Dr Cohen’s letter concerning DOL’s Black Lung examinations during the Coronavirus pandemic

Dr. Cohen, the principal investigator of the Black Lung Clinic Program at the University of Illinois at Chicago, sent the following letter to the nation’s black lung clinics this week.

The letter is in regards to the Department of Labor’s Black Lung examination policy during the Coronavirus pandemic.

Because miners with black lung are at a higher risk of catching and becoming severely ill from COVID-19, Dr. Cohen, the world’s leading specialist in black lung research, believes that those who have or possibly have black lung should stay home until all shelter-in-place orders are no longer in effect.




We have just reviewed the guidance from the DOL regarding appointments for 413B Exams*. We were dismayed that DOL took the stance that it was up to the patient and the testing site to determine if it was safe. The fact that some sites are still performing exams is also putting pressure on some clinics and physicians to reopen prematurely for fear of losing the business.


We would strongly advise all of our patients and clinics to defer testing until a safer time. Certainly, it does not seem safe at a time when there are shelter in place orders in effect throughout most of the country, when there is a huge shortage of testing, and the pandemic still is out of control.


Of especially great concern are lung function tests which are aerosol-generating procedures favoring transmission. At our hospital, we have canceled all of these tests except for transplant patients. The recommendation for those who do get tested is that this be done in a negative pressure room with the technician wearing full PPE including gloves, gowns, N95 masks, and face shields. The room must then be fully cleaned prior to the next patient. You can imagine that this is unlikely to occur in a clinic doing 413B exams.


We believe at this time that miners can safely perform telemedicine visits with examiners to get all of the information prepared. The in-person visit and testing should be deferred.


Remember that even though there are relatively few confirmed cases in some parts of the country, it is highly likely that there are many other cases that have gone undetected because of the lack of testing. Infected individuals without symptoms or mild disease put miners at risk of infection. It would be a shame for a miner to contract COVID-19 as a result of venturing out to a clinic to be examined, and tragic if they died due to COVID-19 while also jeopardizing their claim.


Bob Cohen & Leonard Go

Mining Education and Research Center and the University of Illinois at Chicago School of Public Health



*The 413B exam is the Department Of Labors’s exam to look for the presence of black lung. It includes:
  • A review of medical and work history
  • Physical exam
  • Chest X-ray with NIOSH B read
  • Spirometry (breathing test)
  • Pre and post inhaled bronchodilator
  • Arterial blood gas test (rest and sometimes with exercise)
  • EKG (optional)