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Greg Kelly’s grandson, Caden, scampers to the tree-shaded brook abaft his grandfather’s abode to bolt crawdads, as Kelly shuffles along, aggravating to accumulate up. Kelly’s baby day haversack holds an oxygen catchbasin with a ablaze tube abrupt to his nose. He has chairs spaced out on the abbreviate avenue so he can stop every few minutes, sit bottomward and bolt his breath, until he has abundant wind and backbone to alpha out afresh for the creek.

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“I aloof adjure that the Lord accord me as abundant time as I can with him,” Kelly said, his eyes arising with tears. “He aloof lightens my life. I appetite to be as fun with him as I can. And do as abundant as I can with him.”

Caden is 9 years old, and alike at his age he knows what happened to his paw-paw at the Harlan County, Ky., atramentous mines area Kelly afflicted as a roof bolter for 31 years.

“That atramentous abundance fabricated your lungs dirty, didn’t it?’” Kelly recalled Caden asking. “Yeah it did. … And I can’t breathe and I accept to accept my haversack to breathe,” Kelly told him.

It’s a accustomed account above Appalachia. Two hours arctic and east, above agee abundance roads, Danny Smith revved up a backyard mower. He wore jeans, a T-shirt and a white face affectation addition from eyes to chin, and he pushed alone about 15 anxiety afore he aback shut off the mower, angled to his knees and started hacking uncontrollably.

“Oh God,” he gasped, as he discharge up a abrupt atramentous actuality with gray streaks, and afresh stared at the asleep lung tissue staining the grass. Still coughing and breath hard, Smith acclimatized into a armchair on his balustrade and abrupt an oxygen tube to his nose.

After spending aloof 12 years underground, his lungs are so bad he faces what atramentous miners decades beforehand and with decades added in mining accept endured. His lung tissue is dying so fast, his respiratory therapist says, it aloof peels away.

“I’m terrified,” Smith said, as he remembered his father’s adversity aback he was disturbing with the aforementioned atramentous miner’s disease.

“I abiding don’t appetite to go through what he went through. I apparent a lot of guys that died of atramentous lung and they all suffered like that.”

A multiyear assay by NPR and FRONTLINE found that Smith and Kelly are allotment of a adverse and afresh apparent alpha of the avant-garde date of atramentous lung disease, accepted as complicated atramentous lung or accelerating massive fibrosis.

A federal ecology affairs appear aloof 99 cases of avant-garde atramentous lung ache civic from 2011-2016. But NPR articular added than 2,000 atramentous miners adversity from the ache in the aforementioned time frame, and in aloof bristles Appalachian states.

And now, an NPR/FRONTLINE analysis of federal authoritative abstracts — decades of advice recorded by dust-collection monitors placed area atramentous miners assignment — has appear a adverse abortion to admit and acknowledge to ablaze signs of danger.

For decades, government regulators had affirmation of boundless and baneful abundance dust exposures, the affectionate that can account PMF, as they were happening. They knew that miners like Kelly and Smith were acceptable to become ailing and die. They were apprenticed to booty specific and absolute activity to stop it. But they didn’t.

“We failed,” said Celeste Monforton, a above abundance assurance regulator in the Clinton administering who advised the NPR/FRONTLINE findings.

“Had we taken activity at that time, I absolutely accept that we would not be seeing the ache we’re seeing now,” said Monforton, now a abode assurance apostle who teaches at George Washington and Texas State universities.

“Having miners die at such adolescent ages from exposures that happened 20 years ago … I beggarly this is such a gross and aboveboard archetype of authoritative failure.”

It’s an “epidemic” and “clearly one of the affliction automated anesthetic disasters that’s anytime been described,” said Scott Laney, an epidemiologist at the Civic Institute for Anatomic Assurance and Health.

“We’re counting bags of cases,” he said. “Thousands and bags and bags of atramentous lung cases. Bags of cases of the best astringent anatomy of atramentous lung. And we’re not done counting yet.”

This avant-garde date of atramentous lung leaves lungs abrupt and useless, says Dr. Robert Cohen, a pulmonologist at the University of Illinois, Chicago who has spent decades belief atramentous lung and PMF disease.

“You accept a abundant harder time breath so that you can’t exercise,” Cohen noted. “Then you can’t do some simple activities. Afresh you can about breathe aloof sitting still. And afresh you crave oxygen. And afresh alike the oxygen isn’t enough. And so … they’re about airless while alive.”

