West Virginia Workmen's Compensation Fund
Annual Report and Financial Statement
Year Ending June 30, 1970
The Silicosis Statute of the State of West Virginia was first adopted in 1935, and a specific fund was established out of which benefits payable on account of the disease silicosis were to be expended. In 1945 the Legislature amended the Silicosis Law and incorporated the Silicosis Fund into the already existing Workmen's Compensation Fund. Since that time all benefits payable on account of the disease silicosis have been paid from the Workmen's Compensation Fund. Benefits have continued to be payable in this manner since the adoption of the law effective July 1, 1969, but after that date all claims for occupational pneumoconiosis, including silicosis and coal worker's pneumoconiosis, are payable under the pneumoconiosis provisions of the law.
The Occupational Pneumoconiosis Board was created by Act of Legislature effective July 1, 1969, replacing the Silicosis Medical Board. The Board currently consists of Dr. William C. Stewart, Chairman, Dr. W. Paul Elkin, and Dr. James H. Walker, who represent sixty-one years of service on the Occupational Pneumoconiosis Board and its predecessor, the Silicosis Medical Board. The function of the Occupational Pneumoconiosis Board is to determine all medical questions relating to claims for occupational pneumoconiosis.
When a claimant is examined by the Occupational Pneumoconiosis Board and found to have lung disease, believed to be due to inhalation of minute particles of dust arising out of and in the course of the employment, the Board enters a finding that he is suffering from an occupational pneumoconiosis. A careful medical history of past illnesses which the claimant may have suffered, such as asthma, frequent severe acute or chronic bronchial infections, pneumonia, pleurisy, tuberculosis, or surgical operations on the chest, is obtained. Any history or treatment of and medication for heart disease, particularly heart attack, and high blood pressure is noted as well as any restrictions upon the claimant's activity which would make exercise testing such as that employed by the Board hazardous to the claimant. Further, a complete history of all injuries sustained, whether to the chest or other parts of the body, which would make exercise testing difficult, painful, or hazardous is obtained. Particular attention is given to whether the claimant has smoked cigarettes; and, if so, to what extent.
The clinical members of the Board conduct a physical examination of the claimant giving particular attention to examination of the lungs and heart as well as any crippling injuries the claimant may have sustained. If the claimant is able to be exercised safely, a simple but standardized exercise test is conducted under the close observation of the clinical members of the Board.
X-rays of the chest are made under the supervision of the roentgenologist member of the Board using the most exacting techniques, and nothing but the highest quality films are acceptable. The Federal Coal Mine Health and Safety Act of 1969 established standards for film quality and technical methods to be employed in making X-rays with which the roentgenologist on the Board is very familiar. The specifications of the Federal Act for the making of chest x-rays are being followed by the Board. It should be noted however, that the diagnostic changes in x-rays of the chest which justify a diagnosis of occupational pneumoconiosis have become thoroughly familiar to the Board during its many years of experience, which is unequaled by any examining board in the world. The criteria being employed by the Board are not the same as those prescribed in the Federal Coal Mine Health and Safety Act of 1969, but, we believe, they are more realistic and fairer to the claimant. In addition to the examination of its own x-ray films of the chest, the Board reviews all x-rays of the chest previously made of the claimant and available for consideration and comparison as evidence of any changes which may have occurred.
Since 1961, the Board has conducted pulmonary function testing as a means of identifying the loss of pulmonary function attributable to occupational pneumoconiosis as well as the extent to which such loss has impaired the claimant's capacity to work. This testing consists primarily of measurements of the mechanics of respiration, and the results of such testing have been extremely useful. The Board has great confidence in the laboratory performing these tests. Extremely important help in the problem of estimating pulmonary disability has been secured by consideration of blood gas determinations when they have been available. The Board is indebted to Dr. Donald L. Rasmussen of the Appalachian Regional Hospital, Beckley, West Virginia, for blood gas determinations which he has made on several hundred claimants. Further, the Board has performed blood gas studies on selected patients and have referred others to the Appalachian Laboratory for Occupational Respiratory Diseases (ALFORD) at Morgantown, West Virginia, for additional studies.
During the past year the Board has actively sought other methods of measuring pulmonary function which may assist in estimation of impaired pulmonary function due to lung disease. DuBois, Botelho, and Comroe1 have reported the use of a body plethysmograph, commonly called a body box. The individual being examined is placed inside a specially constructed box equipped with sensitive electronic devices which measure the rise and fall of pressure in the box while the subject being examined breathes normally. Airway resistance, compliance of the lung, or the stiffness and loss of elasticity of the diseased lungs are measured in this manner. Briscoe2 believes that the body plethysmograph gives the best measurements of airway resistance of any type of testing now being used in pulmonary function evaluation.
Numerous scientific reports support the use of measuring the mechanics of respiration as a means of evaluating pulmonary function. Lainhart, Doyle, Enterline, Henschel, and Kendrick3 examined 2,432 working miners and 1,028 nonworking miners in two West Virginia counties by determining the mechanics of breat[h]ing and found the method helpful. They concluded that ventilatory function values decrease with increasing age, cigarette smoking, number of years underground, and degree of dyspnea. The experience of this Board with the measurements of the mechanics of respiration in 5,000 claimants has convinced us that, though this method of examination has some limitations, it is simple and safe to conduct and is very useful in evaluation of lung function and impaired capacity to work.
Blood gas studies have gained wide acceptance as a measurement of lung function. Gaensler and Wright4 have published standards for blood oxygen saturation in relation to disability in individuals suffering from lung disease. Rasmussen5 reported his experience with blood gas studies at the National Conference on Medicine and the Federal Coal Mine Health and Safety Act of 1969, and has published a further article on the same subject.6 Blood gas studies are performed as a part of the investigation of lung disease in coal miners being conducted at ALFORD. As noted previously, the services of that laboratory have often been made available to the Board.
The body plethysmograph has been used by DuBois et al7 and more recently by Ulmer8 and has the advantage of being more objective. The results are less distorted by poor motivation, or, at the least, poor motivation can be promptly recognized. This method of testing has not been employed on a large group of coal miners previously, but is being used by ALFORD. A body plethysmograph was purchased by the Workmen's Compensation Commissioner at a cost of $13,278.16 and is being used selectively by the Occupational Pneumoconiosis Board at the present time for measurement of airway obstruction and will be used on all claimants by October 1, 1970. Examination of large numbers of claimants is now possible with this apparatus because of computer techniques not previously available.
As noted at the outset, the Occupational Pneumoconiosis Board at the present time enters a finding that claimant has been exposed to dust in sufficient quantity to produce an occupational pneumoconiosis if the evidence justifies this conclusion. Our experience in the past year indicates that the hazards of exposure to coal dust in the mines of West Virginia has not diminished and remains a serious problem. We believe that a determined effort should be made to identify all the components of coal dust which may have a harmful effect in order to reduce the incidence and severity of lung disease which coal miners develop. Intense exposure to coal dust, silicon dioxide, dust from other rock formations, and from clay or other derivatives from earth dust may be harmful. At the Spindletop Conference9 it was the unanimous conclusion of the participating experts that "in coal miners whose lung dust contains 18% or more of quartz, the lesion is likely to be morphologically that of silicosis. As the quartz content decreases below 18% of the total dust content, the morphological lesion more closely resembles that of coal worker's pneumoconiosis." Naeye10 in a study of anthracite miners in Eastern Pennsylvania and bituminous miners in Western Pennsylvania and Northern West Virginia, found that changes of silicosis were found with evidence of coal worker's pneumoconiosis. He believes the coal macule is influenced in its development and behaviour by the silicon dioxide which it often contains. From the standpoint of prevention all harmful components of dust to which miners are exposed should be individually identified and their sources sought. Such unscientific and vague terms as "black lung" should not be used, and such terminology has been condemned by Gross and deTreville.11
In addition, the role of other factors in the production of lung disease in coal miners should not be neglected. Lainhart et al12 found that 60.9% of working miners were cigarette smokers and that "two to five times more working miners currently smoking reported persistent productive cough than those who were either former smokers or who never smoked cigarettes." They further found ". . more dyspnea among cigarette smokers than among nonsmokers or past smokers." Approximately the same conclusions concerning the role of cigarette smoking in the production of syrntoms in coal miners was reached at the Spindletop Conference.
