House Report 117-306 - FEDERAL FIREFIGHTERS FAIRNESS ACT OF 2022

[House Report 117-306]
[From the U.S. Government Publishing Office]

117th Congress } { Report
HOUSE OF REPRESENTATIVES
2d Session } { 117-306

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FEDERAL FIREFIGHTERS FAIRNESS ACT OF 2022

_______

May 6, 2022.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed

_______

Mr. Scott of Virginia, from the Committee on Education and Labor,
submitted the following

R E P O R T

together with

MINORITY VIEWS

[To accompany H.R. 2499]

[Including cost estimate of the Congressional Budget Office]

The Committee on Education and Labor, to whom was referred
the bill (H.R. 2499) 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 employees duty, and for other purposes, having considered
the same, reports favorably thereon with an amendment and
recommends that the bill as amended do pass.

CONTENTS

Page
Purpose and Summary.............................................. 3
Committee Consideration.......................................... 4
Committee Views.................................................. 8
Section-by-Section Analysis...................................... 18
Explanation of Amendments........................................ 19
Application of Law to the Legislative Branch..................... 19
Unfunded Mandate Statement....................................... 20
Earmark Statement................................................ 20
Roll Call Votes.................................................. 20
Statement of Performance Goals and Objectives.................... 23
Duplication of Federal Programs.................................. 23
Hearings......................................................... 23
Statement of Oversight Findings and Recommendations of the
Committee...................................................... 23
New Budget Authority and CBO Cost Estimate....................... 23
Committee Cost Estimate.......................................... 26
Changes in Existing Law Made by the Bill, as Reported............ 26
Minority Views................................................... 29

The amendment is as follows:
Strike all after the enacting clause and insert the
following:

SECTION 1. SHORT TITLE.

This Act may be cited as the ``Federal Firefighters Fairness Act of
2022''.

SEC. 2. CERTAIN DISEASES PRESUMED TO BE WORK-RELATED CAUSE OF
DISABILITY OR DEATH FOR FEDERAL EMPLOYEES IN FIRE
PROTECTION ACTIVITIES.

(a) Presumption Relating to Employees in Fire Protection
Activities.--Subchapter I of chapter 81 of title 5, United States Code,
is amended by inserting after section 8143a the following (and by
conforming the table of contents of such chapter accordingly):

``Sec. 8143b. Employees in fire protection activities.

``(a) Certain Diseases Deemed to Be Proximately Caused by Employment
in Fire Protection Activities.--
``(1) In general.--For a claim under this subchapter of
disability or death of an employee who has been employed for a
minimum of 5 years in aggregate as an employee in fire
protection activities, a disease specified on the list
established under paragraph (2) shall be deemed to be
proximately caused by the employment of such employee.
``(2) Establishment of initial list.--There is established
under this section the following list of diseases:
``(A) Bladder cancer.
``(B) Brain cancer.
``(C) Chronic obstructive pulmonary disease.
``(D) Colorectal cancer.
``(E) Esophageal cancer.
``(F) Kidney cancer.
``(G) Leukemias.
``(H) Lung cancer.
``(I) Mesothelioma.
``(J) Multiple myeloma.
``(K) Non-Hodgkin lymphoma.
``(L) Prostate cancer.
``(M) Skin cancer (melanoma).
``(N) A sudden cardiac event or stroke while, or not
later than 24 hours after, engaging in the activities
described in subsection (b)(1)(C).
``(O) Testicular cancer.
``(P) Thyroid cancer.
``(3) Additions to the list.--
``(A) In general.--The Secretary shall periodically
review the list established under this section in
consultation with the Director of the National
Institute on Occupational Safety and Health and shall
add a disease to the list by rule, upon a showing by a
petitioner or on the Secretary's own determination, in
accordance with this paragraph.
``(B) Basis for determination.--The Secretary shall
add a disease to the list upon a showing by a
petitioner or the Secretary's own determination, based
on the weight of the best available scientific
evidence, that there is a significant risk to employees
in fire protection activities of developing such
disease.
``(C) Available expertise.--In determining
significant risk for purposes of subparagraph (B), the
Secretary may accept as authoritative and may rely upon
recommendations, risk assessments, and scientific
studies (including analyses of National Firefighter
Registry data pertaining to Federal firefighters) by
the National Institute for Occupational Safety and
Health, the National Toxicology Program, the National
Academies of Sciences, Engineering, and Medicine, and
the International Agency for Research on Cancer.
``(4) Petitions to add to the list.--
``(A) In general.--Any person may petition the
Secretary to add a disease to the list under this
section.
``(B) Content of petition.--Such petition shall
provide information to show that there is sufficient
evidence of a significant risk to employees in fire
protection activities of developing such illness or
disease from their employment.
``(C) Timely and substantive decisions.--Not later
than 18 months after receipt of a petition, the
Secretary shall either grant or deny the petition by
publishing in the Federal Register a written
explanation of the reasons for the Secretary's
decision. The Secretary may not deny a petition solely
on the basis of competing priorities, inadequate
resources, or insufficient time for review.
``(b) Definitions.--In this section:
``(1) Employee in fire protection activities.--The term
`employee in fire protection activities' means an employee
employed as 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, including the prevention, control,
suppression, or management of wildland fires; and
``(D) performs such activities as a primary
responsibility of his or her job.
``(2) Secretary.--The term `Secretary' means Secretary of
Labor.''.
(b) Research Cooperation.--Not later than 120 days after the date of
enactment of this Act, the Secretary of Labor shall establish a process
by which a Federal employee in fire protection activities filing a
claim related to a disease on the list established by section 8143b of
title 5, United States Code, will be informed about and offered the
opportunity to contribute to science by voluntarily enrolling in the
National Firefighter Registry or a similar research or public health
initiative conducted by the Centers for Disease Control and Prevention.
(c) Review of Science on Breast Cancer.--Not later than 3 years after
the date of enactment of this Act, the Secretary shall--
(1) evaluate the best available scientific evidence of the
risk to an employee in fire protection activities of developing
breast cancer;
(2) add breast cancer to the list established under section
8143b of title 5, United States Code, by rule in accordance
with subsection (a)(3) of such section, if the Secretary
determines that such evidence supports such addition; and
(3) submit a report of the Secretary's findings under
paragraph (1) and the Secretary's determination under paragraph
(2) to the Committee on Education and Labor of the House and
the Committee on Health, Education, Labor, and Pensions of the
Senate.
(d) Application.--The amendments made by this section shall apply to
claims for compensation filed on or after the date of enactment of this
Act.

Purpose and Summary

H.R. 2499, the Federal Firefighters Fairness Act of 2021,
amends the eligibility for workers' compensation benefits under
the Federal Employees' Compensation Act (FECA)\1\ for federal
firefighters by establishing a presumption of causation for 16
diseases associated with employment in firefighting. These
changes to FECA are similar to the policies in 49 states
recognizing the occupational health hazards of firefighting
work.\2\ Since no comparable law covers the approximately
15,000-28,000 firefighters employed by the federal
government,\3\ it is necessary for Congress to fill the gap to
help those who put their lives on the line to protect property,
life, and the environment.
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\1\5 U.S.C. Sec. 8101 et seq.
\2\ Every state except for Delaware has a policy facilitating
access for firefighters to a benefit for one or more occupational
illnesses by applying a presumption of work-relatedness. These policies
vary in terms of conditions covered as well as type of benefit. For
example, New Mexico offers presumptive workers' compensation coverage
for various conditions, including cancer, whereas North Carolina (the
most recent state to establish such a policy) provides a one-time,
lump-sum benefit only for cancers. See Presumptive Health Initiative,
Int'l Ass'n Fire Fighters, https://www.iaff.org/presumptive-health/
(last viewed Mar. 25, 2022).
\3\There are 9,396 federal firefighters in the Office of Personnel
Management job classification GS-0081 (Fire Suppression and
Prevention). Other covered employees may be scattered across other job
classifications, such as GS-0462 (Forestry Technician) and GS-0640
(Health Aid and Technicians).
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Despite a higher incidence of certain diseases due to
occupational hazards, federal firefighters face substantial
evidentiary burdens qualifying for federal workers'
compensation benefits because of their inability to document
specific dates of specific exposures to establish causation.
This legislation addresses the inequity that arises when
federal fighters, who are often working side-by-side with state
and local fire fighters, receive reduced eligibility for
workers' compensation for work related diseases compared to
their peers.\4\
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\4\Letter from Bill Webb, Exec. Dir., Congressional Fire Inst., to
the Hon. Robert C. ``Bobby'' Scott & the Hon. Virginia Foxx (Mar. 30,
2022) (``This legislation will go a long way towards helping federal
firefighters and their families, as well as ensuring that federal
firefighters are eligible to receive the same benefits as their
compatriots employed at the state and local levels.'').
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Committee Consideration

107TH CONGRESS

On June 13, 2001, Rep. Ciro Rodriguez (D-TX-28) introduced
H.R. 2163, the Federal Firefighters Fairness Act of 2001. The
bill was referred to the House Committee on Education and the
Workforce. The Committee on Education and the Workforce
referred the bill to the Subcommittee on Workforce Protections.
The bill had 52 Democratic cosponsors and 10 Republican
cosponsors. No further action was taken on the bill.
On December 18, 2001, Sen. John Kerry (D-MA) introduced S.
1845, the Federal Firefighters Fairness Act of 2001, as a
companion bill to H.R. 2163. The bill had no cosponsors. The
bill was referred to the Senate Committee on Governmental
Affairs. The Committee on Governmental Affairs referred the
bill to the Subcommittee on International Security,
Proliferation and Federal Services. No further action was taken
on the bill.

108TH CONGRESS

On March 5, 2003, Rep. Rodriguez introduced H.R. 1101, the
Federal Firefighters Fairness Act of 2003. The bill was
referred to the House Committee on Education and the Workforce.
The Committee on Education and the Workforce referred the bill
to the Subcommittee on Workforce Protections. The bill had 28
Democratic cosponsors and seven Republican cosponsors. No
further action was taken on the bill.
On March 5, 2003, Sen. Kerry introduced S. 530, the Federal
Firefighters Fairness Act of 2003, as a companion bill to H.R.
1101. The bill was referred to the Senate Committee on
Governmental Affairs. The Committee on Governmental Affairs
referred the bill to the Subcommittee on Financial Management,
the Budget, and International Security. The bill had one
Democratic cosponsor. No further action was taken on the bill.

109TH CONGRESS

On February 9, 2005, Rep. Jo Ann Davis (R-VA-1) introduced
H.R. 697, the Federal Firefighters Fairness Act of 2005. The
bill was referred to the House Committee on Education and the
Workforce. The Committee on Education and the Workforce
referred the bill to the Subcommittee on Workforce Protections.
The bill had 59 Democratic cosponsors, 15 Republican
cosponsors, and one Independent cosponsor.
On May 26, 2005, the Subcommittee on Workforce Protections
held a hearing entitled ``Legislative Hearing on H.R. 697,
`Federal Firefighters Fairness Act of 2005' and H.R. 2561,
`Improving Access to Workers' Compensation for Injured Federal
Workers Act.''' During this hearing, the Subcommittee heard
testimony relevant to H.R. 697 from the Honorable Jo Ann Davis,
Member of Congress, U.S. House of Representatives, Gloucester,
VA; James B. Johnson, 16th District Vice President,
International Association of Firefighters, Washington, D.C.;
and Joel Shufro, Executive Director, New York Committee on
Safety and Health, New York, NY. No further action was taken on
the bill.
On June 9, 2005, Sen. Mark Dayton (D-MN) introduced S.
1221, the Federal Firefighters Fairness Act of 2005, as a
companion bill to H.R. 697. The bill was referred to the Senate
Committee on Homeland Security and Governmental Affairs. The
Committee on Homeland Security and Governmental Affairs
referred the bill to the Subcommittee on Oversight of
Government Management, the Federal Workforce, and the District
of Columbia. The bill had four Democratic cosponsors and two
Republican cosponsors. No further action was taken on the bill.

110TH CONGRESS

On January 4, 2007, Rep. Davis (VA) introduced H.R. 103,
the Federal Firefighters Fairness Act of 2007. The bill had no
cosponsors. The bill was referred to the House Committee on
Education and Labor. The Committee on Education and Labor
referred the bill to the Subcommittee on Workforce Protections.
No further action was taken on the bill.
On February 16, 2007, Rep. Lois Capps (D-CA-23) introduced
H.R. 1142, the Federal Firefighters Fairness Act of 2007. The
bill was referred to the House Committee on Education and
Labor. The bill had 108 Democratic cosponsors and 32 Republican
cosponsors. No further action was taken on the bill.
On August 1, 2007, Sen. Thomas Carper (D-DE) introduced S.
1924, the Federal Firefighters Fairness Act of 2008. The bill
was referred to the Senate Committee on Homeland Security and
Governmental Affairs. The Committee on Homeland Security and
Governmental Affairs referred the bill to the Subcommittee on
Oversight of Government Management, the Federal Workforce, and
the District of Columbia. The bill had 13 Democratic
cosponsors, four Republican cosponsors, one Independent
cosponsor, and one Independent Democratic cosponsor.
On June 25, 2008, the Committee on Homeland Security and
Governmental Affairs held a markup of S. 1924. The Committee
ordered S. 1924 to be reported favorably to the Senate with an
Amendment in the Nature of a Substitute by voice vote.
On October 1, 2008, S. 1924, as amended, was placed on the
Senate Legislative Calendar. No further action was taken on the
bill.

111TH CONGRESS

On February 10, 2009, Rep. Capps introduced H.R. 948, the
Federal Firefighters Fairness Act of 2009. The bill was
referred to the House Committee on Education and Labor. The
Committee on Education and Labor referred the bill to the
Subcommittee on Workforce Protections. The bill had 120
Democratic cosponsors and 20 Republican cosponsors. No further
action was taken on the bill.
On March 16, 2009, Sen. Carper introduced S. 599, the
Federal Firefighters Fairness Act of 2009, as a companion bill
to H.R. 948. The bill was referred to the Senate Committee on
Homeland Security and Governmental Affairs. The Committee on
Homeland Security and Governmental Affairs referred the bill to
the Subcommittee on Oversight of Government Management, the
Federal Workforce, and the District of Columbia. The bill had
16 Democratic cosponsors, two Republican cosponsors, and one
Independent cosponsor.
On May 20, 2009, the Senate Committee on Homeland Security
and Governmental Affairs held a markup of S. 599. The Committee
ordered S. 599 reported favorably to the Senate floor, with an
amendment offered by Sen. Thomas Coburn (R-OK), by voice vote.
On September 14, 2009, S. 599, as amended, was placed on
the Senate Legislative Calendar. No further action was taken on
the bill.

112TH CONGRESS

On April 4, 2011, Rep. Capps introduced H.R. 1066, the
Federal Firefighters Fairness Act of 2011. The bill was
referred to the House Committee on Education and the Workforce.
The Committee on Education and the Workforce referred the bill
to the Subcommittee on Workforce Protections. The bill had 62
Democratic cosponsors and four Republican cosponsors. No
further action was taken on the bill.

113TH CONGRESS

On December 12, 2013, Rep. Capps introduced H.R. 3718, the
Federal Firefighters Fairness Act of 2013. The bill was
referred to the House Committee on Education and the Workforce.
The bill had three Republican cosponsors. No further action was
taken on the bill.
On April 29, 2014, Sen. Carper introduced S. 2266, the
Federal Firefighters Fairness Act of 2014, as a companion bill
to H.R. 3718. The bill was referred to the Senate Committee on
Homeland Security and Governmental Affairs. The bill had one
Republican cosponsor. No further action was taken on the bill.

114TH CONGRESS

On February 24, 2015, Rep. Capps introduced H.R. 1035, the
Federal Firefighters Fairness Act of 2015. The bill was
referred to the House Committee on Education and the Workforce.
The Committee on Education and the Workforce referred the bill
to the Subcommittee on Workforce Protections. The bill had one
Democratic cosponsor and two Republican cosponsors. No further
action was taken on the bill.

115TH CONGRESS

On April 4, 2017, Rep. Salud Carbajal (D-CA-24) introduced
H.R. 1884, the Federal Firefighters Fairness Act of 2017. The
bill was referred to the House Committee on Education and the
Workforce. The bill had 16 Democratic cosponsors and 16
Republican cosponsors. No further action was taken on the bill.

116TH CONGRESS

On February 13, 2019, Rep. Carbajal introduced H.R. 1174,
the Federal Firefighters Fairness Act of 2019. The bill was
referred to the House Committee on Education and Labor. The
bill had 58 Democratic cosponsors and 11 Republican cosponsors.
No further action was taken on the bill.
On June 24, 2019, Sen. Carper introduced S. 1942, the
Federal Firefighters Fairness Act of 2019, as a companion bill
to H.R. 1174. The bill was referred to the Senate Committee on
Homeland Security and Governmental Affairs. The bill had ten
Democratic cosponsors, one Republican cosponsor, and one
Independent cosponsor. No further action was taken on the bill.

117TH CONGRESS

On April 14, 2021, Rep. Carbajal introduced H.R. 2499, the
Federal Firefighters Fairness Act of 2021. The bill was
referred to the Committee on Education and Labor. The bill has
144 Democratic cosponsors and 22 Republican cosponsors.\5\
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\5\The Republican cosponsors include Rep. Don Young (R-AK-At
Large), who died March 28, 2022, and Rep. Jeff Fortenberry (R-NE-1),
who resigned on March 31, 2022.
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On April 14, 2021, Sen. Carper introduced S. 1116, the
Federal Firefighters Fairness Act of 2021, as a companion bill
to H.R. 2499. The bill was referred to the Senate Committee on
Homeland Security and Governmental Affairs. The bill has seven
Democratic cosponsors, one Republican cosponsor, and one
Independent cosponsor.
On December 2, 2021, the Committee on Education and Labor's
Subcommittee on Workforce Protections held a hearing entitled
``Strengthening the Safety Net for Injured Workers''' (December
2 Hearing). During this hearing, the Subcommittee heard
testimony relevant to H.R. 2499 from the Honorable Salud
Carbajal, Member of Congress, U.S. House of Representatives,
Santa Barbara, CA; and Christopher J. Godfrey, Director, Office
of Workers' Compensation Programs (OWCP), U.S. Department of
Labor, Washington, D.C.
On March 16, 2022, the Committee on Education and Labor
held a markup of H.R. 2499. The Committee adopted an Amendment
in the Nature of a Substitute (ANS) offered by Rep. Mark Takano
(D-CA-41). The ANS incorporated the provisions of H.R. 2499
with the following changes:
Changed the year in the short title from
2021 to 2022.
Clarified the bill's applicability to
federal wildland firefighters by adding ``including the
prevention, control, suppression, or management of
wildland fires'' to the definition of ``employee in
fire protection activities.''
Removed language that presumptions can be
rebutted by a preponderance of the evidence from the
employing agency.
Eliminated the stipulation that the
presumption of work-related illness only applies if the
employee is diagnosed within 10 years of the employee's
last date of active employment in fire protection
activities.
Removed the presumption for any communicable
disease declared a pandemic.
Added chronic obstructive pulmonary disease,
mesothelioma, prostate cancer, thyroid cancer, and
stroke or sudden cardiac events within 24 hours of
service to the initial presumptive list, and removed
heart disease, lung disease, and breast cancer from
that list.
Modified ``cancer of the blood or lymphatic
systems,'' ``cancer of the digestive system,'' and
``cancer of the respiratory system'' to include
specific diagnoses within each category.
Required the U.S. Secretary of Labor
(Secretary), in consultation with the Director of the
National Institute for Occupational Safety and Health
(NIOSH), to periodically review and add diseases based
on the weight of the best available scientific
evidence.
Established a process by which any person
may petition the Secretary to add diseases to the
initial list and required the Secretary to provide a
substantive response within 18 months of receiving a
petition.
Required the Secretary, not later than 3
years after the date of enactment, to (1) review the
science on firefighters' risk of developing breast
cancer, (2) determine whether breast cancer should be
added to the presumptive list, and (3) report to
Congress on the Secretary's decision.
Directed the Secretary to inform any federal
firefighter applying for workers' compensation about
the opportunity to enroll in the NIOSH National
Firefighter Registry.
One amendment to the ANS was offered:
Rep. Fred Keller (R-PA-12) offered an
amendment to strike the text of the bill and replace it
with text to direct the Comptroller General to prepare
a report on health care benefits and treatment for
federal firefighters with certain health conditions.
The amendment was defeated by a vote of 20 Yeas and 29
Nays.
H.R. 2499 was reported favorably, as amended, to the House
of Representatives by a vote of 31 Yeas and 18 Nays.

Committee Views

INTRODUCTION

The Committee on Education and Labor (Committee) is
committed to protecting the health and safety of our nation's
workers. The Committee supports federal employees' health and
safety by continuing to strengthen FECA. FECA provides wage-
loss compensation, medical treatment, return-to-work
assistance, and vocational rehabilitation to assist civilian
federal employees (or their survivors) from work-related
injuries, illnesses, or death. FECA provides benefits for
federal employees injured, sickened, or killed as a result of
their work, regardless of fault.
H.R. 2499, the Federal Firefighters Fairness Act of 2022,
supports federal firefighters in their application for FECA
benefits by deeming certain specified diseases as proximately
caused by employment. H.R. 2499 has been endorsed by the
American Federation of Government Employees (AFGE); Antilles
Consolidated Education Association (ACEA); Asbestos Disease
Awareness Organization (ADAO); Congressional Fire Services
Institute (CFSI); Department for Professional Employees, AFL-
CIO (DPE); Federal Education Association/National Education
Association (FEA/NEA); International Association of Fire Chiefs
(IAFC); International Association of Fire Fighters (IAFF);
International Association of Machinists and Aerospace Workers
(IAMAW); International Federation of Professional and Technical
Engineers (IFPTE); Metal Trades Department, AFL-CIO (MTD);
National Active and Retired Federal Employees Association
(NARFE); National Association of Government Employees, SEIU
(NAGE); National Federation of Federal Employees (NFFE);
National Postal Mail Handlers Union (NPMHU); National Weather
Service Employees Organization (NWSEO); Patent Office
Professional Association (POPA); Professional Aviation Safety
Specialists, AFL-CIO (PASS); Seafarers International Union/NMU
(SIU); and United Power Trades Organization (UPTO).

