Division of Coal Mine Workers' Compensation (DCMWC)
If you have been approved as a provider of diagnostic testing of miners and former miners in connection with their claims for black lung benefits, you will be mailed an authorization each time a miner selects you to perform testing. You will also be mailed a complete set of reporting forms preprinted with the claimant’s information. If you need additional copies of the forms, you may download them here:
- CM-933 Roentgenographic Interpretation (PDF)
- CM-2907 Report of Ventilatory Study (PFS) (PDF)
- CM-1159 Report of Arterial Blood Gas Test (PDF)
- CM-988 Medical History and Examination for Coal Mine Workers' Pneumoconiosis (PDF)
Instructions for use of the forms may be downloaded here:
Information about test specifications and standards
- Pulmonary Functions specifications and disability tables.
- Arterial blood gas specifications and disability tables.
Important information about digital x-ray imaging
The Black Lung Benefits Act requires that x-rays must be classified in accordance with guidelines set forth by the National Institutes of Occupational Safety and Health (NIOSH) and the International Labour Office (ILO.) NIOSH has not published standards for and a classification of digital images. Therefore, X-rays performed for diagnostic testing in federal black lung claims must conform to the specifications here, and physicians using the ILO Classification should continue to use traditional film screen radiographs and standards.