Black Lung Disease Remains a Threat, but Federal Officials Delay Effort To Address It

OAK HILL, W.Va. — Each day at New River Health in Oak Hill, Lisa Emery finds disheartening signs of what she describes as a slow-motion repeat of the Hawks Nest Tunnel disaster.

Emery is director of New River’s Breathing Center and chair of the National Coalition of Black Lung and Respiratory Disease Clinics.

The disaster she’s reminded of started in 1930, when construction began on a 3-mile tunnel through Gauley Mountain in West Virginia. Over the course of 18 months, some 3,000 miners, most of them Black, spent long hours drilling through sandstone, engulfed in a cloud of its toxic byproduct, silica dust. More than 750 men died from that exposure.

The risk still exists, and advocates for workers say the government should do more to rein it in.

In April of last year, the Trump administration paused the enforcement of a rule designed to help protect coal miners from an aggressive form of coal workers’ pneumoconiosis, commonly known as black lung disease, the primary cause of which is exposure to silica dust.

(Other occupations at high risk of exposure to silica dust include construction, countertop fabrication, and oil and gas work. The new rule would reduce the permissible limit of exposure in coal mining to the existing level in other industries.)

This April, the Labor Department’s Mine Safety and Health Administration announced an indefinite delay in enforcement of the rule.

Gary Hairston sits on New River Health’s board. For decades, Hairston, a retired coal miner and president of the national Black Lung Association, has been an advocate for miners struggling with the debilitating effects of black lung, including extreme fatigue, an incessant cough, and a sensation of drowning. He regularly lobbies legislators for improved working conditions and black lung benefits. His entreaties, he said, seem to fall on deaf ears. He rarely gets an audience with the legislators themselves.

“I’d just like them to look me in the face,” Hairston said.

Gary Hairston, president of the Black Lung Association, says his lobbying of legislators for improved working conditions and black lung benefits for coal miners seems to fall on deaf ears. (Taylor Sisk for KFF Health News)

Evidence from just-released research underscores the urgency of his appeals for a safer work environment.

In August, the National Institute for Occupational Safety and Health, an agency within the federal Centers for Disease Control and Prevention, released a report on the results of testing conducted over the past five years on miners in central Appalachia — eastern Kentucky, southwestern Virginia, and West Virginia — with 25 or more years underground. Almost 1 in 3 tested positive for black lung disease, the highest rate in nearly 50 years.

The rate in 2018, the last time the agency reported results, was 1 in 5. The lowest reported rate, in 1999, was less than 1 in 10.

“We knew this would happen,” said Sam Petsonk, a West Virginia attorney who has represented thousands of miners in the region. “It’s surprising to me that they only found one in three.”

Silica Dangers

Exposure to silica has increased as more-accessible coal seams are depleted, requiring mining operations to probe deeper, often through sandstone. The stone breaks into sharp particles that are 100 times smaller than a grain of sand and, according to National Institute for Occupational Safety and Health research, are some 20 times more toxic than coal dust. Trapped in lung tissue, those particles can cause a debilitating, sometimes fatal condition.

Kenny Thompson, a retired West Virginia miner who now lives in Richmond, Kentucky, was employed in the mines for 22 years. He would sometimes cut into four feet of sandstone to reach a coal seam.

“You ate a lot of dust,” Thompson recalled. It induced nausea. It took a toll.

In October 2025, he had his left lung removed. Post-surgery, he was in a coma for three months; he flatlined three times, he said. “They were about to really give up on me.”

He had to relearn to walk and to talk. Trekking to the mailbox still leaves him winded, lightheaded, and blurry-eyed.

The new silica rule would cut the allowable level of silica dust in half, thereby meeting the standard of other industries. Miner advocates laud the fact that it would require operators to deploy engineering controls, such as improved ventilation systems and water sprays.