FIREFIGHTERS ARE AT GREATER RISK FOR CERTAIN ILLNESSES FROM
OCCUPATIONAL HAZARDS

Firefighting is strenuous and dangerous work. In addition
to the immediate safety risks posed by an active fire,
firefighters also face the danger of longer-term health
conditions associated with their work. As discussed below,
research shows that firefighters are more likely than other
workers to develop certain cancers and lung diseases and suffer
cardiac events because of their daily exposure to stress,
smoke, heat, carbon monoxide, and toxic substances.
Firefighters are routinely exposed to health hazards
including diesel emissions and toxic substances from burning
buildings.\6\ The primary route of toxic exposure during fires
is through inhalation, but exposure can also occur through
dermal absorption.\7\
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\6\C.C. Austin et al., Characterization of Volatile Organic
Compounds in Smoke at Municipal Structural Fires, 63 J. Toxicol. &
Envtl. health 437 (2001); W.T. Lowry et al., Studies of Toxic Gas
Production During Actual Structural Fires in the Dallas Area, 30 J.
Forensic Sci. 59 (1985).
\7\Jennifer L.A. Keir et al., Elevated Exposures to Polycyclic
Aromatic Hydrocarbons and Other Organic Mutagens in Ottawa Firefighters
Participating in Emergency, On-Shift Fire Suppression, 31 Envtl. Sci. &
Tech. 12,745 (2017).
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Firefighters are exposed to toxic compounds not just on
active fire scenes but also in fire stations. In a study of
dust samples in 26 fire stations across five states,
researchers documented toxic flame retardant levels higher than
those previously reported in homes and other occupational
settings around the world.\8\ Additionally, firefighters are
exposed to high levels of diesel exhaust before and after
responses in the station.\9\
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\8\ Beverly Shen et al., Organophosphate Flame Retardants in Dust
Collected from United States Fire Stations, 112 Envt. Int'l 41 (2017),
doi:10.1016/j.envint.2017.12.009.
\9\Anjoeka Pronk et al., Occupational Exposure to Diesel Engine
Exhaust: A Literature Review, 19 J. Expo. Sci. & Envtl. Epidemiol. 443
(2009), doi:10.1038/jes.2009.21
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Although necessary, personal protective equipment does not
fully protect firefighters from these hazards. First,
firefighters may not always be wearing personal protective
equipment (PPE) during all phases of a fire response.
Firefighters may remove their equipment due to exhaustion or
difficulty breathing.\10\ After the fire is suppressed,
firefighters are less likely to wear PPE on the scene, even
though dangerous chemicals such as benzene and formaldehyde are
still present in the air.\11\ Second, their self-contained
breathing apparatus may run out of air inside a burning
environment, resulting in significant smoke inhalation.\12\
Finally, uniforms do not completely prevent dermal
exposure.\13\ Because of these gaps in personal protective
equipment, toxic chemicals can enter firefighters' bodies via
their breath and skin.
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\10\Michael A. Maglio et al., Situational Pressures That Influence
Firefighters' Decision Making About Personal Protective Equipment: A
Qualitative Analysis, 40 AM. J. Health Behav. 555 (2016).
\11\ D.M. Bolstad-Johnson et al., Characterization of Firefighter
Exposures During Fire Overhaul, 61 Am. Indus. Hygiene Ass'n J. 636
(2000), https://doi.org/10.1080/15298660008984572.
\12\David C. Cone et al., Fireground Use of an Emergency Escape
Respirator, 14 Prehosp. Emerg. Care 433 (2010), doi:10.3109/
10903127.2010.493989.
\13\Kenneth W. Fent et al., Nat'l Inst. Occ. Safety & Health, 2010-
0156-3196, Evaluation of Dermal Exposure to Polycyclic Aromatic
Hydrocarbons in Fire Fighters 39, 41 (2013).
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Smoke now contains more complex combustion products due to
the increased number of synthetics in U.S. homes and
businesses. American homes, cars, and businesses are
increasingly constructed and furnished with synthetic
material.\14\ Studies have observed increased smoke density
related to synthetics, such as styrene and vinyl-based
materials.\15\ In a Harvard study that measured air contaminant
levels at more than 200 structural fires, the carcinogen
benzene was detected in 181 of 197 of samples taken at fire
scenes.\16\ Because of the increased toxicity of structural
fires, firefighters will continue to face health risks in the
years ahead.
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\14\Stephen Kerber, Analysis of Changing Residential Fire Dynamics
and Its Implications on Firefighter Operational Timeframes, 48 Fire
Technol. 865 (2012).
\15\Thomas Fabian et al., U. Lab'ys, Firefighter Exposure to Smoke
Particulates (2010), https://fsri.org/research/firefighter-exposure-
smoke-particulates#tabs-findings.
\16\Robert D. Treitman et al., Air Contaminants Encountered by
Firefighters, 41 Am. Indus. Hygiene Ass'n J. 796 (1980).
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Many fire-related hazards are known to be cancer-causing
chemicals, or carcinogens. The International Agency for
Research on Cancer classifies chemicals according to their
potential to cause cancer in humans: carcinogenic to humans,
probably carcinogenic to humans, and possibly carcinogenic to
humans. There are at least 11 chemicals frequently present in
the firefighting environment that are classified by IARC as
carcinogenic to humans,\17\ such as arsenic, asbestos, benzene,
and formaldehyde.\18\ These chemicals are linked to cancers of
the kidney, prostate, liver, and lung, as well as leukemia,
non-Hodgkin lymphoma, and multiple myeloma.\19\ Many other
chemicals found in fire scenes are probably or possibly
carcinogenic to humans.\20\
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\17\Known Carcinogens in the Firefighting Environment, Int'l Ass'n
Fire Fighters, https://www.iaff.org/wp-content/uploads/2020-
Carcinogens-and-Cancer-handout-002.pdf (last viewed Mar. 25, 2022).
\18\Id.
\19\Id.
\20\Int'l Agency Cancer Res., Painting, Firefighting, and
Shiftwork, 98 IARC Monographs Eval. Carcin. Risks to Humans 397-559
(2010).
---------------------------------------------------------------------------
Due to frequent exposure to carcinogens, firefighters are
more likely to develop cancer compared to the general
population. A meta-analysis of 32 studies identified 10 cancers
that firefighters have a statistically significant increased
risk of developing: testicular (102% greater risk), multiple
myeloma (53%), non-Hodgkin lymphoma (51%), skin and malignant
melanoma (39% and 32%, respectively), brain (32%), rectum
(29%), prostate (28%), stomach (22%), and colon (21%).\21\ A
different study using data from the National Cancer Institute
found that non-lymphatic leukemia risks were also significantly
elevated among firefighters.\22\
---------------------------------------------------------------------------
\21\Grace K. LeMasters et al., Cancer Risk Among Firefighters: A
Review and Meta-Analysis of 32 Studies, 48 J. Occup. & Envtl. Med. 1189
(2006).
\22\William Morton & Danijela Marjanovic, Leukemia Incidence by
Occupation in the Portland-Vancouver Metropolitan Area, 6 AM. J. Indus.
Med. 185 (1984), https://doi.org/10.1002/ajim.4700060304.
---------------------------------------------------------------------------
Firefighters are also more likely to die from certain
cancers. A study of almost 30,000 career firefighters conducted
by NIOSH found that firefighters have a 14% increased risk of
dying from cancer compared to the general population.\23\ This
study identified seven cancers from which firefighters have a
statistically significant increased risk of dying: mesothelioma
(100% increased risk), rectum (45%), buccal/pharynx (40%),
esophagus (39%), colon (31%), kidney (29%), and lung (10%).\24\
Bladder and prostate cancer also posed statistically
significant increased risk of death in firefighters under 65
years old.\25\
---------------------------------------------------------------------------
\23\Robert D Daniels et al., Mortality and Cancer Incidence in a
Pooled Cohort of US Firefighters from San Francisco, Chicago and
Philadelphia (1950-2009), 71 Occup. & Envtl. Med. 388 (2014).
\24\Id.
\25\Id.
---------------------------------------------------------------------------
Smoke inhalation is particularly damaging to the
respiratory system. In addition to lung cancer, firefighters
are at greater risk of developing lung diseases, such as
Chronic Obstructive Pulmonary Disease (COPD). In a cohort of
almost 30,000 U.S. career firefighters, one study found a
positive relationship between COPD mortality and fire-hours
worked.\26\ Another study of urban firefighters in Canada found
an increase in COPD mortality compared to the general
population.\27\ Research suggests that increased COPD
prevalence could be associated with exposure to diesel exhaust,
a common hazard in fire stations.\28\
---------------------------------------------------------------------------
\26\Lynne Pinkerton et al., Mortality in a Cohort of US
Firefighters from San Francisco, Chicago and Philadelphia: An Update,
77 Occup. & Envtl. Med. 84 (2020), https://pubmed.ncbi.nlm.nih.gov/
31896615/.
\27\Tee L. Guidotti, Mortality of Urban Firefighters in Alberta,
1927-1987, 23 Am. J. Indus. Med. 921 (1993).
\28\Sheila Weinmann et al., COPD and Occupational Exposures: A
Case-Control Study, 50 J. Occup. & Envtl. Med. 561 (2008).
---------------------------------------------------------------------------
Smoke inhalation and strenuous activity put firefighters at
greater risk of sudden cardiac events and death. Sudden cardiac
death accounts for 45% of on-duty deaths among firefighters and
is most likely to occur during or shortly after emergency
duties.\29\ Firefighting introduces four primary hazards which
increase the risk of sudden cardiac events: chemical exposures,
physical exertion, heat exertion, and shift work. First, smoke
inhalation exposes firefighters to many compounds which reduce
the availability of oxygen in the body, like carbon
monoxide.\30\ Blood tests in firefighters have demonstrated an
elevated level of carboxyhemoglobin, a marker for carbon
monoxide exposure.\31\ The lack of oxygen caused by carbon
monoxide exposure increases the risk of severe cardiac events,
such as cardiac arrest.\32\ Second, the physical exertion
required during an active fire, combined with the extra weight
of personal gear, increases strain placed on the heart of a
firefighter.\33\ Third, heat stress produced by a combination
of body heat from physical work, insulating protective
equipment, and fire-related heat increases firefighters' core
body temperature, which strains the heart, making firefighters
more susceptible to sudden cardiac events.\34\ Finally, shift
work is a known cardiovascular risk due to frequent sleep
deprivation and disturbance, leaving shift workers with a 23%
higher risk of heart attack and a 24% higher risk of a coronary
event compared to day workers.\35\
---------------------------------------------------------------------------
\29\Stefanos N. Kales et al., Firefighters and On-Duty Deaths from
Coronary Heart Disease: A Case Control Study, 2 Envtl. Health 14
(2003), https://dash.harvard.edu/bitstream/handle/1/8000902/
293431.pdf;sequence=1.
\30\Richard D. Stewart et al., Rapid Estimation of
Carboxyhemoglobin Level in Fire Fighters, 235 JAMA 390 (1976).
\31\Id.
\32\Ibrahim Sari et al., Chronic Carbon Monoxide Exposure Increases
Electrocardiographic P-Wave and QT Dispersion, 20 Inhal. Toxicol. 879
(2008), https://pubmed.ncbi.nlm.nih.gov/18645728/.
\33\Elpidoforos S. Soteriades et al., Cardiovascular Disease in US
Firefighters A Systematic Review, 19 Cardiol. in Rev. 202 (2011).
\34\Id.
\35\Manav V. Vyas et al., Shift Work and Vascular Events:
Systematic Review and Meta-Analysis, 2012 Brit. Med. J. 345:e4800,
https://www.bmj.com/content/345/bmj.e4800.long.
---------------------------------------------------------------------------
In summary, the existing body of research on the
occupational hazards of firefighting demonstrates that the
physical and chemical dangers of fire scenes and fire stations
result in excess illness and death for firefighters compared to
the general population.

FEDERAL FIREFIGHTERS FACE CHALLENGES QUALIFYING FOR WORKERS'
COMPENSATION BENEFITS

Because of the evidence supporting the occupational nature
of conditions such as cancers, COPD, and acute cardiac events,
federal firefighters should qualify for workers' compensation
benefits if they are made ill, disabled, or suffer a fatality
due to one of these illnesses. This aligns with the basic
purpose of workers' compensation systems: to cover medical care
and lost wages for disability or death caused by illness or
injury arising from work.
However, while most workers' compensation systems are well
designed to address acute injuries, they are poorly designed to
provide benefits for occupational illnesses with long latency
periods caused by years of exposure to toxic chemicals.
Illnesses with decades-long latency periods and complicated,
unobservable pathologies, such as cancer, are especially
difficult for traditional workers' compensation systems to
adjudicate. Except where presumptions are stipulated in law,
the burden falls on the claimant to prove that an injury or
illness was more likely than not caused by employment.
Unsurprisingly as a result, experts estimate that fewer than
one in 100 occupational cancer victims receives workers'
compensation benefits.\36\
---------------------------------------------------------------------------
\36\Amer. Pub. Health Ass'n, The Critical Need to Reform Workers'
Compensation (Pol. Statement No. 20174, Nov. 7, 2017), https://
www.apha.org/Policies-and-Advocacy/Public-Health-Policy-Statements/
Policy-Database/2018/01/18/The-Critical-Need-to-Reform-Workers-
Compensation.
---------------------------------------------------------------------------
To establish an illness, injury, or death was work-related,
FECA requires claimants to provide extensive evidence
documenting the exposure and related disability. According to
the U.S. Department of Labor's (DOL) FECA claim form, in
addition to other requirements, claimants must submit a
narrative linking their illness to specific incidents or
exposures. This narrative must include ``a detailed history of
the disease or illness from the date it started, complete
details of the conditions of employment which are believed to
be responsible for the disease or illness, [and] a description
of specific exposures to substances or stressful conditions
causing the disease or illness, including locations where
exposure or stress occurred, as well as the number of hours per
day and days per week of such exposure or stress.''\37\
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\37\The claim form, Form CA-2, is available online at https://
www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-2.pdf (last
viewed Mar. 25, 2022).
---------------------------------------------------------------------------
Federal firefighters face obstacles securing compensation
under FECA because of the difficulty linking their diseases to
specific workplace events or exposures. Because, as discussed
above, their work environment involves routine exposure to
multiple hazardous substances, each incident--or the cumulative
exposure from many incidents over time--could potentially cause
a disease or condition such as cancer or COPD, and it is not
realistic for firefighters to detail dates, locations, and
numbers of exposures for FECA claims. As a result, too many
federal firefighters disabled or killed by these conditions
fail to receive proper benefits from FECA. In fact, according
to DOL, only 30.9% of firefighters' FECA claims for lung and
respiratory diseases were accepted, and only 9% of their claims
for cancers were accepted.\38\ These numbers reflect only the
claims that were actually filed; many occupational illness
claims are never filed at all.\39\
---------------------------------------------------------------------------
\38\Email from U.S. Dep't of Lab. to Dem. Comm. Staff (Mar. 28,
2022). The data could vary if job categories other than GS-0081 (Fire
Suppression and Prevention) were included.
\39\Jeff Biddle et al., What Percentage of Workers With Work-
Related Illnesses Receive Workers' Compensation Benefits?, 40 J. Occ. &
Envtl. Med. 325 (1998) (finding that only 9-45% of workers in database
of known or suspected cases of occupational illness filed for workers'
compensation benefits).
---------------------------------------------------------------------------

