[Senate Report 117-146]
[From the U.S. Government Publishing Office]


                                                      Calendar No. 485
117th Congress     }                                    {       Report
                                 SENATE
 2d Session        }                                    {      117-146
_______________________________________________________________________

                                     



                     FEDERAL FIREFIGHTERS FAIRNESS 
                              ACT OF 2021

                               __________

                              R E P O R T

                                 of the

                   COMMITTEE ON HOMELAND SECURITY AND

                          GOVERNMENTAL AFFAIRS

                          UNITED STATES SENATE

                              to accompany

                                S. 1116

          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







[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]







               September 13, 2022.--Ordered to be printed 
               
                             _________
                              
                 U.S. GOVERNMENT PUBLISHING OFFICE
                 
29-010                   WASHINGTON : 2022
               
               
               
               
               
               
               
               
               
               
               
               
               
               
        COMMITTEE ON HOMELAND SECURITY AND GOVERNMENTAL AFFAIRS

                   GARY C. PETERS, Michigan, Chairman
THOMAS R. CARPER, Delaware           ROB PORTMAN, Ohio
MAGGIE HASSAN, New Hampshire         RON JOHNSON, Wisconsin
KYRSTEN SINEMA, Arizona              RAND PAUL, Kentucky
JACKY ROSEN, Nevada                  JAMES LANKFORD, Oklahoma
ALEX PADILLA, California             MITT ROMNEY, Utah
JON OSSOFF, Georgia                  RICK SCOTT, Florida
                                     JOSH HAWLEY, Missouri

                   David M. Weinberg, Staff Director
                    Zachary I. Schram, Chief Counsel
            Lena C. Chang, Director of Governmental Affairs
              Devin M. Parsons, Professional Staff Member
                Pamela Thiessen, Minority Staff Director
            Sam J. Mulopulos, Minority Deputy Staff Director
       Cara G. Mumford, Minority Director of Governmental Affairs
                  Andrew J. Hopkins, Minority Counsel
                     Laura W. Kilbride, Chief Clerk

















                                                      Calendar No. 485
117th Congress     }                                    {       Report
                                 SENATE
 2d Session        }                                    {      117-146

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



 
               FEDERAL FIREFIGHTERS FAIRNESS ACT OF 2021

                                _______
                                

               September 13, 2022.--Ordered to be printed

                                _______
                                

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

                              R E P O R T

                         [To accompany S. 1116]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Homeland Security and Governmental 
Affairs, to which was referred the bill (S. 1116) 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 (in the nature of a substitute) and 
recommends that the bill, as amended, do pass.

                                CONTENTS

                                                                     Page
  I. Purpose and Summary..............................................  1
 II. Background and Need for the Legislation..........................  2
III. Legislative History..............................................  4
 IV. Section-by-Section Analysis of the Bill, as Reported.............  5
  V. Evaluation of Regulatory Impact..................................  6
 VI. Congressional Budget Office Cost Estimate........................  7
VII. Changes in Existing Law Made by the Bill, as Reported............  9 

                         I. Purpose and Summary

    S. 1116, the Federal Firefighters Fairness Act of 2022, 
amends the eligibility for workers' compensation benefits under 
the Federal Employees' Compensation Act (FECA) for federal 
employees in fire protection activities by establishing a 
presumption of causation for certain specific illnesses and 
diseases associated with employment in firefighting. Under the 
bill, a federal firefighter with five years or more of accrued 
service may file worker compensation claims of disability or 
death due to a disease specified on a list of illnesses and 
diseases established by the bill. Upon medical confirmation, 
the claim will then be approved under FECA, as long as there is 
not more than a ten-year latency period between the last date 
of service and the disease diagnosis. The Department of Labor 
(DOL), in consultation with the National Institute on 
Occupational Safety and Health (NIOSH), must periodically 
review this list to determine if updates are needed based on 
the latest scientific evidence.