But the National Mining Association and other industry trade groups argue that reaching and maintaining compliance would also require supplementing those controls with workforce measures, such as requiring personal protection equipment and rotating miners from particularly dusty areas. Many miners, and their advocates, say such measures are impractical — because respirators can impede breathing, can limit vision, and often malfunction, and because smaller mines don’t have enough workers to support rotating schedules.

In April 2025, the 8th U.S. Circuit Court of Appeals granted an emergency stay of the rule to give operators more time to comply.

In May of this year, the Labor Department sent the White House Office of Management and Budget a request to gather information on the proposed rule. And in July, the department’s regulatory agenda included a new notice of proposed rulemaking, indicating its intent to amend the rule.

The department’s Mine Safety and Health Administration “recognizes it has a clear duty under the law to impose stricter silica standards,” said Petsonk, the attorney representing coal miners. “They’re failing to provide that measure of protection to American coal miners, so they’re going through bureaucratic motions to make it seem like they’re doing something, when, in fact, they’re just perpetuating an illegal and lethal status quo.”

The Labor Department declined to comment on ongoing rulemaking or litigation.

“We knew this would happen,” West Virginia attorney Sam Petsonk says of a recently released report showing that the black lung rate for coal miners in central Appalachia is at a nearly 50-year high. (Taylor Sisk for KFF Health News)

‘It’s On the Books’

The rule is, in fact, in effect, said Chris Williamson, head of the Mine Safety and Health Administration in the Biden administration — it’s just not being enforced. He and his team filed a legal brief in the closing days of the administration defending the rule.

“It’s on the books,” Williamson said, adding that the Mine Safety and Health Act prohibits weakening existing protections for miners. “I’m just genuinely curious,” he said. “I want to know how they can address the issues that the industry’s raised without weakening protections for miners.”

Meanwhile, younger miners, with a decade or less in the mines, are being diagnosed with advanced stages of black lung. New River Health’s Emery said the youngest person her clinic had diagnosed with complicated black lung was 30. He’d worked underground for 10 years.

This is no longer just your “papaw’s disease,” she said. “It’s your husband’s disease. It’s your son’s disease.” (More than 90% of coal miners are men.)

With families to support, Emery said, “what do these guys do when they’re disabled in their 30s?”

Lisa Emery is director of the New River Health Breathing Center in West Virginia and chair of the National Coalition of Black Lung and Respiratory Disease Clinics. She says the youngest person her clinic has diagnosed with complicated black lung was 30. (Taylor Sisk for KFF Health News)

She told of a man who sat in her office with his wife, describing his symptoms. As he spoke, he began to cry. His wife was taken aback. “‘I didn’t know it was that bad,’” Emery recalled her saying. “And he said: ‘That’s why I haven’t fixed the deck. I haven’t fixed the deck because I can’t breathe, and I’m just so tired.’”

Thompson can relate. “For 22 years, you’re used to getting up, putting your boots on every day, and going to work,” he said. “I’d been in great health shape and 160 pounds. And here I am now, I don’t work at all and I’m 115 pounds.”

Still, he recognizes what the job afforded.

“You know, it put my girls through college,” he said. “And to me, as a dad, that was the best reward that I can give them, to move forward in life, to be successful at what they chose to be and not work like a dog like I had to.”

President Donald Trump said in an April 2025 executive order: “Our Nation’s beautiful clean coal resources will be critical to meeting the rise in electricity demand due to the resurgence of domestic manufacturing and the construction of artificial intelligence data processing centers.”

Six months later, the Energy Department announced a $625 million investment to “expand and reinvigorate America’s coal industry.”

Should the administration announce a weaker rule, it would be “an unconscionable crime against American coal miners,” Petsonk said. “But I fear that’s going to happen.”

In June, Hairston spoke at a reception for a photo exhibit titled “Entirely Preventable: The Toxic Legacy of Silica Dust From Hawks Nest to Black Lung.”

“It seems like coal miners, we’re just a number,” he said. “Just a number.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.This article first appeared on KFF Health News and is republished here under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.