CURRENT FEDERAL LAW INADEQUATELY SUPPORTS FEDERAL FIREFIGHTERS AND IS
INCONSISTENT WITH MOST STATES' WORKERS' COMPENSATION LAWS

To avoid burdening firefighters with the task of linking a
workplace cancer or other disease to a specific date and
location of exposure, 49 states provide for a benefit
distributed based on a presumption that certain health
conditions in firefighters are work-related.\40\ California
passed the nation's first presumptive disability law for
firefighters in 1982.\41\ Since then, every state except for
Delaware (whose firefighting services are almost exclusively
staffed by part-time volunteers rather than career firefighters
\42\) has followed suit. For example, Florida law outlines a
presumption for firefighters with five years or more service,
covering all of the cancers included in H.R. 2499, except
leukemias, as well as six other cancers, communicable diseases,
and behavioral health conditions.\43\ While the details of each
law vary between states, all establish a presumption for some
cancers. Many states expand this presumption to other
conditions, such as heart disease, lung disease, infectious
diseases, and behavioral health conditions like post-traumatic
stress disorder (PTSD).\44\
---------------------------------------------------------------------------
\40\Int'l Ass'n Fire Fighters, supra note 1.
\41\The first modern presumption law was California's 1982 law
covering cancer, although the state also passed an earlier law in 1939
addressing some lung, heart, and hernia conditions. Cal. Prof.
Firefighters, Firefighter Presumption Laws: Why They Matter,
CPFNewspaper.org, Summer 2021, https://www.cpfnewspaper.org/
firefighter-presumption.
\42\Zoe Read, Delaware Task Force Offers Recommendations to Address
Dwindling Volunteer Firefighting Force, WHYY, June 16, 2021, https://
whyy.org/articles/delaware-task-force-offers-recommendations-to-
address-dwindling-volunteer-firefighter-force/ (``Fire, rescue, and
emergency medical services in Delaware are mostly provided by volunteer
fire departments. Delaware is the only U.S. state that uses volunteer
firefighters in its capital city. . . Wilmington has the only fully
paid fire department in the state.'').
\43\Fla. Stat. Sec. 112.18 et seq.
\44\Int'l Ass'n Fire Fighters, supra note 1.
---------------------------------------------------------------------------
However, no such law covers the approximately 15,000 28,000
firefighters employed by the federal government. Federal
firefighters often fight alongside firefighters employed by
state and local governments, as Rep. Carbajal observed in the
December 2 Hearing:

Last month, over a thousand firefighters put their
lives on the line to battle the Alisal Fire in my
district on the Central Coast of California. I am so
thankful for the federal, state, and local firefighters
who worked together to put out the blaze and keep our
community safe. All of them performed the same job, but
[federal firefighters] experience a disparity in health
benefits.
It is not fair that federal firefighters are being
denied access to benefits that their local counterparts
receive, especially when they fight the same fires and
expose themselves to the same risks.\45\
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\45\Strengthening the Safety Net for Injured Workers: Hearing
Before the Subcomm. on Workforce Protections of the H. Comm. on Educ. &
Lab., 117th Cong. (Dec. 2, 2021) [hereinafter Strengthening the Safety
Net] (statement of Rep. Salud Carbajal, https://edlabor.house.gov/imo/
media/doc/CarbajalSaludTestimony120221.pdf).

Federal firefighters protect our nation's most important
military installations, laboratories, and national forests, and
they should be fairly protected by federal workers'
compensation law.

H.R. 2499 WOULD REDUCE THE BURDEN FOR FEDERAL FIREFIGHTERS TO QUALIFY
FOR BENEFITS

H.R. 2499 would ease the process for federal firefighters
to qualify for FECA benefits by establishing an initial list of
diseases which would be presumed to be ``proximately caused''
from ``firefighting activities'' for the purposes of FECA
claims. The initial list of conditions includes bladder cancer,
brain cancer, chronic obstructive pulmonary disease, colorectal
cancer, esophageal cancer, kidney cancer, leukemias, lung
cancer, mesothelioma, multiple myeloma, non-Hodgkin lymphoma,
prostate cancer, skin cancer (melanoma), testicular cancer,
thyroid cancer, and sudden cardiac event or stroke not later
than 24 hours after working in fire protection activities.
In filing a FECA claim associated with any of these
conditions, a federal firefighter with at least five years of
service would no longer be required to provide evidence of a
specific incident or exposure. Instead, if the eligibility
requirements are satisfied, the firefighter would be presumed
to have developed the condition from employment and
automatically qualify for FECA disability or death benefits.
This approach is comparable to existing federal laws. For
example, the Energy Employees Occupational Illness Compensation
Program Act\46\ provides compensation and medical benefits to
employees whose work in the nuclear weapons industry made them
ill. This program includes a presumption for covered workers
diagnosed with beryllium disease, silicosis, and cancer.\47\
---------------------------------------------------------------------------
\46\Energy Employees Occupational Illness Compensation Program Act,
Pub. L. No. 106-398 (42 U.S.C. Sec. 7384 et seq.).
\47\Id. Sec. 3621 (42 U.S.C. Sec. 7384l).
---------------------------------------------------------------------------
Similarly, veterans exposed to Agent Orange in the Vietnam
War who are diagnosed with prostate cancer, bladder cancer,
leukemias, and many other conditions are presumed to have a
service-connected disability and are thus automatically
eligible for VA benefits.\48\
---------------------------------------------------------------------------
\48\For a helpful summary, see Presumptive Disability Benefits,
U.S. Vets. Admin., https://www.benefits.va.gov/BENEFITS/factsheets/
serviceconnected/presumption.pdf (last viewed Mar. 25, 2022).
---------------------------------------------------------------------------

H.R. 2499 IS BASED ON SOUND SCIENCE

H.R. 2499 reflects current scientific research. The
relationship between each of the conditions included on the
initial presumptive list and firefighting is backed by a
reputable study or multiple peer-reviewed studies.\49\
Additionally, NIOSH is designated in the legislation to serve
as a scientific resource to DOL in evaluating the addition of
other diseases that would be deemed related to firefighting
activity.
---------------------------------------------------------------------------
\49\See text accompanying notes 6-35 supra.
---------------------------------------------------------------------------
Moreover, H.R. 2499 is limited to firefighters at
heightened risk of developing an occupational condition. The
presumption would take effect for federal firefighters who have
been employed in firefighting activity for a minimum of five
years. While repeated toxic exposure increases the risk of
developing many diseases, a single exposure to a cancer-causing
chemical can cause tumor development.\50\ Five years of
firefighting will routinely expose employees to hazards both in
active fire suppression and in fire stations. On average, a
fire station responds to a structure fire once every 22 days,
or over 16 fires per year.\51\ This means an individual
firefighter could fight 80 fires over a five-year span. Since
the smoke of just a single fire releases dozens of dangerous
chemicals, five years of active employment in firefighting
activities is sufficient time to be occupationally exposed to
the conditions in this bill.\52\
---------------------------------------------------------------------------
\50\Edward J. Calabrese & Robyn N. Blain, The Single Exposure
Carcinogen Database: Assessing the Circumstances Under Which a Single
Exposure to a Carcinogen Can Cause Cancer, 50 Toxicol. Sci. 169 (1999).
\51\Fred S. McChesney, Fewer Fires, So Why Are There Far More
Firefighters?, Wash. Post, Sept. 4, 2015, https://
www.washingtonpost.com/opinions/2015/09/04/05316abe-517c-11e5-933e-
7d06c647a395_story.html.
\52\Accordingly, 23 states with presumptive illness laws include a
five-year minimum service requirement: Arizona, Arkansas, California,
Colorado, Florida, Hawaii, Illinois, Kansas, Kentucky, Massachusetts,
Michigan, Missouri, Nebraska, Nevada, North Dakota, Oregon, South
Carolina, Tennessee, Texas, Vermont, Virginia, West Virginia, and
Wisconsin. See Int'l Ass'n Fire Fighters, supra note 2.
---------------------------------------------------------------------------

H.R. 2499 WOULD ENSURE POLICIES REMAIN ALIGNED WITH EVOLVING SCIENCE

The scientific community's understanding of the
relationship between firefighting and occupational diseases
will likely change as scientists collect more data and complete
additional studies. Accordingly, H.R. 2499 would require the
Secretary, in consultation with the Director of NIOSH, to
periodically review and update through rulemaking the initial
list of diseases with additional conditions that pose a
significant risk to firefighters. This provision would allow
the list of presumed conditions to remain aligned with evolving
science without requiring further congressional action on the
issue. With this provision, the federal government can continue
to support federal firefighters with quality, evidence-based
policy in an efficient manner.
To determine significant risk, the Secretary can rely upon
evidence from a variety of reputable organizations. H.R. 2499
authorizes the Secretary to ``accept as authoritative and may
rely upon recommendations, risk assessments, and scientific
studies'' from NIOSH, the National Toxicology Program, the
National Academies of Science, Engineering, and Medicine, and
the International Agency for Research on Cancer. These
organizations produce credible and reliable research on issues
related to occupational health that can inform the Secretary's
future decisions.
In addition to a periodic review initiated by DOL, H.R.
2499 would authorize any person to petition the Secretary to
consider an addition to the initial presumptive list.
Firefighters, fire chiefs, and the medical practitioners who
treat them can identify trends firsthand and would be well-
positioned to use this petition process. Petitioners would be
required to provide evidence that the condition is a
significant risk to firefighters, rather than base the petition
on an individual case.
One condition of interest to researchers and firefighters
is breast cancer. Epidemiological studies point to both genetic
and environmental factors which can increase risk of developing
breast cancer.\ 53\ Research conducted on rats and mice
identified 20 chemicals which caused mammary gland tumors,
including several carcinogens known to be present in the
firefighting environment, such as benzene and 1,3-butadiene.\
54\ Additionally, polycyclic aromatic hydrocarbons (PAH), often
found in smoke, are known to cause mammary gland tumors in
animals and thought to impact humans during critical exposure
periods.\ 55\ This evidence suggests that there is a plausible
link between the chemicals firefighters are routinely exposed
to and the development of breast cancer.
---------------------------------------------------------------------------
\53 \Esther A. Welp et al., Environmental Risk Factors of Breast
Cancer, 24 Scan. J. Work, Env't & Health 3 (1998).
\54 \Richard A. Griesemer & Scot L. Eustis, Gender Differences in
Animal Bioassays for Carcinogenicity, 36 J. Occup. Med. 855 (1994).
\55 \Jessica Korsh et al., Polycyclic Aromatic Hydrocarbons and
Breast Cancer: A Review of the Literature, 10 Breast Care 316 (2015);
K.C. Snell & H.L. Stewart, Pulmonary Adenomatosis Induced in DBA/2 Mice
by Oral Administration of Dibenz[a, h]anthracene, 28 J. Nat'l Cancer
Inst. 1043 (1962).
---------------------------------------------------------------------------
Occupational health research on firefighters' health risks
has not, to date, included large enough populations of female
firefighters to fully assess this link.\ 56\ ``There have been
too many occasions in the past when the health risks particular
to women have been ignored by researchers and policymakers
alike,'' Rep. Susan Wild (D-PA-7) said during the Committee's
markup of H.R. 2499.\57\ This research gap could soon close,
however, as Ms. Wild pointed out: ``[NIOSH] is developing a
large study population through the National Firefighter
Registry Program--a vital and necessary step, if an overdue
one.''\58\
---------------------------------------------------------------------------
\56\Firefighters and Breast Cancer, Breast Cancer Prev. Partners,
https://www.bcpp.org/resource/firefighters/ (last visited Mar. 25,
2022).
\57\Markup: H.R. 6102, Black Lung Benefits Improvement Act of 2021;
H.R. 5129, Community Services Block Grant Modernization Act of 2021;
H.R. 2499, Federal Firefighters Fairness Act of 2021; H.R. 5428, School
Shooting Safety and Preparedness Act; H.R. 3114, Longshore and Harbor
Workers' COVID-19 Compensation Act of 2021, and H.R. 6087, Improving
Access to Workers' Compensation for Injured Federal Workers Act, H.
Comm. on Educ. & Lab. (Mar. 16, 2022), https://edlabor.house.gov/
hearings/hr-6102-black-lung-benefits-improvement-act-of-2021-hr-5129-
community-services-block-grant-modernization-act-of-2021-hr-2499-
federal-firefighters-fairness-act-of-2021-hr-5428-school-shooting-
safety-and-preparedness-act-hr-3114-longshore-and-harbor-workers-
covid19-compensation-act-of-2021-and-hr-6087-improving-access-to-
workers-compensation-for-injured-federal-workers-act- (video at
3:06:56-3:07:32).
\58\ Id.
---------------------------------------------------------------------------
H.R. 2499 would therefore direct the Secretary to evaluate
the scientific evidence on breast cancer in firefighters within
three years of enactment. If the evidence suggests that
firefighters are at significant risk of developing breast
cancer due to their occupation, the bill instructs the
Secretary to add breast cancer to the presumptive list.
Regardless of the results of the evaluation, the Secretary
would be required to submit a report of the findings to the
House Committee on Education and Labor and the Senate Committee
on Health, Education, Labor, and Pensions. This provision
ensures that this condition receives heightened priority for
inclusion on the presumptive list of diseases.
To expand the data available on the occupational hazards of
firefighting, H.R. 2499 would encourage participation in the
National Firefighter Registry by requiring the Secretary to
inform federal firefighter claimants of the opportunity to
enroll. It would not require a firefighter to enroll in the
National Firefighter Registry; this provision would only
encourage enrollment to improve the science on firefighter
health and safety. More participants in the registry would
enhance researchers' understanding of the occupational hazards
of firefighting by expanding the sample size for research.
Improved research would allow the federal government to better
support firefighters through workers' compensation and other
programs.

