The federal firefighter cancer presumption

The law covers a federal employee who works as a firefighter (wildland firefighters included), paramedic, EMT, rescue worker, ambulance worker or hazardous materials worker, and who meets all of these (§ 8143b):

• You are trained in fire suppression and have the authority and the duty to fight fires.
• Fighting or preventing fires, or answering emergencies, is a main part of the job.
• You have at least 5 years of this work in total. The years can be spread out (Department of Labor), and under the Department's current policy they can include fire jobs outside the federal government (FECA Bulletin 25-02, January 10, 2025).
• The cancer was diagnosed no later than 10 years after your last day in fire work.

State and city firefighters are covered by their own state's law instead: see all 50 state laws.

The law lists 14 cancers (§ 8143b):

• Bladder cancer
• Brain cancer
• Colorectal cancer
• Esophageal cancer
• Kidney cancer
• Leukemias
• Lung cancer
• Mesothelioma
• Multiple myeloma
• Non-Hodgkin lymphoma
• Prostate cancer
• Skin cancer (melanoma)
• Testicular cancer
• Thyroid cancer

It also lists COPD, and a heart attack or stroke during fire work or in the 24 hours after it.

Breast, cervical, uterine and ovarian cancer and basal cell skin cancer are not on the list, but the Department of Labor treats them as high risk and sends them to a medical adviser for faster handling (FECA Bulletin 25-01). Congress also asked the Department to study breast cancer, gynecological cancers and rhabdomyolysis and add them if the science supports it (§ 8143b).

1. Open a free account on ECOMP, the Department of Labor's online claims system (how to file a claim). You do not need your supervisor's or your agency's approval to start.
2. File Form CA-2, Notice of Occupational Disease, the form for an illness that comes from repeated exposure such as cancer. Go through the CA-35 checklist of the evidence an illness claim needs (FECA questions).
3. Your agency fills in its part of the CA-2 and sends the file to the Office of Workers' Compensation Programs (OWCP).
4. Claim lost pay on Form CA-7. A spouse or children claiming after a firefighter's death use Form CA-5 (FECA forms).

• Tell your supervisor in writing within 30 days. For a cancer, the 30 days start when you know, or should know, that it is linked to the job (§ 8119, § 8122).
• File the claim within 3 years. For a cancer, the 3 years start when it keeps you from working and you know, or should know, that it is linked to the job (§ 8122). If you are still exposed after that, the time runs from your last exposure (Department of Labor).
• A late claim can still be accepted if your supervisor knew within 30 days. A disability claim filed on time also covers a later death claim for the same illness (§ 8122).

Firefighter claims get a high-risk flag in ECOMP and go to OWCP's Special Claims Unit; death claims are handled the same way (FECA bulletins). When a claim meets the high-risk rules, you do not have to prove a particular exposure or send a doctor's opinion on the cause: the claim is accepted. The Department of Labor gets more than 2,500 claims a year from federal firefighters and says over 90% are accepted (Department of Labor, 2025).

You will also be offered a place in the CDC's National Firefighter Registry, which is voluntary. For the other federal payments, such as the death and disability benefit, see firefighter cancer benefits.