James Crowley is a firefighter with the Superstition Fire and Medical District in Arizona. Over the course of his 20-year career, Crowley was exposed to diesel exhaust fumes daily. In addition, while on fire calls he was exposed to the smoke and fumes of burning plastics, chemicals, paints, stains, glues, wood, and other miscellaneous substances.
In October 2017, Crowley was diagnosed with Hodgkin’s lymphoma, and he filed a worker’s compensation claim for an occupational disease. The City denied the claim, and the matter eventually landed at the Arizona Court of Appeals.
Arizona has a “presumptive causation” statute covering firefighters and police officers. The statute, which covers cancers such as lymphomas, requires an employee to prove the following: (1) that they were exposed to a known carcinogen as defined by an international agency for research on cancer, (2) that they informed their employer of this exposure; and (3) that the carcinogen is reasonably related to the cancer from which the employee is suffering.
The case featured the testimony of “dueling doctors” on whether Crowley’s claim fit within the statute. Dr. Jonathan Abbas, an oncologist specializing in lymphomas, treated Crowley in 2018. Abbas prefaced his testimony by admitting that causally linking a patient’s exposure to a substance with their cancer diagnosis was “not his area of expertise” and it was “a little bit outside his realm to draw those sort of conclusions.” He then testified that Crowley’s work as a firefighter likely exposed him to “compounds that are known to cause various immunological malignancies, including Hodgkin’s lymphoma” and opined that he did not have “any reason to doubt there is a possible causative relationship to that.”
Although Abbas initially declined to say that the exposure was “more likely than not” a cause of the cancer, he concluded that Crowley’s exposure to substances as a firefighter was a “possible contributing cause” of his cancer diagnosis as there is an association with the type of chemicals he was exposed to and Hodgkin’s lymphoma. Abbas acknowledged that he was unaware of Crowley’s actual exposure to known carcinogens, and that he only knew the general exposure risks Crowley faced as a firefighter.
Dr. Michael Levine, the Division Chief for Medical Toxicology at the University of Southern California, testified for the City. Although he did not conduct a physical examination, he reviewed Crowley’s medical and occupational records. Levine testified that general medical data shows there is a “small link between non-Hodgkin’s lymphoma and firefighters that have worked for 20 years or more.” He also noted that long-term exposure to a chemical known as “butadiene” to which firefighters can be exposed, is associated with Hodgkin’s lymphoma. However, he pointed out that there “is not a statistically significant increased risk of developing Hodgkin’s for firefighters compared to the baseline population.” He concluded that “being a firefighter, which includes exposure to multiple things, including butadiene, is not a risk factor for Hodgkin’s lymphoma.”
The Court found that that it was not unreasonable for the workers’ compensation administrative law judge to rely on Levine’s testimony more than that of Abbas. The Court concluded that “Crowley failed to show he was entitled to a presumption that his cancer was an occupational disease arising out of employment, and accordingly failed to meet his burden to show a direct causal connection between his workplace exposure and his cancer diagnosis. Neither Crowley nor either of the testifying oncologists were able to point to one of the carcinogens to which Crowley was exposed as a firefighter and which has been causally linked to Hodgkin’s lymphoma.
“We hold that the administrative law judge correctly declined to apply the presumption that Crowley’s cancer was an occupational disease covered by worker’s compensation. Without that presumption, Crowley was unable to prove that his condition was a covered occupational disease.”
Crowley v. Industrial Commission of Arizona, 2020 WL 6833794 (Ariz. Ct. App. 2020).