H.R. 2499 WOULD COMPLEMENT DOL'S NEW INITIATIVE ON FIREFIGHTER DISEASE
CLAIMS

In light of the problems discussed above, OWCP announced on
April 20, 2022, a new initiative using existing legal authority
to facilitate occupational illness claims by federal
firefighters. Specifically, OWCP published a policy bulletin
outlining special claims procedures for federal
firefighters.\59\ A Special Claims Unit will handle
firefighters' claims for certain listed diseases (mirroring the
list in H.R. 2499, along with buccal cavity/pharynx cancer,
larynx cancer, hypertension, coronary artery disease, pulmonary
fibrosis, and asthma). As with H.R. 2499, firefighters who will
qualify for special claims processing must have five years or
more of firefighting service. If the claim meets these criteria
and the employee was diagnosed within 10 years of the date of
last exposure to firefighting work, the employee will not need
to submit additional evidence of specific exposures or medical
evidence proving a causal relationship. Instead, the claim will
be reviewed by a medical advisor for verification that the
employment was capable of producing the diagnosed condition(s);
if verified, the claim will then be approved. If a claim does
not meet these three criteria, it will be adjudicated under
established FECA case processing procedures.\60\
---------------------------------------------------------------------------
\59 \Off. of Workers' Comp. Progs., FECA Bull. No. 22-07, Special
Case Handling in Certain Firefighter FECA Claims Processing and
Adjudication, Apr. 19, 2022 [hereinafter Firefighters Bulletin],
https://www.dol.gov/agencies/owcp/FECA/regs/compliance/DFECfolio/
FECABulletins/FY2020-2024#FECAB2207.
\60 \Id.
---------------------------------------------------------------------------
This new Biden Administration initiative is an important
step forward for firefighters, but federal firefighters still
need H.R. 2499. The DOL's policy bulletin effectively imposes a
10-year latency period on claims eligible for special
processing, even though many cancers do not manifest clinically
until much later.\61\ Additionally, although the policy
bulletin pledges that ``OWCP will continue to monitor medical
developments in this area and update its list of specific
medical conditions as appropriate,''\62\ H.R. 2499 would make
that general promise a mandatory, nondiscretionary duty, both
to respond to petitions to add diseases to the list based on
the weight of the best available science and to review the
evidence about one specific disease, breast cancer, by a date
certain.
---------------------------------------------------------------------------
\61\A latency period is the amount of time that elapses between the
initial exposure to a cancer-causing substance and the diagnosis of
cancer. A general rule of thumb in the medical community is that the
latency period for solid tumors is ``on the order of 20 years.'' Tee L.
Guidotti, Evaluating the Association Between Disease and Occupation as
a Firefighter 26 (2d ed. 2012). Some cancers have even longer latency
periods. For example, mesothelioma takes a median of 32 years after
first exposure to be diagnosed, and a Canadian study found the peak
latency for bladder cancer in firefighters was 40 years. Guidotti,
supra note 27; Bruce P. Lanphear & C. Ralph Buncher, Latent Period for
Malignant Mesothelioma of Occupational Origin, 34 J. Occ. Med. 718
(1992).
\62\Firefighters Bulletin, supra note 57.
---------------------------------------------------------------------------

CONCLUSION

Without H.R. 2499, federal firefighters would continue to
experience difficulty accessing health care and disability
benefits they are eligible for through FECA. During the
December 2 Hearing, the Biden Administration agreed that H.R.
2499 is an effective solution to remove that burden from
federal firefighters:

Mr. Scott. Mr. Godfrey, in your written testimony you
mention challenges with claims for firefighters. Does
Mr. Carbajal's bill address those challenges?
Mr. Godfrey. Yes . . . . That piece of legislation is
a positive piece of legislation that does address
issues related to federal firefighters, especially with
those very difficult-to-prove long-term occupational
disease claims due to exposures.\63\
---------------------------------------------------------------------------
\63\Strengthening the Safety Net, supra note 45 (reply of OWCP
Director Christopher Godfrey to question from Chairman Robert C.
``Bobby'' Scott, https://edlabor.house.gov/hearings/strengthening-the-
safety-net-for-injured-workers, video at 1:09:23-1:09:58).

Congress should pass H.R. 2499, as amended, to rectify this
inequity and support our brave federal firefighters.

Section-by-Section Analysis

Section 1. Short title

This section specifies that the bill may be cited as the
Federal Firefighters Fairness Act of 2022.

Section 2. Certain diseases presumed to be work-related cause of
disability or death for Federal Employees in Fire Protection
Activities

Section 2(a) amends chapter 81 of title 5, United States
Code, by adding a new section 8143b as follows:
Section 8143b(a)(1)-(2) establishes an
initial list of diseases for which an automatic
presumption of work-related illness would apply to
``employees in fire protection activities.'' The
presumption would apply for employees who have been
employed in fire protection activities for at least 5
years. The initial list includes the following
diseases: bladder cancer, brain cancer, chronic
obstructive pulmonary disease, colorectal cancer,
esophageal cancer, kidney cancer, leukemias, lung
cancer, mesothelioma, multiple myeloma, non-Hodgkin
lymphoma, prostate cancer, skin cancer (melanoma),
testicular cancer, thyroid cancer, and sudden cardiac
event or stroke not later than 24 hours after working
in fire protection activities.
Section 8143b(a)(3) requires the Secretary
to periodically review the initial list in consultation
with the Director of NIOSH. It requires the Secretary
to add a disease to the list by rule if the Secretary
determines, based on the best available scientific
evidence, that there is a significant risk to employees
in fire protection activities of developing the
disease. In making that determination, this provision
authorizes the Secretary to rely upon authoritative
recommendations and research by NIOSH, the National
Toxicology Program, the National Academies of Sciences,
Engineering, and Medicine, and the International Agency
for Research on Cancer.
Section 8143b(a)(4) establishes a petition
process by which any person may propose additions to
the disease list. The Secretary must grant or deny each
petition with a substantive written explanation within
18 months of receipt.
Section 8143b(b) defines relevant terms. It
establishes a definition for ``employee in fire
protection activities,'' which is the class of
employees to whom the bill would apply, as a federal
employee who is trained and has the legal authority to
engage in fire suppression; is engaged in the
prevention, control, and extinguishment of fires or
response to emergency situations where life, property,
or the environment is at risk, including the
prevention, control, suppression, or management of
wildland fires; and performs such activities as a
primary responsibility of his or her job.
Section 2(b) requires the Secretary to establish a process
to inform claimants under this section of the opportunity to
enroll in the National Firefighter Registry or a similar public
health research initiative.
Section 2(c) requires the Secretary to evaluate the latest
science on breast cancer risks for firefighters and determine
whether breast cancer should be added to the list within 3
years of passage of the Act. The Secretary must submit a report
of the findings and determination to the House Committee on
Education and Labor and the Senate Committee on Health,
Education, Labor, and Pensions.
Section 2(d) states that the amendments made by this
section apply only to compensation claims filed on or after the
date of enactment.

Explanation of Amendments

The amendments, including the Amendment in the Nature of a
Substitute, are explained in the descriptive portions of this
report.

Application of Law to the Legislative Branch

Pursuant to section 102(b)(3) of the Congressional
Accountability Act, Pub. L. No. 104-1, H.R. 2499, as amended,
applies to terms and conditions of employment within the
legislative branch because the law amended by H.R. 2499 (FECA)
is included within the list of laws applicable to the
legislative branch enumerated in section 102(a) of the
Congressional Accountability Act.

Unfunded Mandate Statement

Pursuant to section 423 of the Congressional Budget and
Impoundment Control Act of 1974 (as amended by section
101(a)(2) of the Unfunded Mandates Reform Act, Pub. L. 104-4),
H.R. 2499, as amended, contains no intergovernmental or
private-sector mandates as defined by the Unfunded Mandates
Reform Act.

Earmark Statement

In accordance with clause 9 of rule XXI of the Rules of the
House of Representatives, H.R. 2499 does not contain any
congressional earmarks, limited tax benefits, or limited tariff
benefits as described in clauses 9(e), 9(f), and 9(g) of rule
XXI.

Roll Call Votes

In compliance with clause 3(b) of rule XIII of the Rules of
the House of Representatives, the Committee advises that the
following roll call votes occurred during the Committee's
consideration of H.R. 2499:

[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

Statement of Performance Goals and Objectives

Pursuant to clause (3)(c)(4) of rule XIII of the Rules of
the House of Representatives, the goal of H.R. 2499 is to
improve access to job-related medical, disability, and death
benefits for federal firefighters. The legislation achieves
this by establishing a presumptive illness list for disability
and death claims by federal firefighters and authorizing the
Secretary to add to the list based on the best available
scientific evidence.

Duplication of Federal Programs

Pursuant to clause 3(c)(5) of rule XIII of the Rules of the
House of Representatives, the Committee states that no
provision of H.R. 2499 is known to be duplicative of another
federal program, including any program that was included in a
report to Congress pursuant to section 21 of Public Law 111-139
or the most recent Catalog of Federal Domestic Assistance.

Hearings

On December 2, 2021, pursuant to clause 3(c)(6) of rule
XIII of the Rules of the House of Representatives, the
Committee's Subcommittee on Workforce Protections held a
hearing entitled ``Strengthening the Safety Net for Injured
Workers,'' which was used to develop H.R. 2499. Relevant to
H.R. 2499, the Subcommittee heard testimony from the Honorable
Salud Carbajal, Member of Congress, U.S. House of
Representatives, Santa Barbara, CA; and Christopher J. Godfrey,
Director, Office of Workers' Compensation Programs, U.S.
Department of Labor, Washington, D.C.

Statement of Oversight Findings and Recommendations of the Committee

In compliance with clause 3(c)(1) of rule XIII and clause
2(b)(1) of rule X of the Rules of the House of Representatives,
the Committee's oversight findings and recommendations are
reflected in the descriptive portions of this report.

