[Senate Report 111-75]
[From the U.S. Government Publishing Office]


111th Congress 
 1st Session                     SENATE                          Report
                                                                 111-75
_______________________________________________________________________

                                     

                                                       Calendar No. 160

 
               FEDERAL FIREFIGHTERS FAIRNESS ACT OF 2009

                               __________

                              R E P O R T

                                 of the

                   COMMITTEE ON HOMELAND SECURITY AND

                          GOVERNMENTAL AFFAIRS

                          UNITED STATES SENATE

                              to accompany

                                 S. 599


    TO AMEND CHAPTER 81 OF TITLE 5, UNITED STATES CODE, TO CREATE A 
 PRESUMPTION THAT A DISABILITY OR DEATH OF A FEDERAL EMPLOYEE IN FIRE 
 PROTECTION ACTIVITIES CAUSED BY ANY OF CERTAIN DISEASES IS THE RESULT 
               OF THE PERFORMANCE OF SUCH EMPLOYEE'S DUTY






               September 14, 2009.--Ordered to be printed
        COMMITTEE ON HOMELAND SECURITY AND GOVERNMENTAL AFFAIRS

               JOSEPH I. LIEBERMAN, Connecticut, Chairman
CARL LEVIN, Michigan                 SUSAN M. COLLINS, Maine
DANIEL K. AKAKA, Hawaii              TOM COBURN, Oklahoma
THOMAS R. CARPER, Delaware           JOHN McCAIN, Arizona
MARK L. PRYOR, Arkansas              GEORGE V. VOINOVICH, Ohio
MARY L. LANDRIEU, Louisiana          JOHN ENSIGN, Nevada
CLAIRE McCASKILL, Missouri           LINDSEY GRAHAM, South Carolina
JON TESTER, Montana                  ROBERT F. BENNETT, Utah
ROLAND W. BURRIS, Illinois
MICHAEL F. BENNET, Colorado

                  Michael L. Alexander, Staff Director
                     Kevin J. Landy, Chief Counsel
              Jason T. Barnosky, Professional Staff Member
Lisa M. Powell, Staff Director, Subcommittee on Oversight of Government 
    Management, the Federal Workforce, and the District of Columbia
     Brandon L. Milhorn, Minority Staff Director and Chief Counsel
          Adam J. Killian, Minority Professional Staff Member
    Jennifer A. Hemingway, Minority Staff Director, Subcommittee on 
  Oversight of Government Management, the Federal Workforce, and the 
                          District of Columbia
                  Trina Driessnack Tyrer, Chief Clerk


                                                       Calendar No. 160
111th Congress
                                 SENATE
                                                                 Report
 1st Session                                                     111-75

======================================================================




               FEDERAL FIREFIGHTERS FAIRNESS ACT OF 2009

                                _______
                                

               September 14, 2009.--Ordered to be printed

                                _______
                                

Mr. Lieberman, from the Committee on Homeland Security and Governmental 
                    Affairs, submitted the following

                              R E P O R T

                         [To accompany S. 599]

    The Committee on Homeland Security and Governmental 
Affairs, to which was referred the bill (S. 599) to amend 
chapter 81 of title 5, United States Code, to create a 
presumption that a disability or death of a Federal employee in 
fire protection activities caused by any of certain diseases is 
the result of the performance of such employee's duty, having 
considered the same, reports favorably thereon with amendments 
and recommends that the bill (as amended) do pass.

                                CONTENTS

                                                                   Page
  I. Purpose and Summary..............................................1
 II. Background and Need for the Legislation..........................2
III. Legislative History..............................................6
 IV. Section-by-Section Analysis......................................6
  V. Evaluation of Regulatory Impact.................................10
 VI. Congressional Budget Office Cost Estimate.......................10
VII. Changes in Existing Law Made by the Bill, as Reported...........12

                         I. Purpose and Summary

    S. 599 creates a rebuttable presumption that a Federal 
firefighter who has a disability from or who has died as a 
result of certain specified diseases has suffered the 
disability or death as a result of the performance of such 
employee's job and therefore is eligible for compensation under 
the federal worker compensation law. S. 599 also contains an 
amendment requiring that medical facilities notify first 
responders who treated victims found to have an infectious 
disease and allows first responders who suspect exposure to 
initiate procedures to determine whether exposure actually 
occurred.