The baneful abundance dust that causes astringent ache isn’t atramentous dust alone. It includes silica, which is generated aback miners cut sandstone as they abundance coal. Abounding atramentous seams in axial Appalachia are anchored in sandstone that contains quartz. And aback quartz is cut by mining machines, it creates accomplished and acid particles of silica dust — accomplished abundant to be calmly inhaled and aciculate abundant to abode in lungs forever.

In the accomplished 30 years, the bigger atramentous seams were mined out in Appalachia, abrogation thinner seams coursing through sandstone.

“All the acceptable seams were gone because there were hardly no solid seams of atramentous left,” the 54-year-old Kelly remembered. “And there [was] added bedrock in the coal.”

The silica dust that resulted from acid that bedrock was far added alarming than atramentous dust alone.

Silica is “somewhere about 20 times added baneful and can account ache abundant added rapidly,” said Laney.

The NPR/FRONTLINE investigation activate bags of instances in which miners were apparent — not aloof to atramentous dust but to alarming levels of baneful silica dust. The federal Abundance Assurance and Bloom Administration’s own abstracts account 21,000 instances of boundless acknowledgment to silica aback 1986.

At the aforementioned time, NPR articular atramentous lung diagnoses involving miners in their 30s who additionally accomplished accelerated progression to the avant-garde date of PMF. Smith says he was diagnosed with PMF at 39. NIOSH has accepted this trend in its studies.

NPR/FRONTLINE analyzed 30 years of abstracts calm by federal regulators. They admeasurement atramentous and silica dust area miners are working, and in 85 percent of the samples calm silica was at safe levels. But for that added 15 percent — which amounts to 21,000 dust samples — the abstracts actualization that miners were apparent to boundless silica levels that alone federal bloom standards.

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“That’s what causes disease, is the boundless exposure,” said Jim Weeks, an automated hygienist and abundance dust specialist at MSHA in the Obama administering and at the United Abundance Workers abutment afore that.

An NPR assay of abundance dust regulations additionally activate that federal administering does not anon abode silica dust. If regulators admeasurement too abundant silica in abundance air, they abode atramentous mines on abundant tougher banned for atramentous dust. That’s declared to lower the silica acknowledgment because atramentous and silica dust are generally mixed.

But our assay activate that this aberrant access to authoritative silica dust didn’t consistently work. MSHA’s 30 years’ dust sampling abstracts actualization alarming levels of silica or quartz area miners were alive abutting to 9,000 times, alike afterwards atramentous mines were appropriate to accommodated bargain banned for atramentous abundance dust.

“They didn’t pay acceptable attention,” Weeks concludes. “And …we’ve got the bodies to prove it. I beggarly these guys wouldn’t be dying if bodies had been advantageous absorption to quartz. It’s that simple.”

We activate addition archetype of overexposure in MSHA’s data. Each time federal abundance inspectors issued citations for too abundant silica, which they did alone a atom of the time, they included an appraisal of how abounding miners were affected. A assay of those abstracts shows added than 9,000 workers were apparent to silica levels that the regulations advised dangerous.

This boundless acknowledgment to silica about absolutely happens added generally than the abstracts suggest. That’s because the abstracts actualization alone what happens aback regulators are checking. The inspectors don’t assay best of the time miners are working. Dust sampling takes abode during approved abundance inspections, which are appointed four times a year in underground mines and alert a year at apparent operations.

And until recently, sampling did not booty abode every hour miners formed or while mines were at abounding production.

Another award of the NPR/FRONTLINE investigation: During some of the heaviest periods of acknowledgment to silica, regulations acquiesce miners to assignment afterwards any ecology for it at all.

Smith accumulating us accomplished a brace of adjoining atramentous mines abreast his home in Canada, Ky., area he and added miners cut annihilation but bedrock for months.

He was afraid to cull over at the Rockhouse Energy Mine, alike admitting it is closed, because aegis guards were watching from a parking lot. So he boring anesthetized by, anecdotic assignment accouterment that lasted 16 hours a day, seven canicule a week, for months, while acid through solid rock. They acclimated drills and mining machines to dig from one atramentous bond to addition underground.

“It wasn’t atramentous dust that you would see,” Smith said. “It was added of a white bedrock … dust.”

Smith and his coworkers were acid what’s alleged a abruptness mine. It’s not absolutely mining because there’s no atramentous involved. It’s all about acid through mountainsides or blocks of bedrock to ability atramentous seams.

And because there’s no coal, it is advised development mining or construction. So sampling the air for baneful dust is not required, alike admitting it is the best alarming dust. Above MSHA admiral told us some inspectors did it, but best did not.

Smith spent months acid at atomic two abruptness mines in his career and believes that could explain his astringent disease, alike admitting he formed underground alone 12 years.

“Very possible,” he said, as we anesthetized the mine’s alone agent belts that amplitude over the road. “Most of my mining career I run a continuous miner. I run a roof bolter also. And it’s actual accessible from all the hours we worked.”

Roof bolters accomplish a apparatus that pins roof supports into underground mines by conduct into solid rock. The machines accept customized dust-control systems that blot abroad dust, but miners accuse they get bursts of silica dust aback they activate conduct and afresh afterwards aback they abandoned boxes that aggregate the dust that was sucked abroad during drilling.

The apparatus accepted as a connected miner grinds up bedrock and coal. Dust is declared to be controlled by massive blast admirers that pump air through the mine, while abundant curtains approach that air to ambit abroad dust. Mining machines aerosol baptize as they cut, to allegation bottomward dust.

NPR interviewed 34 atramentous miners, all diagnosed with PMF and with 12 to 40 years in mining in Pennsylvania, West Virginia, Virginia and Kentucky. Sometimes the dust controls worked, best told us, and sometimes they didn’t.

Federal law requires mining companies to activity dust masks or respirators to miners, but their use is not required. The law considers them a accessory and alternative bureau of protection. Mines are appropriate to accommodate air ablaze of alarming dust, aboriginal and foremost.

Most of the ailing and dying miners we interviewed who acclimated dust masks said they generally didn’t work.

“They would clog up with dust, diaphoresis and spit,” said Edward Wayne Brown, who spent 21 years underground in Buchanan County, Va. “And afresh it feels like somebody aloof sitting there with their duke over your face.”

In fact, dozens of miners, including Smith, accept filed artefact liability lawsuits adjoin dust affectation suppliers. Best cases are still awaiting but a few accept resulted in multimillion-dollar verdicts for the miners.

“This is apparently the oldest accepted anatomic hazard,” said retired automated hygienist Weeks, who has a accumulating of aged books to prove it — with references to abundance dust hazards from Pliny the Elder in the aboriginal aeon and addition dating to the 15th century.

“There’s annihilation new about this,” Weeks added. “And you’d anticipate by now we’d accept ample out how to accord with it.”

Awareness of silica dust as a hazard in the United States goes aback at atomic 100 years, with a alternation of studies and letters alpha in 1908. In the 1930s, hundreds of workers were sickened and asleep by acknowledgment to silica dust while tunneling through a abundance of solid bedrock in West Virginia.

In 1974, NIOSH first alleged for silica acknowledgment banned alert as austere as those in abode for atramentous miners and added workers. But it wasn’t until the 1990s that MSHA and others began to get austere about silica in atramentous mines.

NPR and FRONTLINE obtained centralized memos from the Clinton administering that showed anxiety aback afresh about clusters of avant-garde lung ache amid atramentous miners as adolescent as 40. MSHA beatific out alerts to atramentous mining companies, admonishing about boundless acknowledgment to silica dust and astringent ache amid miners. NIOSH afresh alleged for a silica acknowledgment limit that would be alert as tough, additional abstracted adjustment of silica, as did a Department of Activity advising committee.

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“We started a civic attack aboriginal to accession awareness,” recalled Davitt McAteer, the abettor secretary of activity for abundance assurance and bloom from 1994 to 2000.

“And it was that attack that began to try to go afterwards the silica requirements, accession the silica standard, and alpha on a abstracted aisle to ascendancy silica.”

McAteer proposed a major check of the dust sampling system, which included added loopholes that acceptable boundless exposures and inaccurate altitude of atramentous abundance dust. But the accomplishment encountered stiff opposition from the Civic Mining Association, the industry’s bigger lobbying group. The accumulation sued over some elements of the plan and won.

“And afresh we ran out of time,” McAteer says. “And it’s article that’s adverse and put a lot of lives at risk.”

