Extensions of Remarks

8664 EXTENSIONS OF REMARKS May4, 1982 EXTENSIONS OF REMARKS AMERICAN LUNG ASSOCIATION The X-ray is instrumental in diag gressive massive fibrosis <PMF). These rela REPORTS ON RESPIRATORY nosing black lung, so rereading of an tively specific pathologic changes, along DISEASE OF COAL WORKERS X-ray should not be prohibited; and with any consequent physiologic abnormali Compensation laws need to distin ties, constitute coal workers' pneumoconio sis <l, 2). Clearly, these histopathologic guish between impairment and disabil changes may precede radiographic evidence HON. JOHN N. ERLENBORN ity, and it is the latter on which a com of CWP, but it should be emphasized that, OF ILLINOIS pensation determination should be particularly during the stage of pre-radio based. graphic abnormality, no pulmonary func IN THE HOUSE OF REPRESENTATIVES I hope my colleagues find the ALA's tional changes due to CWP can be anticipat Tuesday, May 4, 1982 discussion useful in evaluating the cur ed. Substantial support for this conclusion rent shortcomings in the black lung stems from the repeated findings that even e Mr. ERLENBORN. Mr. Speaker, program and as a guide to judging in categories 1 and 2 of simple CWP <deter since its enactment in 1969 as title IV other occupational disease legislation. mined by X-ray) clinically significant pul of the Coal Mine Health and Safety monary functional abnormalities are absent. Act, I have been a critic of the black REPORT ON RESPIRATORY DISEASE OF COAL while histopathologic changes can therefore WORKERS BY AN AD Hoc WORKING GROUP be said to be more sensitive and specific for lung program. My disenchantment OF THE AMERICAN THORACIC SOCIETY stems in part from the program's fail the disagnosis of CWP, impairment and dis INTRODUCTION ability are not a consequence of these early ure to assure that compensation is The American Lung Association and its morpholog- ic changes. Since lung biopsy is paid only in cases of total disability or medical section, the American Thoracic So very rarely indicated in this or other occu death due to coal workers' pneumo ciety, are pleased to provide this position pational lung disorders, the chest radio coniosis. In fact, according to the summary on selected medical issues dealing graph is ordinarily the only definitive GAO, in 88.5 percent of the Social Se with respiratory health effects which may method for diagnosing the presence of CWP curity Administration black lung cases be associated with coal dust exposure. Our in life. We feel therefore that heavy, if not and 84 percent of the Labor Depart organizations have in the past provided exclusive, reliance must be placed on the ment cases, benefits were awarded input into the Federal legislative process proper reading of a technically satisfactory which compensates workers who are judged chest X-ray film in order to establish the di without adequate medical evidence of to have coal dust exposure-related disease. agnosis of CWP in actively employed or re black lung or disability due to black In this brief summary statement we have tired miners. It therefore follows that denial lung. Moreover, concluded the GAO, elected to focus on several issues of concern of a compensation claim may very well ap this was not contrary to the law. Thus, to our community. The first deals with the propriately be based on a negative chest X the black lung program provides noth definition and diagnosis of coal workers' ray film, and that there will be frequent cir ing more than a pension for coal pneumoconiosis, the second the relationship cumstances when re-reading of chest films miners and their survivors in the guise between coal dust exposure and chronic air is desirable to enhance the validity of the of an occupational disease compensa ways obstruction, and finally the assessment assessment for pneumoconiosis. Once a diag of functional impairment and disability in nosis of CWP is established, generally on tion program. coal miners and the determination of attrib the basis of radiographic evidence, impair This cynical use of occupational dis utability of their occupation. We are grati ment and disability should be determined as ease has been accomplished through a fied that recent reports of the National In discussed below. stitute for Occupational Safety and Health disregard of the medical basis of coal RELATIONSHIP OF OBSTRUCTIVE AIRWAY workers' pneumoconiosis. <NIOSH> and the College of American Pa thologists have helped to provide the basis DISEASE TO CWP It is the law which has presumed for a consensus among medical experts in The occurrence of symptoms of cough, that any pulmonary impairment cou this field. We are also pleased that the sputum, shortness of breath, wheezing, pain pled with 10 years' work in the mines recent amendment passed by the Senate <S. in the chest or weight loss in a coal miner constitutes black lung. 1922) for