              II. Background and Need for the Legislation

    Numerous studies have shown that firefighters--due to their 
daily exposure to stress, smoke, heat and various toxic 
substances--are far more likely than other workers to contract 
certain illnesses such as heart disease, lung disease, and 
certain cancers. In addition, the role firefighters play in 
providing emergency medical services often exposes them to a 
number of infectious diseases. Heart disease, lung disease, 
cancer, and infectious disease are now among the leading causes 
of death and disability for firefighters. The following are 
examples of the many studies that have established linkages 
between fighting fires and such diseases and conditions:
    1. A study of male Massachusetts firefighters from 1987 to 
2003 found increased risk for numerous cancers, including colon 
and brain cancer.\1\
---------------------------------------------------------------------------
    \1\Dongmug Kang, M.D., Ph.D., et al. ``Cancer Incidence Among Male 
Massachusetts Firefighters, 1987-2003.'' American Journal of Industrial 
Medicine. 2008; 51:329-335.
---------------------------------------------------------------------------
    2. A 2006 study conducted by the University of Cincinnati 
found that on-the-job exposure to soot and toxins creates an 
increased risk for various cancers among firefighters.\2\
---------------------------------------------------------------------------
    \2\Grace K. LeMasters, Ph.D., et al. ``Cancer Risk Among 
Firefighters: A Review and Meta-analysis of 32 Studies.'' Journal of 
Occupational and Environmental Medicinek. 2006; 48(11):1189-1202.
---------------------------------------------------------------------------
    3. A 2007 Harvard study published in the New England 
Journal of Medicine found that firefighters face a risk of 
death from heart attacks up to 100 times higher when involved 
in fire suppression as compared to non-emergency duties.\3\
---------------------------------------------------------------------------
    \3\Stefanos N. Kales, M.D., M.P.H., et al. ``Emergency Duties and 
Deaths from Heart Disease among Firefighters in the United States.'' 
The New England Journal of Medicine. 2007; 356(12):1207-1215.
---------------------------------------------------------------------------
    4. A federal government study conducted during the 
development of an Occupational Safety and Health Administration 
Bloodborne Pathogen Standard showed that 98 percent of 
Emergency Medical Technicians and 80 percent of firefighters 
are exposed to bloodborne infectious diseases on the job.\4\
---------------------------------------------------------------------------
    \4\29 CFR 1910.1030 Occupational Safety and Health Administration 
Regulatory Impact and Flexibility Analysis.
---------------------------------------------------------------------------
    5. A 2007 study published in Occupational Medicine found 
that the preponderance of evidence supports the presumption of 
causation for numerous cancers for firefighter.\5\
---------------------------------------------------------------------------
    \5\Tee L. Guidotti. ``Evaluating Causality for Occupational 
Cancers: The Example of Firefighters.'' Occupational Medicine. 2007; 
57:466-471.
---------------------------------------------------------------------------
    Forty-two states have enacted ``presumptive disability'' 
laws which presume that cardiovascular diseases and certain 
cancers and infectious diseases contracted by firefighters are 
job-related for purposes of worker's compensation and 
disability retirement unless proven otherwise (see Figure 1). 
However, no such law covers firefighters employed by the 
federal government. There are approximately 15,000 federal 
firefighters, the majority of whom are employed by the 
Department of Defense.
    According to the International Association of Fire Fighters 
(IAFF), Federal firefighters who have contracted cancers and 
infectious diseases have experienced difficulty in receiving 
compensation under the Federal Employee Compensation Act (FECA) 
(5 U.S.C. 81) because of the difficulty of linking the disease 
to precise incidents or exposures. Because their work 
environment involves routine exposure to hazardous 
substances,\6\ each incident--or the repeated exposure from 
many incidents over time--could potentially cause a disease or 
condition. This legislation would establish the presumption 
that the listed diseases and conditions are consistent with the 
work environment of firefighting. Therefore, in filing a claim 
associated with any of these diseases or conditions, an 
employee would no longer be required to establish a connection 
to a specific incident or incidents.
---------------------------------------------------------------------------
    \6\See Kang et al: ``Firefighters are known to be exposed to 
recognized or probable carcinogens. These include benzene, polycyclic 
aromatic hydrocarbons, benzo(a)pyrene, formaldehyde, chlorophenols, 
dioxins, ethylene exide, orthotoluidine . . .'' (329).


