[Senate Hearing 118-334]
[From the U.S. Government Publishing Office]




                                                           
                                                          S. Hrg. 118-334



                       DIGGING DEEPER FOR HEALTH


                       AND SAFETY: EXAMINING NEW


                        STANDARDS AND PRACTICES


                               IN MINING

=======================================================================

                                HEARING

                              [before the]

                       SUBCOMMITTEE ON EMPLOYMENT
                          AND WORKPLACE SAFETY

                    COMMITTEE ON HEALTH, EDUCATION,
                          LABOR, AND PENSIONS
                          UNITED STATES SENATE

                    ONE HUNDRED EIGHTEENTH CONGRESS

                             SECOND SESSION

                               ----------                              

                              MAY 22, 2024

                               ----------                              

                       Printed for the use of the
          Committee on Health, Education, Labor, and Pensions
          
          
          
          
          


          DIGGING DEEPER FOR HEALTH AND SAFETY: EXAMINING NEW

                   STANDARDS AND PRACTICES IN MINING
                   
                   
                   
                   
                   
                   
                   



                                 ______


                                                        S. Hrg. 118-334
 
                       DIGGING DEEPER FOR HEALTH
                       AND SAFETY: EXAMINING NEW
                        STANDARDS AND PRACTICES
                               IN MINING

=======================================================================

                                HEARING

                               BEFORE THE

            SUBCOMMITTEE ON EMPLOYMENT AND WORKPLACE SAFETY

                                 OF THE

                    COMMITTEE ON HEALTH, EDUCATION,
                          LABOR, AND PENSIONS

                          UNITED STATES SENATE

                    ONE HUNDRED EIGHTEENTH CONGRESS

                             SECOND SESSION

                                   ON

EXAMINING NEW STANDARDS AND PRACTICES IN MINING, FOCUSING ON HEALTH AND 
                                 SAFETY

                               __________

                              MAY 22, 2024

                               __________

 Printed for the use of the Committee on Health, Education, Labor, and 
                                Pensions
                                
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             U.S. GOVERNMENT PUBLISHING OFFICE 
 55-878PDF          WASHINGTON : 2024  
        
        
        
        
        
        
          COMMITTEE ON HEALTH, EDUCATION, LABOR, AND PENSIONS

                 BERNIE SANDERS (I), Vermont, Chairman
PATTY MURRAY, Washington             BILL CASSIDY, M.D., Louisiana, 
ROBERT P. CASEY, JR., Pennsylvania       Ranking Member
TAMMY BALDWIN, Wisconsin             RAND PAUL, Kentucky
CHRISTOPHER S. MURPHY, Connecticut   SUSAN M. COLLINS, Maine
TIM KAINE, Virginia                  LISA MURKOWSKI, Alaska
MAGGIE HASSAN, New Hampshire         MIKE BRAUN, Indiana
TINA SMITH, Minnesota                ROGER MARSHALL, M.D., Kansas
BEN RAY LUJAN, New Mexico            MITT ROMNEY, Utah
JOHN HICKENLOOPER, Colorado          TOMMY TUBERVILLE, Alabama
ED MARKEY, Massachusetts             MARKWAYNE MULLIN, Oklahoma
                                     TED BUDD, North Carolina

                Warren Gunnels, Majority Staff Director
              Bill Dauster, Majority Deputy Staff Director
                Amanda Lincoln, Minority Staff Director
           Danielle Janowski, Minority Deputy Staff Director
                                 ------                                

            SUBCOMMITTEE ON EMPLOYMENT AND WORKPLACE SAFETY

                 JOHN HICKENLOOPER, Colorado, Chairman
ROBERT P. CASEY, JR., Pennsylvania   MIKE BRAUN, Indiana
TAMMY BALDWIN, Wisconsin             ROGER MARSHALL, M.D., Kansas
TIM KAINE, Virginia                  MITT ROMNEY, Utah
BEN RAY LUJAN, New Mexico            TOMMY TUBERVILLE, Alabama
ED MARKEY, Massachusetts             TED BUDD, North Carolina
BERNIE SANDERS (I), Vermont, (ex     BILL CASSIDY, M.D., Louisiana, (ex 
    officio)                             officio)
                            C O N T E N T S

                              ----------                              

                               STATEMENTS

                        WEDNESDAY, MAY 22, 2024

                                                                   Page

                          Subcommittee Members

Hickenlooper, Hon. John, Chairman, Subcommittee on Employment and 
  Workplace Safety, Opening statement............................     1
Braun, Hon. Mike, Ranking Member, U.S. Senator from the State of 
  Indiana, Opening statement.....................................     2

                               Witnesses

Brown Barnes, Cindy, Managing Director, Education, Workforce, and 
  Income Security, Government Accountability Office, Washington, 
  DC.............................................................     5
    Prepared statement...........................................     6
Harris, Drew, M.D., Associate Professor of Medicine, University 
  of Virginia and Medical Director, Stone Mountain Black Lung 
  Program, St. Charles and Vansant, VA...........................    16
    Prepared statement...........................................    18
Roberts, Cecil E., President, United Mine Workers of America, 
  Triangle, VA...................................................    22
    Prepared statement...........................................    24
Schafrik, Steven, Ph.D., Associate Professor of Graduate Studies, 
  Mining Engineering, University of Kentucky, Lexington, KY......    31
    Prepared statement...........................................    32

                          ADDITIONAL MATERIAL

Statements, articles, publications, letters, etc.
Roberts, Cecil E.:...............................................
    Additional testimony and material submitted for the Record...    54


                       DIGGING DEEPER FOR HEALTH



                       AND SAFETY: EXAMINING NEW



                        STANDARDS AND PRACTICES



                               IN MINING

                              ----------                              


                        Wednesday, May 22, 2024

                                       U.S. Senate,
           Subcommittee on Employment and Workplace Safety,
       Committee on Health, Education, Labor, and Pensions,
                                                    Washington, DC.
    The Subcommittee met, pursuant to notice, at 2:30 p.m., in 
room 430, Dirksen Senate Office Building, Hon. John 
Hickenlooper, Chairman of the Subcommittee, presiding.

    Present: Senators Hickenlooper [presiding], Casey, Kaine, 
Lujan, and Braun.

               OPENING STATEMENT OF SENATOR HICKENLOOPER

    Senator Hickenlooper. Let's try that again. This will 
happen to each of you, I guarantee you, over the course of--or 
one of you at least. The Subcommittee on Employment and 
Workplace Safety will come to order.

    Today, we are here for an important discussion about mining 
health, mining safety. Ranking Member Braun and I will each 
give an opening statement, then we will introduce the 
witnesses. After the witnesses give their testimony, Senators 
will have 5 minutes for a round of questions.

    We have for long--for a long time, we have relied on our 
miners to help us keep the lights on, and we owe it to them to 
make sure that they have a safe and healthy workplace. And that 
is why we are here today, to talk about what is needed to best 
protect our miners, both today and in the future.

    For generations, we have relied on resources like coal, 
uranium, copper to fuel our economy, to run electrical 
generators, to support infrastructure and power--not just 
manufacturing but all aspects of our society.

    We know that the work to extract these resources could be 
dangerous without good and consistent safety measures in place. 
Thousands of miners have contracted and died from preventable 
diseases like black lung and silicosis.

    Our miners deserve safety protection in their workforce and 
their workplace, just like any other job. Our Country, I think, 
is at the cusp of, I call it a great transition. We are gearing 
up for a clean energy economy to help secure energy 
independence and to address climate change in a pragmatic and 
real way.

    As we make this new transition, I think it is an exciting 
time. We have to make sure that miners are not left behind. 
These workers are going to be as important, probably more 
important than they ever have been.

    We are going to need critical minerals like cobalt and 
graphite to build electric vehicles, to build wind turbines, 
and to support nuclear power, but we are going to have to work 
and fast for some of these minerals we currently don't have 
close to enough for what we anticipate will need. For others, 
our processing options are too long.

    Our supply chains are too concentrated, really. We need to 
strike the right balance to procure these important resources 
responsibly and protect both our communities and our workers. 
That means ensuring health and safety standards and supporting 
new mining safety technologies.

    We need to build trust and strengthen workforce pipelines 
for the mining industry all together. Now, we can do this by 
taking steps to proactively protect our miners and making sure 
that the mines that we create are safer, safer than they have 
ever been. And these actions should look like mitigating 
exposure to the irritants that cause preventable mining 
illnesses like black lung and silicosis.

    What start out as irritants, over a period of year, lead to 
these insidious diseases. We need to make sure that Federal 
benefits, like those available under the Black Lung Benefits 
Program and the Radiation Exposure Compensation Act, are 
available to the workers who need them.

    We should be exploring how we can make sure that workplace 
safety resources, like real time dust sampling technologies, 
are accessible to workers and employers around the country. I 
appreciate Ranking Member Braun for working with us to host 
this hearing.

    I also want to thank Senators Kaine and Casey for their 
collaboration on this issue that they both have worked on so 
hard, and both know so well. In many cases, their constituents 
have been side by side with them.

    With that, I will recognize Ranking Member Braun for his 
opening statement and to introduce our first witness.

                   OPENING STATEMENT OF SENATOR BRAUN

    Senator Braun. Thank you, Mr. Chairman, and the witnesses 
here today. With today's hearing, we are looking at a 
profession that is tremendously beneficial to our society, but 
one that is not without risks and hazards for those who work in 
and around it.

    My home State of Indiana is one of the top coal producing 
states in the country. I understand the importance of ensuring 
working conditions for American miners that are safe and as 
healthy as they can be.

    In the past, I have been proud to champion mining 
legislation that became law with Senator Casey, the Stream Act, 
which addressed the safety and environmental hazards of 
abandoned mine lands.

    This bill made it easier for states to maintain treatment 
systems for the release of highly acidic water from abandoned 
mines, which pose a threat to those that work and live around 
those areas.

    Black lung disease also poses a significant threat to those 
in the mining industry. In 1969, Congress passed legislation to 
provide compensation for miners suffering from black lung 
disease and later established the Black Lung Disability Trust 
Fund.

    This fund pays out benefits to coal workers and their 
families in the unfortunate cases when they become afflicted 
with the disease. In Indiana, there were nearly 19,000 black 
lung compensation claims filed in Fiscal Year 2023, and that 
number is significantly higher in places like Kentucky and West 
Virginia.

    It is important that this fund remain financially stable to 
provide for affected miners and their families. In the past, 
this fund has been grossly mismanaged where its total 
liabilities exceeded its assets by billions of dollars. It is 
no good. It is not going to be there for the people that need 
it.

    Following recommendations from the GAO, past 
administrations have taken concrete steps to enhance oversight 
and improve the trust fund's financial position. Unfortunately, 
those efforts have run into hurdles in recent years.

    This is simply unacceptable, and vigorous oversight from 
Congress is needed to ensure that this fund is properly 
administered and remains solvent in the long run. I look 
forward to hearing the perspective of our witnesses and giving 
these issues that are critically important for miners in the 
coal industry the attention they deserve with this hearing.

    Move to witness introduction. I will start or you----

    Senator Hickenlooper. Please begin.

    Senator Braun. I would like to introduce Mrs. Cindy Brown 
Barnes, who serves as Director of the Government Accountability 
Office's Education, Workforce, and Income Security team.

    Mrs. Brown Barnes has over 30 years of service performing 
financial, forensic, and performance audits of Federal agencies 
and programs. We welcome her expertise to this panel. Thank you 
for being here. I yield back, Mr. Chairman.

    Senator Hickenlooper. Now I have great pleasure in turning 
it over to Senator Kaine to introduce our next witness, Dr. 
Drew Harris.

    Senator Kaine. Thank you, Mr. Chairman and Ranking Member 
Braun. And it is great to welcome all the witnesses.

    Even though I am not charged with introducing Cecil 
Roberts, I just have to say that there is not a better labor 
leader in this country not only today but during the history of 
the labor movement than my friend Cecil Roberts, and I am so 
glad you are here with us.

    Now, my job is to introduce a great Virginian, Drew Harris. 
Dr. Drew Harris is the Medical Director of the Black Lung 
Program at Stone Mountain Health Services, which is a federally 
qualified health center in Southwest Virginia.

    It is the only FQHC that has a black lung clinic in the 
Commonwealth of Virginia, and it is the largest in the country 
with about 2,000 coal miners seen there annually. As Medical 
Director, Dr. Harris provides medical and--medical legal 
consultations and oversees the Pulmonary Function Lab and the 
Pulmonary Rehabilitation Program.

    Dr. Harris also serves as the Associate Program Director in 
the University of Virginia's Internal Medicine Residency 
Program. He founded and directs the Health Equity, Advocacy, 
and Leadership Track Program and coordinates community partner 
medicine programs in collaboration with community partners 
including the Charlottesville Free Clinic and The Haven, which 
is a homeless shelter and resource center.

    He teaches UVA residents seminars on physician advocacy, 
black lung disease, rural health, and a practical approach to 
the social drivers of health. He is also the co-principal 
investigator on a research study that brings seven black lung 
clinics around the country together to better understand the 
mental health of coal miners.

    He is the first editor in chief of a publication called 
Chest Advocates, focusing on practical approach to physician 
advocacy in the pulmonary space. I am so grateful for the work 
that he does, and I am so grateful, Dr. Harris, that you are 
joining us today.

    Senator Hickenlooper. Thank you. And now I will have the 
responsibility and the opportunity to introduce I would say not 
just one of the great leaders in organized labor, but 
certainly--perhaps the greatest leader, how is that? Yes, I 
can't let him outdo me.

    [Laughter.]

    Senator Hickenlooper. Mr. Cecil Roberts is the President of 
the United Mine Workers of America. And having been a coal 
miner himself, President Roberts has an extensive background 
with the mining industry.

    He helps the union's more than 50,000 members navigate 
Federal and statewide mining benefits programs while advocating 
for health and safety reforms. He is also on top of a level of 
detail that most leaders don't. He has chastised me at one 
point when we first met about not having gotten a tour of the 
Ludlow site.

    Luckily I was back on my toes and could quote back to him 
Ron Chernow's book, Titan, how the Ludlow massacre in Colorado 
actually transformed the Rockefeller family from being titans 
and magnets, worried about their business, into focusing 
completely on creating a foundation that could make the world a 
better place.

    It is unfortunate it takes sometimes a tragedy to create 
that--act as that kind of a catalyst. Then I also have a 
great--I can't--I won't be able to put on quite the 
superlatives just because I haven't been challenged by another 
Senator, but we are very grateful to have Doctor Steve Schafrik 
here.

    He is the Associate Professor and Director of Graduate 
Studies in the Mining Engineering Department at the University 
of Kentucky, one of the great schools around mining technology 
and mining education in the country.

    There, he leads research about mining technologies, 
including mine automation, ventilation, and mine dust 
filtering, obviously which all have an efficiency aspect, but a 
real bearing on the health of the miners.

    Anyway, why don't we go down and start with Ms. Barnes, and 
you can give your opening testimony, and we will go down in 
order.

STATEMENT OF CINDY BROWN BARNES, MANAGING DIRECTOR, EDUCATION, 
   WORKFORCE, AND INCOME SECURITY, GOVERNMENT ACCOUNTABILITY 
                     OFFICE, WASHINGTON, DC

    Ms. Barnes. Chairman Hickenlooper, Ranking Member Braun, 
and Members of the Subcommittee, I am pleased to be here today 
to discuss, one, the serious financial challenges facing the 
Black Lung Disability Trust Fund.

    Two, GAO's prior recommendations concerning the Department 
of Labor's limited oversight of coal mine operators' self-
insurance. And three, updated actions that the Department has 
taken to improve oversight of self-insurance and implement our 
recommendations.

    My testimony is based primarily on GAO reports from 2018 
through 2021. The Black Lung Benefits Program provides cash and 
medical assistance to coal miners who are disabled due to black 
lung disease.

    Over 23,000 beneficiaries received benefits during Fiscal 
Year 2023. Black lung benefits are generally paid by liable 
coal mine operators. Operators may purchase commercial 
insurance or self-insure to cover the benefits.

    The Federal Government's Black Lung Disability Trust Fund 
pays benefits when no responsible mine operator can be 
identified, or the liable mine operator doesn't pay, such as in 
the case of a bankruptcy.

    Our domestic coal tax is a primary source of revenue. This 
brings me to my three discussion points. First, the trust fund 
has serious financial challenges, with expenditures 
consistently exceeding revenue, especially its debt and 
interest repayments.

    Consequently, the trust has borrowed from the Treasury 
almost every year since 1979. In Fiscal Year 2023, the trust 
fund had to borrow $2.7 billion to cover its expenses, and 
based on Department of Labor's projection, the trust debt could 
exceed $13 billion by 2050.