the Black Lung Benefits Revenue cannot automatically be assumed to be aris It is the law which, until the 1981 Act of 1977 includes the provision that the ing from CWP or necessarily a consequence Secretaries of Labor and Health and Human of coal mining exposure. Coal miners, like Black Lung Act amendments, prohibit other individuals, smoke cigarettes, inherit ed rereading of a positive X-ray. Services "shall undertake a study of current medical methods for the diagnosis of pneu the predisposition to develop allergies and It is still the policy, if not the law, moconiosis and of the nature and extent of asthma, are exposed to air pollution, may that a claim for totally disabling black impairment and disability that are attribut contract respiratory infections and develop lung cannot be denied on the basis of a able to the existence of both simple and lung cancer. Since the lungs have relatively negative X-ray. complicated pneumoconiosis." We are hope few, stereotyped ways of manifesting symp Now the American Lung Association ful that the biomedical community expert toms that are due to a wide variety of and its medical section, the American in this area will be provided full opportunity causes, disease;; of diverse origins may be to participate in these deliberations and present with the same pulmonary symp Thoracic Society, have reviewed the assist in the preparation of the report to the toms. It is usually possible by careful in medical issues relating to coal workers' Congress mandated by this amendment. quiry, physical examination, and appropri pneumoconiosis. Their findings sup This summary statement has been prepared ate pulmonary function tests to sort out the port what I have been saying for by an ad hoc working group of the Ameri causes for these common symptoms. It is, years, based on other medical evalua can Thoracic Society 1 appointed by the therefore, necessary to discuss what, if any, tions of coal workers' pneumoconiosis, President and expresses views recently relationship there is between naturally oc adopted by the American Lung Association. curring conditions that may produce the namely: same symptoms as CWP and an individual's Not every coal miner with a pulmo DEFINITION AND DIAGNOSIS OF COAL WORKERS' occupational exposure in coal mining. nary impairment has black lung, and PNEUMOCONIOSIS Chronic bronchitis is a respiratory disease it is · possible to sort out the cases of Coal workers' pneumoconiosis <CWP> re defined by the American Thoracic Society sults from the inhalation and deposition in (3) as "a condition characterized by the these other symptoms; the lung of respirable coal mine dust. The Not everyone with black lung is dis presence of cough and phlegm on most days lung tissue reaction to the dust may for at least three months of the year, for at abled; produce coal macules, coal nodules, or pro- least two consecutive years, and not due to Disabling black lung is diagnosable localized disease such as tuberculosis, pneu by X-ray and, thus, a claim for total 1 Hans Weill, M.D., Tulane University <Chair>; At monia, cancer, or bronchiectasis." Epidemio disablility can be denied on the basis tilio D. Renzetti, Jr., M.D., University of Utah; N. logical studies have shown that the most im of a negative X-ray; Leroy Lapp, M.D., West Virginia University. portant single factor associated with chron- e This "bullet" symbol identifies statements or insertions which are not spoken by the Member on the floor. May4, 1982 EXTENSIONS OF REMARKS 8665 ic bronchitis is cigarette smoking. While tion, thus differentiating it from centrilobu the statement referred to above. We believe other conditions such as climate and indus lar, diffuse emphysema and from the mini that the adoption of such a system will trial exposure may also contribute, these mal alteration in airflow seen in industrial result in considerable cost saving, a rational contributions may not be detectable unless bronchitis. and comprehensive approach to the prob only non-smokers are studied <4). The Medi The best current perspective on the rela lem and general acceptance by the pulmo cal Research Council of Great Britain con tive importance of dust and cigarette smok nary community. cluded in 1966 (5) with particular reference ing in causation of obstructive airways dis In our view the handling of "black lung" to the coal mining industry, that "on ease is provided by a recent article by Elmes disability claims by the Social Security Ad present evidence, intensity of dust exposure 04). It reviewed extensive data from studies ministration <SSA) and by the Department does not appear to be a very significant of coal miners, slate quarry workers, iron of Labor prior to the new "permanent regu factor in determining the prevalence of and steel workers, and those working with lations" has been poor, to say the least.

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