              II. Background and Need for the Legislation

    The Federal Employees Compensation Act established a 
workers' compensation program for federal employees.\1\ The 
FECA program pays disability, survivors, and medical benefits 
to employees who are injured or become ill in the course of 
their federal employment and to survivors of employees killed 
on the job.\2\ DOL administers the FECA program, and the costs 
of the benefits are paid by each employee's host agency.\3\
---------------------------------------------------------------------------
    \1\5 U.S.C. Sec. 8101 et seq.
    \2\Department of Labor, Federal Employees' Compensation Program 
(www.dol.gov/agencies/owcp/FECA) (accessed July 7, 2022).
    \3\Congressional Research Service, The Federal Employees' 
Compensation Act (FECA): Workers' Compensation for Federal Employees 
(R42107) (June 7, 2022).
---------------------------------------------------------------------------
    It can be challenging for individuals to make successful 
claims under FECA when they are diagnosed with illnesses or 
diseases with a long latency period, like cancers and lung and 
heart diseases. Except where presumptions are stipulated in 
law, the claimant must provide extensive evidence of each 
incident where they may have contracted their service-related 
disease.\4\ Experts estimate that fewer than 1 in 100 
occupational cancer victims receives workers' compensation 
benefits.\5\ Federal firefighters are uniquely susceptible to 
the challenges of navigating the complex FECA process, given 
that they face both immediate safety risks posed by an active 
fire and the danger of longer term health conditions associated 
with their work.
---------------------------------------------------------------------------
    \4\Department of Labor, Federal Employees' Compensation Act--
Frequently Asked Questions (www.dol.gov/agencies/owcp/FECA/fec-faq) 
(accessed July 7, 2022).
    \5\American Public Health Association, The Critical Need to Reform 
Workers' Compensation (Policy Statement No. 20174) (Nov. 7, 2017) 
(www.apha.org/Policies-and-Advocacy/Public-Health-Policy-Statements/
Policy-Database/2018/01/18/The-Critical-Need-to-Reform-Workers-
Compensation) (accessed July 7, 2022).
---------------------------------------------------------------------------
    Firefighters are routinely exposed to health hazards, 
including flame retardants and toxic substances from burning 
buildings.\6\ The primary route of toxic exposure during fires 
is through inhalation, but exposure can also occur from 
absorption through the skin.\7\ Although necessary, personal 
protective equipment (PPE) does not fully protect firefighters 
from these hazards. Firefighters may not always be wearing PPE 
during all phases of a fire response.\8\ Additionally, a self-
contained breathing apparatus may run out of air inside a 
burning environment, resulting in significant smoke 
inhalation.\9\ Furthermore, uniforms do not completely prevent 
dermal exposure.\10\ Because of these gaps in PPE, toxic 
chemicals can enter firefighters' bodies via their breath and 
skin.
---------------------------------------------------------------------------
    \6\Beverly Shen et al., Organophosphate Flame Retardants in Dust 
Collected from United States Fire Stations, Environment International 
(Dec. 13, 2017); B.M. Alexander and C. Stuart Baxter, Flame Retardant 
contamination of firefighter personal protective clothing-A potential 
health risk for firefighters, Journal of Occupational and Environmental 
Hygiene (July 13, 2016); C.C. Austin et al., Characterization of 
Volatile Organic Compounds in Smoke at Municipal Structural Fires, 
Journal of Toxicology and Environmental Health (July 20, 2001); and 
W.T. Lowry et al., Studies of Toxic Gas Production During Actual 
Structural Fires in the Dallas Area, Journal of Forensic Sciences (Jan. 
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, Environmental 
Science and Technology (Nov. 7, 2017).
    \8\Michael A. Maglio et al., Situational Pressures That Influence 
Firefighters' Decision Making About Personal Protective Equipment: A 
Qualitative Analysis, American Journal of Health Behavior (Sept. 2016); 
D.M. Bolstad-Johnson et al., Characterization of Firefighter Exposures 
During Fire Overhaul, American Industrial Hygiene Association Journal 
(June 4, 2010).
    \9\David C. Cone et al., Fireground Use of an Emergency Escape 
Respirator, Prehospital Emergency Care (July 7, 2010).
    \10\Department of Health and Human Services, Centers for Disease 
Control and Prevention, National Institute for Occupational Safety and 
Health, Evaluation of Dermal Exposure to Polycyclic Aromatic 
Hydrocarbons in Firefighters (2010-0156-3196) (Dec. 2013).
---------------------------------------------------------------------------
    Firefighters are exposed to smoke that contains more 
complex combustion products due to the increased number of 
synthetics in U.S. homes and businesses.\11\ Many fire-related 
hazards are known to be cancer-causing chemicals, or 
carcinogens. The International Agency for Research on Cancer 
(IARC) classifies chemicals according to their potential to 
cause cancer in humans: carcinogenic to humans; probably 
