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Coal miners in Kentucky and other parts of Appalachia are contracting serious cases of black lung disease at rates not seen since the early 1970s — just after preventive regulations were enacted, according to a study published Monday.

Only 15 years ago, progressive massive fibrosis — an advanced form of black lung for which there is no cure — was virtually eradicated, health researchers say. But now, the prevalence of the disease in Kentucky, Virginia and West Virginia is at levels not seen in 40 years. .

"Each of these cases is a tragedy and represents a failure among all those responsible for preventing this severe disease," wrote researchers for the National Institute for Occupational Safety and Health in the latest issue of the American Journal of Respiratory and Critical Care Medicine.

Black lung is caused by the excessive inhalation of coal dust.

"So this increase can only be the result of overexposures and/or increased toxicity stemming from changes in dust composition," wrote researchers David J. Blackley, Cara N. Halldin and A. Scott Laney.

Such a finding could re-open the debate over how well coal-dust limits and enforcement of those limits by the federal Mine Safety and Health Administration are protecting American coal miners.

"Some way or another, they need to do something," said Gary Caudill, 64, of Blackey, Ky., who was a miner for nearly 35 years and now suffers from severe black lung. "Only thing I could figure out is they ain't doing what they're supposed to do," he said, referring to mine operators.

Caudill worked on the large machines called continuous miners that cut into the coal seams, operated roof bolting machines, and "a little bit of everything."

"You cannot get fresh air all the time" in a coal mine, Caudill said in a telephone interview. The coal dust gets thick and "I worked in quite a bit of it."

His breathing at times was labored and he explained: "I can talk for a long period of time, I just run plum out of air."

He now takes three kinds of medicine daily to help him breathe and sleeps with the aid of an oxygen machine at night.

MSHA, which is part of the Department of Labor, announced lower coal-dust limits just last April, although the agency stopped short of recommendations that the exposure levels be cut in half. It was the first time the limits had been lowered in 45 years.

Under the new rules, the government is requiring miners to wear real-time dust monitors, expanding dust sampling, closing sampling loopholes, instituting faster enforcement against violations and increasing medical surveillance of miners.

The agency also is cutting by 25 percent the concentration limits for breathable coal mine dust, to 1.5 milligrams per cubic meter of air, effective Aug. 1, 2016.

"Our goal is to lower dust levels that miners breathe … to a level that we're comfortable with," MSHA chief Joseph Main said at the time. "All of these changes collectively get us there."

Main, a former coal miner, said in a statement Monday that his agency is reviewing the study.

"However, as I have said, when the Upper Big Branch investigation concluded and we found out that 17 of 24 miners tested had pneumoconiosis (black lung), that was enough to tell us there was a serious problem here," Main said, referring to MSHA's probe of the 2010 West Virginia mine explosion that killed 29 miners.

Main said the new study's results are "further evidence that our efforts to lower miners' exposure to respirable coal mine dust was the right thing to do."

But health and safety advocates said the study's findings reveal a disturbing trend.

"For more than 10 years we've been hearing about the resurgence of black lung. Sadly, there's been little sense of urgency to address the problem," said Celeste Monforton, professorial lecturer at The George Washington University School of Public Health and a former MSHA policy adviser.

Noting that MSHA's new dust limits are two years away, Monforton said that "without tough enforcement and much steeper penalties for poisoning miners' lungs, the problem will continue."

"This data is truly frightening," said Wes Addington, deputy director at the Appalachian Citizens' Law Center, a non-profit law firm in Whitesburg, Ky., that represents miners in black lung and worker safety cases.

"A decade ago it would have been unimaginable that we would see rates of severe black lung back up to 1960s levels," he said. "We have broken our promise to protect our miners."

Because black lung is a latent disease, miners will be suffering from the illness for decades to come, said center staff attorney Evan Smith.

"Severe cases of black lung should not exist in the 21st century, but this data shows it's actually worsening," Smith said.

Bill Bissett, president of the Kentucky Coal Association, which represents mine operators, said he was studying the report.

During health checks of coal miners in the three states between 1998 and 2012, the occupational safety and health institute discovered 154 cases of the severe form of black lung, most in miners who had worked for a long time underground. But some cases involved surface coal miners.

In all, 3.23 percent of working miners in 2012 had contracted the severest form of black lung.

Just 15 years ago, severe cases constituted just .08 percent of all miners in a federal health surveillance program and just .33 percent of active underground miners with at least 25 years of experience, the researchers said.

Congress in 1969 passed a sweeping law, the Federal Coal Mine Health and Safety Act, which set limits on the amount of coal dust miners could be exposed to.

"Despite readily available dust control technology and best practices guidance, recent findings suggest dust exposures have not been adequately controlled and that a substantial portion of U.S. coal miners continue to develop" the advanced form of black lung, the study said.

McConnell and Grimes both say new carbon emissions standards proposed by the EPA would hurt Kentucky. Joseph Gerth, The Courier-Journal

The Appalachian Citizens' Law Center said there is another reason miners are contracting severe black lung: mining operators are fraudulently reporting dust levels, placing sampling devices in parts of mines that are less dusty rather than in places where miners are exposed to illegal levels of dust.

Black lung has caused or contributed to the deaths of more than 75,000 coal miners since 1968, according to the Government Accountability Office. The government also has paid out more than $45 billion in black-lung benefits since 1970.

Kentucky had 11,181 underground coal miners in 2012, second in the nation only to West Virginia's 17,065 miners, according to the National Mining Association.

Even though he's had lung cancer and was diagnosed a year ago with the severe form of black lung, Caudill said mining is "a way to make a living, and I enjoyed it."

"I can't say nothing bad about it," he said. "I would go back tomorrow if I was able."

Caudill said his prognosis is uncertain.

"I've known people live maybe 12, 15 years after they get it, some longer than that," he said.

[James R. Carroll is a reporter for the Courier Journal in Louisville, Kentucky. He can be reached at (703) 854-8945. Follow him on Twitter@JRCarrollCJ.]