                        III. Legislative History

    On March 16, 2009, Senators Carper and Collins introduced 
S. 599, which was referred to the Senate Committee on Homeland 
Security and Governmental Affairs. On March 25, 2009, the bill 
was referred to the Subcommittee on Oversight of Government 
Management, the Federal Workforce, and the District of 
Columbia. The Subcommittee reported the bill to the full 
committee, and on May 20, 2009, the full Committee, by voice 
vote, ordered it reported favorably to the Senate floor with an 
amendment offered by Senator Coburn.
    The Coburn amendment restores language originally in the 
Ryan White CARE Act of 1990 regarding notifying emergency 
responders of their exposure to infectious diseases. The 
amendment requires the Secretary of Health and Human Services 
to develop a list of life-threatening infectious diseases and 
guidelines regarding potential exposure and notification. 
Further, it requires that medical facilities notify first 
responders who treated victims found to have an infectious 
disease, and it allows first responders who suspect exposure to 
an infectious disease to initiate procedures to determine, 
through a designated officer and the medical facility, whether 
exposure actually occurred.
    S. 599 was ordered reported favorably by voice vote as 
amended. Senator Coburn asked to be recorded as ``No.'' 
Senators present were Senators Lieberman, Levin, Akaka, Carper, 
Pryor, McCaskill, Burris, Bennet, Collins, Coburn, and 
Voinovich.
    Rep. Lois Capps introduced a similar bill (H.R. 948) in the 
House of Representatives on February 10, 2009.

                    IV. Section-by-Section Analysis


Section 1. Short title

    Section 1 designates the name of the Act as the ``Federal 
Firefighters Fairness Act of 2009.''

                 TITLE I. FEDERAL FIREFIGHTERS FAIRNESS

Section 101. Certain diseases presumed to be work-related cause of 
        disability or death for Federal employees in fire protection 
        activities

    Subsection (a) defines the class of employees to whom the 
bill would apply. The presumption created by the bill would 
only apply to individuals who are trained in fire suppression, 
authorized to engage in fire suppression, and engage in fire 
suppression and other emergency response activities as a 
primary responsibility of their job.
    Subsection (b) lists 20 infectious and non-infectious 
diseases for which the presumption would apply for employees 
covered by the bill. The Secretary of Labor would be permitted 
to add additional diseases to the list if he or she determines 
that such diseases are related to the hazards firefighters face 
on the job. The presumption for non-infectious diseases would 
only apply to employees who have been employed by the Federal 
government for five years or more. The presumption for 
infectious diseases would apply to all covered employees. The 
presumption for both non-infectious and infectious diseases 
would be rebuttable by a preponderance of the evidence.
    Subsection (c) requires the National Institute of 
Occupational Safety and Health in the Centers for Disease 
Control and Prevention to report to Congress, no later than 10 
years after enactment, on the claims filed under the 
presumption created in this title and on the available research 
related to the health risks associated with firefighting. The 
report will also include any recommendations for administrative 
or legislative actions necessary to ensure that those diseases 
most closely associated with firefighting are included in the 
presumption created in the bill.
    Subsection (d) states that the presumption included in this 
title applies only to injuries diagnosed and deaths occurring 
after the date of enactment.