    Compounding these challenges, coal operated bankruptcies 
have further strained the trust fund. We previously reported 
that bankruptcies between 2014 and 2016 of self-insured 
operators led to the transfer of $865 million and benefit 
responsibility to the trust.

    Since then, at least five more self-insured operators have 
filed for bankruptcy. Making things worse, there has been an 
increased occurrence in the number of miners contracting the 
most severe form of black lung, likely leading to increased 
future liabilities.

    Now, on to my second point. In response to the department's 
limited oversight of coal mine operator insurance, we made two 
priority recommendations for Labor to, one, develop procedures 
for self-insurance renewal that clarify how long an operator is 
authorized to self-insure, as well as when the self-insurance 
authority would not be renewed.

    Two, that they developed procedures for self-insured 
operator appeals. Both of these recommendations remain open. 
Now for my third point, when we testified in February 2020, we 
noted that the Department of Labor had begun implementing a new 
process for self-insurance that, if implemented effectively, 
might have helped address past deficiencies and our 
recommendations.

    That didn't happen. DOL said their ability to resolve 
appeals was hindered by the COVID-19 pandemic, as they and coal 
operators adjusted to different working conditions and also 
experienced challenges in processing documentation.

    As a result, the department suspended its reviews of 
operator appeals. However, in January 2023, the department 
issued a notice of proposed rulemaking that would, among other 
things, require all self-insured coal mine operators to post 
security to cover at least a 120 percent of their total 
estimated current and future liabilities.

    The Department of Labor is also proposing changes to the 
self-insurance application, the renewal, and the appeals 
processes. Labor submitted its final draft rule to OMB for 
review earlier this month.

    The department's rulemaking effort, once completed, and if 
implemented effectively, may address our open recommendations. 
Given the dire situation facing the trust fund, we reiterate 
the need for the Department of Labor to complete action on its 
proposed rule, address our priority recommendations, and 
effectively oversee the program.

    This completes my prepared statement. I will be happy to 
entertain and look forward to your questions.

    [The prepared statement of Ms. Barnes follows.]
                prepared statement of cindy brown barnes
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                                 ______
                                 

    Senator Hickenlooper. Thank you.

    Dr. Harris.

    STATEMENT OF DREW HARRIS, M.D., ASSOCIATE PROFESSOR OF 
 MEDICINE, UNIVERSITY OF VIRGINIA AND MEDICAL DIRECTOR, STONE 
    MOUNTAIN BLACK LUNG PROGRAM, ST. CHARLES AND VANSANT, VA

    Dr. Harris. Chairman Hickenlooper, Ranking Member Braun, 
Senator Casey, and Senator Kaine, I appreciate the opportunity 
to talk today, and I am going to start off by sharing the story 
of one of my patients. And Paul is 62. He is a father and a 
grandfather, and in his 20's, he worked for 8 years underground 
in a coal mine in Eastern Kentucky.

    He worked until a roof collapsed and crushed him, and he 
was no longer able to work, and he became a church pastor. And 
about 10 years ago, he started to develop shortness of breath. 
And he was evaluated, diagnosed with black lung with an X-ray 
and pulmonary function tests at my clinic.

    About 5 years ago, the symptoms progressed, and he felt 
difficulty occasionally even finishing his church sermons. And 
he applied three times for black lung benefits, but was denied 
benefits each time, despite imaging and a lung biopsy showing 
that his lungs were full of coal and rock dust.

    Paul's story is similar to countless other miners that I 
care for and illustrate three main points that I want to 
illustrate today. The first is that rates of severe black lung 
are at near historical highs in central Appalachia. The second 
point is that we should be using additional existing tools to 
improve the early detection and diagnosis of black lung.

    The third is that the black lung benefits process is 
frustrating for nearly all coal miners, and the Black Lung 
Benefits Improvement Act would be a big step in the right 
direction. So first, Paul is not alone and is in fact part of a 
much larger problem.

    Earlier this year, my colleagues and I published in JAMA, 
the Journal of the American Medical Association, a publication 
describing over a thousand coal miners who in the last 5 years 
were diagnosed with progressive massive fibrosis, which is the 
most severe form of black lung.

    We are seeing a huge resurgence of severe black lung, which 
is an entirely preventable disease. And like Paul, many of 
these miners were young when they got diagnosed and they only 
worked a short tenure in the mines.

    My second point is that better early detection of black 
lung is possible and key to preventing severe disease, and I 
have two suggestions for improving black lung diagnosis and 
detection. The first is we should be screening all miners with 
a special breathing test called diffusing capacity.

    This is cheap, widely available, and measures how well the 
lungs perform, and an impaired diffusing capacity can be an 
early warning signal for black lung. The second is that we 
should be utilizing CT scans for especially high risk miners to 
diagnose disease. We know that CT scans are more sensitive than 
X-rays for early detection.

    Perhaps Paul's disease would have been diagnosed earlier if 
he were offered a CT scan or a diffusion test during his coal 
mining career. And if so, perhaps he could have requested a 
transfer to a less dusty position and may not be struggling to 
breathe today.

    My last point is that the black lung benefits system, as 
currently designed, now does not work for miners like Paul and 
a fix is needed now. Coal miners with severe black lung fight 
for more than their breath, they fight for their livelihood.

    The Federal Black Lung Benefits Program provides health 
insurance and a small monthly stipend to the minority of miners 
that prove they are sick enough to meet a disability standard, 
and this is almost always a long and difficult process. Paul 
didn't qualify for benefits until I published his story in a 
medical journal, which was submitted along with this fourth 
application.

    It shouldn't have taken Paul 6 years, three rejected 
claims, a lung biopsy, and a publication in the Lancet to get 
Paul qualified, or many other miners like Paul that should be 
qualified. And my patients who eventually do receive benefits 
are receiving a small stipend that is not even indexed to 
inflation.

    The Black Lung Benefits Improvement Act would improve this 
process in several ways. Importantly, it would improve accuracy 
in diagnosis of progressive massive fibrosis by incorporating 
the better imaging that we get from a CT scan in miners that 
have abnormal X-rays.

    This Act would also increase benefits by indexing the 
benefits to inflation. But as you all know, a version of this 
Act has been proposed for nearly a decade and has not yet 
passed. And while it is too late for Paul to benefit from these 
proposed changes, many in his church congregation and his 
community could still be helped by these changes.

    Nationally, there are many thousands of miners with 
devastating black lung that desperately need this help. Thank 
you for taking this black lung crisis seriously by having me 
here to speak with you today, and I hope that you will consider 
the improved early detection of black lung methods that we 
talked about, and not delay the passage of the Black Lung 
Benefits Improvement Act.

    [The prepared statement of Dr. Harris follows.]
                   prepared statement of drew harris
    Chairman Hickenlooper, Ranking Member Braun, and Members of the 
Subcommittee, thank you for the opportunity to testify today. The 
opinions expressed in this testimony are solely my own and do not 
necessarily reflect those of the University of Virginia or Stone 
Mountain Health Services.

    I am a pulmonologist and the medical director of the Black Lung 
Program at Stone Mountain, a federally Qualified Health Center in 
Southwest Virginia. Stone Mountain is the largest black lung clinic in 
the Nation--we see about 2,000 coal miners each year. Most of these 
miners are no longer working.

    I'd like to start off by sharing the story of one of my patients. 
Paul is a charming 62-year-old family man who just this week welcomed 
to the world his 6th grandkid. Paul worked for 8 years underground as a 
roof bolter in eastern Kentucky before a mine caved in and crushed him. 
No longer able to work underground, Paul now pastors a church. For 
years, he has struggled to keep up with his grandkids, and sometimes 
has difficulty finishing his sermons due to his trouble breathing. 
Despite his severe lung disease with lung biopsies indisputably showing 
silica and coal dust, he was denied benefits 3 times before I met him.

    Paul's story is similar to countless other miners and illustrates 3 
main points I want to get across today:

        (1) The rates of severe black lung are at near-historical highs 
        in Central Appalachia.

        (2) We should start using additional, existing tools to improve 
        early detection of disease.

        (3) The black lung benefits process is frustrating for nearly 
        all coal miners. The 2023 Black Lung Benefits Improvement Act 
        would be a big step in the right direction.

    First: Paul is not alone, and is in fact part of a larger problem. 
Earlier this year, my colleagues and I published a report in JAMA, the 
Journal of the American Medical Association describing over 1,000 
miners who, in the last 5 years, were newly diagnosed with the most 
severe form of black lung: progressive massive fibrosis (PMF). Like 
Paul, many of these miners are young and worked short tenures in 
mining. \1\ A previous large study of former U.S. miners applying for 
Federal Black Lung Program benefits shows that the proportion of miners 
with PMF has significantly increased since the 1990's with the highest 
rates of disease seen in Central Appalachia. \2\ The figure below from 
this study (Almberg ET al.) shows the percentage of claimants with PMF 
in Virginia has rapidly increased in the last 2 decades to a rate 
greater than 10 percent. This bears repeating: in Virginia more than 1 
out of 10 miners applying for Federal black lung benefits have the most 
advanced stage of black lung. Even in actively working miners, rates of 
black lung including PMF are still unacceptably high. In a study of 
miners participating in the Coal Worker's Health Surveillance Program 
from 2014-2022, 331 (8.5 percent) of miners from Central Appalachia had 
evidence of black lung--with 52 (1.3 percent) showing evidence of 
progressive massive fibrosis. \3\
---------------------------------------------------------------------------
    \1\  Harris DA, Almberg KA, Blackley DJ ET al. JAMA 2024 331 (5). 
https://pubmed.ncbi.nlm.nih.gov/38175652/.
    \2\  Almberg KA, Halldin CN, Blackley DJ ET al. Ann ATS 2018 
December; 15 (12). https://pubmed.ncbi.nlm.nih.gov/30114941/.
    \3\  Hall NB, Reynolds L, Blackley ET al. JOEM 2024 66 (2). https:/
/pubmed.ncbi.nlm.nih.gov/37907411/.

GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT
 

    .epsMy second point: Better early detection of black lung is 
possible and is key to preventing severe disease. Voluntary 
participation in respiratory health screening for coal miners, as part 
of the NIOSH Coal Worker's Health Surveillance Program (CWHSP), is not 
working as it is intended. Only about 1 in 3 working miners participate 
in this voluntary program. But even more concerning, the participation 
rates are lowest in Central Appalachia--where the black lung disease 
rates and severity are the highest. Hall ET al. noted that while 
Central Appalachia accounted for 40 percent-45 percent of U.S. coal 
mining employment annually from 2014 to 2021, only 21.9 percent of 
---------------------------------------------------------------------------
CWHSP participants worked in Central Appalachia.

    This lack of participation in the CWHSP has significant health 
consequences. 39 percent of miners with disabling pneumoconiosis did 
not participate in the CWHSP during their working careers. \4\ Earlier 
disease detection might have allowed many of these miners to reduce 
their subsequent dust exposures and prevent the development of severe 
disease.
---------------------------------------------------------------------------
    \4\  Almberg KS, Cohen RA, Blackley DJ, ET al. Linking compensation 
and health surveillance data sets to improve knowledge of U.S. coal 
miners' health. J Occup Environ Med 2017;59:930-934. https://
www.ncbi.nlm.nih.gov/pmc/articles/PMC5710793/.

    There are many barriers to participation in the CWHSP including 
stigma, fear and financial disincentives (such job loss and inability 
to find additional employment). These barriers are challenging to 
address, especially as studies of miners have highlighted that for many 
miners, providing for their family is paramount, even at the cost of 
their own health. \5\
---------------------------------------------------------------------------
    \5\  Reynolds LE, Blackley DJ, Colinet JF, ET al. Work practices 
and respiratory health status of Appalachian coal miners with 
progressive massive fibrosis. J Occup Environ Med 2018;60:e575-e581. 
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6607434/.

    To stop this crisis of black lung that is ongoing in the U.S., we 
need to work to both improve participation in the CWHSP and to improve 
screening tools used in the CWHSP to better identify early disease in 
---------------------------------------------------------------------------
working miners. I have three suggestions in this regard:

        (1) Reduce the financial disincentive to participate in the 
        CHWSP. Working miners can apply for Federal black lung benefits 
        even while they are working. If they are found to have severe 
        enough disease to meet the disability criteria and are awarded 
        benefits, they can immediately start receiving part of their 
        benefit, even while continuing to work in the mines: a health 
        insurance benefit. However, working miners cannot receive 
        another critical component of this benefit: a monthly stipend 
        associated with the black lung benefits program until after 
        they stop working. This represents a departure from the 
        original congressional intent under the Black Lung Benefits 
        Act, which long allowed miners with PMF to draw full medical 
        and monetary benefits. If the Department of Labor would once 
        again allow miners to draw the monetary benefit during their 
        working years, it is likely that many miners would seek earlier 
        health screening.

        (2) We should be screening all miners with a breathing test 
        called ``diffusion capacity.'' Diffusion capacity is cheap, 
        widely available and measures how well the lungs perform. An 
        impaired diffusing capacity can be an early warning signal for 
        black lung. \6\, \7\
---------------------------------------------------------------------------
    \6\  Carta P, Aru G, Barbieri MT, ET al. Occupational and 
environmental medicine. 1996;53(5):312- 319. https://
pubmed.ncbi.nlm.nih.gov/8673178/.
    \7\  Wang X, Yu IT, Wong TW, ET al. Am J Ind Med. 1999;35(2):124-
131. https://pubmed.ncbi.nlm.nih.gov/9894535/.

        (3) We should utilize CT scans for screening especially high-
        risk miners, like Paul. We know that the rates of rapidly 
        progressive and severe disease are highest in certain 
        geographic regions. One study of CWHSP-participating miners, in 
        which 84 percent worked in Central Appalachia, highlights how 
        rapidly severe black lung can develop in high-risk miners: 17 
        percent of miners progressed from a normal chest X-ray to PMF 
        (the most severe type of black lung) in less than 10 years. \8\ 
        These miners are at increased risk for rapidly progressive 
        disease largely because of where they work--central Appalachia, 
        where exposure to toxic silica dust in thin seam mines is known 
        to be the highest.
---------------------------------------------------------------------------
    \8\  Laney AS, Blackley DJ, Halldin C. OEM 2017 Jul 74 (7). https:/
/pubmed.ncbi.nlm.nih.gov/28408654/.

        We also know that specific job types in coal mines also leads 
        to increased risk of PMF due to increased silica dust 
        exposures. Miners working at the mine face, in jobs like roof 
        bolting or operating a continuous miner, face an increased risk 
        of severe disease. \9\
---------------------------------------------------------------------------
    \9\  Zell-Baran L, Go LHT, Sarver E ET al. J OEM 2023 65 (4). 
https://pubmed.ncbi.nlm.nih.gov/36730599/.

        We know who is at the highest risk for rapidly progressive and 
        severe black lung disease. If we are truly committed to ending 
        the countless preventable deaths that are devastating the 
        coalfield communities in America, then we need to utilize the 
        most sensitive tools to identify early disease in the highest 
---------------------------------------------------------------------------
        risk miners.

        CT scans are more sensitive test than X-rays for early 
        detection of disease in both silica \10\ and coal mine dust 
        \11\ exposed workers. When coal miners are screened by X-rays, 
        early diagnoses of occupational lung disease will be missed.
---------------------------------------------------------------------------
    \10\  Hoy RF, Dimitriadis C, Abramson M ET al. OEM. 2023 80 (8). 
https://oem.bmj.com/content/80/8/439.
    \11\  Savranlar A, Altin R, Mahmutyazicioglu ET al. Eur J Radiology 
2004 51 (2). https://pubmed.ncbi.nlm.nih.gov/15246524/.

        There are challenges in utilizing CT scans at a population 
        level for surveillance in occupational lung disease. In the 
        U.S., there is a formal certification program (e.g. NIOSH B-
        reader) \12\ and classification system (e.g. The International 
        Labor Organization ILO classification of radiographs) \13\ to 
        categorize abnormalities on chest X-rays. Similar programs do 
        not yet exist in the U.S. for CT scans. But the key word here 
        is: yet. Outside of the U.S., surveillance and screening 
        programs in other countries are beginning to pivot toward 
        utilizing CT scans in this context. \14\ We should be leading 
        the world in innovative solutions in occupational health 
        disease prevention and early detection, not following in the 
        footsteps of other countries while American coal miners are 
        suffering.
---------------------------------------------------------------------------
    \12\  The ILO Classification System: https://www.ilo.org/resource/
ilo-international-classification-radiographs-pneumoconioses-1.
    \13\  CDC/NIOSH's B-reader Program: https://www.cdc.gov/niosh/docs/
2019-111/default.html.
    \14\  Tamura T, Suganuma N, Hering KG ET al. Ind Health 2015 53 
(3). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4463184/.

