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

By Taylor Sisk

AK 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.

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.”

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.

(KFF/AM)