carcinogenic to humans; and possibly carcinogenic to 
humans.\12\ There are at least 11 chemicals frequently present 
in the firefighting environment that are classified by IARC as 
carcinogenic to humans, such as arsenic, asbestos, benzene, and 
formaldehyde.\13\ These chemicals are linked to cancers of the 
kidney, prostate, liver, and lung, as well as leukemia, non-
Hodgkin lymphoma, and multiple myeloma.\14\ Many other 
chemicals found in fire scenes are probably or possibly 
carcinogenic to humans.\15\
---------------------------------------------------------------------------
    \11\Stephen Kerber, Analysis of Changing Residential Fire Dynamics 
and Its Implications on Firefighter Operational Timeframes, Fire 
Technology (Sept. 20, 2012).
    \12\International Agency for Research on Cancer, Known Carcinogens 
in the Firefighting Environment, (www.iaff.org/wp-content/uploads/2020-
Carcinogens-and-Cancer-handout-002.pdf) (accessed July 21, 2022).
    \13\Id.
    \14\Id.
    \15\Lyon France and International Agency for Research on Cancer, 
Painting, Firefighting, and Shiftwork, (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%).\16\ Data 
from the National Cancer Institute also found that non-
lymphatic leukemia risks are significantly elevated among 
firefighters.\17\ 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, 
including seven specific cancers identified by this study as 
having a statistically significant increased risk of death.\18\ 
Furthermore, in addition to lung cancer, firefighters are at 
greater risk of developing lung diseases, such as Chronic 
Obstructive Pulmonary Disease (COPD) and are at increased risk 
for sudden cardiac events.\19\
---------------------------------------------------------------------------
    \16\Grace K. LeMasters et al., Cancer Risk Among Firefighters: A 
Review and Meta-Analysis of 32 Studies, Journal of Occupational and 
Environmental Medicine (Nov. 2006).
    \17\William Morton & Danijela Marjanovic, Leukemia Incidence by 
Occupation in the Portland-Vancouver Metropolitan Area, American 
Journal of Industrial Medicine (1984).
    \18\Robert D Daniels et al., Mortality and Cancer Incidence in a 
Pooled Cohort of US Firefighters from San Francisco, Chicago and 
Philadelphia (1950-2009), Occupational and Environmental Medicine (June 
2014).
    \19\Lynne Pinkerton et al., Mortality in a Cohort of US 
Firefighters from San Francisco, Chicago and Philadelphia: An Update, 
Occupational and Environmental Medicine (2020); Tee L. Guidotti, 
Mortality of Urban Firefighters in Alberta, 1927-1987, American Journal 
of Industrial Medicine (June 1993); Sheila Weinmann et al., COPD and 
Occupational Exposures: A Case-Control Study, Journal of Occupational 
and Environmental Medicine (May 2008); Stefanos N. Kales et al., 
Firefighters and On-Duty Deaths from Coronary Heart Disease: A Case 
Control Study, Environmental Health: A Global Access Science Source 
(Nov. 6, 2003); Elpidoforos S. Soteriades et al., Cardiovascular 
Disease in US Firefighters A Systematic Review, Cardiology in Review 
(July-August 2011).
---------------------------------------------------------------------------
    This wealth of evidence outlining the occupational hazards 
of firefighting and the increased risk of certain diseases, 
illnesses, and death relates to the importance of federal 
firefighters qualifying for workers' compensation benefits. 
Currently, 49 of 50 states have in place presumptive disability 
coverage for state and local firefighters in recognition of the 
research tying increased instances of these illnesses to the 
firefighting occupation.\20\ However, to establish that an 
illness, injury, or death is work-related, FECA requires 
extensive information linking the disease or illness to a 
specific exposure and requires a detailed narrative of the 
history of the disease or illness.\21\ This puts an unrealistic 
burden on federal firefighters to link their disease or illness 
to a specific exposure or event, despite the overwhelming 
research that indicates such a link to the firefighting 
profession. As a result, many of these claims are denied or 
result in delayed approval.
---------------------------------------------------------------------------
    \20\International Association of Fire Fighters, AFL-CIO 
(www.iaff.org/presumptive-health/) (accessed June 28, 2022).
    \21\Department of Labor, Notice of Occupational Disease and Claim 
for Compensation (Oct. 2018) (www.dol.gov/sites/dolgov/files/owcp/regs/
compliance/ca-2.pdf) (access July 21, 2022).
---------------------------------------------------------------------------
    The Federal Firefighters Fairness Act of 2022 supports 
federal firefighters in their application for FECA benefits by 
deeming 16 specified diseases as proximately caused by their 
employment. In recognition of the extensive research that has 
been conducted tying these illnesses and diseases to the 
firefighting occupation, this bill shifts the burden of 
evidence away from the firefighter. The bill also requires 
periodic updates of the list of diseases so that the FECA 
policy toward presumptive conditions stays up-to-date with the 
latest scientific evidence.

