When Profit Outweighs Protection: Veterans, Coal Miners, and the Cost of Responsibility
Where do we draw the line between financial survival and human responsibility? In my work as a physician, I’ve seen how government agencies and industries sometimes place profit ahead of the very people who sacrificed for them—veterans who served our nation and coal miners whose lungs bear the cost of their labor.
Where is the line between a company’s right to profit—or a government’s mandate to cut costs—and the obligation to protect its citizens and employees? It is a difficult question, and one that I once viewed differently than I do today.
Earlier in my career, I believed more firmly that corporations and governments had every right to prioritize financial health. But my perspective has shifted. Over the years, part of my work has grown beyond direct patient care. I now write medical nexus letters for veterans applying for VA benefits, and I prepare federal black lung appeal letters for coal miners. In doing so, I have witnessed firsthand the extraordinary lengths institutions will sometimes go to in order to avoid paying benefits to the people who served them.
The True Cost of Service
What is the cost of war? It extends far beyond death. Veterans return home with invisible wounds: loss of limbs, loss of senses, loss of peace of mind, and loss of their ability to function in society. These sacrifices are as real—and as devastating—as death itself. Should they not be recognized, and reimbursed?
Yes, fraud exists, and part of my responsibility is to help identify it. But I lean toward giving the benefit of the doubt to the veteran. They went where I could not—or would not—go, so that the rest of us did not have to. That sacrifice deserves not only gratitude but fair treatment. Yet too often, the government’s default position is denial. My role is to step in, review the medical evidence, and provide research that calls for a second look.
The Struggle for Breath
The coal industry is another sphere where I see this painful conflict. Officially, it often seems that no miner has ever developed black lung or lung disease related to their work underground. But I have read the reports, seen the X-rays, and sat across from patients whose lungs are so scarred that each breath is a struggle. I grew up around the coal industry; my own father suffered from black lung yet never received benefits.
It is widely recognized in mining communities that one must be nearly at death’s door before benefits are approved. Denials and delays are routine. Meanwhile, men and women who gave their lives’ labor to the mines can no longer walk across a room without oxygen.
My job is to evaluate their lung function, their test results, and their capacity to exert themselves. From there, I present an honest medical opinion to the courts. Sadly, not every physician approaches it this way. Some seem to view their role as defending the industry rather than the patient, consistently concluding that no one has black lung. I cannot imagine how one reconciles that stance with the reality of patients who are visibly suffocating.
Why It Matters
Both of these sidelines—advocating for veterans and for coal miners—affect me deeply. They are reminders that behind every statistic and every line item on a balance sheet is a human being who has given something of themselves, often something they can never regain.
Profit and protection will always exist in tension. But if our nation is to honor those who serve in war and those who labor in dangerous industries, that balance must tip toward compassion. To me, it is not just professional duty—it is personal conviction, and part of the legacy I hope to leave behind.