New Budget Authority and CBO Cost Estimate

Pursuant to clause 3(c)(2) of rule XIII of the Rules of the
House of Representatives and section 308(a) of the
Congressional Budget and Impoundment Control Act of 1974, and
pursuant to clause 3(c)(3) of rule XIII of the Rules of the
House of Representatives and section 402 of the Congressional
Budget and Impoundment Control Act of 1974, the Committee has
received the following estimate for H.R. 2499 from the Director
of the Congressional Budget Office:

U.S. Congress,
Congressional Budget Office,
Washington, DC, April 19, 2022.
Hon. Robert C. (Bobby) Scott,
Chairman, Committee on Education and Labor,
House of Representatives, Washington, DC.
Dear Mr. Chairman: The Congressional Budget Office has
prepared the enclosed cost estimate for H.R. 2499, the Federal
Firefighters Fairness Act of 2022.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Meredith
Decker.
Sincerely,
Phillip L. Swagel
Director.
Enclosure.

[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

The bill would
Increase the number of firefighters and
other federal employees who can receive federal
workers' compensation benefits under the Federal
Employees' Compensation Act
Estimated budgetary effects would mainly stem from
Additional spending for workers'
compensation benefits
Areas of significant uncertainty include
Estimating the incidence of disease among
federal firefighters
Bill summary: H.R. 2499 would expand eligibility for
federal workers engaged in fire protection who have certain
diseases and conditions to receive medical, wage replacement,
and death benefits under the Federal Employees' Compensation
Act (FECA).
Estimated Federal cost: The estimated budgetary effects of
H.R. 2499 are shown in Table 1. The costs of the legislation
fall within budget functions 300 (natural resources), 550
(health) and 600 (income security).

TABLE 1.--ESTIMATED BUDGETARY EFFECTS OF H.R. 2499
--------------------------------------------------------------------------------------------------------------------------------------------------------
By fiscal year, millions of dollars--
-------------------------------------------------------------------------------------------
2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2022-2026 2022-2031
--------------------------------------------------------------------------------------------------------------------------------------------------------
Net Increases in Direct Spending

Estimated:
Budget Authority........................................ * 1 1 1 2 2 3 3 4 4 5 22
Estimated Outlays....................................... * 1 1 1 2 2 3 3 4 4 5 22

Increases in Spending Subject to Appropriation

Estimated:
Authorization........................................... 0 1 1 1 2 2 3 4 4 5 5 23
Estimated Outlays....................................... 0 1 1 1 2 2 3 4 4 5 5 23
Memorandum:
Intragovernmental collectionsa.......................... 0 -1 -1 -1 -2 -2 -3 -4 -4 -5 -5 -23
--------------------------------------------------------------------------------------------------------------------------------------------------------
Components may not sum to totals because of rounding; * = between zero and $500,000.
aIntragovernmental collections from federal agencies to the Department of Labor to pay for federal workers' compensation benefits paid to those
agencies' employees.

Basis of estimate: For this estimate, CBO assumes that H.R.
2499 will be enacted in fiscal year 2022 and that the estimated
amounts will be available in each year. Estimated outlays are
based on historical spending patterns for the affected
programs.
Direct spending: Under current law, federal employees are
eligible for workers' compensation benefits, including medical
expenses, disability payments, and death payments to survivors,
if they can demonstrate a connection between their federal
employment and their injury or illness. H.R. 2499 would confer
presumptive eligibility for such benefits upon firefighters and
other federal workers engaged in fire protection if they
contract certain diseases, including heart disease, lung
disease, and certain cancers. Based on the rates of incidence,
disability, and death associated with those diseases, CBO
estimates that between 300 and 400 people would newly qualify
for benefits over the next decade than would qualify under
current law. CBO estimates that providing such additional FECA
benefits would increase direct spending by $24 million over the
2022-2031 period.
Some claimants who would receive FECA benefits under the
legislation would have received other federal benefits under
current law. When such claimants qualify for FECA benefits,
spending from other programs could be reduced. Enacting the
bill would reduce the federal government's share of health care
premiums for federal retirees under the Federal Employees
Health Benefits program because costs for covered medical
conditions would be paid under FECA. In addition, spending for
some disability programs could be lower but CBO expects that
reduction would not be significant. In addition, after
accounting for those effects, which would total $2 million over
the 10-year period, CBO estimates that enacting H.R. 2499
would, on net, increase mandatory spending by $22 million over
the 2022-2031 period.
Spending subject to appropriation: FECA costs are charged
back to a claimant's employing agency and those amounts are
paid from the agency's salaries and expense accounts. (Most
federal firefighters are employed by the Departments of
Agriculture and the Interior.) Based on the timing of those
reimbursements, CBO estimates that H.R. 2499 would increase
discretionary costs for salaries and expenses by a total of $23
million over the 2022-2031 period; most of the costs would be
borne by those two departments. Any spending would be subject
to the availability of appropriated funds. Those reimbursements
would be transferred to and credited to the FECA account, as
shown in the memorandum line in Table 1.
Uncertainty: The disease incidence among federal
firefighters and other workers engaged in fire protection is a
significant source of uncertainty in the estimate. CBO
estimates that a higher percentage of those workers would be
diagnosed with heart disease, lung disease, and certain cancers
compared to the general population, based on studies of
firefighters' relative risk of contracting these diseases. If
the incidence of disease differs from CBO's estimates, spending
might be higher or lower than estimated.
Pay-As-You-Go considerations: The Statutory Pay-As-You-Go
Act of 2010 establishes budget-reporting and enforcement
procedures for legislation affecting direct spending or
revenues. The net changes in outlays are subject to those pay-
as-you-go procedures are shown in Table 1.
Increase in long-term deficits: CBO estimates that enacting
H.R. 2499 would not increase on-budget deficits by more than $5
billion in any of the four consecutive 10-year periods
beginning in 2032.
Mandates: None.
Estimate prepared by: Federal Costs: Meredith Decker
(federal workers' compensation), Stuart Hammond (Federal
Employees Health Benefits); Mandates: Andrew Laughlin.
Estimate reviewed by: Elizabeth Cove Delisle, Chief, Income
Security Cost Estimates Unit; H. Samuel Papenfuss, Deputy
Director of Budget Analysis.

Committee Cost Estimate

Clause 3(d)(1) of rule XIII of the Rules of the House of
Representatives requires an estimate and a comparison of the
costs that would be incurred in carrying out H.R. 2499.
However, clause 3(d)(2)(B) of that rule provides that this
requirement does not apply when the committee has included in
its report a timely submitted cost estimate of the bill
prepared by the Director of the Congressional Budget Office
under section 402 of the Congressional Budget and Impoundment
Control Act of 1974.

Changes in Existing Law Made by the Bill, as Reported

In compliance with clause 3(e) of rule XIII of the Rules of
the House of Representatives, changes in existing law made by
the bill, H.R. 2499, as reported, are shown as follows:

Changes in Existing Law Made by the Bill, as Reported

In compliance with clause 3(e) of rule XIII of the Rules of
the House of Representatives, changes in existing law made by
the bill, as reported, are shown as follows (new matter is
printed in italics and existing law in which no change is
proposed is shown in roman):

TITLE 5, UNITED STATES CODE

* * * * * * *
PART III--EMPLOYEES

* * * * * * *

SUBPART G--INSURANCE AND ANNUITIES

* * * * * * *

CHAPTER 81--COMPENSATION FOR WORK INJURIES

SUBCHAPTER I--GENERALLY

Sec.
* * * * * * *
8143b. Employees in fire protection activities.
* * * * * * *

SUBCHAPTER I--GENERALLY

* * * * * * *

Sec. 8143b. Employees in fire protection activities.

(a) Certain Diseases Deemed to Be Proximately Caused by
Employment in Fire Protection Activities.--
(1) In general.--For a claim under this subchapter of
disability or death of an employee who has been
employed for a minimum of 5 years in aggregate as an
employee in fire protection activities, a disease
specified on the list established under paragraph (2)
shall be deemed to be proximately caused by the
employment of such employee.
(2) Establishment of initial list.--There is
established under this section the following list of
diseases:
(A) Bladder cancer.
(B) Brain cancer.
(C) Chronic obstructive pulmonary disease.
(D) Colorectal cancer.
(E) Esophageal cancer.
(F) Kidney cancer.
(G) Leukemias.
(H) Lung cancer.
(I) Mesothelioma.
(J) Multiple myeloma.
(K) Non-Hodgkin lymphoma.
(L) Prostate cancer.
(M) Skin cancer (melanoma).
(N) A sudden cardiac event or stroke while,
or not later than 24 hours after, engaging in
the activities described in subsection
(b)(1)(C).
(O) Testicular cancer.
(P) Thyroid cancer.
(3) Additions to the list.--
(A) In general.--The Secretary shall
periodically review the list established under
this section in consultation with the Director
of the National Institute on Occupational
Safety and Health and shall add a disease to
the list by rule, upon a showing by a
petitioner or on the Secretary's own
determination, in accordance with this
paragraph.
(B) Basis for determination.--The Secretary
shall add a disease to the list upon a showing
by a petitioner or the Secretary's own
determination, based on the weight of the best
available scientific evidence, that there is a
significant risk to employees in fire
protection activities of developing such
disease.
(C) Available expertise.--In determining
significant risk for purposes of subparagraph
(B), the Secretary may accept as authoritative
and may rely upon recommendations, risk
assessments, and scientific studies (including
analyses of National Firefighter Registry data
pertaining to Federal firefighters) by the
National Institute for Occupational Safety and
Health, the National Toxicology Program, the
National Academies of Sciences, Engineering,
and Medicine, and the International Agency for
Research on Cancer.
(4) Petitions to add to the list.--
(A) In general.--Any person may petition the
Secretary to add a disease to the list under
this section.
(B) Content of petition.--Such petition shall
provide information to show that there is
sufficient evidence of a significant risk to
employees in fire protection activities of
developing such illness or disease from their
employment.
(C) Timely and substantive decisions.--Not
later than 18 months after receipt of a
petition, the Secretary shall either grant or
deny the petition by publishing in the Federal
Register a written explanation of the reasons
for the Secretary's decision. The Secretary may
not deny a petition solely on the basis of
competing priorities, inadequate resources, or
insufficient time for review.
(b) Definitions.--In this section:
(1) Employee in fire protection activities.--The term
``employee in fire protection activities'' means an
employee employed as 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, including the
prevention, control, suppression, or management
of wildland fires; and
(D) performs such activities as a primary
responsibility of his or her job.
(2) Secretary.--The term ``Secretary'' means
Secretary of Labor.

* * * * * * *

MINORITY VIEWS

INTRODUCTION

The Federal Employees' Compensation Act (FECA) is
administered by the Department of Labor's (DOL) Office of
Workers' Compensation Programs (OWCP) and provides workers'
compensation benefits for the roughly 10,000 federal
firefighters employed by the United States federal
government.\1\ The FECA program provides benefits to
individuals who sustain an injury or illness in the performance
of their duty anywhere in the world. Such benefits include wage
replacement, reasonable and necessary medical treatment related
to the injury, vocational rehabilitation and job placement
assistance for disabled workers, compensation for the permanent
impairment of limbs and use of body systems, and compensation
for survivors of employees due to a work-related death.
---------------------------------------------------------------------------
\1\Information provided to Committee on Education and Labor
Republican staff by the Congressional Research Service.
---------------------------------------------------------------------------
H.R. 2499, the Federal Firefighters Fairness Act of 2021,
establishes a presumption of eligibility for medical benefits,
lost wages, and survivor benefits for federal employees
employed in fire protection activities for five years who
contract certain illnesses.\2\ H.R. 2499 creates an extremely
broad presumption that federal firefighters who are diagnosed
with heart disease, lung disease, or various cancers contracted
the disease due to work-related activities. The bill also
creates a presumption that any disability or death of the
employee due to such disease is presumed to result from
performance of duty. Further, the bill requires the Secretary
of Labor to add conditions to the bill's list of diseases that
are presumed to have caused illness due to work-related
activities.
---------------------------------------------------------------------------
\2\Under H.R. 2499, an employee in fire protection activities can
include firefighters, paramedics, emergency medical technicians, rescue
workers, ambulance personnel, and hazardous material workers.
---------------------------------------------------------------------------
Under long-standing law governing federal workers'
compensation programs, there is no list of injuries or
illnesses that are automatically or presumptively covered.
Instead, claims have been evaluated on a case-by-case basis
depending on the medical and supporting evidence available to
validate the benefit claim.

