Variability in the evaluation of the Federal black lung benefits claimant

A critical review of the medical data accumulated on 100 consecutive miners referred for evaluation for disability under the Federal Coal Mine Health and Safety Act documented the generation of an excess of unreliable data at an unacceptable cost, even though the evaluations had been performed by physicians who regularly perform this service. Physician training appears to have an impact on the accuracy and reproducibility of historical inquiry regarding items that would identify other causes of activity-limiting dyspnea. Physicians with pulmonary training are statistically more likely to include the cigarette smoking history, as well as history for the presence or absence of exertional chest pain and paroxysmal nocturnal dyspnea. Spirometric pulmonary functions that are supervised and interpreted by physicians with pulmonary training are less likely to show wide variation between the forced expiratory volume in 1 sec, and the direct maximum voluntary ventilation. Regardless of the source, the direct MVV measurement does not contribute additional useful information about a claimant's pulmonary impairment. Arterial blood gas analysis does not add to the discriminatory value of spirometry and should be dropped from the routine claimant's evaluation. Electrocardiography identifies cardiovascular disease in a sufficient number of applicants to make this test worthwhile. The presence or absence of pneumonconiosis on chest radiograph does not vary significantly when interpreted by the examining physician regardless of pulmonary training.(ABSTRACT TRUNCATED AT 250 WORDS)