        Perhaps Paul's disease would have been recognized earlier if he 
        had been offered a CT scan or a diffusion test during his coal 
        mining career. If so, he could have requested a job transfer to 
        a less dusty position and may not be struggling to breathe 
---------------------------------------------------------------------------
        today.

    My last point: The black lung benefit system, as currently designed 
does not work for miners like Paul and a fix is needed now. Coal miners 
with severe black lung fight for more than their breath. They fight for 
their livelihood. The Federal black lung benefits program provides 
health insurance and a small monthly stipend to the minority of miners 
who can prove they are sick enough to meet a disability standard. This 
is almost always a long and difficult process.

    Paul didn't qualify for benefits until a he had a CT scan, a lung 
biopsy and his story published in a medical journal. \15\ His published 
story, including images of his lung masses and lung biopsy (image 
below) showing lungs full of coal and rock dust, was submitted along 
with his 4th, finally successful application. It shouldn't take 6 years 
and a publication in the Lancet to get Paul, or many other miners like 
Paul, awarded benefits.
---------------------------------------------------------------------------
    \15\  Harris DA, Willis JA, Tomann. The Lancet 2020, 395(10234). 
https://pubmed.ncbi.nlm.nih.gov/32359461/.

    The 2023 Black Lung Benefits Improvement Act would improve this 
process in several ways. One key mechanism is by improved accuracy in 
diagnosing progressive massive fibrosis by strategically incorporating 
the better imaging obtained by CT scans in miners with specific 
abnormalities seen on their X-rays. CT scans are more accurate at 
identifying PMF than X-rays, and for miners with known black lung on X-
rays, we should be utilizing the better test (CT scans) to confirm 
---------------------------------------------------------------------------
whether or not PMF is present.

    However, as you know, a version of Black Lung Benefits Improvement 
Act has been proposed for nearly a decade. While we wait, my patients 
who do receive benefits are receiving a small stipend that is not 
indexed to inflation. And those who are sick-but-not-yet-qualified are 
often frustrated by conflicting X-ray results that leads to years-long 
disputes.

    While it is too late for Paul to benefit from these proposed 
changes, many in his church congregation and his community could still 
be helped by these changes, and nationally there are thousands of 
miners that desperately need this help. Thank you for taking this black 
lung crisis seriously by having me here to speak with you today. I hope 
that you will consider ways to improve early detection of black lung 
and no longer delay the passing of the Black Lung Benefits Improvement 
Act.

GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT
 
                                 

    Senator Hickenlooper. Thank you, Dr. Harris.

    Mr. Roberts.

 STATEMENT OF CECIL E. ROBERTS, PRESIDENT, UNITED MINE WORKERS 
                    OF AMERICA, TRIANGLE, VA

    Mr. Roberts. Thank you very much. I hit talk--there it 
goes. Thank you very much, Chairman Hickenlooper, and Ranking 
Member Braun, and my friends, Senator Casey and Kaine. I have 
worked for many years--with these two for many years to make 
miners' live better, whether it is defending their pensions and 
their health care, making the mines safer, and most recently, 
this issue of black lung.

    I am a coal miner. My father was a coal miner. My 
grandfathers were coal miners. My great grandfathers were coal 
miners. Unfortunately, I never met either one of my 
grandfathers. Both of them were killed in the coal mines before 
I was born, and I had to depend on stories about their lives to 
get to know them and appreciate what they did when they were 
alive. And they died very young in the coal mines.

    But that is a story you can hear anywhere you want to hear 
it in the coalfields of this country. I have testified over and 
over and over again here, not in this room per se, but here in 
Congress. Starting in 2003, and two other times, particularly 
about the black lung problem and what it does to miners, and 
what we need to do.

    I want to follow-up on what the doctor said here, if he 
doesn't mind. There are thousands of polls out there. And the 
most sincere--excuse me, the most dangerous type of black lung 
is progressive massive fibrosis that the doctor alluded to.

    We all understand something, if you contract this, you are 
going to die. And the average lifespan once you contract this 
form of black lung is 3 years. That is the average lifespan of 
somebody who contracts this. And this is happening in too large 
of numbers. And we know where it is.

    We know, everybody in here knows where it is. It is in 
Eastern Kentucky, Southern West Virginia, and Southwestern 
Virginia. And we testified to this in 2019, and we pleaded with 
the Congress of the United states to do something about this. 
And recently, we did have a victory. And that was for the first 
time we promulgated a rule dealing with silica.

    This form of black lung is caused by silica. So how in the 
world did we get an area of the country where all these cases 
are originating in young miners? We are not talking about 
people who have spent 20 years in coal mines. We are talking 
about miners who spent 3 years in the coal mines.

    We are talking about people in their 30's. And the news 
media is starting to pick up. And there has been a series--that 
voted to this problem of young people choking to death and 
dying because they went to work. So, my position has been, and 
our union's position is, if we know what is causing this and we 
know where it is, why do we continue on? But I want to point 
something out, if I might.

    I don't mean to be too aggressive about this, but somebody 
has got to be. This is the story of this industry. And I have 
said repeatedly that most coal companies try to do the right 
thing, but we have to come to grips with some reality here. 
Some do not. It is like saying, everybody who drives on the 
road, drives safely, and we know that is not true.

    We also know that people commit crimes. It would be like 
saying we don't need to police anymore because everything is 
resolved. But it took a 100 years, a 100 years before the first 
law was ever passed by the U.S. Government that protected the 
working coal miner--100 years.

    It was in 1969, and that wouldn't have happened had not we 
had an explosion in Northern West Virginia that the entire 
nation watched on television. And then we created the Black 
Lung Program with that law, and we said for the first time, for 
the first time ever, we recognized black lung as an 
occupational illness.

    We never did that before. And the truth of the matter is, 
this industry claimed that there is no such thing as black lung 
or pneumoconiosis until 1969. That is a fact. And they also 
said, if you make us abide by these laws you are passing, we 
are going to go out of business and go bankrupt.

    That wasn't true. And we have lived with these laws for a 
long time now. But now we have this. If you think it is bad, 
tough to work in a coal mine, get sick. Get pneumoconiosis and 
try to get benefits. And here is the problem, we have rich 
people, we have lawyers saying that I am not sick, and we have 
me or another coal miner trying to hire a local guy to 
represent me.

    That is not fair. It is not balanced. People are sick. They 
are out working, and they should be recognized for that. And 
they should not have to live on $700 something dollar or die. 
And that is the way the program works.

    It is unfair. It needs to be made more fair. And that is 
coming from the heart of a coal miner who has seen too many 
people die from this.

    [The prepared statement of Mr. Roberts follows.]
                  prepared statement of cecil roberts

    Good morning, Chairman Hickenlooper; Ranking Member Braun and the 
Members of the Committee on Education, and Labor in attendance today. 
My name is Cecil E. Roberts, International President of the United Mine 
Workers of America (``UMWA''). In that capacity, I represent the 
largest unionized group of active and retired coal miners in North 
America. However, today, Mr. Chairman, I come before the Members of 
this distinguished Committee as the representative of every coal miner 
in this Nation, whether an active dues-paying member, a retiree of the 
UMWA, or a coal miner who is working in the industry and has not yet 
joined the ranks of the Union. In short, I am here to be the voice of 
the miners who have risked their lives and health to energize and build 
this Nation, no matter where they live and no matter their affiliation 
with organized labor.

    This Committee plays an important role in addressing employees' 
health and safety. I would like to express my particular appreciation 
to the leadership of this Committee for your efforts directed at 
protecting and enhancing the health and safety of coal miners 
throughout the Nation. Your continued attention is critical to dealing 
with the challenges that all too often prevent some miners from being 
able to go home safely at the end of their shift. After all, going to 
work, whether as a coal miner or other worker, should be a means for 
earning a paycheck and providing for your family, not a roll of the 
dice about whether you will live to see another day.

    The testimony I will present to this Committee today will outline 
the struggles coal miners face every day in this country. These 
struggles exist not just for miners who are actively employed in the 
industry but also for those who have left the mines, whether they 
retire after years of hard work in dusty and dangerous conditions or 
are forced from their jobs by occupational injury or illness. I will 
focus my testimony on the specific topic of this very important 
hearing: the effects of Coal Workers' Pneumoconiosis (``CWP'' or 
``Black Lung disease'') on the lives of America's coal miners.

    According to data from the Center for Disease Control (``CDC''), 
the National Institute for Occupational Safety and Health (``NIOSH''), 
the Mine Safety and Health Administration (``MSHA'' or ``Agency''), and 
a host of independent studies, the highest concentration of these 
historic increases in the disease are occurring in the central 
Appalachian Region of the United States. This area includes all or 
parts of Kentucky, Ohio, Pennsylvania, Virginia, and West Virginia.

    As you may know, this is not the first time I have come to Capitol 
Hill to speak on behalf of coal miners regarding the dangers of Black 
Lung disease. Studies have consistently shown there has been an 
alarming resurgence in the number of Black Lung cases, including the 
most severe form of the disease known as Progressive Massive Fibrosis 
(``PMF''). I have been here before to discuss that risk.

    This is not a new or unprecedented danger in the Nation's 
coalfields. We know this disease, we know what causes it, and we know 
how to prevent it. The industry and the Federal Government have known 
for years of this resurgence. I have testified in the past about the 
failures of MSHA's dust control rules and policies. I have testified 
before about the nefarious methods that operators have used to 
circumvent mandatory dust monitoring. The UMWA has recommended methods 
and ways of improving the sampling system and that might have helped 
head off this resurgence.

    However, it was not until recently that the Mine Safety and Health 
Administration (MSHA), under its current leadership, took meaningful 
steps to protect miners from silica dust and Black Lung disease. First, 
in June 2022, the Agency launched its Silica Enforcement Initiative 
(SEI). The SEI increased silica sampling and fast-tracked the 
deployment of significant measures to slow, stop, and reverse the 
escalating rates of extreme overexposure to silica dust, especially at 
thin-seam coal mines where sandstone exposure is most pronounced. Then, 
in April 2024, building on that record of innovation and success, MSHA 
published a historic final rule placing an enforceable limit on 
respirable silica dust in America's mines. While we believe it could be 
further improved to better protect miners, we believe that rule will 
set us on the path to achieving our goal of ending this debilitating 
lung disease among mine workers.

    If you hear me say something that I have already raised in May, 
2003 (the first time I testified before a congressional Committee on 
this issue), July, 2010, March, 2012, or then again in June 2019, 
consider it an indictment of the government's failure to take seriously 
the known threat of Black Lung disease. Know that I repeat myself today 
because, since May 2003, over 20,000 miners have died in this country 
from Black Lung. And if Congress again fails to act, that number is 
expected to skyrocket in the coming decades. Those are deaths we know 
how to prevent, but this body has not taken the action needed to do so. 
I will not stop repeating these truths until Congress listens.

    The Union would argue that the seeds of the recent wave of Black 
Lung were sown by the actions of Federal agencies and coal operators 
whose primary job is to protect the health and safety of the Nation's 
miners. This epidemic was further propagated by medical and legal 
professionals who profited from the misery of those miners unfortunate 
enough to contract this horrible disease. The fact is, Mr. Chairman, 
Black Lung is a preventable occupational disease that would have been 
eradicated from the industry years ago, but for the greed of the 
industry and the failings of those who are charged to protect the 
Nation's miners.
                    Previous Congressional Hearings
    On July 13, 2010, and again on March 27, 2012, I came before the 
House Committee on Education and Labor and the House Committee on 
Education and the Workforce, respectively, to discuss the disaster at 
Massey Energy's Upper Big Branch Mine South (``Upper Big Branch'' or 
``UBB'') in Montcoal, Raleigh County, West Virginia (attachments 1-2). 
While the overriding context of that testimony dealt with the events 
leading up to the mine explosion and its aftermath, the information I 
submitted and the testimony I gave predicted that if action was not 
taken by Congress and MSHA, we would witness the Black Lung crisis we 
are discussing today.

    The Union has been raising the concerns routinely for years. I have 
enclosed the past several years of the UMW Journal (attachments 3-12), 
the official publication of the Union, that chronicles the Union's 
continual attempts to bring these problems to the forefront of public 
debate. However, like so many other efforts to protect workers, the 
legitimate warnings about Black Lung the Union has raised have not been 
heeded.

    The conditions in the Upper Big Branch mine, specifically the 
amount of coal dust that exploded and killed 29 miners, present a 
microcosm of the dust problem that has haunted the industry for almost 
two centuries. While the UBB disaster could still provide fodder for 
hundreds of congressional hearings, what is important to the topic we 
are here to discuss today is that the thick layers of coal dust that 
filled the entries of the UBB were not restricted only to the mine 
surfaces. This respirable and deadly dust also lined the lungs of the 
workers at that operation, slowly but surely killing the miners. In my 
2012 testimony, I specifically referred to the fact that autopsies 
performed on the miners killed at UBB showed the majority of them had 
some level of Black Lung Disease. This is true of some of the youngest 
miners who lost their lives in the disaster.

    Further, the report issued by the Union after the disaster, 
``Industrial Homicide,'' (attachment 13) stated, ``The fact that miners 
worked in such a dusty atmosphere offers great insight into the 
prevalence of Black Lung disease in many of the miners killed in the 
disaster. Of the 24 miners, between the ages of 24 and 61 whose lungs 
could be examined during autopsy, 17 miners or 71 percent, showed some 
stage of Black Lung.'' With respect to the mining practices at UBB, the 
report noted that the practice of running the long-wall shearer without 
the required water sprays amounted to, `` . . . reckless disregard for 
the law . . . And over the long term, exposure to uncontrolled coal 
mine dust greatly increases miners' chances of contracting Black Lung 
disease.''

    Mr. Chairman, the UBB disaster occurred on April 5, 2010. It is not 
ancient history. More importantly, based on the information that is 
available, it is clear that this type of illegal activity on the part 
of many coal operators were and still are accepted practices in the 
industry. There is a clear and uninterrupted pattern of behavior on the 
part of the coal industry that runs back to the earliest days of the 
Respirable Dust Sampling Program. Tragically, even the spotlight shone 
on the issue by martyrs of UBB could not put an end to the industry's 
reckless behavior.
                          After the Diagnosis
    For most miners who have contracted Black Lung, the difficult and 
deadly process is only just beginning. The reality is that rather than 
accept the responsibility for their actions and seek to compensate 
disabled miners and mitigate the effect of the disease, coal operators 
and others do everything in their power to shirk that responsibility. 
It is not confined to dust sampling and Black Lung. I could fill the 
congressional record with stories of operators disclaiming 
responsibility for anything and everything that happens to miners they 
are charged to protect. But when it comes to Black Lung, it seems that 
the excuses and evasions never end. Too many operators will stop at 
nothing to avoid paying for Black Lung benefits. It's a sad situation 
that just keeps playing out over and over again.

    There are countless stories of miners who have contracted the most 
severe form of Black Lung disease, PMF, but were unable to receive the 
benefits they were owed. These miners are examined by medical experts 
from the U.S. Department of Labor and their own doctor to confirm their 
worst fears only to see their employer contest their eligibility in 
administrative proceedings, sometimes for decades. The truth is that, 
almost without exception and despite overwhelming evidence supporting 
the miner, coal operators still refuse to recognize the miners' 
disability. The premise behind the operator's decision to deny benefits 
is simple: The delaying effort allows them to rely on time and money, 
two things most miners with the disease don't have. The immorality of 
their actions is also simple: it is reprehensible.

    The expense of pursuing the claim can cost the miner tens of 
thousands of dollars they do not have and most lawyers familiar with 
the Black Lung legal system know the return on their investment in time 
and research is meager at best. So, after an initial filing and a 
series of hearings before an administrative law judge, most miners 
cannot afford to continue the fight. The case is dropped, the company 
wins and the miner suffers in obscurity until the disease causes their 
lungs to fill with liquid and they drown.

    Perhaps one reason the company wins so many Black Lung claims is a 
rule employed by the Department of Labor's Administrative Law Judges 
(``ALJs''), and the Benefits Review Board that oversees those ALJs, 
that denies benefits when the evidence supporting and the evidence 
refuting a claimant's Black Lung diagnosis is equal. Under the 
adversarial system created to administer the Black Lung Benefits Act, 
claimants and their former employers will each submit a certain number 
of X-ray readings, a certain number of spirometry and blood gas 
results, and a certain number of medical reports to prove their case.

