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PO1 William "Chip" Nagel
...""I honestly never imagined it would get this bad," Smith, 51, wrote in a text message from his home in the coalfields of eastern Kentucky. His breathing is so labored at times, he wrote, that he wasn't sure he could get through a phone call.

"I have a hard time just walking to the kitchen without losing breath," he wrote. "I stay so tired and exhausted."

Smith's lungs are riddled with fibrotic tissue. When NPR and PBS's Frontline last visited in 2018, he tried to mow his lawn, but a fit of heavy hacking forced him to his knees. Coughing violently, he spit out what looked like moist and crusty bits of dark gray paper with black streaks — dead lung tissue, his respiratory therapist told us.

Smith suffers from progressive massive fibrosis, or complicated black lung, an advanced, incurable and fatal stage of black lung disease. It's caused by the inhalation of coal mine dust, especially exposure to highly dangerous silica dust."...
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