H.R. 2499 REMOVES CRITICAL INTEGRITY MEASURES IN THE FECA PROGRAM

Coverage for occupational illness was added to the FECA
program in 1924.\3\ The federal government has provided
benefits for occupational related diseases for nearly 100
years, processing claims on a case-by-case basis. H.R. 2499
would overturn these longstanding precedents and fundamentally
alter the FECA program.
---------------------------------------------------------------------------
\3\https://www.crs.gov/Reports/
R42107?source=search&guid=46624cf11fd34da08b337fe2c845020e&index=0.
---------------------------------------------------------------------------
To apply for FECA benefits, federal employees must file a
claim with OWCP, which processes and adjudicates occupational
illness claims. Federal employees, including federal
firefighters, who believe they have contracted an occupational
illness must submit form CA-2, ``Notice of Occupational Disease
and Claim for Compensation.''\4\ Workers submitting a CA-2 form
may also refer to CA-35, ``Evidence Required in Support of a
Claim for Occupational Disease.''\5\ CA 35 includes
documentation to be submitted depending on the type of
occupational disease. The employee's claim must be filed within
three years of the onset of the condition.\6\ However, in the
case of a latent disability, the three-year limitation does not
begin until the employee is disabled and aware, or reasonably
should be aware, that the disability was due to employment
related activities.\7\
---------------------------------------------------------------------------
\4\https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-
2.pdf.
\5\https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-
35.pdf.
\6\5 U.S.C. Sec. 8122(a); https://www.federalregister.gov/
documents/2011/06/28/2011-14915/performance-of-functions-claims-for-
compensation-under-the-federal-employees-compensation-act#sectno-
reference-10.101.
\7\5 U.S.C. Sec. 8122(b); 20 C.F.R. Sec. 10.100(c).
---------------------------------------------------------------------------
Contrary to the bill sponsor's claim, federal firefighters
are not required to pinpoint ``the precise exposure that caused
their illness.''\8\ Instead, the CA-2 form asks the claimant
for the date they first realized the disease or illness was
caused or aggravated by their employment and to explain why
they came to this realization. The claimant must then submit a
statement which further narrates a history of the disease and
the conditions of employment which are believed to be
responsible for the disease or illness. The claimant must also
provide a medical report with a description of the physicians'
findings and opinions as to whether the disease or illness was
caused or aggravated by employment.
---------------------------------------------------------------------------
\8\https://e-dearcolleague.house.gov/Home/Preview?DCID=358104.
---------------------------------------------------------------------------
Claimants generally submit the claim through their
employing agency. The OWCP district office will review the
information submitted by the employing agency and determine
whether there is sufficient information to adjudicate the
claim. If there is insufficient information to adjudicate the
claim, OWCP will send the claimant a letter advising of the
additional information needed.
Creating a presumption of eligibility for a specific group
of federal employees not only creates disparities among FECA
beneficiaries based upon their occupation but also removes
critical oversight measures in the FECA program. Currently, all
FECA claimants must attest that their disease or illness was
the result of their employment and must provide supporting
medical evidence to OWCP. Without a process to determine
whether the disability or illness is work-related, there is
nothing to prevent coverage of nonoccupational medical costs
from being shifted from the private insurance market to the
federal government.

OWCP HAS TAKEN STEPS TO ADDRESS FIREFIGHTERS' NEEDS

In December 2021, OWCP released a bulletin to streamline
the processing of federal firefighter claims. The bulletin
states that all new incoming firefighter claims must be
adjudicated by OWCP's Special Claims Unit and that the agency
is ``developing policy changes to ease the evidentiary
requirements needed to link a firefighter's exposure to toxic
substances when they are diagnosed with certain conditions
where there is a medically documented increased risk of
developing those conditions due to such exposure.''\9\
---------------------------------------------------------------------------
\9\https://www.dol.gov/agencies/owcp/FECA/FederalFirefighterclaims.
---------------------------------------------------------------------------
According to OWCP, approximately 16 occupational disease
claims are filed per year by firefighters for heart disease,
lung disease, or cancer.\10\ The Biden administration has not
sought additional resources to address occupational illness
claims from federal firefighters. The President's Fiscal Year
2023 budget request did not address federal firefighter claims
or request any legislative changes to FECA occupational illness
claims.\11\ Congress should allow OWCP to continue implementing
its improvements assisting federal firefighters through the
Special Claims Unit. Congress should also thoroughly examine
whether adding presumptions to FECA is appropriate before
enacting H.R. 2499.
---------------------------------------------------------------------------
\10\Information provided to Committee on Education and Labor
Republican staff by the Department of Labor.
\11\https://www.dol.gov/sites/dolgov/files/general/budget/2023/
FY2023BIB.pdf.
---------------------------------------------------------------------------

H.R. 2499 IS BROADER THAN MANY STATE WORKERS' COMPENSATION PROGRAMS FOR
FIREFIGHTERS

The bill's sponsor claims that ``49 states already
recognize the link between certain serious diseases and the
occupational hazards of firefighting and have enacted
presumptive disability laws. These laws presume that heart
disease, lung disease, certain cancers, and other infectious
diseases are job-related for purposes of worker's compensation
and disability retirement unless proven otherwise.''\12\
However, this assertion is disingenuous, because it combines
presumptions in state retirement and pension systems with
presumptions in state workers' compensation programs. In fact,
only 26 states have some form of a presumption that certain
illnesses are employment related for firefighters under state
workers' compensation programs. Additionally, very few state
workers' compensation laws have a presumption as broad as the
one in H.R. 2499.\13\
---------------------------------------------------------------------------
\12\https://e-dearcolleague.house.gov/Home/Preview?DCID=358104.
\13\https://www.iaff.org/wp-content/uploads/
Presumptive_Disability_Chart_as_of_4-12-2021.pdf.
---------------------------------------------------------------------------
According to the International Association of Firefighters,
federal fighters and many state and provincial fire fighters do
not have presumptive laws in their jurisdictions. Most states
and provinces also limit the types of cancers or diseases that
are presumed to be associated with firefighting. Moreover, most
states and provinces include rebuttable clauses that allow an
employer to challenge that a condition or illness came from
firefighting and not from other causes. A classic example is
when a fire fighter is diagnosed with cancer but was also a
smoker: the employer is allowed to rebut the presumption of
occupational illness and claim that smoking was the primary
cause of the cancer, not firefighting.\14\
---------------------------------------------------------------------------
\14\https://www.iaff.org/presumptive-health/.
---------------------------------------------------------------------------

H.R. 2499 MAKES CHANGES TO FECA WITHOUT THE BENEFIT OF DATA FROM THE
NATIONAL FIREFIGHTER REGISTRY

The Firefighter Cancer Registry Act of 2018 requires the
Centers for Disease Control and Prevention (CDC) to develop and
maintain a National Firefighter Registry to collect data
regarding the incidence of cancer in firefighters.\15\ The CDC
anticipates opening enrollment to all U.S. fire service members
in the summer/fall of 2022.\16\ Enacting H.R. 2499 would be
premature without the benefit of the data that the National
Firefighter Registry will collect on the incidence of cancer in
firefighters.
---------------------------------------------------------------------------
\15\Pub L. No. 115-19 (2018).
\16\https://www.cdc.gov/niosh/firefighters/registry.html.
---------------------------------------------------------------------------

H.R. 2499 EXPANDS A GOVERNMENT PROGRAM IN NEED OF REFORM

FECA is widely considered to be in need of reform since the
last meaningful amendments to the Act were made in 1974.
Government watchdogs have consistently documented mismanagement
in the FECA program. In 2014, the Office of Inspector General
of the U.S. Government Accountability Office (GAO) found
several instances of mismanagement:

GAO has not effectively managed its FECA program to
ensure that it pays only valid claims for continuation
of benefits, and employees are returned to work when
able. Information documenting eligibility of employees
receiving benefits is generally outdated and not
maintained. In addition, efforts to identify employees
for reemployment and pursue options to return them to
suitable work are limited. Third-party cases are not
monitored to minimize GAO's workers' compensation
program costs. Furthermore, policy intended to prevent,
identify, and report potential fraud for investigation
lacks specific fraud-prevention controls and is
outdated.\17\
---------------------------------------------------------------------------
\17\https://www.gao.gov/assets/oig-14-2.pdf.

In the 112th Congress, the Committee took steps on a
bipartisan basis to reform FECA. In July 2011, then-Chairman
John Kline (R-MN) introduced the Federal Workers' Compensation
Modernization and Improvement Act (H.R. 2465), which contained
several reforms to modernize the FECA program, improve its
integrity, and enhance its efficiency. The Committee reported
the bill by voice vote in July 2011 and it passed the House by
voice vote in November 2011, but the Senate did not take it up.
It is irresponsible for Congress to expand an unreformed
program and remove oversight mechanisms when additional
oversight of the FECA program is clearly needed.