    The miners will present evidence showing they have Black Lung and 
are disabled. Operators will present evidence showing they are not sick 
or are not disabled. As I will discuss later, the evidence presented by 
operators is sometimes inaccurate or downright fraudulent. Nonetheless, 
it is easy for an ALJ to look at the submitted evidence, determine that 
all the doctors involved have equally impressive credentials, and 
decide the evidence is equal. And, finding the evidence is ``in 
equipoise'' those ALJs then deny the claim. In short, if an ALJ cannot 
or will not make up his or her mind about the existence of disabling 
Black Lung, the miner pays the price.

    Under the current circumstances, should a miner have enough 
resources and find an attorney willing to accept and stick with their 
case to continue the fight for benefits, the employer's legal team 
relies on the passage of time to settle the case. Miners with PMF have 
a limited time left on this earth. Through court hearings, delays, 
appeals, and any number of stalling tactics, the miners' time is slowly 
drained away as the case languishes in the system. Ultimately, the 
miner will suffocate and die. But, for the mine operator and his legal 
team, the case is over and no benefits are paid. It's a win for them no 
matter what the cost in human tragedy!

    Unfortunately, the truth about these despicable tactics by mine 
operators and the law firms they hire with the profits from the miners' 
labor is that they work.
   Legislative Reforms to the Black Lung Benefits Program are Needed
    The UMWA is grateful to Senators Casey, Kaine, Brown, Manchin, 
Fetterman, Warner, and Warren for reintroducing the Black Lung Benefits 
Improvement Act (S. 3304). Although the last formal Senate hearing on 
Black Lung was held in July 2014, I would be remiss if I did not note 
that there has been important legislative action over the past 10 
years, especially with regard to permanently restoring the Black Lung 
excise tax to fund the Trust Fund, increased appropriations for Black 
Lung clinics, and a boost in funding to cut the backlog on claims 
before Administrative Law Judges.
  The Black Lung Benefits Act Claims Process is Both Adversarial and 
                                Daunting
    The Black Lung benefits adjudication process is an adversarial 
system. An adversarial system only works to deliver justice, however, 
when both parties to the dispute have an equal opportunity to 
participate.

    Coal operators have leveraged their formidable legal resources and 
medical experts to frequently overwhelm the capacity of disabled miners 
and their families to secure benefits to which they are otherwise 
entitled.

    Governmental and journalistic investigations have identified 
numerous impediments to claimants' ability to obtain Black Lung 
benefits, including:

          Challenges in obtaining legal representation and 
        developing medical evidence to support a miner's claim;

          Obstacles to fair adjudication of claims because of 
        dubious strategies employed by coal operators' lawyers and 
        experts; and

          Bureaucratic delays in the processing of claims 
        applications.
  Expanding Availability of Legal Representation for Miners in Claims 
                                Process
    A 2009 GAO report (Attachment 14) about the Black Lung program 
found that securing representation is a significant challenge for many 
Black Lung claimants and that ``claimants' lack of representation, 
particularly in the early stages of a claim,'' is ``a significant 
barrier to successful claims.'' DOL's Office of Administrative Law 
Judges (OALJ) confirmed ``that few attorneys will represent Black Lung 
claimants and that lack of legal representation limits OALJ's ability 
to process cases quickly.''

    DOL data continue to bear this out more than a decade later. In the 
last 10 years, most claimants have lacked attorney representation at 
the District Director level. The rate of attorney representation has 
fluctuated from a low of 25 percent in 2013 to a high of 47 percent in 
2019. Although lay representation has increased at the District 
Director level in recent years following an increase in funding for 
Black Lung clinics, fully 36 percent of claimants lacked attorney or 
lay representation in 2023. There is a good reason there is such a 
small pool of attorneys willing to take on these difficult cases.

    The nub of the problem was explained in GAO's 2009 report:

        ``[A]ttorneys are not inclined to take claimants' cases due to 
        a low probability of success . . . and the process can be 
        lengthy and costly. For example, one attorney told us that it 
        has taken as long as 15 years from the start of a Black Lung 
        case to receive compensation for working on it. Because 
        claimants lack financial resources for evidence development and 
        DOL's payment of claimant attorneys' fees is contingent on the 
        success of cases, claimant attorneys bear much of the legal 
        costs during the litigation of claimants' cases.''

    In BLBA cases, a claimant may not be charged a fee by an attorney, 
and fees are not paid by the operator (or Trust Fund) unless Black Lung 
benefits are awarded. Disputes over attorney fees usually require a 
separate round of litigation. To incentivize more attorneys to take on 
Black Lung cases, the Black Lung Benefits Improvement Act creates a 
reimbursement mechanism where an attorney could be awarded a partial 
fee through the Trust Fund if they are successful at various stages in 
the claim proceedings (up to a maximum of $4,500), and then that 
payment from the Trust Fund would eventually be paid back by the 
operator if the award is upheld. Attorneys may also seek reimbursement 
of up to $1,500 at each level for medical costs. This applies if the 
claims take longer than 2 years to finalize.
   Securing Sufficient Medical Evidence to Establish Entitlement to 
                                Benefits
    Miners' challenges in obtaining counsel are intertwined with their 
difficulty in developing the medical evidence needed to support a 
claim. This issue is particularly acute at the earliest stages of the 
claims process. Both GAO and the DOL Inspector General (DOL-IG) have 
urged DOL to assist claimants in securing better quality medical 
evidence, because this speeds up cases, reduces appeals, and improves 
fairness.

    A Pulitzer Prize-winning series of investigative reports in 2013 
(Attachment 15) by the Center for Public Integrity (the Center), 
coupled with reporting by NPR, ABC News, the Charleston Gazette, and 
others, uncovered patterns of deception, suppression of evidence, and 
willful distortion of diagnostic tests by coal operators' counsel and 
medical experts aimed at preventing miners and their survivors from 
obtaining the benefits to which they were rightfully entitled.

    Radiologists working at Johns Hopkins Medical produced reports 
``almost unwaveringly negative for Black Lung,'' but one expert in 
particular, Dr. Paul Wheeler, was ``the leader and most productive 
reader for decades.'' The Center found that, in more than 3,400 X-ray 
readings involving more than 1,500 cases, Dr. Wheeler had never once 
interpreted an X-ray as positive for complicated pneumoconiosis, 
preferring instead to apply his own idiosyncratic criteria which were 
``at odds with positions taken by government research agencies, 
textbooks, peer-reviewed scientific literature, and the opinions of 
many doctors who specialize in detecting the disease, including the 
Chair of the American College of Radiology's task force on Black Lung.

    Following this report, Johns Hopkins Medical permanently shut down 
the program. But Hopkins never released its internal review which led 
to this closure.

    In the span of 13 years alone, miners lost more than 800 cases in 
which doctors found severe Black Lung while Dr. Wheeler offered a 
contrary opinion. Ultimately, DOL notified approximately 1,100 miners 
that their claims may have been wrongfully denied because of Dr. 
Wheeler's involvement.

    Unsurprisingly, the problem of dubious medical evidence polluting 
the claims process was not remedied merely by closing the mill at Johns 
Hopkins. Academic studies have found consistent bias in medical 
opinions proffered by physicians hired by coal operators. The 
researchers identified 55 operator-hired B-readers who provided 
negative readings in more than 99 percent of their assignments. 
``Although the radiograph data ended in 2013,'' the researchers point 
out, ``nearly all the physicians are still classifying radiographs 
today, and many of these cases are still pending.''

    In 2014, DOL sought to address this imbalance by providing 
additional assistance to miners who met the criteria for the 15-year 
presumption under the law. In addition to the legally mandated DOL 
medical examination, DOL also provided claimants with access to a 
supplemental medical opinion from the DOL-approved medical examiner 
after evidence contrary to a preliminary finding supporting benefits 
entitlement was submitted for consideration by the responsible 
operator. Prior to this, DOL only funded one medical opinion to miners. 
This additional medical opinion involving evidence supplied by mine 
operators not only assisted miners and improved the quality of 
decisions, but even reduced the need for so many appeals.

    However, this DOL initiative is too limited. It needs to be 
expanded to cover claimants who do not meet the requirement of 15 years 
of underground coal employment, as we know many miners are getting 
Black Lung diseases at an earlier age and with shorter tenure due to, 
in part, increased silica exposures. If necessary, Congress should 
legislate this expanded medical review.
        Increasing Benefit Levels and Adjustments for Inflation
    Benefit levels under this law are woefully insufficient. The 
monthly benefit, which is pegged to 37.5 percent of GS-2, Step 1 pay 
schedule, is a meager $772.60 per month and is adjusted upwards with 
dependents--plus medical benefits for the related medical condition. 
This merits re-examination.

    Further, because the monthly cash benefits are pegged to the 
Federal employees' pay scale, any Federal employee pay freeze means 
that miners and their surviving dependents do not receive a cost-of-
living adjustment. As you may recall, in response to the budget deficit 
and political pressures, a Federal pay freeze was implemented for 
fiscal years 2011 through 2013. And Federal pay increases fell short in 
fiscal years 2014 and 2015. It was not until 2016 that the Federal 
Government reinstated full cost of living increases. These political 
choices have permanently sliced benefits for disabled coal miners. 
Congress needs to legislate a catchup adjustment and establish reforms 
to peg the annual cost of living adjustments to the consumer price 
index--not Federal employee pay adjustments.

    Finally, preventable delays in claims processing need to be 
addressed. One of these is the process for verification of employment. 
According to the DOL-IG, DOL still uses a manual, paper-based system to 
request employment records from the Social Security Administration 
(SSA) ``because it does not have the statutory authority to directly 
access SSA's data base.'' That outdated mode of communication adds time 
to the Black Lung claims process.
                         Summary of Key Reforms
    We are pleased the Black Lung Benefits Improvement Act contains a 
number of these reforms and note that the House Committee on Education 
and Labor marked up similar legislation in the last Congress. The UMWA 
urges the Senate to prioritize legislation that:

          Increases miners' benefits and ensures benefits are 
        adjusted for inflation to benefits from losing value during any 
        future government employee pay freeze.

          Speeds benefits by authorizing DOL to get employment 
        and earnings verification for miners from the IRS. Enables more 
        miners to get legal representation and assistance in securing 
        medical evidence.

          Expands DOL's program to provide supplemental medical 
        opinions by DOL medical examiners.

          Expands access to CT scans to assist in the diagnosis 
        of Black Lung disease when a conventional lung X-ray fails to 
        provide a definitive image for diagnosing complicated 
        pneumoconiosis.

          Increases the authorization of funding levels for 
        Black Lung Clinics.

          Ensures accountability for operator misconduct in the 
        claims process.
                 Trust Fund Solvency and Self Insurance
    The purpose of the Trust Fund and the Black Lung Benefits Revenue 
Act of 1977 was to ensure that coal mine operators, or the coal 
industry, will fully bear the cost of Black Lung disease for the 
present time and in the future.

    As such, benefits are to be paid by ``Responsible Operators'' or 
their commercial insurers. If a mine operator is self-insured and 
declares bankruptcy or ceases business operations, the Black Lung 
Disability Trust Fund (Trust Fund) assumes responsibility for paying 
benefits to these miners. The Trust Fund, which currently pays benefits 
to 52 percent of all finalized claims, is financed through an excise 
tax on coal that is mined and sold domestically. Exported coal is 
excluded from the excise tax. Today, the Trust Fund is $6.4 billion in 
debt.

    We commend the Senate for permanently restoring the Black Lung 
Excise Tax rate as part of the Inflation Reduction Act in 2022. This 
was essential to prevent the Trust Fund from going even deeper into red 
ink, as was projected by the Government Accountability Office.

    However, given the already dropping production and utilization of 
coal domestically, we believe it is time to examine extending the tax 
to exported coal. The U.S. Energy Information Agency predicts that coal 
utilization for domestic power generation will drop to near zero by 
2050. The only significant market remaining at that point will be 
exported coal. However, there will be no income to the Trust Fund from 
the production of that coal. The Fund's deficit will never be wiped 
from the books without extending the tax to exported coal.
 DOL Rule to Reform Operator Self Insurance is Languishing and Must be 
                                 Issued
    While coal production is declining, and excise tax revenues along 
with it, it is imperative to protect the Trust Fund from additional 
liabilities due to self-insured operators failing to maintain adequate 
collateral. According to a 2021 GAO report (Attachment 16), roughly $1 
billion in undercollateralized Black Lung liability was shifted into 
the Trust Fund in recent years. In some cases, large operators reserved 
as little as 3 percent of their current and future Black Lung liability 
when they filed for bankruptcy.

    According to DOL, the risk of more red ink in the Trust Fund is 
growing: self-insured operators have reported $700 million in current 
and projected Black Lung liabilities with only $120 million on deposit 
with DOL. In the event of future bankruptcies, under-collateralization 
of these liabilities would increase the Trust Fund's indebtedness.

    The good news is that the Biden administration has proposed to plug 
this leaky bucket through a proposed rule that would set a minimum 
collateral level of 120 percent of current and future Black Lung 
liabilities.

    We think this is a reasonable approach because it mirrors the self-
insurance rules that are implemented by many state workers' 
compensation programs.

    I should be clear here, not all self-insured operators are failing 
to put up sufficient collateral. But by compelling self-insured 
operators to fully internalize the costs of current and future Black 
Lung liabilities as part of the cost of production, the proposed rule 
eliminates the unfair windfall that accrues to those operators who fail 
to fully secure such claims, while potentially incentivizing operators 
to reduce the incidence of Black Lung.

    The UMWA has joined with a number of groups and Members of Congress 
in supporting this proposal. Although the comment period on this rule 
closed over a year ago, progress on getting it finalized has been far 
too slow. Earlier this month, the Department of Labor sent a final 
version to the Office of Management and Budget for its review 
(Attachment 17). We urge the Administration not to let this rule 
languish any longer, because what we have learned is that whenever 
there is a bankruptcy, there is a real risk that self-insured operators 
will shift unfunded liabilities to the Trust Fund and drive up the 
mountain of red ink.

    While the Trust Fund can continue to borrow from the Treasury to 
cover benefits and administrative costs, at some point the red ink 
reaches a tipping point that jeopardizes the Trust Fund's solvency. In 
1981, certain interests used a rising tide of red ink enact cuts in 
benefit eligibility. It took 30 years to reverse those cuts as part of 
the Affordable Care Act in 2010, but it left thousands of miners and 
their survivors without recourse in the interim.

    It is past time for DOL to move forward on this rule, as this 
problem has been festering at great expense to the Trust Fund for over 
a decade.
                            Closing Remarks
    The sad fact is, no matter how far we seem to come in this country, 
whether it is advances in science, technology, medicine, or a host of 
other subjects, some things never seem to change. I suppose many 
industries deny the problems they cause, but some of the people who own 
and operate coal mines can be the worst. They argue that they should be 
allowed to make as much money as possible on their investment without 
government interference. Then, when their actions cause major economic, 
environmental or health problems, they want the government to force 
taxpayers to bail them out. They want to keep their profits private but 
socialize their losses. It is time Congress held these businesses 
responsible to pay for their misdeeds, not the American taxpayer.

    Statistics from the mining industry offer dramatic proof that 
improved laws and regulations make a huge difference in workers' 
safety. We recently celebrated the 45th anniversary of the mining 
industry's key legislation, the Federal Coal Mine Health and Safety Act 
of 1969. In the 40 years before that landmark legislation, an average 
of 803 miners were killed in coal mines each year; and in the 40 years 
since it was enacted an average of 83 miners were killed.

    While these numbers prove beyond a doubt that strong laws make a 
huge difference, more must be done. We are here today to talk about 
what could and should be done to change a system that still allows 
miners and other workers to die at work or as a result of their work, 
whether from preventable occupational illnesses or from avoidable work-
site tragedies.

    Unless operators do what the law requires of them each and every 
day--not just when a government inspector is physically onsite--miners 
will continue to be exposed to needless hazards to their health and 
safety. Too many will be injured, too many will be made sick, and too 
many will pay the ultimate price with their life.

    These challenges have persisted for decades, if not longer. I have 
been here repeatedly, and my predecessors before me, to complain about 
the terrible conditions miners endure when operators don't follow the 
law and miners are killed as a result.

    Turning to the factors that adversely impact miners' health and 
safety, we must start by looking at the operators and their mines. 
First and foremost, it is every operator's responsibility to provide a 
safe and healthy workplace. Many try to do that. Yet too many do not. 
Corners are frequently cut, which means that miners' health and safety 
get sacrificed.

    Operators who invest in equipment and training to make a mine safer 
should not have to compete against those who refuse to make these 
needed investments. In the end, it's miners who pay the price when 
operators do not adhere to what the law requires. But so long as there 
are good paying jobs in mining, there will be workers willing to take 
the work hoping and praying they will be the lucky ones. Working in 
America in the 21st Century should not require such a gamble. And 
unless operators start running their mines consistent with what the law 
requires, we will continue to witness miners dying.

    The Union and coal miners have hailed MSHA for releasing its new 
silica rule as the dawn of a new day in improving coal mine health and 
safety. We have seen some improvements, but we still have a long way to 
go. MSHA should be given additional funding and resources to enhance 
its ability to enforce the law.

    I believe that the facts that have been laid out at this hearing 
and the facts that have been available in the public domain for decades 
are sufficient to demand action by this Committee and ultimately by the 
entire U.S. Congress. There is no longer an alternative, and there can 
no longer be excuses. The carnage in the coalfields from this 
preventable disease must stop.

    Mr. Chairman I would like to take this opportunity to thank you, 
Ranking Member Braun, and the entire Committee for allowing me the 
opportunity to testify at this extremely important hearing. The 
nation's miners are some of the hardest working, dedicated, and 
patriotic people in this country. They have made great sacrifices to 
protect and energize the Nation. They are willing to continue providing 
whatever is necessary to keep our Nation strong and moving forward. 
They would simply request that their sacrifice be rewarded with a long 
retirement, not cut short because of Black Lung disease. Mr. Chairman, 
the miners have waited for congressional action far too long. Thank 
you.
                                 ______
                                 

    Senator Hickenlooper. Thank you, Mr. Roberts.

    Dr. Schafrik.

  STATEMENT OF STEVEN SCHAFRIK, PH.D., ASSOCIATE PROFESSOR OF 
 GRADUATE STUDIES, MINING ENGINEERING, UNIVERSITY OF KENTUCKY, 
                         LEXINGTON, KY

    Mr. Schafrik. I would like to thank the Subcommittee of the 
U.S. Senate Committee on Health, Education, Labor, and Pensions 
for the opportunity to discuss important topics for miners 
safety. Your staff has been excellent, and I hope to continue 
to work together with them.

    My career as a researcher has been working on the difficult 
challenges that face the mining industry. The main goal of this 
work has been to create solutions that help the miner work in a 
safe, healthy, and productive environment.

    In our industry, the details matter and every side is as 
varied as the Earth's crust, but I am going to be talking in 
general terms. Extracting useful minerals involves breaking, 
moving, and, or processing tons of rock.

    Making a rock or anything smaller generates dust. Dust 
generation, characterization, monitoring, and suppression are 
all important topics with a wealth of information, and my 
written testimony discusses them in more detail than I will 
today. Thus, monitoring the laboratory and in the field are 
very different.

    We have excellent tools for research lab experiments but 
not so many to use in the field. NIOSH's mining division has 
developed several technologies for monitoring and evaluation of 
dust, like the fast method for silica exposure in coal mines, 
and the CPDM for real--which is a real time tool for overall 
dust exposure.

    What we lack is a real time tool for all miners, 
specifically for silica exposure. It would help if it were OSHA 
compliant too. NIOSH has been soliciting for such a device to 
be developed for the last few years in anticipation of the 
silica rule.

    These projects have had mixed results, but I believe that 
we can get there with an effort similar to the one put forth on 
the communication and tracking problem. In my work, I want to 
get the dust out of the air.

    In a NIOSH funded effort, we investigated the impingement 
screen on flooded bed scrubbers used in underground coal mines 
because the screen can be clogged, making it less effective. We 
have developed a field trial--and field trialed a maintenance 
free screen to replace it.

    Our field trials met airflow requirements and were well 
received by the workers but had disappointing cleaning results. 
We are currently working with Virginia Tech and the NIOSH 
Pittsburgh Mining Research Division to improve the design.

    We have also developed a radical style of filter that is 
based on a filter type used in automotive spray boots and is 
extremely difficult to clog. This shows great results in the 
lab and can be used as a standalone area filter.

    I am working with an international manufacturer to make a 
prototype in trial at most likely in South Africa. I think this 
kind of filter would be useful for off-earth mining and 
exploration applications, where dust impacts on the machines 
and astronauts can be easily overlooked. In this industry, if 
it is easy to do, it has already been done.

    The only way to keep us--keep up is to increase our 
technology, which means more engineers. The technology 
developed in the mines is important to many other industries, 
as our products. Modern mining machines resemble robots much 
more than shovels.

    They rely on the expertise of the worker to operate safely 
and efficiently. But we have the mineral resources. And thanks 
to efforts by NIOSH and SME, we also have the educational 
expertise. But we lack the public will to encourage highly 
talented engineering students to pursue a career in the mining 
industry.

    The rhetoric around the mining industry is pushing away 
talent. The No. 1 question I get from parents of prospective 
engineering students is, will we still have mines in 5 years? 
It is not just parents asking that. It is executives at major 
technology companies too. To meet the challenges of the day, we 
need more engineers working together on the dust problems.

    Those engineers need to have a deep understanding of the 
processes from the mine face to the load out, and the 
particular needs in each place. They need to have--they need to 
take a risk based approach to solve this as efficiently as 
possible.

    Inefficiencies at the beginning of the production chain 
affect everyone in society. I thank you for your time and 
attention, and I am looking forward to some questions.

    [The prepared statement of Mr. Schafrik follows.]
                 prepared statement of steven schafrik

    I'd like to thank this Subcommittee of the U.S. Senate Committee on 
Health, Education, Labor, and Pensions, and the Subcommittee for the 
opportunity to discuss this important topic of miner safety.

    I am an Associate Professor and Director of Graduate Studies for 
Mining Engineering and a Faculty Fellow of the James B. Beam Institute 
for Kentucky Spirits at the University of Kentucky. I currently teach 
circuits, programming, mine design, ventilation, and automation at the 
undergraduate and graduate levels. My research is in automation, 
communication, ventilation, and training. I have two patents for dust 
filtering technologies. I am the founding Secretary/Treasurer of the 
Eastern Collegiate Mine Rescue Organization and the faculty advisor for 
the University of Kentucky RescUKats. I am very active in our 
professional society, the Society for Mining Metallurgy and 
Exploration, where I am currently the Chair of the Coal and Energy 
Division.

    Much of this work has been developed under several CDC NIOSH 
contracts. The views and data are from me and in no way represent the 
views or opinions of the CDC, NIOSH, or any of its employees.

    Much of the work described here was performed by nearly a dozen 
researchers at the University of Kentucky, Virginia Tech, particularly 
Dr. Emily Sarver; Penn State, particularly Dr. Ashish Kumar; and 
Missouri University of Science and Technology, particularly Dr. Guang 
Xu. Much of the testimony I will be describing and generalizing about 
mining technology, and there will always be exceptions to my comments. 
My comments are aimed at a general audience and not at specific mines 
or specific mining operations.
                  Sources and Characterization of Dust
    There are various sources of dust in mining operations. Mining 
operations, by definition, extract minerals from the earth's crust for 
society to use. These minerals are used for anything from cosmetics to 
electric power to the metals that make up every piece of electronics. 
It is a truism that if something is not grown, then it has to be mined. 
Even though some of the things that are grown don't need to be mined, 
the tools that we use in order to harvest things that are grown are 
mined.

    Most mining operations involve breaking stones using explosives or 
mechanical means to extract valuable minerals. These minerals are then 
used to produce items that are bought and sold every day. Mining is the 
beginning of the value chain for every product in society.

    When a rock or any rigid body is broken, it creates dust, even if 
it's something that is cut. Cutting things with lasers, saws, and 
everything else will still create dust. The particular size and 
chemical makeup of the dust determine its health effects. Not all dust 
is created equally.

    Mining operations have their own characteristics. Most of the 
mining operations in the United States are surface mines. Most of the 
mines in the United States are classified as metal/non-metal (M/NM), 
which means they produce a commodity other than coal. Most mines 
operate by what we think of as the classic mining cycle. That is, they 
drill holes and load those holes with explosives to provide the energy 
to break the rock. This leaves them with a pile of rocks that should be 
suitable for loading into a haulage system. They are hauled to a 
location and dumped in that location, and the production cycle 
continues. The rock is then processed. It is either sold as-is, crushed 
to smaller sizes, and/or processed in a mineral processing plant and 
then sold.

    Dust from drilling is well known to the general public. Drilling 
was one of the most dangerous occupations when mechanization was first 
introduced into the mining and tunneling industries. The Hawk's Nest 
tunnel construction in West Virginia famously accounted for hundreds of 
cases of silicosis. This construction was before the adoption of the 
Jack Leg Drill, which was a step change in the safety of the miners. 
Most corporate mining operations today will use remote drilling 
machines that move the worker even further away from the drilling 
operation. The reduction of dust from drilling is a success in the 
mining industry, with the techniques adopted anywhere else where rock 
and concrete are drilled.

    During loading, dust can be disturbed and created from the rocks 
running against each other. This process is done by machines where the 
operator is in the cabin and away from the digging. They are loading 
haul trucks, or equivalent, that are similarly operated from a cabin. 
Hauling can create dust from the trucks themselves or whatever haulage 
is used, stirring the dust up from the road or disturbing it in the 
loaded material. There are ways that we handle that with water sprays, 
and dumping creates dust, but this is also an activity where there's 
generally not a human being around. They will employ a negative 
pressure system and or water sprays in dust-related operations.

    Surface coal mines in the United States operate in much the same 
manner as surface M/NM mines. However, the hard rock above the coal 
seam requires hard digging, while the softer coal is generally not 
blasted but is directly dug. Underground coal mining and soft rocks, 
such as trona, can be mechanically mined using a continuous mining 
machine or, under the right circumstances, using a long-wall system. In 
these mining methods, the rock is broken with a mechanical drum with 
cutting heads on it. The drilling, blasting, and loading are all done 
by mechanical means within the machines. The cutting heads come around, 
make contact with the mineral, break it away from the earth's crust, 
and knock it down into some form of gathering system. On a continuous 
mining machine, gathering arms move around and pull the broken ore into 
the machine's body. It's loaded onto a conveyor belt and can be loaded 
onto a shuttle car or similar haulage system and taken to a dump, moves 
the material onto a conveyor belt, and takes it outside.

    In a long-wall system, the conveyor belt is called a pan line, and 
it runs underneath the long-wall shearer's head. The shearer is two 
drums with cutting heads that move back and forth across a face of 
coal. The coal face is typically between 800 and 1,500 feet wide, 
depending on the geologic and economic conditions. Coal and the rocks 
around it are cut and dropped directly onto a set of conveyor belts to 
take it outside. It's a very highly productive means of mining.

    With all kinds of mining, we have modeled the material that we are 
mining, but no model is perfect. The geological conditions will dictate 
how much out-of-seam material will be mined. Material that is not 
economical to sell is not desirable to mine, although in some cases it 
must be mined in order to fit equipment and people into the underground 
opening. In surface mines, the material that overlays the ore body 
generally must be moved or disturbed to get to the ore body.

    Focusing on underground coal, the high-quality thick seam coal 
deposits are being mined out. A lot of economical coal seams are 
thinner than in the past. Sometimes, the coal is not as thick as the 
cutting head, and often, especially in central Appalachian coals, the 
rock surrounding the coal must be taken. That rock can be the source of 
silica dust or the nature of how the coal was formed, which made it 
contain silica. What we've seen in dust characterization studies, 
especially those that were done at Virginia Tech under Dr. Sarver, is 
that it doesn't necessarily depend on how much out-of-seam material is 
being mined. It may just depend on the mineralogy of what is being 
mined. In the case of Central Appalachian coals, there's mineralogical 
evidence that more silicates and silicon dust are generated even when 
the mining height is predominantly in the coal. This same trend has not 
been found outside of the Central Appalachian coals. The study looked 
at more than 20 room and pillar coal mines both inside of Central 
Appalachia and outside of Central Appalachia.
                 Dust Exposure Reduction and Mitigation
    We've been producing dust in mines for thousands of years and have 
determined many different ways to deal with that dust. Personal dust 
masks that are both passive and active will not be discussed, I will 
focus on engineering and administrative controls and not personal 
protective equipment. The first and simplest way is to inject water at 
the cutting or dust generation point. In the drills, dust is generated 
at the end of the cutting tool. There's a water stream that captures 
the dust. This traps the dust the second that it's made. That's been a 
highly effective method. In fact, that technique was the innovation in 
the Jack-leg drill mentioned above. This can commonly be seen on 
construction sites where water is injected immediately to capture the 
dust.

    The U.S. Bureau of Mines did a lot of work optimizing the angle of 
attack for mechanical breakage to reduce the amount of dust generated. 
Common in underground working is having a lot of airflow and keeping 
flow away from the workers. When the dust is created is blown away from 
where people are located.

    In many mines, the best way to keep the workers away from the dust 
is to keep them in enclosed cabins. They may be in a heavily dusted 
machine, but they do not experience any dust because their cabin is 
enclosed, and these machines often have various filtering techniques 
for the cabin air.

    There is a type of continuous miner that injects water at the point 
of cutting, called a wet head. In some mines, water spray bars behind 
the cutting head knock down the dust. Coal and clays are hydrophobic 
and are not as easily mixed with water. It's common in underground coal 
to filter or scrub the air after the mechanical cutting. These devices 
are called flooded bed scrubbers on continuous mining machines or 
scrubbers, and I'll be talking about those more later.

    Another fairly new technique in the industry, but it's not uncommon 
is air curtains. These can generally be found on drills, such as the 
roof bolting machine, and haulage like shuttle cars. These are jets of 
filtered air blowing down around where a worker is working, keeping 
dust from encountering that person's work area.

    This is very similar to the air curtains found in grocery stores 
between refrigerated sections and the rest of the store. These are 
needed where you cannot put that operator into an enclosed cabin 
because of the job's nature or the mine opening's size.

    Dust is generated from explosions both on the surface and 
underground. Time and distance are taken away from those explosions, 
reducing the dust exposure for the workers. Areas that are blasted must 
be inspected before workers are allowed to enter them and that has kept 
the dust exposure down as well.

    Automation as a dust control technique is gaining more acceptance 
and will be discussed later.
                    Novel Approaches to Dust Capture
    The continuous miner scrubbers have somewhere between 60 and 90 
percent dust reduction, although they have a maintenance issue where 
the impingement screen is prone to clogging. The way that these systems 
work is they have a shroud over the continuous mining machine that is 
behind the cutting head. Dust is generated by the cutting head passes 
over the shroud. Inside the scrubber, there's a fan pulling air into 
the shroud. That air is assumed to be dust-laden and goes through an 
impingement screen. That screen filters out the large materials. A 
water spray sprays water onto that screen, keeping it flooded with 
water. The air then enters the dust box and is treated with water. The 
dust box feeds into a demister device that pulls the water and dust 
from the air trapping it in a sump before it's ejected from the 
scrubber. The demister is thought to be responsible for most of the air 
cleaning.

    Part of my work has been improving the impingement screen to reduce 
the amount of maintenance necessary by the workers. That research aims 
to test a maintenance-free flooded bed scrubber screen that would be 
acceptable for use in underground coal mining applications. This 
research had many challenges. The first challenge was creating a 
maintenance-free screen that won't clog and has the same air resistance 
as the existing screen. This way, no modification is needed to use it. 
We want a worker to pull the existing screen out and put in a new 
screen design. Another challenge is actually measuring the 
effectiveness because as you can imagine, this is all taking place in a 
part of the mine not well disposed to sensitive scientific equipment.

    It's in permissible areas, which means that you have strict 
restrictions on the type of electronic equipment that can be used. You 
also move a lot of rock, which is detrimental to scientific equipment. 
I'm going to be discussing work done at the University of Kentucky. 
Aaron Noble at Virginia Tech took another approach, funded by the Alpha 
Foundation.

    We started with an idea, and then we did a variety of computational 
fluid dynamics (CFD) to test how the idea would work and optimize it as 
best we could in simulation. We know that there are constraints to the 
software. Physical prototypes were manufactured and tested in a 
controlled lab environment and also in a dust gallery that we have at 
the University of Kentucky, which lets us work in a less controlled 
laboratory setting. This was an iterative process of testing and CFD, 
we generated several different generations of these screens. We were 
working with the manufacturer, Komatsu, to be sure that the screens 
would not harm scrubbers deployed in the field.

    As part of this research, we found three mines willing to test the 
prototype screens in various ways. It's important to note that in these 
tests, dust was sampled in areas, not on workers. The workers were 
positioned away from the machines to reduce their potential exposure to 
dust. Because we were testing the safety device, we needed to ensure 
the workers were protected.

    We used the Personal Dust Monitor (CPDM), which was critically 
important in these tests. There are just a few minutes of delay in the 
dust concentration, so you can see your exposure more or less 
immediately. It was originally designed as a research tool by NIOSH and 
is now used as an enforcement tool.

    The design of our maintenance-free screens creates a torturous path 
for the air to flow through plates. Instead of going through a mesh 
where it can randomly hit a mesh screen, it's forced to make sharp 
turns. The larger, heavier particles won't be able to take the turn, 
will hit the plate, and be captured because they lose their momentum.

    Working with Komatsu we did a variety of different testing on our 
screens and compared them to the existing screens that can be purchased 
today. In an example test, when it's clean using the existing screen a 
particular scrubber is flowing about 6,500 cubic feet per minute (CFM) 
and when it's dirty it's flowing about 5,500 CFM. The screen that we 
manufactured for Mine A was able to flow a little closer to 6,500 CFM 
and when it was dirty it was flowing 5,900 CFM. The screen that we 
manufactured for Mine B was running 6500 when it was clean, and the 
screen that we manufactured for Mine C was running 7,800 when it was 
clean and 7,200 CFM when it was dirty. It's important to note that the 
screens that we manufactured will clean themselves, and so even though 
the dirty flow decreases, it will increase again while running.

    The mines took their existing screen and checked the airflow 
through it and checked the screen that we manufactured. In all cases, 
we were able to meet the project's first goal, which was to have no 
airflow difference. In all cases, there is a 1 percent or less airflow 
difference, within the measurement error range. Mine A&B only tested 
the screens for one cut, but mine C tested the screen on 13 cuts, seven 
of them with the new screen and six with the fiber screens. They found 
that, when loaded, the maintenance-free screen will allow 11 percent 
more air through the scrubber than the current screen. That's 
consistent with the lab testing that was done at Komatsu.

    They liked the improved airflow, and that improved the visibility 
for the continuous minor operator while he was operating the machine. 
They knew that more air was being pulled into the scrubber. 
Unfortunately, it resulted in 53 percent more dust being measured 
downwind, which means that the screen is causing a change to the 
scrubber system, making it less efficient overall at reducing the dust 
amount despite having more air going through it.

    We decided to take the prototypes and bring them back to the lab. 
While we were doing the work in the field, the NIOSH Pittsburgh Mine 
Research Division built a scrubber set up with the help of Komatsu. 
They have started instrumenting it so that they can do much more 
detailed work on the internal workings of the scrubber system. It had 
previously been thought that most of the dust collection was being done 
inside of the demister and not at the impingement screen. But our 
results show that may not be the case. The NIOSH setup has already been 
used to test the Virginia Tech vibrating screen from Dr. Noble's 
research, which will require a major change to the scrubber design.

    Dr. Sarver's Virginia Tech research group is using NIOSH's lab to 
investigate our maintenance-free screen. Their preliminary results have 
shown similar results to our lab results. It's important to note that 
our lab results and their preliminary results are currently at lower 
air flows than scrubbers at the mines. This work is ongoing and is 
difficult because of the nature of the measurement devices. They are 
not designed to work at the high flows that are seen in mining machines 
and in most underground coal mines. Instrumentation work is ongoing to 
find the point that the maintenance-free screen changes the 
effectiveness of the scrubber. My hypothesis is that the maintenance-
free screen is capturing the water from the water spray and choking the 
demister. We may need to change the spray nozzle to one that is 
emitting smaller water particles. All of this is being investigated 
right now and we just don't have, we just don't have results on it at 
this time.

    Scrubber systems are not the only and best solution. Also, running 
more air through the scrubber is not always the best solution if the 
air is dirty. In previous work, we've seen that the running air through 
the scrubber can actually cause other problems because what it can tend 
to do is it can pull the fresh air coming in that is intended to get 
the dust and gas away from the continuous mining machine and pull it 
into the scrubber. Because the scrubber is creating so much negative 
pressure, it's pulling the clean air through before it can get dirty or 
mix with the gases being emitted.

    Potentially, flooded bed scrubbers are not the best technology. 
Researchers prior to me at the University of Kentucky looked at a 
machine called the Vortecone. Most notably it's used in paint spray 
booths in auto automobile manufacturing in order to capture the spray 
particles out of the air. In the Vortecone, air is drawn through the 
system, accelerated, and spun. The heavier particles tend to move 
closer to the wall of the Vortecone. When they make contact with the 
wall, they become captured because there's also a water jacket that is 
introduced, creating a thin film of water all along the wall of these 
types of filters. Effectively, dirty air and clean water enter with 
air, and dirty water leaves with a very high cleaning efficiency. The 
Vortecone has a high resistance to airflow and will take a lot of 
energy to achieve the airflows that are necessary in mining conditions. 
More power is not always available for airflow because the motors on 
the fans and the fans themselves can be loud.

    This device is good at cleaning but not ideal for underground 
mining conditions or machines. We performed CFD development on these 
devices and physical testing to understand the cleaning mechanism and 
to adopt it to a horizontal orientation. We created a physical 
prototype and tested it in our lab and found that we were able to get 
better cleaning efficiency than the original as well as were able to 
drop the resistance to flow to approximately 10 percent of the 
Vortecone resistance. This allows the horizontal version, the 
Hortecone, to achieve the airflows necessary in mining conditions. We 
are investigating developing a standalone version of the Horticone 
specifically for mines in South Africa.

    There are tradeoffs in all the mitigation work. You want to clear 
all of the air in the area, but you don't want the maintenance of the 
filters to be constant. If it's too much, it won't be done.

    The only way to find the balance, which will be site-specific, is 
to deploy good monitoring technology. There's a lot of monitor 
monitoring technology that has been developed. Much of the work that 
has been described thus far, all of the in mine testing and dust 
gallery testing, was done with real time dust accumulation that's 
reported by the CPDM.
                            Dust Monitoring
    In laboratory testing, we use devices such as the TSI DustTrak 
that give excellent repeatable results. Those and others like it are 
excellent devices, but they can only work on extremely low flows of air 
compared to what we need in the mining industry. That is why we must do 
area sampling when developing dust mitigation technologies. Doing 
direct sampling of the air stream is difficult and introduces errors 
with the machines that are available to us to use. We cannot sample the 
air while it's not flowing, the point of the sample is to see how much 
and the size of the dust in the air.

    Especially in coal mining operations, mines move a tremendous 
amount of air. It is not uncommon for a coal mine to move more than a 
million CFM of air at the main fan. To put that in perspective, a 
typical bathroom fan and a house is somewhere around 200 to 800 CFM and 
a typical 2,000 square foot house will have an air conditioner fan on 
it that runs somewhere between 4,000 to 6,000 CFM.

    Underground M/NM can be running very significant CFM at their main 
fan, but because these openings are so large, it can appear underground 
as if it is stagnant or quiescent flow. To put that in perspective, the 
average coal mine opening cannot exceed 20 feet wide and 3-8 feet high. 
In the United States, a 10-foot-high coal seam is very high and very 
unusual in modern times. At 10 feet of height and 20 feet wide the area 
is 200 square feet. In stone operations, they can be anywhere from 20 
to 80 feet wide in their opening and 20 to 120 feet tall. At 40 feet 
wide and 60 feet high, the cross-sectional area is 2,400 square feet, 
or 12 times more than the coal mine. An order of magnitude larger areas 
inside of stone operations and although they can have a good amount of 
air going through them, you won't notice it because the cross-sectional 
area is so much bigger.

    It's also important to note that dust isn't only present 
underground, it is also present in surface mines and it's also present 
in the plant. When we're talking about dust and dust mitigation, we 
need to make sure that we are looking beyond just what is going on in 
underground coal mines and looking at the surface and plant operators.

    There has been a lot of research and evaluations of enclosed cabins 
and clean areas of plants. There are different air intake systems that 
are available on drill rigs and other places where lots of dust is 
being generated. We have water trucks in order to reduce dust along 
hall roads. There has been a lot of work and also a lot of things with 
the air curtains in the surface operations and plant operations that 
have dramatically decreased dust exposure outside of the underground 
environment.

    For silica in particular, it's important that the silica risk for a 
site be evaluated because this risk is going to be site-specific. Rocks 
in the Earth's crust are not homogeneous, they are not the same 
everywhere. A particular kind of deposit or mineral mineralogy in one 
location will have big differences from another. Those differences can 
be from the way that it was deposited or what rocks are around it. The 
dust constituency must be present in the rock to be present in the air.

    There are a lot of current silica measuring technologies, such as 
the Field Analysis of Silica Tool (FAST) from NIOSH, which is fast and 
accurate. They tell you about the worker's exposure, but it's after the 
fact. Many of these systems have been developed for specific mineralogy 
and dust constituencies and should not be universal. Many methods rely 
on personal dust pumps that are widely available and used in dust 
sampling for M/NM mines. However, in coal mines the CPDM has mainly 
been used in place of the pumps.

    Several projects, such as NIOSH's Helmet-Cam project, can be used 
in surface operations and mostly in M/NM operations. The Helmet-Cam 
monitors what the person is doing and monitors their dust and noise 
exposure. When the dust is post-processed and contains higher exposure 
than expected the video can be investigated to determine the source. 
That project has been popular with several different M/NM operations, 
but it is not widely used and can't be used underground or in 
underground coal. It would be much more valuable if it gave real-time 
data to the worker.

    For at least the past 4 years, NIOSH's Broad Agency Announcements 
have been soliciting proposals to develop something that is similar to 
the CPDM but for silica dust. That effort has had some promising 
results and some difficulties. In my understanding of that effort, I 
think these difficulties can be engineered out, but it will require 
more than the NIOSH can do with that funding mechanism. I was very 
involved in the development and deployment of the communication and 
tracking systems that were required by the MINER Act. That effort was a 
huge effort for the industry, pulling in many new people and 
technologies into the coal mines and resulting in some very successful 
communication and tracking equipment. I think that the difficulties, as 
I understand them, encountered by NIOSH in the FAST and vendors such as 
Ring IR and ThermoFisher can be engineered out if they have sufficient 
funding and backing.
                               Automation
    I consider automation a means of dust mitigation and reduces dust 
exposure for workers. Modern mines, right now today are highly 
automated operations. Most of the mining machines that you see in 
operation, especially in production operations, resemble robots more 
than they resemble shovels and picks. These systems have a tremendous 
amount of data logging on them for maintenance purposes and for 
efficient use. A major component of efficient use is safe use. Reducing 
dust improves the life of the machine and even highly automated 
machines need to be run efficiently. Off-Earth mining operations are 
projected to be highly automated and will encounter tremendous dust 
issues. A lot of the lessons learned in terrestrial mines have 
immediate relevance to NASA's moon missions and any mission to mine 
asteroids.

    We are at a point in the industry, underground, where we have a 
fleet of highly automatable machines that are being operated by humans. 
We have reliable communication and tracking information, and that's the 
opportunity to automate those machines and turn them into remote 
control or completely autonomous machines. One of the solutions we've 
discussed is reducing workers' dust exposures to get them away from 
where the dust is being generated. If you can make all the machines so 
that they are or they can mostly work by themselves with a human 
supervising them, then you can put that human into a place where 
they'll be able to work in a protected environment. They would be more 
readily able to work in a closed cab or away from where dust is being 
generated or anywhere. It's not uncommon for a mining machine in 
Kalgoorlie, Australia, to be operated by a human in Perth.

    At the University of Kentucky, my research group has been doing 
extensive work in automating underground coal mining machines. In our 
work, we are moving the machine operator from being on the machine to 
supervising it. The American coal miner's expertise is necessary for 
the successful conduct of a mining operation. The expertise of 
America's coal miners is the best in the world, and they are needed to 
spot issues and keep everyone safe and working together.

    In M/NM, the automation constraints are different. They don't have 
the permissibility issues amongst other things. Also, coal mines are 
constantly moving the area of the coal mine where the mine face is 
located. In some mining techniques, you can keep the mine equipment in 
place for a relatively long time. In a mining technique called block 
caving, the draw points underneath the block cave will stay there for 
months. Setting up autonomous pathways underneath the ore body is much 
more like setting up a factory than setting up a mine. In those cases 
where you have a fairly static mine opening and so you don't need 
people working in that area.

    You can travel around the world today and visit underground 
autonomous mines where pretty much nobody is working underground. 
There's definitely nobody working around the equipment except for 
during maintenance or if there are any issues. But this is very 
expensive, and it's really just for particular types of mine methods 
and particular types of ore bodies. I don't think that these kinds of 
completely automated operations will be widely distributed inside of 
the industry.

    I think that more we need to be looking at automation as being a 
collaboration between humans and the mining machine robot.
                               Conclusion
    In conclusion, we know that dust is generated at mining operations, 
and it needs to be managed. Especially if the dust particle size is 
small and the constituents of the dust are potentially harmful to 
worker health. We don't have a good model for where the dust will go or 
how far it will run in the airstream. Especially in the high-flow 
airstreams that we have in various parts of the minerals industry. 
Monitoring does exist, but the issue is when it comes to dust, not very 
much dust monitoring is available in real-time. This is necessary to 
give the worker the tools they need to make their own decisions about 
their health.

    Dust mitigation technologies exist and are always evolving. No dust 
mitigation is perfect, especially when we generate a lot of dust at 
scale. We've worked to reduce the maintenance for dust mitigation 
technologies because that will keep them running as efficiently as 
possible for as long as possible.

    Using automated machines or more automated machines can reduce 
exposure to dust, noise, and vibration. But automation can't always be 
implemented; the skills and knowledge of the mine worker must still be 
present in the system. Today, most mining machines are customized to 
their locations, so particular autonomous machines are a lot more 
expensive because they need additional engineering work before they can 
be deployed.
                             Current Needs
    The issues discussed highlight the current needs of the minerals 
industry. It's clear, and it's been well documented several different 
ways, that we don't have enough engineers going into the mines. This is 
the fundamental problem that is shared by industry, academia, and 
society as a whole. The products of the mines are the basis of the 
economic activity because it's the beginning of the production chain. 
Technology developed or adapted to the mines is important to many other 
industries. The less that we are mining in the United States, the more 
that we have to transport materials around the world, and the more that 
material is produced in locations without our environmental, health, 
and safety standards.

    We have the mineral resources and education expertise, but we lack 
the public will to encourage highly talented engineering students to 
pursue a career in the mining industry. I meet with the parents and 
with students to do quite a lot of recruiting into our discipline. I 
teach an introductory freshman engineering class with approximately 150 
students in two sections every fall. What I see in the incoming 
engineering students is they want to solve the big problems. This is 
what engineering students do, they want big problems.

    They are directed to other engineering disciplines in other 
industries. A lot of it's because of the rhetoric around the mining 
industry. The No. 1 question I get from parents of prospective 
engineering students is, ``Will we still have mines in 5 years?'' 
There's a fundamental misunderstanding of the importance of the 
minerals industry. I think it has been an issue that we, as leaders in 
society, can address. I've been addressing it by bringing mining 
technology to other industries.

    The mines and their conditions are as difficult and varied as the 
Earth's crust. That level of challenge is the sort of thing that should 
be attracting the top engineering talent. We should be saying you're 
really smart, you need to go work in the mines. There is tremendous 
opportunity for engineers in the mining industry. Everything in this 
discussion around the dust problems is rife for engineering solutions. 
We just need engineers to put existing solutions together in the right 
way.

    In terms of what needs to be done in the future, we need to have 
more engineers working together on the dust problems. Those engineers 
need to have a deep understanding of the processes from the mine face 
to the load out, where customers' materials are loaded, and the 
particular needs in each of those places. They need to take a risk-
based approach to all of the health and safety issues in that area and 
make tools that match the problem so that we can solve these things as 
efficiently as possible. Inefficiencies at the beginning of the 
production chain go all the way through to everyone in society.

    The solutions to dust problems in the mines will be direct and 
immediate solutions in other industries. We are not the only industry 
that turns big things into little things and creates dust. Our 
solutions are the basis for others to learn from because we solve big 
problems in this industry.
                                 ______
                                 

    Senator Hickenlooper. Great. And thank all of you again for 
being here. We really do appreciate it. I am going to be here 
the whole time, so Senator Kaine, if you want to go ahead and 
start with questions. Each of us is going to take 5 minutes of 
questions. I will let it run over a little bit maybe, but I am 
kind of a hard ass.

    [Laughter.]

    Senator Kaine. Dr. Harris, you talked about Paul. I have 
been struck with what Cecil Roberts said that this is happening 
to younger and younger people.

    As I am out in the coalfields of Southwest Virginia meeting 
with miners at the COMPAC office in Castlewood or others, I am 
hearing these stories about the silica exposure getting people 
diagnosed with black lung earlier and earlier. Is that what you 
are seeing in your clinic as well?

