The mining union fears a new wave of black lung cases after the first diagnosis in a coal miner who worked exclusively above ground.
Queensland man Paul Head, 55, spent three decades working as an open-cut coal miner and was recently diagnosed with the potentially deadly disease.
He joins 15 underground workers who've learned since May last year that they have the dust-related condition, which was thought to have been eradicated in Australia.
The CFMEU says Mr Head's diagnosis busts the myth that black lung is isolated to underground sites, and shows the urgent need for tighter dust controls at all coal mines across the country.
"This should put all governments on notice: black lung disease is not just a threat to coal miners working in underground mines in Queensland, but to miners at all coalmines across Australia," union spokesman Stephen Smyth said.
The union fears many more cases of black lung, or coal workers' pneumoconiosis, in above-ground miners.
Mr Smyth said a 2012 study of surface coal miners in the US found one in 50 had black lung, and he believes Australia's figure is probably comparable.
The Queensland government has already promised tougher dust controls, better testing, improved training for screening medicos, and a compensation safety net after a scathing review into the state coal industry's health scheme.
The review found systemic failures at "virtually all levels" when it came to black lung and systems meant to safeguard miners.
Mandatory screening x-rays were incorrectly read, meaning some cases of the disease went undetected for years.
It also found most lung function tests - a key indicator that the disease might be taking hold - were conducted by unqualified staff, rendering many meaningless.
Mr Head, who worked above ground at BMA's Goonyella Riverside open-cut mine near Moranbah, learned he had black lung after a routine medical check.
He's urged other mine workers to get checked, regardless of whether they worked above or below ground.
"Beating around the bush saying we haven't got a dust problem, we haven't got a dust problem - you ask any of the workers and they'll tell you, you've got a dust problem," he told the ABC.
BMA says dust exposure and controls had greatly improved in the decades since Mr Head began working in coal mining.
It said workers were being informed about black lung developments and the support on offer.
The head of the AMA Queensland, Dr Chris Zappala, said underground workers remained at a significantly higher risk of developing black lung.
But he said people outside the mining industry shouldn't be concerned about mere passing exposure to coal dust.
"Clearly, not everyone who is exposed is going to get the disease," Dr Zappala said.
"If you think you've had exposure, more importantly if you've got symptoms that are unexplained... then go along to your general practitioner and speak to them about getting breathing studies done and a chest X-ray done."
Liberal National Party MP Jarrod Bleijie renewed his party's calls for a royal commission into the re-emergence of the disease.
"No one deserves to contract an illness or disease from going to and from work earning an honest living to support them and their families," he told state parliament.
Labor last month agreed to set up a parliamentary review into the issue after resisting calls for a royal commission.