Idaho Supreme Court Upholds Cancer Presumption for Firefighters

The Supreme Court of Idaho has upheld the constitutionality of the state’s cancer presumption law for firefighters, in a challenge brought by a city contesting a firefighter’s right to workers’ comp benefits for leukemia. Captain Richard Nelson served as a firefighter in Pocatello. He retired in 2014.

In 2018, Captain Nelson was diagnosed with early-stage chronic lymphocytic leukemia (CLL). He notified the Pocatello Fire Department and submitted a workers’ compensation claim, in accordance with a state law that made certain cancers rebuttably presumed to be work related. Here is the applicable langue of the Idaho law:

72-438. Occupational diseases.

Compensation shall be payable for disability or death of an employee resulting from the following occupational diseases: …

(14) Firefighter occupational diseases: …

(b) If a firefighter is diagnosed with one (1) or more of the following diseases after the period of employment indicated in subparagraphs (i) through (xi) of this paragraph, and the disease was not revealed during an initial employment medical screening examination that was performed according to such standards and conditions as may be established at the sole discretion of the governing board having authority over a given fire district, fire department, or fire brigade, then the disease shall be presumed to be proximately caused by the firefighter’s employment as a firefighter: …

(vi) Leukemia after five (5) years;

(e) The presumption created in this subsection shall not apply to any specified disease diagnosed more than ten (10) years following the last date on which the firefighter actually worked as a firefighter as defined in paragraph (a) of this subsection. Nor shall the presumption apply if a firefighter or a firefighter’s cohabitant has regularly and habitually used tobacco products for ten (10) or more years prior to the diagnosis.

Pocatello denied Captain Nelson’s claim, prompting him to appeal to the Industrial Commission of Idaho. The commission concluded the city failed to rebut the presumption created by Idaho Code Section 72-438, and awarded him comp benefits. The city appealed that decision to the Supreme Court of Idaho.

The city’s argument was two-fold. First it alleged that it had successfully rebutted the presumption that Captain Nelson’s leukemia was related to his employment by showing the presumption lacked definitive scientific support that leukemia was more likely in firefighters. Second it alleged that Idaho Code Section 72-438 is unconstitutional under the state constitution.

The court tackled the constitutionality test first, applying rational basis review and upholding the law, reasoning as follows:

• Rational basis review only requires us to determine whether “there is any conceivable state of facts which will support [the statutory provision],” without judging “the wisdom or fairness of the legislation being challenged.”
• Thus, “[u]nder the rational basis test, a classification will pass scrutiny if it is rationally related to a legitimate governmental purpose.”
• Here, the challenged legislation is a statute that protects firefighters who develop cancer by providing a presumption of causation for the enumerated occupational disease, making it easier for them to qualify for workers’ compensation benefits.
• We conclude that there is ample evidence and facts in the legislative record to support the legislation’s purpose and will not second-guess the Legislature’s policy choices.
• Therefore, we conclude that the rational basis test applies and is satisfied by the facts of this case. Accordingly, Idaho Code section 72-438(14)(c) does not violate the City of Pocatello’s equal-protection rights.

The court then addressed the factual question of whether the city rebutted the presumption by affirming the Industrial Commission’s ruling. The court noted a series of questions posed by Captain Nelson’s attorney to the city’s expert, who testified that there was a lack of proof that firefighters had higher prevalence of leukemia:

• Q. All right. Let me read from your report so I get it correct and I don’t misstate it. I believe you say that a physician cannot conclude with medical probability that Mr. Nelson’s CLL is causally related on a more probable basis than not to toxins that he may have been exposed to during his employment with the City of Pocatello as a firefighter. Is it fair to say that, no one can say what caused Mr. Nelson’s CLL?
• A: That’s accurate.
• Q. All right. So you cannot say with a reasonable degree of medical certainty what is the cause of [Nelson’s CLL]; is that accurate?
• A. That’s accurate.

Citing similar testimony being admitted before the Industrial Commission, the court held:

• The Industrial Commission correctly determined that the City failed to present “substantial evidence to the contrary” to rebut the presumption that Nelson’s cancer was caused by his occupation as a firefighter.

Here is a copy of the decision: