Overview of Occupational Pneumoconiosis Jack Kinder, M.D.

Basic Function of the OP Board Evaluate for presence or absence of disease Evaluate for presence or absence of disease Determine level of impairment Determine level of impairment Protest hearing testimony Protest hearing testimony

Evaluation of Claimant Work history Work history Medical history Medical history X-Ray X-Ray PFTs PFTs Physical exam of the chest Physical exam of the chest

Exposure History - Coal Type of work - Underground - Surface Type of work - Underground - Surface

Exposure History - Asbestos Industrial Industrial Private employment Private employment

Medical History Respiratory - Illness - Surgery Respiratory - Illness - Surgery Medications - Beta Blockers - Pulmonary Meds Medications - Beta Blockers - Pulmonary Meds

X-Ray Evaluation Pleural Disease Pleural Disease Parenchymal Disease Parenchymal Disease

Pulmonary Function Testing FVC FVC FEV 1 FEV 1 FEV 1 /FVC Ratio FEV 1 /FVC Ratio Diffusion Diffusion ABGs ABGs

Physical Exam of the Chest Abnormal breath sounds Abnormal breath sounds Cardiac Disease Cardiac Disease Chest wall deformities Chest wall deformities

Special Considerations Malignancy Malignancy Cardiac Dysfunction Cardiac Dysfunction Transplantation Transplantation

Pulmonary Malignancy Primary Parenchymal Cancer Primary Parenchymal Cancer Mesothelioma Mesothelioma

Primary Lung Cancer Coal Exposure Coal Exposure Asbestos Exposure - Tobacco Influence Asbestos Exposure - Tobacco Influence

Mesothelioma Special Type of Pleural Disease Special Type of Pleural Disease Without Parenchymal Disease Without Parenchymal Disease Tobacco Exposure Tobacco Exposure

Cardiac Disease Role in Pulmonary Dysfunction Role in Pulmonary Dysfunction Cor Pulmonale Cor Pulmonale

Coronary Atherosclerosis Primary Disease of the Heart Primary Disease of the Heart Myocardial Infarction Myocardial Infarction

Cor Pulmonale Right Ventricular Size Right Ventricular Size Emphysema or Pneumoconiosis Emphysema or Pneumoconiosis

Cardiac Transplantation Rare Event Rare Event Multiple Factors Multiple Factors

Type of Transplant Single Organ Single Organ Double Organ Double Organ

Examples of Claimants 42 year old Coal Miner 42 year old Coal Miner 12 years surface mine - Blaster / Drill 12 years surface mine - Blaster / Drill Non Smoker Non Smoker PFTs - FVC 62% - FEV 1 67% - FEV 1 /FVC Normal PFTs - FVC 62% - FEV 1 67% - FEV 1 /FVC Normal

Examples of Claimants 78 year old Plant Worker 78 year old Plant Worker 40 years Pipe Fitter 40 years Pipe Fitter 45 years – 1 ppd smoker 45 years – 1 ppd smoker PFTs - FVC70% - FEV 1 50% - FEV 1 /FVC45% - Diffusion50% PFTs - FVC70% - FEV 1 50% - FEV 1 /FVC45% - Diffusion50%

Examples of Claimants 70 year old Coal Miner 70 year old Coal Miner 35 years underground roof bolter 35 years underground roof bolter 40 years – 1 ppd smoker 40 years – 1 ppd smoker PFTs - FVC60% - FEV 1 30% - FEV 1 /FVCTotal Impairment PFTs - FVC60% - FEV 1 30% - FEV 1 /FVCTotal Impairment Right Lung Mass Right Lung Mass