    Dr. Harris. Definitely. I think still the average age of 
the person who gets diagnosed with progressive massive fibrosis 
is older in our clinics from mostly seeing retired former 
miners.

    In the publication we just recently published in JAMA, I 
think we had 75 miners that were in their 30's or 40's, which 
is an outrageous number. I mean, it is 75 people that are in 
the prime of their life that are getting this incurable, 
potentially fatal disease.

    Senator Kaine. What more can we do to promote early 
detection?

    Dr. Harris. Yes, I think that is a great question. I 
alluded a little bit to what other tests we can potentially run 
for early detection.

    I want to, if it is Okay, circle back to talk about CT 
scans for a little bit. It gets a little bit in the weeds, but 
I think it is important to know that CT scans are a more 
sensitive test than X-rays.

    We know that through other occupations. In Australia, they 
have screened thousands of people that are silica exposed, and 
many of those folks had both X-rays and CTs. X-rays that look 
normal. The CT are not normal. And so, we are missing things 
when we just rely on X-rays.

    The challenge for us is that we don't have a system like we 
have for X-rays already set up. So, we have B Readers, which 
are certified by NIOSH and trained to read these X-rays. We 
have a classification system called the ILO System for X-rays.

    We don't have that for CT scans in the U.S.. 
Internationally, there is a system that exists for CT scans. It 
is just not widely utilized. And hardly anyone in the United 
States is probably trained on it. And so, I don't think we are 
ready to, from a population level, start with CT scans.

    But I do think that since we know who are the highest risk 
miners, and they are folks working in Central Appalachia, they 
are folks working underground with the face, that we should 
think about using CT scans to screen the folks that are highest 
risk, even if we don't have the perfect tools to understand and 
categorize it.

    We can at least find the nodules. They are easy to see on 
CT. So that is, I think, my biggest pitch for early detection.

    Senator Kaine. I really appreciate that. And now President 
Roberts in the time that I have been in the Senate, you have 
gone to bat again and again and again to solve tough problems.

    The miner retiree health care plan was on the verge of 
going bust in 2017. And together with Senator Casey and others, 
working with the UMW, your UMW members in camouflage shirts 
pestering us until we got it right, we got that one fixed. And 
then a couple of years later, it was the retiree pension plan 
that was on the verge of collapsing.

    Again, with great miner advocacy here and your leadership, 
we got that fixed. And then the excise tax reverted back to an 
insufficient level that was going to leave the fund even more 
challenged, and we were able to work together to get that 
fixed.

    But every time you knock one down, there is another one 
staring you in the face. I am happy about this silica standard. 
I know Senator Casey and others really leaned hard on the 
Administration to issue it.

    A standard is great if it is implemented. What advice do 
you have to us now that the standard is in place about what we 
ought to be doing as Congress to make sure that this standard 
gets implemented?

    Mr. Roberts. Well, I was pleased to--sorry. I was pleased 
to go to Pennsylvania with the Secretary of Labor and the 
Assistant Secretary for MSHA to announce this rule.

    I think the key here, it is a rule. I think it should be 
the law because if we have a change in leadership at MSHA or 
the Secretary of Labor, we might see this rule changed and we 
will be right back where we were before the rule was 
promulgated. So, I would urge consideration with respect to 
that.

    If it is a good rule, it should be a good law, because this 
is something that is going to take silica out of the 
atmosphere. I fully support what the medical professionals have 
said about silica and testing for it, Okay--black lung testing 
for it.

    But there is nothing like eliminating the problem, so you 
don't get sick. I hope the X-ray people--and they can't find a 
single person in this country suffering from this disease. That 
is what our goal should be here in the U.S. Congress and in our 
union also. Because if you don't take the silica out of the 
atmosphere, I don't see how we are going to save people's 
lives.

    We might catch this early, but here is our problem. The 
coal industry has been shrinking. Young miners can't find jobs 
in any other professions. So, one of the things that I would 
advocate for is bringing some good paying union jobs to these 
areas, so people don't have to depend on mining. I am a strong 
advocate for this--mining as much coal as we can.

    I have been very open about that and provide as many jobs 
as possible. But one of the things that happens, a young man 
with children will give up his health in order to support that 
family. What we need to do is make that job he has in the mine 
safe and healthy, and also find other places of employment in 
these coalfield communities.

    Everywhere I go--I am sorry, I am getting long winded here, 
but everywhere I go somebody tells me, we want to address the 
transition for you guys, but I never see it. I certainly don't 
see enough of it.

    What we need to do is find a way, in my opinion, to mine 
coal cleanly and safely, and help and people be healthy when 
they come home every night.

    Senator Kaine. I was in Tazewell County this weekend down 
near the Pocahontas area where there have been one massive 
tragedy after the next over the course of history.

    I was hearing the same message from folks, mine coal 
safely. Help us diversify and find other opportunities. And I 
am so glad that you mention that. I yield back, Mr. Chairman.

    Senator Hickenlooper. Thank you.

    Senator Braun.

    Senator Braun. Thank you, Mr. Chairman. I had some 
questions prepared but I always listen to the witnesses and try 
to discern what the meat of this whole conversation ought to be 
about.

    I know in my own company many years ago, when you try to 
take care of your employees, and that ounce of prevention being 
worth a pound of cure. In this case, it sounds like it would be 
even more than a pound of cure that you would save. Coal mining 
has been around for so long.

    I want to ask Mr. Roberts some simple questions. First, and 
keep the answers fairly brief, because I think you can, with 
your experience, tell me this. Is this an issue only in 
underground mining, or is an issue on strip mining above ground 
as well?

    Mr. Roberts. It is found primarily in underground mining. 
Just quickly, most of the easy coal, as they say back home, has 
been mined.

    Senator Braun. You got to go underground----

    Mr. Roberts. Coal seams are shrinking--so you are banning 
coal in a place about the height of this table. You can't do 
that without taking a rock. When you start taking a rock so you 
can mine, this coal, that is where you get to silica.

    Senator Braun. You get that same type of dust floating 
around in the air if it is above ground versus being 
underground. So, it--do you get it in both methods?

    Mr. Roberts. When you do surface mining, it has been my 
experience and based on the knowledge that I have, is you don't 
get the same amount of coal dust, nor do you get to rock silica 
above ground.

    Senator Braun. Then when it comes to silica versus regular 
coal dust, is that confined just to that triangle down in 
Appalachia or do you have that elsewhere?

    Mr. Roberts. This would be like saying, where did the 
disease breakout? And the disease in this instance is in that 
geographic area. You could take it probably a 70 mile radius 
there and you could identify where most of these cases are.

    It is not to say that this couldn't happen, say, in 
Northern West Virginia or in Pennsylvania, but the likelihood 
of that is very remote because they are not mining to rock as 
they mine to coal in those areas. They don't have----

    Senator Braun. It depends on the geology of where you are 
mining.

    Mr. Roberts. Pretty much, yes.

    Senator Braun. Okay. And then on something as clear as 
silica versus coal dust, and one happening at an earlier age, 
it seems like just taking and focusing on where the issue is or 
where it is most dramatic, what has been done by Government and 
companies to focus on something where it is surfacing so much 
earlier in coal miners? What has been done?

    Mr. Roberts. Let me give you an example of my frustrations, 
if I might. I looked at my testimony. I have been doing this 
for years here. The first time we talked about needing to do 
something about black lung and in mentioning silica was in 
2003.

    20,000 miners have died from black lung since I gave their 
testimony. So, we haven't done much of anything. We didn't even 
have a rule about silica until a few weeks ago. So, to answer, 
there is not a lot.

    Senator Braun. Next questions will be for Dr. Harris and 
Schafrik. When it comes to individual miners, do all seem to be 
affected in the same way, or does it vary by miner? In other 
words, if you are in a mine that has got poor ventilation and 
doesn't do anything about it, is everyone there generally going 
to come up with some issue, or is it different among miners?

    Dr. Harris. I think it is a complicated answer. It depends. 
I think, I have miners who have mined for four decades in low 
coal underground and never got black lung. And so, it sort of 
depends on what your body does to the dust it inhales.

    You have an immune system that can kick out dust more 
effectively in some people than others. I think it is--I don't 
think we know enough to say who individually is at risk, but we 
do know of risk factors of where they are working and what kind 
of coal they are mining, and what their specific job tasks are.

    The closer you are to the seams, the more rock you are 
mining, the more dust exposure cumulatively over time, the 
higher risk you are. But I don't think individual risk factors, 
we have totally sorted out yet.

    Senator Braun. Dr. Schafrik.

    Mr. Schafrik. Yes, Senator. I am an engineering, mining 
engineer, so I will yield to the medical discussion of that.

    But I would also agree that it would most likely have a lot 
to do with what their specific job was, what they were doing, 
how much rock was being cut at the time that they were working 
downwind from it, and what dust mitigation technologies of the 
many that are available were being deployed at that site, and 
if that site decided that they needed those or was told that 
they need those.

    There is a huge number of variables here to be able to 
answer that question fully, so I would be more than happy to 
answer it in more detail for you if you had some like specific 
case that you were looking for.

    Senator Braun. My simple observation would be, since there 
is variability among miners and Mr. Roberts said it is 
inherently kind of dangerous in some places, is that early 
detection would seem to be the only way that you can kind of in 
a fairly simple, broad way make sure you are getting at it 
before it becomes incurable. So, I think that is where a lot of 
attention and focus would need to be placed.

    Mr. Roberts. Right. I don't--I wouldn't disagree with that, 
but I would point out that if you are mining rock along with 
the coal, you are creating coal dust and you are creating rock 
dust. And that rock dust mixed with the coal dust is deadly.

    Senator Braun. That would be the best prevention, is to 
make sure you filter that all out in the first place.

    Mr. Roberts. If you could. But I would just point out there 
has quite frankly not been a great deal of effort put into that 
until the silica rule was promulgated. That is the only step 
that I have seen in the many years that we have been raising 
this here in Congress.

    Senator Braun. Thank you.

    Senator Hickenlooper. Yes. And as the probably one of the 
only former geologists in the room, it is interesting if you 
look at the sedimentary environments by which rock, sedimentary 
rocks get created.

    You generally have shoreline features that have milk--clay 
and sandstone, silica coming down, little critical particles of 
quartz that becomes--that is sand. And then it gets mixed into 
embayment where you have lots of lagoons and swamps. We have a 
lot of carbon the leaves from trees and all that comes in and 
that becomes coal.

    Then the clay and the sand has different--they kind of 
feather into each other. And in certain places where it is 
dropping rapidly, you get huge, thick packages of coal. Other 
places you get beaches.

    You can see deserts or, become sort of big, thick packages 
of rock. What is critical here is the fact that where miners 
can make money best is where you have those thick packages of 
what becomes coal or that organic material and not much of the 
silica. But there has always some silica in there.

    In other words, there is an inner fingering of the grains. 
I think what Dr. Harris was describing was the--or actually, I 
think Mr. Roberts was describing that the easy stuff is gone 
and so now you are getting thinner packages of the coal itself. 
And even that coal that you get is going to have some silica in 
it.

    It is obviously a problem that is not going to get--go 
away. It is not going to get better.

    Senator Casey.

    Senator Casey. Mr. Chairman, thanks so much and I 
appreciate you having this hearing along with the Ranking 
Member. I want to welcome and thank our guests for their 
testimony and the experience they bring to bear on these 
subjects.

    In particular, I want to thank President Roberts for his 
work, his toil, and, dare I say, sweat on behalf of miners, 
coal miners all these years. I wanted to start just with a 
little background. I grew up and still live in Scranton, 
Pennsylvania, which for a while was the anthracite capital of 
the world, or pretty close to it, so-called hard coal.

    For a while there, virtually every family had a coal miner 
or more than one, generation after generation. I have had, 
since my family emigrated from Ireland, one, two, three--three 
generations of coal miners.

    Then the fourth generation was my grandfather, Alphonsus L. 
Casey--I wanted to just say his name in the hearing record. He 
was a coal miner as a kid, really, from the age of 11 to 15--15 
or 16, about 5 years from 1905 to 1910.

    He was in the mines right around the time that Stephen 
Crane, the great novelist of the Red Badge of Courage. He was 
dead at the age of 28 but he wrote an essay about a miner near 
Scranton, and he described it in the most haunting and horrific 
way that only a coal miner would understand.

    At one point, Crane wrote in the essay that before him 
stretched and inscrutable darkness, a soundless place of 
tangible loneliness. Then he went on to describe all the ways 
someone could die in a mine. So, it is a haunting portrayal, 
but obviously accurate for the late--I guess around the 1890's 
when he wrote it.

    Obviously we have made some good progress over the 
generations since then, but this problem is still with us, the 
black lung and the horrors that some families have experienced, 
some miners have.

    Dr. Harris, I was noting in your testimony about the 
reality here of what this means. The debilitating nature of 
these cases and how painful they are when someone is 
experiencing black lung.

    In your experience, do miners with the most serious black 
lung disease always get the benefits they have earned? That is 
kind of part one of the question. And part two is, what stands 
in their way?

    Dr. Harris. Thanks for that question. The short answer is 
no, they don't always get the benefits they deserve. And I 
think it is important to understand how long and painful the 
process is for the miners.

    I mean, the average case takes years to resolve and the 
layers of appeal that happens goes on and on. From the 
Department of Labor to the administrative law judge, to the 
Benefits Review Board, to the District Court, it just goes on 
and on and on, and it is super frustrating for people.

    I think the biggest reason like claims are disputed is 
whether or not complicated disease, whether or not progressive 
massive fibrosis is present or not, which is usually one X-ray 
opinion versus another X-ray opinion. And so, I think an 
important way to improve that process is to utilize CT scans.

    Inside the Black Lung Benefits Improvement Act, it 
specifies if someone's X-ray is abnormal, we should be using CT 
scans. And I think that would help tremendously to improve the 
process. It is not going to help every miner. And I could name 
a million examples--not a million.

    I can name many examples of miners that I have cared for 
that have really horrible, horrendously severe disease--
category B progressive massive fibrosis. Last week, I was 
working on a case and his case has gone on for 5 years. He has 
a mass that is five centimeters in his lung.

    It is not subtle, and it has still taken 5 years to 
resolve. And I think it eventually will resolve in his favor 
because the evidence is indisputable, but it has taken a really 
long time and so there are lots of challenges.

    Senator Casey. I think there are a few diseases where 
literally every breath you take, you can feel it. And 
obviously, one of the many reasons why we have to pass the 
Black Lung Benefits Improvement Act and to close loopholes--if 
we pass that law, to close loopholes and order courts to award 
benefits.

    I wanted to conclude, and maybe I will submit this for the 
record, but President Roberts, you talked about the silica 
rule, and we are grateful for that, for the work on that. And 
maybe I will just--I don't know if we have time for a question 
or--what is the most important thing we could do here in the 
Senate and in the House to ensure the coal miners affected by 
black lung disease can easily access the disability benefits to 
which they are entitled?

    Mr. Roberts. Well, first of all, the system is grossly 
unfair. And what the doctor said here has been our experience 
too. And I think you should take a look at some of the things 
that has happened along the way here.

    We have had attorneys that withheld evidence that miners 
had pneumoconiosis, and they did not inform the opposing 
attorney that they had that. Those people have been sanctioned.

    Then just go over to Johns Hopkins Hospital episode. I 
think CBS did a story on this. They had a doctor there that was 
well known that never, one time in his career found 
pneumoconiosis in a miner's lungs.

    Every time that he made a decision like that, the miner did 
not get their benefits. So, there has got to be some way to 
level the playing field. I would suggest just ask any attorney 
in the coal fields if they want to be a black lung attorney and 
see what they tell you. They can't afford to be a black lung 
attorney.

    Workers who are sick found themselves without 
representation or depending on a law attorney that just wants 
to be helpful to society--and there are some of those out 
there. And I know that. But if you want to make a living as an 
attorney, you don't want to be doing this.

    We have got to figure out how we balance the playing field 
here. But the most important thing we could do is not have 
anybody else contract black lung. And if you think that can't 
be done, that is not true.

    We have heard for years that you couldn't make coal mines 
safe, but we proved with the law that was passed in 1969 that 
you could. Just look at the statistics of the 20 years, 10 
years, 30 years, or 40 years before the law passed and see what 
has happened to 40 years afterwards.

    There are people walking around alive today that would have 
been dead in 1970 if they didn't have this law to fall back on. 
So, laws work, but you got to have laws that are enforced, and 
people have to want to make those mines safer.

    Let's just not have any more black lung cases. And we--
Congress has the power and ability to do that. That is a fact.

    Senator Casey. Thank you.

    Senator Hickenlooper. Senator Lujan.