                        III. Legislative History

    Senator Thomas Carper (D-DE) introduced S. 1116, the 
Federal Firefighters Fairness Act of 2021, on April 14, 2021, 
with Senators Susan Collins (R-ME), Dianne Feinstein (D-CA), 
Angus King (I-ME), and Chris Van Hollen (D-MD). The bill was 
referred to the Committee on Homeland Security and Governmental 
Affairs. An additional 21 Senators have since joined the bill 
as cosponsors.
    The Committee considered S. 1116 at a business meeting on 
May 25, 2022. Senator Carper offered a substitute amendment and 
a modification to the substitute amendment. The substitute 
amendment made a number of changes to the underlying text, 
including: (1) updating the short title to the Federal 
Firefighter Fairness Act of 2022; (2) updating the list of 
diseases and illnesses to align with a version that passed the 
U.S. House of Representatives; (3) establishing a new section 
in title 5 specific to workers' compensation for fire 
protection activities; (4) directing the Department of Interior 
and U.S. Department of Agriculture, in consultation with NIOSH, 
to conduct a study on the long-term health effects of federal 
wildland firefighters; (5) directing DOL to submit a report on 
affected employees; and (6) increasing the time period for 
claimants to provide supporting documentation to DOL. The 
modification to the substitute amendment made adjustments to 
the processes for updating the list of presumptive diseases to 
require DOL and NIOSH make such updates based on the weight of 
the best available scientific evidence and to clearly identify 
that evidence in the rule. Senator Carper's substitute 
amendment and modification to the substitute amendment were 
adopted by voice vote en bloc.
    The bill, as amended by the Carper modified substitute 
amendment, was ordered reported favorably by voice vote en 
bloc, with Senators Peters, Hassan, Sinema, Rosen, Padilla, 
Ossoff, Portman, Lankford, Romney, Scott, and Hawley present.

        IV. Section-by-Section Analysis of the Bill, as Reported


Section 1. Short title

    This section establishes the short title of the bill as the 
``Federal Firefighters Fairness Act of 2022.''

Sec. 2. Certain illnesses and diseases presumed to be work-related 
        cause of disability or death for federal employees in fire 
        protection activities

