The Department of Labor (DOL) provides a grant to UPMC Altoona to conduct examinations on patients who are interested in applying for Black Lung benefits. The process involved in this evaluation encompasses two distinct areas. The first is the medical portion, in which I have been involved for about 30 years, and the second is the governmental portion which involves the law surrounding coal miners and their benefits, either under state or federal law. This merger of law and medicine and the path that it may take an individual coal miner is often confusing and frustrating.

I start most interviews and exams with two pieces of information I want the coal miner patient to know. The first is that any miner who has spent any time in the coal mining industry, whether above or below ground, has coal dust in their lungs. That is not the issue. The second piece of information is that, in general, in order to have a successful claim a chest X-ray interpreted by a so-called “B reader” must have findings consistent with coal dust deposition and there must be some abnormality with the miner’s pulmonary function study or blood gas analysis. Both of these findings are usually needed for a successful claim.

Adding to the above confusion is the fact that the X-ray findings in coal miners lung disease do not correlate directly with lung function. A miner with a minimal finding on X-ray may have serious lung dysfunction.

I am sympathetic to the confusion and frustration.