Black Lung in the 21st Century: Disease, Law, and Policy

26 Pages Posted: 25 Apr 2018 Last revised: 22 Jul 2018


The past decade has seen many changes in the fields related to black lung. Although American coal production and employment have been declining, more coal miners are suffering from breathing problems related to coal-mine dust. 20th-century efforts to end black lung failed. The Appalachian coalfields are now the epicenter of one of the worst industrial health disasters in U.S. history. Current rates of severe black lung among career Appalachian miners are worse than when federal statistics started being kept in 1970.

While the disease has worsened, the legal system has seen some important improvement. In particular, the past decade has seen four major changes to the federal law concerning black lung. First, in 2014, the U.S. Department of Labor (“DOL”) made the first changes since 1972 to the regulations limiting the dust that miners breathe while working underground. The Dust Rule reduces the permissible dust level by 25%, closes important loopholes, and provides miners with better information about their working conditions. Second, the Affordable Care Act (“ACA”) contains provisions known as the “Byrd Amendments” that automatically entitle many widows to black lung benefits and provide experienced coal miners suffering from a respiratory disability with a powerful presumption that their disabling breathing problems are due to black lung. Third, in 2000, DOL made major revisions to its regulations that went into effect in 2001 and, once ingrained, simplified black lung benefits litigation. Fourth, in 2016, DOL mandated that most medical evidence developed in black lung benefits claims be disclosed to the other parties.

This Article provides an overview of the current medical reality of black lung and recent changes to federal law. It also discusses current policy issues in the black lung benefits system. This Article will argue for two changes to improve the compensation system for those miners who already have the disease. First, we must eliminate the delays plaguing the adjudication of federal black lung benefits system. Second, we must shift the responsibility of black lung medical benefits from coal operators to a federal health insurance program that covers all coal miners. This would greatly decrease the amount of litigation and provide needed health benefits for a broader group of miners.

Unfortunately, black lung will continue to be a salient topic in Appalachia over the next century. This Article hopes to contribute to an inquiry into how this disease can be eliminated and how compensation can be provided to coal miners and their families consistent with the public interest.

Keywords: black lung, coal, pneumoconiosis, coal workers' pneumoconiosis, CWP, black lung benefits, workers' compensation, mine safety, public benefits, Department of Labor, DOL, Affordable Care Act, ACA, Dust Rule, Medical Disclosure, Health Insurance

JEL Classification: K39

Suggested Citation

Smith, Evan, Black Lung in the 21st Century: Disease, Law, and Policy. 120 West Virginia Law Review 797 (2018), Available at SSRN:

Evan Smith (Contact Author)

AppalReD Legal Aid ( email )

120 N. Front Ave.
Prestonsburg, KY 41653
United States

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