Black Lung Still Kills: Pneumoconiosis in the Commonwealth

When I clicked on a recent National Public Radio story about Black Lung disease in Appalachia, I expected the story to profile workers in West Virginia and Kentucky. To my surprise, however, most of the people referred to in the piece live in Southwest Virginia. That made me curious about the Commonwealth’s response to the largely union-led, mid-20th-century push for Black Lung compensation in the United States.

The many daily dangers faced by underground coal miners are well known and have been for centuries. Along with roof falls, methane explosions, and cave-ins came a more insidious danger that slowly robbed a miner of breath. George Pearson, an English physician and chemist, published a paper in 1813 regarding “black glands” from inhaling soot from coal and wood. However, the causal relationship continued to be debated until 1831, when a Scottish physician James C. Gregory positively identified coal dust as the cause for “miner’s asthma” or anthracosis. By the end of WWII, Britain designated coal workers’ pneumoconiosis (Black Lung) as a compensable work-related disability under their workmen’s compensation laws. Even though one can find 19th-century newspaper references to “miner’s asthma,” in the United States, it would take until 1969 for any meaningful federal action.

Industrial mobilization during WWII helped to speed up the large-scale mechanization already underway in coal mining. More machines meant less of a need for miners, but it also meant a massive increase in the amount of coal dust being inhaled by those miners who kept their jobs.

Prior to federal legislation, Pennsylvania, Alabama, and briefly, Virginia acknowledged Black Lung as an occupational disease. Virginia could have been the second early adopter of compensation for Black Lung, after Pennsylvania. In 1948, an amendment to the workers’ compensation law recognized pneumoconiosis as an occupational disease. However, law-makers removed the amendment shortly after it was added.

Over the next two decades, members of the “coalfield delegation” introduced bills in the General Assembly to restore pneumoconiosis to the state Industrial Commission’s list of recognized occupational diseases. The Industrial Commission of Virginia (now the Virginia Workers’ Compensation Commission) had responsibility for administering a system of compensation for disabled workers under the 1918 Virginia Workmen’s Compensation Act.

Union membership in Virginia’s coal mining region was not at the level of other coal producing states. United Mine Workers of America (UMWA) locals existed and were active in many southwestern localities, but they did not have the level of political influence that the UMWA exercised in other state capitals. A perennial chief opponent of bills introduced to add pneumoconiosis to the occupational diseases list was Delegate Dr. W. C. Elliott of Russell County. Dr. Elliott operated the Lebanon General Hospital along with his brother, and since the 1940s had worked at Clinchfield Coal Corporation’s hospital in Dante.

In 1964, Dr. Elliott did advocate for the addition of silicosis to the list of occupational diseases. While silicosis is often experienced by coal miners, it is a far more specific and narrowly defined condition unrelated to coal dust. Airborne coal dust is highly combustible, and poor remediation could lead to explosions, as well as lung disease. Mine safety laws in Virginia at the time had no enforceable guidelines for managing coal dust.

In March of 1968, advocates for Black Lung compensation in Virginia had a breakthrough. The General Assembly passed legislation to add pneumoconiosis to the list of compensable occupational diseases. Eight months later, however, the issue of coal miner health and safety would become a national one.

At 5:30 a.m. on November 20, 1968, just outside the town of Farmington, West Virginia, the Consol No. 9 coal mine exploded with 99 miners inside. Seventy-eight miners died that day, and 19 of their bodies could not be recovered. The tragedy would help launch a renewed effort by the UMWA and other groups to pass national coal mine health and safety legislation. The resulting Federal Coal Mine Health and Safety Act of 1969 (the “Coal Act”) created the Mine Safety and Health Administration (MSHA), improved mandatory federal health and safety rules for coal operators, established a national Black Lung compensation program, and set up a central repository for coal mine maps.

The executive papers of Governors Linwood Holton (1970-1974) and Mills Godwin (1974-1978) contain letters from coal company executives, Southwest Virginia Chambers of Commerce, and business leaders lamenting the passage of the Coal Act and predicting the downfall of the economy in Virginia’s Appalachian region if federal mine inspectors are allowed to close down operations for “minor infractions.” The July 1970 “Governor’s Special Fact-Finding Investigation on Coal Supply” report blames the Coal Act for closing 167 Virginia coal mines to date.^[1] The report begins by referencing several examples of negligible violations such as signage or bulletin board placement to frame the federal oversight as frivolous. However, it then goes on to identify the “3.0 mg respirable dust standard” by MSHA as the biggest compliance obstacle for coal operators.

Governor Godwin’s second-term files contain letters from coal miners, several written by their wives, asking the governor to assist them in claiming their Black Lung benefits. The Social Security Administration (SSA), which administered the federal compensation program, was severely understaffed, had very specific rules for inclusion, and was nearly two years behind in responding to applications. One miner writes that his employee hospital card was cut off because he could no longer work due to his breathing.² In another letter, a coal miner’s wife relates her fears about not being able to pay bills due to her husband’s inability to work and anticipates the loss of their house where they lived with their six children.³

The Black Lung Associations, initially formed in West Virginia in 1969 to push for pneumoconiosis to be included in workmen’s compensation laws, were revived in the early Seventies and spread across Appalachian coal counties, including Southwest Virginia. The associations sought to pressure the UMWA leadership, mine operators, and the federal government to make it easier to be accepted into the Black Lung benefits program administered by the SSA under the Coal Act. Their efforts were boosted by the work of Dr. Donald L. Rasmussen and others, who proved that a diagnosis of pneumoconiosis required more than a simple chest x-ray.

Thanks to this grassroots advocacy, which included protests, work stoppages, and wildcat (not union sanctioned) strikes, in 1972 Congress passed a specific federal Black Lung Benefits Act to improve on the system created in the 1969 Coal Act. The federal program covers disabled miners when their employers cannot, typically due to bankruptcy or dissolution. The act was amended throughout the 1970s and 1980s, and as recently as 2023. Since 1977, the act has relied on a coal excise tax for its funding. Over the decades, reductions in the excise tax rate coupled with a decrease in coal production have caused the Black Lung Disability Trust Fund to run a significant deficit.

According to a report from the Virginia Department of Energy, in 2025, forty-four companies operating 121 mines in Buchanan, Dickenson, Russell, Lee, Tazewell, and Wise Counties produced 9.5 million short tons of coal estimated to be worth $1.31 billion. In 2023, 2,530 Virginians were employed in the coal mining industry, approximately 65% of those employed work underground.

Virginia’s coal mining employment and output is significantly lower than its peak production year of 1990, when 10,000 miners produced 46.5 million tons,⁴ however, the scourge of coal miner’s pneumoconiosis persists. Phossy jaw, erethism (or “mad hatter’s disease”), shipboard scurvy, and other archaic maladies have all disappeared thanks to science, technology, and safety standards. Black Lung, a centuries-old industrial hazard, continues to rob the breath of those who mine coal.