Despite the best efforts of the Mine Safety and Health Administration’s (MSHA) efforts to control exposure to respirable coal mine dust, the number of Black Lung cases currently being diagnosed in Appalachia is unprecedented, according to some researchers. In the decades since the passage of the 1977 Mine Act, MSHA has tried everything from new and more stringent regulations, including Lowering Miners’ Exposure to Respirable Coal Mine Dust, final rule, the use of Continuous Personal Dust Monitors and compliance assistance initiatives to eliminate the conditions that lead to the disease.