    Senator Lujan. Thank you, Mr. Chairman. And thank you very 
much for having this important hearing.

    I very much appreciate in your opening remarks the 
inclusion of your statement with the Radiation Exposure 
Compensation Act as well. Thank you very much for that. To all 
of our panelists, I want to thank you for being here today.

    As I begin, I want to be abundantly clear that I am fully 
supportive of working with my colleagues to improve all of the 
environment associated with exposure to uranium--or pardon me, 
to coal mine workers. There must be more that we can do, 
whether it is adoption of technology, it is looking to make 
sure people have those that can best represent them given all 
that is going on.

    Families deserve to heal for those that are still fighting 
cancer. Now, what I want to use my time today is to bring some 
attention to uranium mine workers as well.

    New Mexico uranium mine workers who work beyond 1971 have 
faced a huge injustice. They have no access to any programs in 
the United States, even though Congress took action with the 
leadership of Orrin Hatch once upon a time to provide 
protection to uranium mine workers through 1971.

    The Radiation Exposure Compensation Act, enacted in 1990, 
expanded in 2000, left outpost-71 uranium mine workers in New 
Mexico, Colorado, Arizona, Wyoming, North Dakota, South Dakota, 
Washington, Utah, Idaho, Oregon, and Texas.

    Due to their work and exposure to radioactive uranium in 
the name of national security, mine workers are now struggling 
and dying of lung cancer, lung and pulmonary fibrosis, and 
other conditions.

    The U.S. Government has left them to fend for themselves. 
It created the uranium mining industry, but when the Government 
stopped being the sole purchaser of uranium ore after 1971, it 
left workers excluded from RECA even though they were working 
alongside eligible workers.

    Now, Dr. Harris, yes or no, is uranium ore exposure in 1971 
associated with lung cancer, lung and pulmonary fibrosis, 
silicosis, pneumoconiosis, and renal cancer?

    Dr. Harris. Yes.

    Senator Lujan. Is uranium ore exposure in 1972 associated 
with lung cancer, lung and pulmonary fibrosis, silicosis, 
pneumoconiosis--I pronounced it incorrectly--and renal cancer?

    Dr. Harris. Yes. And I will--I can tell you that because 
Dr. Akshay Sood, who is one of my mentors, did a study to 
answer that question and looked specifically at lung disease 
before and after December 31st, 1971, and found there is still 
exceedingly high amounts of chronic lung disease after the 1972 
cutoff, which is a bit arbitrary.

    Senator Lujan. Is that consistent in 1990?

    Dr. Harris. Yes, I don't know any data to suggest that 
anything has improved dramatically in that time period.

    Senator Lujan. To my colleagues, even though we have the 
evidence, RECA excluded those who were exposed after 1971 and 
experiencing the ever deepening damage of Government sanctioned 
uranium mining.

    Ciprano Lucero, who is from Grants, New Mexico, he began 
working in the uranium mines back in April of 1977. Now, this 
is a quote from Mr. Lucero. He said, ``the lunchroom where we 
ate, lunch was covered in a fine layer of the yellowcake as 
well, as that was the only place we had to sit and eat.

    No matter how many times we wiped it down, the table and 
chairs were always covered in the fine yellowcake.'' That is 
the place that they designated for them to have a bite, which 
was supposed to be one of the cleaner places.

    He suffered from pulmonary fibrosis, sleep apnea, high 
blood pressure, cognitive heart failure, kidney failure, 
arthritis, and diabetes. He sadly died in 2020 at the age of 
66. Now, Mr. Lucero died without his sacrifice recognized or 
compensated by the U.S. Government. I have endless stories of 
constituents, not just from New Mexico, from--through different 
parts of America and I certainly hope that we can find a way to 
take action.

    To every one of my colleagues in the U.S. Senate that voted 
yes to advance the Radiation Exposure Compensation Act 
amendments to be part of the NDAA, and those of you who voted 
yes to advance it as a standalone bill working with Senator 
Josh Hawley, where we had 69 Senators show up and say, yes, we 
can do better, it is now before the U.S. House of 
Representatives.

    This program expires on June 7th of this year. All we need 
is a vote from Speaker Johnson. I am confident that we have the 
votes to get this done there, and I just appreciate my 
colleagues giving me another opportunity to raise this issue.

    Now, to this hearing, Mr. Chairman, you can count on my 
support to stand side by side with colleagues who are fighting 
on behalf of uranium, of coal mine workers and their families, 
and to make all of these environments safer.

    I look forward to learning more from families all across 
America and through New Mexico to make sure I am doing my part. 
And I continually pray for your health and for your wellness, 
and I hope that you will consider lifting your prayers up as 
well for those families that we are fighting for within the 
Radiation Exposure Compensation Act as well.

    Thank you, Mr. Chairman.

    Senator Hickenlooper. Thank you, Senator Lujan.

    Why don't I let you ask your question and then I will ask 
my questions.

    Senator Braun. I think it has been a good conversation in 
terms of understanding what we are up against, and I want to 
ask this of Ms. Brown Barnes.

    When it comes to the entity that financially should be in 
good shape to handle this, and we are in an industry where we 
know it has taken a lot of heat for many other reasons and it 
has put it in financial distress, how does this all work itself 
out, in your opinion, in the long run when you have a trust 
fund that is being underfunded and you got liabilities that are 
increasing.

    How does that all work out, and at what point would 
potential future liabilities make it impossible to dig out of 
the hole we are in?

    Ms. Barnes. Well, it isn't likely one solution. Congress 
could forgive some of the interest in the debt in terms of the 
borrowing that has been going on since 1979. There is also the 
coal tax.

    But one thing that the Department of Labor has projected is 
the coal tax is enough, at least for this Fiscal Year, to be 
able to meet the benefit liabilities, as well as the 
administrative costs of administering the program, but it is 
the debt servicing cost part of it that is--that is still 
something that needs to be worked out.

    In terms of overseeing a program, the Department of Labor 
itself has to have some sustained focus and leadership 
attention to looking at this, to overseeing the coal mine 
operators, especially with regard to self-insurance and making 
sure that they have the necessary collateral to be able to 
cover not just the current benefits, but also the future 
benefits.

    Senator Braun. When you describe the fact that the debt 
service is overwhelming, of course, that comes from running 
annual deficits--it is a cumulative result of that. Our own 
Federal Government is doing that now to the tune of almost 
$0.30 on every $1.00 we spend. I am on the Budget Committee.

    You talk about a distressing subject. Being there, and we 
are trying to figure out what to do there to make this place 
fund itself better. And this is the backstop for this trust 
fund. So, there is a lot there that looks like is in peril.

    One of those annual deficits been as a percentage of what 
it should be to actually avoid the deficits in the first place? 
In other words, how much are we missing the mark on the 
average, say, percentage wise?

    Did we start this back in 1979 when it was annually--
running deficits to where it wasn't funding--we weren't paying 
enough into the fund to pay the benefits?

    Ms. Barnes. It did start back in 1979 when we were doing 
the borrowing from the Treasury, from the actual General Fund--
--

    Senator Braun. That is when you had the shortfall. And has 
it been every year since then?

    Ms. Barnes. It has been just about every year Congress did 
forgive some debt in 2008. It was about $6.5 billion. That did 
help some. The coal tax has had some decreases and increases. 
And so, that has changed over the years as well.

    Senator Braun. That is likely to be less. Just looking at 
where the country is going in general. So, what is the total 
debt currently held by the Disability Trust Fund?

    Ms. Barnes. Well, I know, in terms of at least speaking to 
the borrowings, in 2023, there was a $2.7 billion that had to 
be borrowed that totaled----

    Senator Braun. That was an annual deficit that year?

    Ms. Barnes. That was how much they had to borrow to even 
cover all of the expenses, including the benefit payments and 
administrative costs.

    Senator Braun. Mr. Roberts.

    Mr. Roberts. It is $6.4 billion.

    Senator Braun. In total, the debt--?

    Mr. Roberts. Yes, in total. I think so, yes----

    Senator Braun. Okay. So, it looks like, with an industry 
that is shrinking and maybe now new liabilities that are 
arising, it has no way to currently pay for the benefits that 
need to come from it. And the Federal Government is borrowing 
$0.30 on every dollar.

    We have got a predicament there and it is probably an issue 
more broad than just this conversation. So, that ought to make 
us all take pause on what we do to eventually solve this 
problem.

    Senator Hickenlooper. Rather sober--the entire discussion 
is rather sober. Dr. Schafrik, the U.S. is on track to create 
thousands of new mining jobs in the future. There will be 
millions of new mining jobs worldwide as we transition to 
different energy systems, more electric vehicles.

    This great transition is going to move in various 
directions, but they are all going to require more materials, 
and we need to respond to health and safety best practices that 
are responsive to this growth.

    As we work to explore best practices, what lessons do you 
think we can learn from our international partners? I know 
Australia is a good example, but what is someplace that we 
can--make sure that we our mines are as safe as they possibly 
can be?

    Mr. Schafrik. Yes, Senator, thank you. One of the issues 
that we have in the United States is that we have several 
different regulatory environments around workers. And MSHA has 
their own set of regulations and OSHA has their set.

    Now, this makes sense from a variety of points of view, but 
it does cause issues when we are trying to both export and 
import safety technology into the United States because a 
technology--and we experience this quite a bit in the 
communication tracking field. Technology that was perfectly 
acceptable in say Europe, or in Australia, was not acceptable 
for use in the United States.

    Now, a lot of these get into details very, very quickly. 
So, I would just, suffice it to say, for the higher level view 
is that I think that we need to do a look at a lot of the 
regulatory procedures. And I know that MSHA is not necessarily 
happy with those either.

    I think that we should look at these things and in the 
detail and in particular sections of the regulations and say, 
where are we building an impediment where we should be building 
an incentive.

    Senator Hickenlooper. Yes. Yes, thank you. I think that is 
true. Ms. Brown Barnes, you contributed to a number of studies 
about the Federal benefits program. What lessons do you learn 
from our history in administering the black lung benefits 
program that we can apply to other existing or future workers 
compensation programs?

    Ms. Barnes. Some of the key practices or leading principles 
that we use when we are looking at other benefit programs is 
the leadership focus and sustained attention on managing the 
program. We also look at goals and performance, outcomes, and 
having some key measures. It is also important to take a look 
at the data.

    Have some reliable data that you are analyzing and some 
hard evidence there. We also look at the involvement of the key 
stakeholders, the employees, those who are having those 
experiences that you can talk to and learn from as well, just 
to name a few of the practices.

    Senator Hickenlooper. All right, I appreciate that. Thank 
you. President Roberts, you have obviously had a long history 
in the mining industry, not just as a miner yourself, but as 
someone who has been supporting miners and making sure they get 
the benefits and the health care that they need and deserve.

    You have seen firsthand the benefits of previous mining 
health and safety improvements--the 2009 dust rule that 
everyone has referred to. And you have in many ways been at the 
helm of addressing the efforts to pass remediation for black 
lung, to make sure that the black lung benefits, Improvement 
Act delivers.

    How would you approach--and again, we are going to need 
miners, not just in coal but in all different levels. How would 
you approach encouraging a new generation of miners to join the 
workforce, and how do we best support them?

    Mr. Roberts. I don't believe that, at least at this time, 
that we have a shortage of people willing to work in mining, 
particularly if it is not coal mining.

    We have people who are applying every day to be in a coal 
mine, right. So, we know that people are hungry for employment. 
And quite frankly, a coal miner working under UMW contract can 
easily make $100,000 a year.

    If we make those jobs safer and healthier, then we will 
have plenty of people wanting those jobs. But I think we are 
talking about the future here of different kinds of mining. I 
think what we need to do is the opposite of what we did with 
respect to coal mining.

    We never worried--when I say we, I am talking about the 
Government itself and all of us part of the Government one way 
or the other, we never worried about, we need safety laws here, 
we need laws to protect people's health, we need laws to 
protect them from being killed, covered up, blown up, burn up, 
and all that happens and has happened in the coal industry.

    We need to look at that in the beginning, not at the end, 
in which we seem to be doing with respect to coal mining.

    Senator Hickenlooper. Right. Well, that is a good point. 
Dr. Harris, in Colorado, we have got a long history of not just 
coal mining but uranium mining as well. We are the proud home 
to the hospital, National Jewish Health, which is the only HRSA 
funded black lung clinic in our state, and it also does 
radiation screening for former uranium miners.

    As you have described, accessing timely screenings is a 
vital part of disease prevention and management, and helps 
miners, a, get the support they need quickly, but also, it 
improves their eligibility for black lung benefits.

    What would you say or what would you describe as specific 
steps that we should take to make sure that timely information 
and medical services can reach miners across the nation?

    Dr. Harris. I think mining often happens in rural 
communities, and accessing rural communities is challenging in 
general. And I think the key is having local, regional people 
that are experts.

    I think for industries like uranium, there are very few 
people who are experts in how to take care of someone with 
uranium issues related--that cause health issues. Similar for 
black lung.

    I did my fellowship training in Connecticut and never once 
saw a coal miner until I moved to Virginia. And so, a lot of 
this is regional problems and we have to come up with ways to 
have regional solutions.

    I think the RECA clinics that do the uranium screening 
should be expanded. And there is--they are going to get cutoff 
when the RECA benefits expire because those are who are 
eligible to be seen in those RECA clinics.

    I think building on the expertise that already exists for 
those clinics is critical. And I also think coming up with more 
innovative ways to bring care to rural areas is important. And 
so, we can learn from programs like the Co-Worker's Health 
Surveillance Program, which has a mobile unit that does mobile 
X-rays and mobile screening.

    There is a program like that at the University of New 
Mexico. I think having--we have the technology to do these 
things. And to be able to take digital X-rays and to bring the 
care locally to people.

    The last point I will make is I work in Central Appalachia. 
It is really hard to recruit doctors there. It is just hard. 
And most of our new hires for providers are nurse practitioners 
or physician assistants.

    I think those folks are often coming from the communities 
where they are serving. And to build some expertise into the 
nurse practitioner. PA capacity locally is going to be key for 
the future.

    Senator Hickenlooper. Good points, each one of them. 
Appreciate that. I don't know if anybody has anything left 
unsaid that is boiling over, before I close the hearing. I 
suspected Mr. Roberts might have a comment.

    Mr. Roberts. This would be just one quick point. We have 
focused on the most severe cases of pneumoconiosis here, but we 
should not leave here thinking that coal dust doesn't kill coal 
miners.

    It just takes a longer time for a miner to die. And once 
again, the ability to receive benefits in this program is so 
unjustly--it is not administered unjustly. It is just unfair 
because a coal miner who is sick and can't work is trying to 
get benefits against an attorney just making $400,000 a year.

    They have access to doctors from all over the United 
States, and that coal miner doesn't have that. It is not a 
level playing field, folks.

    Senator Hickenlooper. Yes. Dr. Schafrik, are you going to 
say something?

    Mr. Schafrik. Yes, Senator. I just wanted to point out 
that--because it hasn't--it is an important thing to keep in 
mind with the new silica rule is that it applies to all miners. 
That is not an underground coal, surface coal, coal only.

    That is all miners. And there are miners everywhere in the 
United States. And the vast majority of mines in the United 
States are surface mines. The vast majority of mines in the 
United States are not coal mines.

    When we are considering a lot of these issues, I think that 
we need to consider that it does impact the industry as a 
whole. It doesn't just impact the underground coal miner.

    Senator Hickenlooper. I couldn't agree more. And I think 
that is a longer discussion even as we look at how many smaller 
mines there are and how difficult is to get their not just 
efficiency, but their health, safety, and precautionary methods 
in place. Thank you all for not just being here, but for your 
service in your lifetimes.

    One of the saddest songs I know is called Dark as a 
Dungeon, where it says--the end of the song says, where the 
rain never falls, and the sun never shines. Where it is dark as 
a dungeon, way down in the mine.

    It is a challenge that I think we all share, and I think 
that we can successfully address. But it is going to take 
persistence and commitment from us in the Senate. But again, 
appreciate all the commitment that you guys have displayed. 
That is going to end our hearing today.

    I would like to thank each of the Senators who came and 
joined us. I would like to recognize and thank my Vice Chair, 
Senator Braun, for his efforts. We thank each of our witnesses, 
Ms. Brown Barnes, Dr. Harris, Mr. Roberts, Dr. Schafrik, for 
your participation.

    For any other Senators who couldn't get here watching from 
their office, if any Senator wants to ask a question or an 
additional question, questions for the record will be due in 10 
business days, June 5th at 5.00 p.m. The Committee now stands 
adjourned.

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    [Whereupon, at 3:45 p.m., the hearing was adjourned.]