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


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

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



 
               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\
---------------------------------------------------------------------------
    \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.
---------------------------------------------------------------------------
    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
---------------------------------------------------------------------------
    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).
---------------------------------------------------------------------------
    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\
---------------------------------------------------------------------------
    \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\
---------------------------------------------------------------------------
    \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\
---------------------------------------------------------------------------
    \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.
---------------------------------------------------------------------------
           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\
---------------------------------------------------------------------------
    \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.
---------------------------------------------------------------------------
           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]