Coal miners are tested for black lung at a clinic in West Virginia. David Deal for NPR hide caption

Black Lung Returns To Coal Country
A deadly coal miners' disease is surging back despite rules created to control the disease.Coal miners are tested for black lung. Recently, the deadly disease has been discovered in younger miners and at more advanced stages. David Deal for NPR hide caption
Coal miner Lee Hipshire in 1976, shortly after emerging from a mine in Logan County, W.Va. at the end of his shift. At age 36, he had worked 26 years underground. A few years later, Lee took early retirement because of pneumoconiosis, or black lung disease. He died at 57. Courtesy of Earl Dotter hide caption
In central Appalachia, the black lung rate for working coal miners with at least 25 years experience underground is the highest it's been in a quarter century. Don Klumpp/Getty Images hide caption
A roof bolter secures the roof of a newly mined section of a coal mine. Studies show roof bolters sometimes have high exposure to the silica dust that is especially toxic to lungs. Thorney Lieberman/Getty Images hide caption
Sheralin Greene, 57, mined coal for 20 years. She now suffers paralyzing coughing fits from black lung and receives payments and medical care from the federal trust fund. Courtesy of Sheralin Greene hide caption
The rate of the advanced stage of the deadly disease black lung is growing in central Appalachia, according to a new study. Tyler Stableford/Getty Images hide caption
Excised and preserved lungs on display at the National Institute for Occupational Safety and Health in Morgantown, W.Va., in 2012, show the dramatic effect of black lung disease. Howard Berkes/NPR hide caption
Severe black lung disease deeply scarred the lung of a 61-year-old West Virginia coal miner, which was removed as part of a lung transplant. Courtesy of NIOSH hide caption
Kentucky Lawmakers Limit Black Lung Claims Reviews Despite Epidemic
Mine-safety officials speak with workers at the Gibson North mine in Princeton, Ind., in 2015. Timothy D. Easley/AP hide caption
David Zatezalo, the Assistant Secretary of Labor for Mine Safety and Health, was asked about the advanced black lung epidemic at a congressional hearing in Washington, D.C., on Feb. 6, 2018. Huo Jingnan/NPR hide caption
Black Lung Study Finds Biggest Cluster Ever Of Fatal Coal Miners' Disease
The National Institute for Occupational Safety and Health sent a mobile testing unit to a fire station in Wharton, W.Va., in 2012 to screen coal miners for black lung disease. Howard Berkes/NPR hide caption
Branham wears reflective mining pants in his home in Elkhorn City, Ky. Branham has advanced stage black lung and was forced to quit mining earlier this year. Benny Becker/Ohio Valley ReSource hide caption
A memorial at the entrance to Massey Energy's Upper Big Branch coal mine represents the 29 coal miners who were killed in an explosion in 2010. Jeff Gentner/AP hide caption
Coal miner Lee Hipshire in 1976, shortly after emerging from a mine in Logan County, W.Va., at the end of his shift. A few years later, Lee took early retirement because of pneumoconiosis, or black lung disease. He died at 57. Courtesy of Earl Dotter hide caption