  TITLE II. NOTIFICATIONS OF POSSIBLE EXPOSURE TO INFECTIOUS DISEASES

Section 201. Infectious diseases and circumstances relevant to 
        notification requirements

    Subsection (a) requires the Secretary of Health and Human 
Services to complete a list of potentially life-threatening 
infectious diseases to which emergency responders may be 
exposed; guidelines describing the circumstances in which 
emergency responders may be exposed to these infectious 
diseases; and guidelines describing how medical facilities 
should determine whether an emergency responder was exposed to 
these infectious diseases. These should be completed no later 
than 180 days after enactment.
    Subsection (b) requires that the Secretary's list 
identifying potentially life-threatening infectious diseases 
specify the infectious diseases that are routinely transmitted 
through airborne or aerosolized means.
    Subsection (c) requires that the Secretary provide the 
completed list and guidelines to state public health officers 
for dissemination throughout the states. It also requires that 
the Secretary make copies available to the public.

Section 202. Routine notifications with respect to airborne infectious 
        diseases in victims assisted

    Subsection (a) requires medical facilities to notify the 
designated officer of emergency response employees (who has 
been selected pursuant to Section 206 below) when the 
facilities determine that a victim the emergency responders 
transported has an infectious disease. It also requires medical 
facilities to notify the designated officer if they determine 
that a victim has a disease that is transmittable through the 
air.
    Subsection (b) requires that medical facilities issue these 
notifications no later than 48 hours after making the 
determination.

Section 203. Request for notifications with respect to victims assisted

    Subsection (a) establishes a process for an emergency 
responder to request that a designated officer determine 
whether the responder was exposed to an infectious disease. If 
a responder believes that a victim he treated or transported 
exposed him to an infectious disease, the responder can request 
that a designated officer begin a review.
    Subsection (b) lists the responsibilities of the designated 
officer in making an initial determination as to whether an 
emergency responder was exposed to an infectious disease. The 
subsection requires the designated officer to collect and 
evaluate the facts and determine whether the victim has any of 
the diseases the Secretary of Health and Human Services has 
listed.
    Subsection (c) states that if the designated officer has 
determined that an emergency responder was exposed to an 
infectious disease, the officer must contact the medical 
facility that treated the victim and request an evaluation as 
to whether the emergency responder was exposed.
    Subsection (d) states that after receiving a request from a 
designated officer, the medical facility must evaluate whether 
the emergency responder was exposed to an infectious disease. 
The facility must notify the designated officer of its 
determination in writing, including when the facility finds it 
has insufficient or no information to make a determination.
    Subsection (e) requires the medical facility to notify the 
designated officer of its determination no later than 48 hours 
after receiving the request.
    Subsection (f) identifies the responsibilities of medical 
facilities when a victim transported or treated by an emergency 
responder dies. Medical facilities must provide a designated 
officer's request for an evaluation to the facility determining 
the cause of death, if it is a different facility. This 
facility must evaluate whether the emergency responder was 
exposed to an infectious disease and notify the designated 
officer of its determination in writing no later than 48 hours 
after receiving the request.
    Subsection (g) provides a process for reviewing a medical 
facility's decision that it has insufficient information to 
determine whether an emergency responder has been exposed to an 
infectious disease. In such cases, the designated officer can 
request that the public health officer in the medical 
facility's community evaluate the request and response. The 
public health officer must complete the evaluation no more than 
48 hours after receiving the request. If the public health 
officer finds that sufficient information existed, he must 
resubmit the request to the facility, and the facility must 
provide a determination to the designated officer. If the 
public health officer finds that insufficient information 
existed, he should provide advice to the designated officer 
regarding the collection of appropriate facts, and he must 
resubmit the request on the behalf of the designated officer if 
the officer obtains them. The medical facility must then 
evaluate whether the emergency responder was exposed to an 
infectious disease and notify the designated officer of its 
determination in writing no later than 48 hours after receiving 
the request.

Section 204. Procedures for notification of exposure

    Subsection (a) states that the notifications medical 
facilities provide to designated officers should include the 
name of the infectious disease involved and the date the 
emergency responder transported the victim.
    Subsection (b) requires medical facilities to inform 
designated officers when they mail notifications. No later than 
10 days after being informed, the designated officer must 
inform the medical facility whether or not he has received the 
notification.

