February 11, 2019

One of the duties I accepted many years ago was to provide evaluations for coal miners claiming disability due to Coal Worker’s Pneumoconiosis (CWP). These evaluations are for the Department of Labor (DOL), and have specific criteria that I must report. Many of the coal miners present with so-called “simple pneumoconiosis”, which may or may not be associated with significant pulmonary functional impairment.
One of the most severe forms of Coal Worker’s Pneumoconiosis is called progressive massive fibrosis, or PMF. This form of the disease is characterized by the conglomeration of small coal dust nodules in the lungs into very large coal dust nodules, which retract and distort the lung tissue. This form of disease is clear evidence that the patient has severe and disabling CWP, preventing him (rarely her) from doing his usual coal mine work.
The effect of PMF on patients is not new. What does seem to be new is the resurgence of this form of the disease in the last 20 years. This rise occurred during a period of declining workforce numbers and is not related to any increase in claims. The increase in claimants with PMF has significantly risen since 1996, with most coming from Kentucky, Virginia and West Virginia.
Changes in mining procedure with mechanization, mining of thin-seam coal, and an increase in silica exposure may be part of the answer to increased PMF claims. More research is called for, and greater attention to primary and secondary prevention of coal dust related lung disease is needed.

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George M. Zlupko, MD, FCCP

Timothy A. Lucas, MD, FCCP

Alan J. Kanouff, DO, FCCP

Dr. Michael C. Zlupko, MD

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