The adjustment of silica dust wasn’t addressed during the administering of George W. Bush. During the Obama administration, abundance assurance apostle Joe Main was in allegation of MSHA. Main was the longtime bloom and assurance administrator at the mineworkers abutment and was on that Activity Department advising board that approved tougher adjustment of silica aback in 1996.

“It was actual accessible that that accomplished arrangement that had been in place, that has larboard so abounding bodies sick, had to be afflicted and had to be fixed,” Main said.

He was successful in closing above abundance dust loopholes, and he deployed new technology — dust sampling accessories that abstinent atramentous dust in absolute time and helped accomplish sampling added immediate, honest and accurate.

Main additionally fabricated the acknowledgment absolute for atramentous abundance dust tougher. But not the acknowledgment absolute for silica. He didn’t accommodate any specific activity on silica in his plan.

“A aerial course rises all boats, as the adage goes,” Main explained. “We were activity to get a account out of abbreviation all-embracing dust acknowledgment by what we did. [That] would not alone lower atramentous abundance dust but all dust that was allotment of that, including silica.”

But as the NPR/FRONTLINE data assay shows, that blueprint bootless bags of times in the past. Lowering all-embracing abundance dust doesn’t necessarily abate silica acknowledgment to safe levels.

Monforton wonders why MSHA absent or abandoned that allotment of the dust sampling data.

“The actuality that [NPR and FRONTLINE] went aback for 30 years and looked at that data, and that abstracts was accessible to the bureau to appraise as well, why wasn’t that botheration accustomed and rectified?” Monforton asked.

Main and added above MSHA admiral say they anticipation they were accomplishing what they bare to do to ascendancy silica.

Another bureau did act on silica during the Obama administration. The Anatomic Assurance and Bloom Administering assured a 44-year assay of silica acknowledgment by enacting tougher adjustment of silica dust.

So now, every industry in the country that cuts rock, every industry except mining, has abstracted adjustment of silica and an acknowledgment absolute alert as boxy — the absolute aboriginal recommended by NIOSH in 1974.

Mining companies additionally knew they were acid added quartz, creating added silica dust, and advertisement miners to baneful dust. They were not alone acutely warned by MSHA in the 1990s; they could see what was activity on in their mines. Acid bedrock slows mining machines and hurts production. And bedrock has to be removed from atramentous afore it can be sold.

So NPR and FRONTLINE wanted to apperceive why mining companies didn’t act on their own to assure their workers.

“Sure they could accept done that,” responded Bruce Watzman, the Civic Mining Association’s top lobbyist for added than 30 years. “But … I’m not activity to brainstorm on why they did or didn’t do what they chose.”

“Our focus actuality is advanced looking,” he said. “How do we anticipate this in the future? I can’t acknowledgment for … what happened in the past.”

Watzman additionally asserted that the industry “is accomplishing far bigger today than we did in the past, far better.”

That appraisal is based on new abstracts from MSHA following the new atramentous abundance dust rules that began to booty aftereffect in 2014. Aback then, mining companies accept met acknowledgment banned for atramentous and silica dust 99 percent of the time, the abstracts show.

MSHA cited the aforementioned abstracts in a accounting account to NPR and FRONTLINE.

“The dust aphorism … has abundantly bargain miners’ acknowledgment to respirable dust,” wrote MSHA backer Amy Louviere, who additionally acclaimed a aciculate bead in the accomplished 10 years in the allotment of abundance dust samples with balance silica. Her account did not abode the NPR/FRONTLINE findings assuming 30 years of boundless acknowledgment to silica.

“MSHA continues to assignment agilely to assure atramentous miners’ health,” Louviere said.

But NIOSH epidemiologist Laney isn’t assertive the botheration is solved.

“They’re sampled actual infrequently so we don’t apperceive what’s activity on with these miners aback they’re not actuality sampled,” Laney said. “Ninety-nine percent of the time we don’t accept advice on that.”

That’s additionally the cessation of a recent review by the Civic Academies of Sciences, Engineering and Medicine. The new atramentous dust rules, the assay board said, “may not agreement that exposures will be controlled abundantly or that approaching ache ante will decline.”

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It will additionally booty 10 years or added to apperceive whether the new dust rules aftereffect in beneath cases of disease. It takes that connected for ache to develop.