Section 205. Notification of employee

    Subsection (a) states that upon receiving a notification, a 
designated officer should immediately notify employees who 
responded to the emergency involved and may have been exposed 
to an infectious disease, to the extent practicable.
    Subsection (b) describes the contents of a notification to 
an emergency responder. The notification should inform an 
employee of the fact that he may have been exposed to an 
infectious disease, as well as the name of the disease; 
medically appropriate actions; and the date of the emergency.
    Subsection (c) requires the designated officer to 
immediately inform an emergency responder, to the extent 
practicable, if the medical facility has determined that the 
responder was not exposed to an infectious disease or that it 
lacks sufficient information to make a determination.

Section 206. Selection of designated officers

    Subsection (a) requires that each state's public health 
officer select a designated officer for each employer of 
emergency responders in the state. Designated officers will 
receive notifications and responses from medical facilities and 
make requests for emergency responders.
    Subsection (b) states that public health officers should 
give preference to individuals trained in health care of the 
control of infectious diseases when selecting designated 
officers.

Section 207. Limitations with respect to duties of medical facilities

    Section 207 describes the conditions under which the duties 
established in this title apply to medical facilities. These 
duties apply to information medical facilities possess when 
they are treating a victim or during the 60 days after the 
emergency responders bring the victim to the facility, 
whichever ends first. These duties do not apply 30 days after 
the end of either of these periods. However, an exception is 
made if a designated officer makes a request to a medical 
facility on behalf of an emergency responder before the end of 
these 30 days.

Section 208. Rules of construction

    Subsection (a) states that this title does not authorize a 
cause of action or civil penalties against a medical facility 
or designated officer for not complying with the duties 
described in this title.
    Subsection (b) states that this title does not authorize or 
require that medical facilities test victims for infectious 
diseases.
    Subsection (c) states that this title does not authorize or 
require that a medical facility, designated officer, or a 
similar employee disclose identifying information of a victim 
or emergency responder.
    Subsection (d) states that this title does not authorize an 
emergency responder to fail to respond or deny services to the 
victim of an emergency.

Section 209. Injunctions regarding violation of prohibition

    Subsection (a) states that the Secretary of Health and 
Human Service can commence a civil action in order to obtain 
temporary or injunctive relief if this title is violated.
    Subsection (b) requires the Secretary of Health and Human 
Services to establish a process for emergency responders to 
report violations of this title. The Secretary should 
investigate these allegations when appropriate.

Section 210. Applicability of title

    Section 210 states that this title should not apply to a 
state whose chief executive has certified to the Secretary of 
Health and Human Services that state law is in substantial 
compliance with this title.

                   V. Evaluation of Regulatory Impact

    Pursuant to the requirements of paragraph 11(b) of rule 
XXVI of the Standing Rules of the Senate, the Committee has 
considered the regulatory impact of this bill. The 
Congressional Budget Office states that the bill would impose 
both intergovernmental and private-sector mandates as defined 
in the Unfunded Mandate Reform Act (UMRA). However, based on 
the number of emergency medical transports that could result in 
exposure to an infectious disease and the cost of 
notifications, CBO estimates that the costs of the mandates 
would fall below the annual thresholds established in UMRA ($69 
million for intergovernmental mandates and $139 million for 
private-sector mandates in 2009, adjusted annually for 
inflation).

             VI. Congressional Budget Office Cost Estimate


S. 599--Federal Firefighters Fairness Act of 2009

    Summary: S. 599 would expand eligibility for federal 
firefighters with certain diseases and conditions to receive 
medical, wage replacement, and death benefits under the Federal 
Employees' Compensation Act (FECA).
    CBO estimates that enacting S. 599 would increase net 
direct spending for benefits for firefighters by $26 million 
over the 2010-2019 period. Enacting the bill would not affect 
revenues.
    Because employing agencies ultimately bear the cost of 
federal workers' compensation claims, CBO estimates that 
discretionary costs for salaries and expenses would rise along 
with the FECA claims. Assuming appropriation of the necessary 
amounts, CBO estimates that spending subject to appropriation 
would increase by $25 million over the 2010-2019 period.
    S. 599 would impose intergovernmental and private-sector 
mandates as defined in the Unfunded Mandates Reform Act (UMRA) 
because it would require public and private medical facilities 
to notify emergency response employees of possible exposures to 
an infectious disease. CBO estimates that the costs of the 
mandates would fall below the annual thresholds established in 
UMRA for both intergovernmental and private-sector mandates 
($69 million and $139 million in 2009, respectively, adjusted 
annually for inflation).
    Estimated cost to the Federal Government: The estimated 
budgetary impact of S. 599 is shown in the following table. The 
costs of this legislation fall within budget function 600 
(income security).