The objectionable and often serious pulmonary changes resulting from smoking cannot be specifically recognized by x-ray changes or plumonary function testing but that they exist cannot be questioned.
Chronic bronchitis is a common disorder, and its more severe forms may be associated with x-ray changes including pulmonary fibrosis and emphysema. Lainhart et al13 found a significant increase in the incidence of symptoms of bronchitis among miners as compared with nonminers; this also is the opinion of the Occupational Pneumoconiosis Board based on medical histories taken and physical examinations conducted on many thousands of coal miners. Histories of frequent chest infections; peristent cough producing sputum which may be purulent and which may be present winter and summer with, at times, blood streaking of the sputum; wheezing over the chest; and heavy persistent rales at the lung bases, associated with diagnostic x-ray changes in some cases, make it possible to recognize the presence of chronic bronchial disease.
In view of the considerations which have been enumerated, we suggest the following:
(1)A vigorous and persistent campaign should be carried on by all parties interested in preventing lung disease in coal miners to point out the hazard of cigarette smoking and to encourage all coal miners to become nonsmokers.
(2) The periodic x-ray of the chest of coal miners as provided in the Federal Coal Mine Health and Safety Act is strongly endorsed.
We believe, if the above can be accomplished, the incidence of the lung diseas[e] in coal miners can be greatly reduced and the development of advanced seriously disabling lung disease prevented.
OCCUPATIONAL PNEUMOCONIOSIS BOARD
William C. Stewart, Chairman
James H. Walker, Member
W. Paul Elkin, Member
1 DuBois, W. A., Botelho, S. Y., and Comroe, J. H.: A. New Method of Measuring Airway Resistance in Man Using a Body Plethysmograph; Values in Normal Subjects and in Patients with Respiratory Disease. J. Clin. Investigation, 37:1279-1285, 1958.
2 Briscoe, W. A.: Archives of Environ. Health, Vol. 16, April, 1968.
3 Lainhart, W. S., Doyle, H. N., Enterline, P. E., Henschel, A., and Kendrick, M. A.: Pneumoconiosis in Appalachian Bituminous Coal Miners. U. S. Department of Health, Education and Welfare, 1969.
4 Gaensler, E. A., and Wright, G. W.: Evaluation of Respiratory Impairment. Arch. Environ. Health, 12:146-199, 1966.
5 Rasmussen, Donald L.: National Conference on Medicine and the Federal Coal Mine Health and Safety Act of 1969, Washington, D. C., June 15-18, 1970.
6 Rasmussen, Donald L., Laquer, W. A., Futterman, P., Warren, H. D., and Nelson, C. W.; Amer. Review of Resp. Diseases, 1968, 98, 658.
7 DuBois, supra note 1.
8 Ulmer, W. T.: Regional Conference on Coal Workers Pneumoconiosis, Pittsburgh, Penna., October 15-16, 1968.
9 Spindletop International Conference on Coal Workers Pneumoconiosis, Lexington, Ky., September 10-12, 1969.
10 Naeye, R. L.: National Conference on Medicine and the Federal Coal Mine Health and Safety Act of 1969, Washington, D. C., June 15-18, 1970.
11 Gross, Paul, deTreville, Robert T. P.: Archives of Environmental Health.
12 Lainhart, supra note 3.