MSHA beneath assorted requests for interviews with top bureau officials, including David Zatezalo, a above atramentous aggregation controlling and industry lobbyist who now active the agency.

So we showed up at West Virginia University in September area Zatezalo was appointed to accomplish a attenuate accessible appearance.

“You apprehend the byword in bloom circles of accelerating massive fibrosis, these sorts of things,” Zatezalo told an admirers of mining engineering students, bureau advisers and industry admiral and lobbyists.

“To me, I accept those are all acutely silica problems,” Zatezalo continued. “Silica is article that has to be controlled.”

But anon afterwards his speech, aback NPR and FRONTLINE approached him, Zatezalo seemed aback ambiguous about silica and PMF.

“I don’t anticipate that the science of the account is that well-defined,” Zatezalo said.

Asked about the absolute articulation amid silica and ache he declared in his speech, Zatezalo became defensive.

“No, I said I doubtable silica. I didn’t say it was. … I anticipate until such time as you amount out what it is you don’t absolutely know,” Zatezalo responded.

So far, beneath Zatezalo, MSHA has no plan to abode a tougher absolute for silica dust or abstracted adjustment of silica in atramentous mines.

In the meantime, the PMF catching continues. The bigger array of ache anytime reported, according to NIOSH, continues to body at the Stone Abundance Bloom Services atramentous lung clinics in Southwestern Virginia. The clinics abide to analyze new cases at the amount of about a dozen a month.

“I’m not seeing any arrest whatsoever,” says Ron Carson, who directed the Stone Abundance clinics for 28 years afore backward beforehand this year.

“I anticipate that America needs to apperceive that these miners … accept paid a price,” Carson added, his articulation breaking. Carson cited the nation’s decades of assurance on atramentous for ability and animate production.

“They paid a amount so that we can accept affluence and … so abounding accept died. Bags accept died.”

Kelly has a connected account of simple tasks he can no best accomplish: walking up his driveway to the mailbox; aggressive the few accomplish to his barn; benumbed horses; alike aloof accepting up to arch to the bathroom. He has to stop and blow on the way, he says.

But what hurts the best are the things he can’t do with his grandson, Caden, abnormally antic angry on the floor.

“Now he has to battle a pillow while I alarm the match,” Kelly said, his articulation awkward and his eyes red. “It’s still fun, but …” and Kelly paused, his face bound and the tears flowing.

“I appetite to be that pillow.”

Smith pulled up to addition mine, which was additionally bankrupt but had no guards in its weed-choked parking lot. This Solid Energy mine, forth with the Rockhouse abundance he accumulating by earlier, was operated by Massey Energy, now a asleep aggregation with deadly abundance disasters in its history and a CEO who went to prison for cabal to breach abundance assurance laws.

Smith got out and absolved up to a decayed fence with a padlock. A brawl cap atramentous his face. Sunglasses hid his tears.

“It’s [been] bistro at me for the aftermost two years,” he said, “that I’m activity to die over this. … Of all the things that could’ve asleep me while I did assignment there, the rockfalls and all that stuff, I lived through all of that. And I acquisition out years afterwards I’m activity to die over atramentous lung. And it’s heartbreaking.”

Smith afresh mentioned his wife and two daughters and wondered what will appear to them aback he’s gone. He wondered about the grandchildren he may never see. His articulation breaking again, he talked about the action of actuality a adolescent miner, about the achievement and affiance of acceptable pay and acceptable lives.

“We was all adolescent and able and stout and they took advantage of us. Every one of us is either bedridden or dead. We was all adolescent men,” he said, arrant softly.

Back at his abode in a attenuated basin — a bark — in Canada, Ky., Smith acicular to a ancestors cemetery on a altitude at the bend of the backyard he has so abundant adversity mowing. It appearance a distinct cairn with ablaze flowers and the names of his parents. Abaft it, Smith told us, in the shade, is the burying artifice he has best out for himself. He’s 46 years old.

NPR’s Adelina Lancianese, Barbara Van Woerkom, Katie Lawrie and Cat Schuknecht; Elaine McMillion Sheldon of FRONTLINE; Benny Becker and Jeff Adolescent of Ohio Basin ReSource; and Ellen Smith of Abundance Assurance and Bloom News contributed to this story.

This adventure is allotment of a collective assay with NPR, which includes an accessible documentary Coal’s Deadly Dust, appointed to air Jan. 22 on PBS.

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