--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                  By fiscal year, in millions of dollars--
                                                   -----------------------------------------------------------------------------------------------------
                                                     2010    2011    2012    2013    2014    2015    2016    2017    2018    2019   2010-2014  2010-2019
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                               CHANGES IN DIRECT SPENDING

Estimated Budget Authority........................       2       2       2       2       3       3       3       3       3       3        11         26
Estimated Outlays.................................       2       2       2       2       3       3       3       3       3       3        11         26

                                                      CHANGES IN SPENDING SUBJECT TO APPROPRIATION

Estimated Authorization Level.....................       1       2       3       3       3       3       3       3       3       3        12         27
Estimated Outlays.................................       1       2       2       2       3       3       3       3       3       3        10         25
Memorandum:
Intragovernmental Collections from Agencies to Pay      -1      -2      -2      -2      -3      -3      -3      -3      -3      -3       -10        -25
 for FECA Costs...................................
--------------------------------------------------------------------------------------------------------------------------------------------------------
Notes: Components may not sum to totals because of rounding.
      FECA = Federal Employees' Compensation Act.

    Basis of estimate: For purposes of this estimate, CBO 
assumes that S. 599 will be enacted near the start of fiscal 
year 2010.

Direct spending

    S. 599 would make federal firefighters who contract certain 
diseases presumptively eligible for benefits under FECA. The 
specified diseases include heart disease, lung disease, certain 
cancers, tuberculosis, hepatitis A, B, or C, and human 
immunodeficiency disease. Affected firefighters would be 
eligible for federal workers' compensation benefits, including 
medical expenses, disability payments, and death payments to 
survivors. Based on the incidence, disability, and death rates 
for the specified diseases, CBO estimates that between 200 and 
300 people per year, on average, would qualify for benefits. 
CBO estimates that providing FECA benefits for eligible 
firefighters would increase direct spending by $28 million over 
the 2010-2019 period.
    Costs under FECA would be partially offset by small savings 
in federal payments for disability and payments under the 
Federal Employees Health Benefits program. For those claimants 
who would have been able to qualify for federal disability 
payments under current law, those disability payments would be 
replaced by FECA payments. In addition, the federal 
government's share of health care premiums for retirees would 
decline slightly as costs for covered medical conditions would 
be paid by FECA. After accounting for those offsets ($2 million 
over the 10-year period), CBO estimates that enacting S. 599 
would increase net mandatory spending by $26 million over the 
2010-2019 period.

Spending subject to appropriation

    Because FECA costs ultimately are charged back to the 
claimant's employing agency, the costs are borne by those 
agencies' salaries and expense accounts. Therefore, CBO 
estimates that enacting S. 599 would increase discretionary 
costs for salaries and expenses governmentwide by a total of 
$25 million over the 2010-2019 period, assuming appropriation 
of the estimated amounts. Those reimbursements would be 
transferred to and credited to the FECA account, as shown in 
the memorandum line in the table above.
    Intergovernmental and private-sector impact: Under current 
law, public and private medical facilities must notify workers, 
including emergency response employees, if they have or could 
have been exposed to bloodborne pathogens. S. 599 would impose 
additional duties on medical facilities, including those that 
establish the cause of death, to notify emergency response 
employees if they have or could have been exposed to an 
infectious disease, including an airborne infectious disease. 
They also would be required to evaluate and respond to a notice 
request from emergency response employees who believe they may 
have been exposed to an infectious disease while attending, 
treating, assisting, or transporting an individual to the 
facility. The duty to comply with these new requirements would 
impose both intergovernmental and private-sector mandates as 
defined in UMRA. Based on the number of emergency medical 
transports that could result in exposure to an infectious 
disease and the cost of notifications, CBO estimates that the 
costs of the mandates would fall below the annual thresholds 
established in UMRA ($69 million for intergovernmental mandates 
and $139 million for private-sector mandates in 2009, adjusted 
annually for inflation).
    Estimate prepared by: Federal costs: Christina Hawley 
Anthony; Impact on state, local, and tribal governments: Lisa 
Ramirez-Branum; Impact on the private sector: Patrick 
Bernhardt.
    Estimate approved by: Theresa Gullo, Deputy Assistant 
Director for Budget Analysis.

