House Education & Labor Committee Issues Report on Federal Firefighters Fairness Act (Part 2 of 3)

WASHINGTON, May 20 -- The House Education and Labor Committee issued a report (H.Rpt. 117-306) on the Federal Firefighters Fairness Act (H.R. 2499) that aims to amend chapter 81 of title 5 of the U.S. 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. The report was advanced by Rep. Rep. Robert C. Scott, D-Virginia, on May 6, 2022.

(Continued from Part 2 of 3)

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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:

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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, D.C., 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.

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* 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).

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TABLE 1.--ESTIMATED BUDGETARY EFFECTS OF H.R. 2499

Components may not sum to totals because of rounding; * = between zero 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.

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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.

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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.

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/1/Information provided to Committee on Education and Labor Republican staff by the Congressional Research Service.

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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.

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/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.

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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.

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/3/https://www.crs.gov/Reports/R42107?source=search&guid=46624cf11fd34da08b337fe2c845020e&index=0.

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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/

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/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).

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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.

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/8/https://e-dearcolleague.house.gov/Home/Preview?DCID=358104.

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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/

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/9/https://www.dol.gov/agencies/owcp/FECA/FederalFirefighterclaims.

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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.

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/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.

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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/

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/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.

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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/

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/14/https://www.iaff.org/presumptive-health/.

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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.

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/15/Pub L. No. 115-19 (2018).

/16/https://www.cdc.gov/niosh/firefighters/registry.html.

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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/

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/17/https://www.gao.gov/assets/oig-14-2.pdf.

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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/

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/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.

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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/

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/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.

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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/

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/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.

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Colorectal Cancer: Colorectal cancer is the third most common cancer diagnosed in the United States, excluding skin cancers. In 2022, there were 106,180 new cases of colon cancer and 44,850 new cases of rectal cancer. Overall, the lifetime risk of developing colorectal cancer is about 1 in 23 for men and 1 in 25 for women./25/ Many lifestyle-related factors have been linked to colorectal cancer. The links between diet, weight, and exercise and colorectal cancer risk are some of the strongest for any type of cancer./26/ Five to 10 percent of all colon cancer cases are hereditary./27/

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/25/https://www.cancer.org/cancer/colon-rectal-cancer/about/key-statistics.html.

/26/https://www.cancer.org/cancer/colon-rectal-cancer/causes-risks-prevention/risk-factors.html.

/27/https://www.hopkinsmedicine.org/gastroenterology_hepatology/diseases_conditions/faqs/familial_colorectal_cancer.html.

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Esophageal Cancer: Esophageal cancer makes up about 1 percent of all cancers diagnosed in the United States, impacting approximately 1 in 125 men and 1 in 417 in women./28/ Tobacco usage is a major risk factor for esophageal cancer, and someone who smokes a pack of cigarettes a day or more has at least twice the chance of getting adenocarcinoma of the esophagus than a nonsmoker. Other risk factors include having gastroesophageal reflux disease, drinking alcohol, age, having Barrett's esophagus, obesity, diet, physical activity, and other digestive health issues relating to the esophagus./29/

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/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.

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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/

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/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.

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Leukemia: Leukemia occurs most often in adults older than 55./32/ Factors that may increase risk of developing some types of leukemia include previous cancer treatment, genetic disorders, exposure to certain chemicals, smoking, and a family history of leukemia./33/

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/32/https://www.cancer.gov/types/leukemia.

/33/https://www.mayoclinic.org/diseases-conditions/leukemia/symptoms-causes/syc-20374373#::text=Leukemia%20is%20cancer%20of%20the,involves%20the%20whit e%20blood%20cells.

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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/

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/34/https://www.cancer.org/cancer/lung-cancer/about/key-statistics.html.

/35/https://www.cancer.org/cancer/lung-cancer/causes-risks-prevention/risk-factors.html.

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Mesothelioma: Mesothelioma is rare in the United States and only about 3,000 new cases are diagnosed each year./36/ The main risk factor for mesothelioma is exposure to asbestos. The link between asbestos and mesothelioma is well known, and most use in the United States stopped several decades ago, although it is still used in some products./37/

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/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.

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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/

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/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.

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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/

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/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.

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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/

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/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.

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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/

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/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.

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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/

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/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.

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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/

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/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.

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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.

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The report is posted at: https://www.congress.gov/congressional-report/117th-congress/house-report/306/1?s=1&r=20

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