I’m still haunted by the voice on my car radio. It was one of those “NPR moments.”

We were parked at our destination, but there was no way we were getting out of the car. National Public Radio’s (NPR) Howard Berkes was reporting from eastern Kentucky and interviewing Mackie Branham. The 39 year old coal miner gasped for air over every word. Chills ran up my spine. Branham’s lungs were hardened by coal mine dust. It was painful to listen yet the perfect punctuation for a powerful story.

Berkes’ reported findings of an NPR investigation of the incidence of the most severe form of coal workers’ pneumoconiosis, known as progressive massive fibrosis (PMF). NPR obtained data from 11 rural health clinics in Appalachia that specialize in respiratory disease. (They are just a few of the black lung clinics located across the U.S.) For the last six year period, the clinics have diagnosed 962 coal miners with PMF, including Mackie Branham. The federal government’s data for a recent 14 year period is just one-seventh that number of PMF cases.

Complementing Berkes’ story was an article in the December 16 edition of CDC’s Morbidity and Mortality Weekly Report. It described 60 cases of PMF identified between January 2015 and August 2016 at a single radiology clinic. The article’s authors include Dr. James B. Crum, a radiologist from Pikeville, Kentucky who alerted CDC’s National Institute for Occupational Safety and Health (NIOSH) in June 2016 about the dramatic spike he was witnessing of PMF in his patients.

NIOSH manages the federal government’s Coal Workers’ Health Surveillance Program. It was established in 1969 by the Coal Mine Health and Safety Act. The voluntary program offers periodic, free medical screenings, including chest x-ray, for working coal miners.  The data from that program, as well as from death certificates, is the best way we have to assess the incidence and prevalence of respiratory disease from exposure to coal mine dust. Between 1998-2012, the surveillance program identified 125 cases of PMF among underground coal miners from central Appalachia. I can imagine the alarm bells in NIOSH’s Division of Respiratory Health Division to hear about 60 cases diagnosed in less than a two-year period at a single clinic in Pikeville, Kentucky. A NIOSH spokesperson indicated that the agency is continuing to investigate the disease cluster. This will include steps to independently confirm the chest x-ray findings through its B-reader program.

NPR’s and NIOSH’s reports offer further evidence of the deadly legacy of coal mining. The coal mine dust that caused Mackie Branham’s and the other’s black lung disease is not an artifact of bygone days. It’s today’s coal mine dust, it’s from 10 or only 20 years ago.

Mackie started his career as a coal miner when I was working at the Mine Safety and Health Administration (MSHA). That was 1996-2001.  The agency had proposed regulatory improvements before I arrived to protect coal miners from black lung and while I was there. Asst. Secretary of Labor Davitt McAteer worked diligently with MSHA staff to implement new regulations. The National Mining Association, state coal industry groups, fought them and sued them at every turn. The UMWA blocked them too. Those protections from black lung disease died at the end of the Clinton Administration awaiting White House approval.

I can’t help but wonder if Mackie Branham and thousands of other young coal miners are the victims of that regulatory delay.  An MSHA rule to better protect coal miners from black lung disease was ultimately issued and took affect in August 2014.  Sadly, 20 years too late for 39 year-old Mackie Branham.