       VII. Changes to Existing Law Made by the Bill, as Reported

    In compliance with paragraph 12 of rule XXVI of the 
Standing Rules of the Senate, changes in existing law made by 
S. 599 as reported are shown as follows (existing law proposed 
to be omitted is enclosed in brackets, new matter is printed in 
italic, and existing law in which no change is proposed is 
shown in roman):

             TITLE 5--GOVERNMENT ORGANIZATION AND EMPLOYEES

                          PART III--EMPLOYEES

                   Subpart G--Insurance and Annuities

               CHAPTER 81--COMPENSATION FOR WORK INJURIES


                        Subchapter I--Generally


Sec. 8101. Definitions

    For the purpose of this subchapter--

           *       *       *       *       *       *       *

          (19) ``organ'' means a part of the body that performs 
        a special function, and for purposes of this subchapter 
        excludes the brain, heart, and back; [and]
          (20) ``United States medical officers and hospitals'' 
        includes medical officers and hospitals of the Army, 
        Navy, Air Force, Department of Veterans Affairs, and 
        United States Public Health Service, and any other 
        medical officer or hospital designated as a United 
        States medical officer or hospital by the Secretary of 
        Labor [.]; and
          (21) `employee in fire protection activities' means a 
        firefighter, paramedic, emergency medical technician, 
        rescue worker, ambulance personnel, or hazardous 
        material worker, who--
                  (A) is trained in fire suppression;
                  (B) has the legal authority and 
                responsibility to engage in fire suppression;
                  (C) is engaged in the prevention, control, 
                and extinguishment of fires or response to 
                emergency situations where life, property, or 
                the environment is at risk; and
                  (D) performs such activities as a primary 
                responsibility of his or her job.

Sec. 8102. Compensation for disability or death of employee

           *       *       *       *       *       *       *


    (c)(1) With regard to an employee in fire protection 
activities, a disease specified in paragraph (2) shall be 
presumed to be proximately caused by the employment of such 
employee, subject to the length of service requirements 
specified. The disability or death of an employee in fire 
protection activities due to such a disease shall be presumed 
to result from personal injury sustained while in the 
performance of such employee's duty. Such presumptions may be 
rebutted by a preponderance of the evidence.
    (2) The following diseases shall be presumed to be 
proximately caused by the employment of the employee:
          (A) If the employee has been employed for a minimum 
        of 5 years:
                  (i) Heart disease.
                  (ii) Lung disease.
                  (iii) The following cancers:
                          (I) Brain cancer.
                          (II) Cancer of the blood or lymphatic 
                        systems.
                          (III) Leukemia.
                          (IV) Lymphoma (except Hodgkin's 
                        disease).
                          (V) Multiple myeloma.
                          (VI) Bladder cancer.
                          (VII) Kidney cancer.
                          (VIII) Testicular cancer.
                          (IX) Cancer of the digestive system.
                          (X) Colon cancer.
                          (XI) Liver cancer.
                          (XII) Skin cancer.
                          (XIII) Lung cancer.
                  (iv) Any other cancer the contraction of 
                which the Secretary of Labor determines to be 
                related to the hazards to which an employee in 
                fire protection activities may be subject.
          (B) Regardless of the length of time an employee has 
        been employed, any uncommon infectious disease, 
        including tuberculosis, hepatitis A, B, or C, and the 
        human immunodeficiency virus (HIV), the contraction of 
        which the Secretary of Labor determines to be related 
        to the hazards to which an employee in fire protection 
        activities may be subject.

                                  