    Subsection (a) adds a new section 8143b to title 5, United 
States Code, entitled ``Employees in fire protection 
activities.''
    Subsection (a) of the new section 8143b defines the terms 
``employee in fire protection activities,'' ``rule,'' and 
``Secretary'' in the context of this section.
    Subsection (b) of the new section 8143b establishes an 
initial list of illnesses and diseases that are deemed to be 
proximately caused by employment in fire protection activities. 
Federal employees who have worked for at least 5 years in 
aggregate in fire protection may file worker compensation 
claims of disability or death due to an illness or disease 
specified on the list, provided they are diagnosed with the 
illness and disease within 10 years after their last active 
date of employment in fire protection. The initial list 
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, sudden 
cardiac events or strokes within 24 hours of engaging in fire 
protection activities, testicular cancer, and thyroid cancer.
    In addition, subsection (b) of the new section 8143b 
directs DOL to periodically review the list of illnesses and 
diseases in consultation with NIOSH. The Secretary may add an 
illness or disease to the list by rule based on the best 
available scientific evidence, such as recommendations and 
assessments by NIOSH, the National Toxicology Program, the 
National Academies of Sciences, Engineering, and Medicine, and 
the International Agency for Research on Cancer.
    Subsection (b) requires the Secretary, within 120 days 
after the bill's enactment, to establish a process to inform 
federal employees in fire protection activities who file a 
claim related to an illness or disease under the new section 
8143b of title 5 about opportunities to voluntarily enroll in 
the National Firefighter Registry or a similar initiative 
conducted by the Centers for Disease Control and Prevention.
    Subsection (c) directs the Secretary, within three years 
after the bill's enactment, to evaluate the best available 
scientific evidence related to the risk of developing breast 
cancer, gynecological cancers, and rhabdomyolysis due to fire 
protection activities and to add these conditions to the list 
established in the new section 1843b of title 5 if the evidence 
leads to such a determination. The Secretary must submit a 
report of the findings and determination to the Senate Homeland 
Security and Governmental Affairs Committee and the House 
Committee on Education and Labor.
    Subsection (d) calls for a comprehensive study conducted by 
the Department of the Interior and U.S. Department of 
Agriculture, in consultation with NIOSH, on the long-term 
health effects that federal wildland firefighters experience 
after being exposed to fires, smoke, and toxic fumes when in 
service. The report will include the race, age, gender, and 
time of service of wildland firefighters participating in the 
study and recommendations to Congress on what legislative 
actions are needed to prevent such health issues. The report 
will be submitted to the Senate Homeland Security and 
Governmental Affairs Committee and the House Committee on 
Education and Labor.
    Subsection (e) requires the Secretary to include, within 
the Department's annual reports to Congress on the 
administration of the workers' compensation program, a report 
on the number and demographics of employees in fire protection 
activities with illness and diseases from the list established 
by the bill. The report may include recommendations for 
additional actions that would minimize the risk of adverse 
health impacts.

Sec. 3. Increase in time-period for FECA claimant to supply supporting 
        documentation to Office of Worker's Compensation

    This section instructs the Secretary to amend federal 
regulations to increase the number of days claimants have to 
submit additional evidence after the Office of Workers' 
Compensation Programs (OWCP) determines the evidence already 
submitted is not sufficient. Specifically, claimants would be 
allowed at least 60 days to submit additional evidence required 
by OWCP, rather than 30 days.

                   V. Evaluation of Regulatory Impact

    Pursuant to the requirements of paragraph 11(b) of rule 
XXVI of the Standing Rules of the Senate, the Committee has 
considered the regulatory impact of this bill and determined 
that the bill will have no regulatory impact within the meaning 
of the rules. The Committee agrees with the Congressional 
Budget Office's statement that the bill contains no 
intergovernmental or private sector mandates as defined in the 
Unfunded Mandates Reform Act (UMRA) and would impose no costs 
on state, local, or tribal governments.

             VI. Congressional Budget Office Cost Estimate

                                     U.S. Congress,
                               Congressional Budget Office,
                                 Washington, DC, September 8, 2022.
Hon. Gary Peters,
Chairman, Committee on Homeland Security and Governmental Affairs, U.S. 
        Senate, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for S. 1116, 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: S. 1116 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). 
The bill would also extend the length of time FECA claimants 
have to provide documentation to the Department of Labor (DOL).
    Estimated Federal Cost: The estimated budgetary effects of 
S. 1116 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 S. 1116
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                     By fiscal year, millions of dollars--
                                                      --------------------------------------------------------------------------------------------------
                                                        2022   2023   2024   2025   2026   2027   2028   2029   2030   2031   2032  2022-2027  2022-2032
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                            Net Increases in Direct Spending
 
Estimated Budget Authority...........................      0      *      1      1      2      2      3      3      4      4      5         7         26
Estimated Outlays....................................      0      *      1      1      2      2      3      3      4      4      5         7         26
 