H.R. 2499 IGNORES NON-OCCUPATIONAL CAUSES OF DISEASES

H.R. 2499 includes 16 diseases on the initial list of
diseases that are presumptively caused by employment related
activities. These diseases occur throughout the U.S. population
and may have environmental causes unrelated to employment or
genetic causes. Presuming these diseases are caused by
occupational exposure ignores other potential causal factors.
Moreover, H.R. 2499 unfairly creates an unequal, two-tiered
system for federal employees in which presumptions apply to
federal firefighter claims but not to other federal employee
claims. These other federal employees would be subject to
higher standards in seeking medical benefits under FECA than
federal firefighters.
Bladder Cancer: Bladder cancer is the sixth
most common cancer in the United States, with more than
80,000 new cases diagnosed each year.\18\ It is more
prevalent among men than women--men are four times more
likely to develop bladder cancer--and mainly develops
in adults older than age 55.\19\ People who have family
members with bladder cancer have a higher risk of
getting it themselves.\20\
---------------------------------------------------------------------------
\18\https://www.cancercenter.com/cancer-types/bladder-cancer.
\19\https://www.cancer.org/cancer/bladder-cancer/about/key-
statistics.html.
\20\https://www.cancer.org/cancer/bladder-cancer/causes-risks-
prevention/risk-factors.html.
---------------------------------------------------------------------------
Brain Cancer: Brain tumors may be linked to
hereditary genetic factors or conditions.\21\ Other
than radiation, no known environmental factors are
clearly linked to brain tumors.\22\
---------------------------------------------------------------------------
\21\https://rarediseases.info.nih.gov/diseases/2491/glioblastoma.
\22\https://www.cancer.org/cancer/brain-spinal-cord-tumors-adults/
causes-risks-prevention/what-causes.html.
---------------------------------------------------------------------------
Chronic Obstructive Pulmonary Disease
(COPD): In 2018, 16.4 million people, or 6.6 percent of
adults, reported a diagnosis of COPD.\23\ The vast
majority of COPD is caused by long-term cigarette
smoking. One percent of COPD cases result from a
genetic disorder.\24\
---------------------------------------------------------------------------
\23\https://www.lung.org/research/trends-in-lung-disease/copd-
trends-brief/copd-prevalence.
\24\https://www.mayoclinic.org/diseases-conditions/copd/symptoms-
causes/syc-20353679.
---------------------------------------------------------------------------
Colorectal Cancer: Colorectal cancer is the
third most common cancer diagnosed in the United
States, excluding skin cancers. In 2022, there were
106,180 new cases of colon cancer and 44,850 new cases
of rectal cancer. Overall, the lifetime risk of
developing colorectal cancer is about 1 in 23 for men
and 1 in 25 for women.\25\ Many lifestyle-related
factors have been linked to colorectal cancer. The
links between diet, weight, and exercise and colorectal
cancer risk are some of the strongest for any type of
cancer.\26\ Five to 10 percent of all colon cancer
cases are hereditary.\27\
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\25\https://www.cancer.org/cancer/colon-rectal-cancer/about/key-
statistics.html.
\26\https://www.cancer.org/cancer/colon-rectal-cancer/causes-risks-
prevention/risk-factors.html.
\27\https://www.hopkinsmedicine.org/gastroenterology_hepatology/
diseases_conditions/faqs/familial_colorectal_cancer.html.
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Esophageal Cancer: Esophageal cancer makes
up about 1 percent of all cancers diagnosed in the
United States, impacting approximately 1 in 125 men and
1 in 417 in women.\28\ Tobacco usage is a major risk
factor for esophageal cancer, and someone who smokes a
pack of cigarettes a day or more has at least twice the
chance of getting adenocarcinoma of the esophagus than
a nonsmoker. Other risk factors include having
gastroesophageal reflux disease, drinking alcohol, age,
having Barrett's esophagus, obesity, diet, physical
activity, and other digestive health issues relating to
the esophagus.\29\
---------------------------------------------------------------------------
\28\https://www.cancer.org/cancer/esophagus-cancer/about/key-
statistics.html.
\29\https://www.cancer.org/cancer/esophagus-cancer/causes-risks-
prevention/risk-factors.html.
---------------------------------------------------------------------------
Kidney Cancer: Kidney cancer is among the 10
most common cancers in both men and women.\30\ Factors
that can increase the risk of kidney cancer include
older age, smoking, obesity, high blood pressure,
treatment for kidney failure, certain inherited
syndromes, and a family history of kidney cancer.\31\
---------------------------------------------------------------------------
\30\https://www.cancer.org/cancer/kidney-cancer/about/key-
statistics.html.
\31\https://www.mayoclinic.org/diseases-conditions/kidney-cancer/
symptoms-causes/syc-20352664.
---------------------------------------------------------------------------
Leukemia: Leukemia occurs most often in
adults older than 55.\32\ Factors that may increase
risk of developing some types of leukemia include
previous cancer treatment, genetic disorders, exposure
to certain chemicals, smoking, and a family history of
leukemia.\33\
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\32\https://www.cancer.gov/types/leukemia.
\33\https://www.mayoclinic.org/diseases-conditions/leukemia/
symptoms-causes/syc-
20374373#::text=Leukemia%20is%20cancer%20of%20the,involves%20the%20whit
e%20blood%20cells.
---------------------------------------------------------------------------
Lung Cancer: Lung cancer is the second most
common cancer (not counting skin cancer).\34\ Smoking
is by far the leading risk factor for lung cancer, and
about 80 percent of lung cancer deaths are thought to
result from smoking. Other risk factors include
exposure to radon, asbestos, and other carcinogens,
taking certain dietary supplements, and consuming
arsenic in drinking water.\35\
---------------------------------------------------------------------------
\34\https://www.cancer.org/cancer/lung-cancer/about/key-
statistics.html.
\35\https://www.cancer.org/cancer/lung-cancer/causes-risks-
prevention/risk-factors.html.
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Mesothelioma: Mesothelioma is rare in the
United States and only about 3,000 new cases are
diagnosed each year.\36\ The main risk factor for
mesothelioma is exposure to asbestos. The link between
asbestos and mesothelioma is well known, and most use
in the United States stopped several decades ago,
although it is still used in some products.\37\
---------------------------------------------------------------------------
\36\https://www.cancer.org/cancer/malignant-mesothelioma/about/key-
statistics.html.
\37\https://www.cancer.org/cancer/malignant-mesothelioma/causes-
risks-prevention/risk-factors.html.
---------------------------------------------------------------------------
Multiple Myeloma: In the United States, the
lifetime risk of getting multiple myeloma is 1 in
132.\38\ Scientists do not know what causes most cases
of multiple myeloma, but factors that may increase risk
include older age, sex (more common in men), race (more
common in African Americans), family history, obesity,
and having other plasma cell diseases.\39\
---------------------------------------------------------------------------
\38\https://www.cancer.org/cancer/multiple-myeloma/about/key-
statistics.html.
\39\https://www.cancer.org/cancer/multiple-myeloma/causes-risks-
prevention/risk-factors.html.
---------------------------------------------------------------------------
Non-Hodgkin Lymphoma (NHL): NHL is one of
the most common cancers in the United States,
accounting for about 4 percent of all cancers.\40\ Most
people diagnosed with NHL do not have any obvious risk
factors.\41\ Some factors that may increase the risk
for NHL include older age, gender, race, ethnicity,
geography, family history, exposure to certain
chemicals and drugs, radiation exposure, a weakened
immune system, autoimmune diseases, certain infects,
and body weight.\42\
---------------------------------------------------------------------------
\40\https://www.cancer.org/cancer/non-hodgkin-lymphoma/about/key-
statistics.html#::text=Non%2DHodgkin%20lymphoma%20(NHL),will%20be
%20diagnosed%20with%20NHL.
\41\https://www.mayoclinic.org/diseases-conditions/non-hodgkins-
lymphoma/symptoms-causes/syc-20375680.
\42\https://www.cancer.org/cancer/non-hodgkin-lymphoma/causes-
risks-prevention/risk-factors.html.
---------------------------------------------------------------------------
Prostate Cancer: About one in eight men will
be diagnosed with prostate cancer during their
lifetime. About six cases in 10 are diagnosed in men
who are 65 or older, and it is rare in men under
40.\43\ The most common risk factors for prostate
cancer are age, race, geography, family history, and
inherited gene changes.\44\
---------------------------------------------------------------------------
\43\https://www.cancer.org/cancer/prostate-cancer/about/key-
statistics.html.
\44\https://www.cancer.org/cancer/prostate-cancer/causes-risks-
prevention/risk-factors.html.
---------------------------------------------------------------------------
Skin Cancer: Cancers of the skin are by far
the most common types of cancer. About 5.4 million
basal and squamous cell skin cancers are diagnosed each
year in the United States, occurring in about 3.3
million Americans, as some people have more than one
type.\45\ Factors that may increase risk of skin cancer
include fair skin, a history of sunburns, excessive sun
exposure, living in sunny or high-altitude climates,
moles, precancerous skin lesions, a family history of
skin cancer, a weakened immune system, and exposure to
radiation and other substances.\46\
---------------------------------------------------------------------------
\45\https://www.cancer.org/cancer/basal-and-squamous-cell-skin-
cancer/about/key-statistics.html.
\46\https://www.mayoclinic.org/diseases-conditions/skin-cancer/
symptoms-causes/syc-20377605.
---------------------------------------------------------------------------
Sudden Cardiac Event or Stroke: There are
more than 356,000 out-of-hospital cardiac arrests
annually in the United States, nearly 90 percent of
them fatal.\47\ Every year, more than 795,000 people in
the United States have a stroke.\48\ The American Heart
Association tracks seven key health factors and
behaviors that increase risks for heart disease and
stroke: smoking, physical inactivity, nutrition,
obesity, high cholesterol, diabetes, and high blood
pressure.\49\ A family history of coronary artery
disease is also a major risk factor.\50\
---------------------------------------------------------------------------
\47\https://www.sca-aware.org/about-sudden-cardiac-arrest/latest-
statistics#::text=According%20to%20the%20report%2C%20cardiac,nearly
%201%2C000%20people%20each%20day.
\48\https://www.cdc.gov/stroke/
facts.htm#::text=Every%20year+%2C%20more%20than%20795%2C000,are%20first
%20or%20new%20strokes.&text=
About%20185%2C000%20strokes%E2%80%94nearly%201,have%20had%20a%20previous
%20stroke.&text=About%2087%25%20of%20all%20strokes,to%20the%20brain%20is
%20blocked.
\49\https://www.heart.org/-/media/PHD-Files-2/Science-News/2/2022-
Heart-and-Stroke-Stat-Update/2022-Stat-Update-At-a-Glance.pdf.
\50\https://www.mayoclinic.org/diseases-conditions/sudden-cardiac-
arrest/symptoms-causes/syc-20350634#::text=A%20previous%20episode
%20of%20cardiac,sudden%20cardiac%20arrest%20increases%20with.
---------------------------------------------------------------------------
Testicular Cancer: About one out of every
250 males will develop testicular cancer at some point
during their lifetime.\51\ Factors that may increase
risk of testicular cancer include an undescended
testicle, abnormal testicle development, family
history, age (most common in men between ages 15 and
35), and race (more common in white men than in African
American men).\52\
Thyroid Cancer: Every year about 12,000 men
and 33,000 women get thyroid cancer.\53\ Thyroid
cancers are about three times more common in women than
men.\54\ Risk factors for thyroid disease include
hereditary conditions, a family history of thyroid
cancer, radiation exposure, obesity, and low iodine in
diet.\55\
---------------------------------------------------------------------------
\51\https://www.cancer.org/cancer/testicular-cancer/about/key-
statistics.html.
\52\https://www.mayoclinic.org/diseases-conditions/testicular-
cancer-care/symptoms-causes/syc-20352986.
\53\https://www.cdc.gov/cancer/thyroid/index.htm.
\54\https://www.cancer.org/cancer/thyroid-cancer/causes-risks-
prevention/risk-factors.html.
\55\https://www.cancer.org/cancer/thyroid-cancer/causes-risks-
prevention/risk-factors.html.
---------------------------------------------------------------------------
The 16 diseases listed in H.R. 2499 can be caused by
environmental factors unrelated to work, by lifestyle, or by an
individual's genetic makeup, in addition to occupational
causes. Congress should not remove OWCP's authority to
determine an occupational link by inserting a presumption of
eligibility.

CONCERNS WITH THE SECRETARY ADDING DISEASES TO THE LIST OF DISEASES IN
H.R. 2499

H.R. 2499 requires the Secretary of Labor to add diseases
to the list of 16 diseases in the bill presumed to be caused by
occupational exposure upon a showing by a petitioner or the
Secretary's own determination that there is a significant risk
to firefighters of developing such a disease. This provision in
the bill gives too much authority to the Secretary to determine
without oversight whether a disease poses significant risk to
firefighters. The list of diseases presumed to be caused by
employment could expand indefinitely for federal firefighters,
while all other federal employee claims are processed on a
case-by-case basis.

REPUBLICAN SUBSTITUTE

Committee Republicans are committed to ensuring that all
federal workers, including federal firefighters, have access to
workers' compensation benefits. However, H.R. 2499 creates
presumptions of eligibility that are not justified. DOL has not
indicated there is a need to create a new presumption of
eligibility for federal firefighters covered by FECA. DOL has
instead used its existing authority to direct resources to
provide federal firefighters with additional tools and
assistance when filing occupational illness claims.
Before removing critical oversight mechanisms in the FECA
program, Congress should be fully informed of the specific
barriers that federal firefighters with occupational illnesses
and diseases face when applying for FECA benefits. To achieve
this goal, Representative Fred Keller (R-PA) offered a
substitute amendment at the Committee markup directing GAO to
conduct a study on the medical benefits and treatment provided
to federal firefighters with occupational illnesses under FECA.
The report would also examine any barriers to care, evaluate
the approval rate of federal firefighter occupational illness
claims, and provide a description of the standard that DOL uses
to determine causation with respect to these claims.
Unfortunately, Committee Democrats chose to remove important
oversight mechanisms in the FECA program by unanimously
opposing this commonsense amendment.

CONCLUSION

Committee Republicans strongly support assisting federal
firefighters and ensuring they have access to medical benefits
under the FECA program. Unfortunately, H.R. 2499 will remove
important oversight mechanisms within the program while
creating an unequal, two-tiered system for federal firefighters
as compared to all other federal employees. H.R. 2499 is not
grounded in science. It mandates coverage of certain diseases
and illnesses without sufficient research on the causes of such
illnesses, proceeds without the benefit of data from the
National Firefighter Registry, and requires the Secretary of
Labor to add new diseases to the list of diseases presumed to
be work-related based upon public petitions with no oversight.
H.R. 2499 also expands an unreformed program that needs
additional federal oversight. Finally, DOL has not indicated
any need for broad presumption of eligibility for federal
firefights and has directed existing resources to address the
needs of federal firefighters filing occupational illness
claims.
For these reasons, Congress should reject H.R. 2499 so that
Democrats and Republicans can work across the aisle to pursue
policies that will help federal workers, including federal
firefighters, receive appropriate benefits.

Virginia Foxx,
Ranking Member.
Joe Wilson.
Tim Walberg.
Glenn Grothman.
Elise M. Stefanik.
Rick W. Allen.
James Comer.
Russ Fulcher.
Fred Keller.
Mariannette Miller Meeks, M.D.
Burgess Owens.
Bob Good.
Lisa C. McClain.
Scott Fitzgerald.
Julia Letlow.
Chris Jacobs.

[all]