosis at Autopsy in the United States of America.” Archives of Pathology and Laboratory Medicine 135 (2011): 1550-556. https://doi.org/10.5858/arpa.2010-0393-OA                    

Valdmanis, Richard. “A Tenth of U.S. Veteran Coal Miners Have Black Lung Disease: NIOSH.” Reuters, July 19, 2018. https://www.reuters.com/article/us-usa-coal-blacklung/a-tenth-of-us-veteran-coal-miners-have-black-lung-disease-niosh-idUSKBN1K92W1