                                                     Increases in Spending Subject to Appropriation
 
Estimated Authorization..............................      0      *      1      1      2      2      3      4      4      5      5         6         27
Estimated Outlays....................................      0      *      1      1      2      2      3      4      4      5      5         6         27
Memorandum:
    Intragovernmental Collectionsa...................      0      *     -1     -1     -2     -2     -3     -4     -4     -5     -5        -6        -27
--------------------------------------------------------------------------------------------------------------------------------------------------------
Components may not sum to totals because of rounding; * = between -$500,000 and $500,000.
a.Intragovernmental 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 S. 
1116 will be enacted by the end of calendar 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. S. 1116 would confer 
presumptive eligibility for such benefits upon federal 
firefighters 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 more than 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 $29 million 
over the 2022-2032 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. After accounting for those 
effects, which would total $3 million over the 10-year period, 
CBO estimates that enacting S. 1116 would, on net, increase 
mandatory spending by $26 million over the 2022-2032 period.
    S. 1116 would extend the period of time that FECA claimants 
have to provide additional documentation to DOL, if the agency 
has determined more evidence is needed to support their claim. 
Using information about current practices, CBO estimates that 
this provision would result in a negligible increase in direct 
spending over the next 10 years.
    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 S. 1116 would increase 
discretionary costs for salaries and expenses by a total of $27 
million over the 2022-2032 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 
S. 1116 would not increase on-budget deficits by more than $5 
billion in any of the four consecutive 10-year periods 
beginning in 2033.
    Mandates: None.
    Previous CBO estimate: On April 19, 2022, CBO transmitted a 
cost estimate for H.R. 2499, the Federal Firefighters Fairness 
Act of 2022, as ordered reported by the House Committee on 
Education and Labor on March 16, 2022. Both pieces of 
legislation would expand eligibility for federal workers 
engaged in fire protection who have certain diseases and 
conditions to receive FECA benefits. The Senate bill also would 
provide more time for FECA claimants to provide documentation. 
Differences in the estimated costs between the two pieces of 
legislation are primarily because of different assumed 
enactment dates.
    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.

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


UNITED STATES CODE

           *       *       *       *       *       *       *


TITLE 5--GOVERNMENT ORGANIZATION AND EMPLOYEES

           *       *       *       *       *       *       *


PART III--EMPLOYEES

           *       *       *       *       *       *       *



Subpart G--Insurance and Annuities

           *       *       *       *       *       *       *



Chapter 81--Compensation for Work Injuries

           *       *       *       *       *       *       *



Subchapter I--Generally

           *       *       *       *       *       *       *



SEC. 8143B. EMPLOYEES IN FIRE PROTECTION ACTIVITIES

    (a) 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 in which life, property, 
                or the environment is at risk, including the 
                prevention, control, suppression, or management 
                of wildland fires; and 
                  (D) performs the activities described in 
                subparagraph (C) as a primary responsibility of 
                the job of the employee.
          (2) Rule.--The term ``rule'' has the meaning given 
        the term in section 804.
          (3) Secretary.--The term ``Secretary'' means 
        Secretary of Labor.
    (b) Certain Illnesses and 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 not less than 5 years in aggregate as an 
        employee in fire protection activities, an illness or 
        disease specified on the list established under 
        paragraph (2) shall be deemed to be proximately caused 
        by the employment of that employee, if the employee is 
        diagnosed with that illness or disease not later than 
        10 years after the last active date of employment as an 
        employee in fire protection activities.
          (2) Establishment of initial list.--There is 
        established under this section the following list of 
        illnesses and 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 
                (a)(1)(C). 
                  (O) Testicular cancer.
                  (P) Thyroid cancer.
          (3) Additions to the list.--
                  (A) In general.--
                          (i) Periodic review.--The Secretary 
                        shall--
                                  (I) in consultation with the 
                                Director of the National 
                                Institute on Occupational 
                                Safety and Health and any 
                                advisory committee determined 
                                appropriate by the Secretary, 
                                periodically review the list 
                                established under paragraph 
                                (2); and 
                                  (II) if the Secretary 
                                determines that the weight of 
                                the best available scientific 
                                evidence warrants adding an 
                                illness or disease to the list 
                                established under paragraph 
                                (2), as described in 
                                subparagraph (B) of this 
                                paragraph, make such an 
                                addition through a rule that 
                                clearly identifies that 
                                scientific evidence.
                          (ii) Classification.--A rule issued 
                        by the Secretary under clause (i) shall 
                        be considered to be a major rule for 
                        the purposes of chapter 8. 
                  (B) Basis for determination.-- The Secretary 
                shall add an illness or disease to the list 
                established under paragraph (2) based on the 
                weight of the best available scientific 
                evidence that there is a significant risk to 
                employees in fire protection activities of 
                developing that illness or 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.

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