Employer's Guide to Hidden Disabilities

Chronic Health Problems

Also included under the blanket of hidden disabilities are chronic health problems (to the extent that they substantially limit one or more major life activities). Examples of such ailments are listed below.
AIDS/HIV
Allergies
Arthritis
Back Condition
Cancer
Cerebral Palsy
Chemical/Fragrance Sensitivity
Chronic Fatigue
Chronic Pain
Diabetes
Epilepsy
Fibromyalgia
Heart Condition
Hepatitis
Lupus
Lyme Disease
Migraines
Multiple Sclerosis
Muscular Dystrophy
Myasthenia Gravis
Parkinsonís Disease
While this is not a complete list, it is clear that there are many health-related conditions that can be considered disabling. It should be noted, however, that not all individuals with these conditions are considered disabled. They must meet the criteria set forth in the ADA to be covered under it.

It would be impossible to describe every chronic health problem that could be a disabling condition, but this guide will address a few that are probably the least understood.

Chronic Fatigue Syndrome (CFS)

CFS is a disorder characterized by profound fatigue that is not improved by bed rest and that may be worsened by physical or mental activity. Other symptoms include headaches, recurrent sore throats, muscle and joint pains, and cognitive complaints.

The degree of severity can vary widely among patients, and will also vary over time for the same patient. Severity can vary between getting unusually fatigued following stressful events, to being totally bedridden and completely disabled. The symptoms will tend to wax and wane over time.

Possible Limitations/Issues for Employees with CFS:
Difficulty Concentrating
Depression / Anxiety
Fatigue / Weakness
Migraine Headaches
Photosensitivity
Sleep Disorder
Temperature Sensitivity
Time of Day

Examples with Accommodations from JAN:

A teacher with chronic fatigue syndrome had difficulty meeting the physical demands of her job and was exhausted by early afternoon. She was provided with a teacher's aid, her off-hour was moved to the afternoon, and she was excused from afternoon recess duty.

A social worker with chronic fatigue syndrome experienced headaches and photosensitivity. Accommodations included changing the lighting in her workstation from fluorescent lighting to task lighting, adding a glare guard to her computer monitor, providing window blinds, and implementing other workstation changes to enhance ergonomics.


Reference: Job Accommodation Network (http://www.jan.wvu.edu/media/cfs.html)

Fibromyalgia Syndrome (FMS)

FMS is a complex, chronic condition that causes widespread pain and severe fatigue. Deep muscular pain is the most common symptom. It can be all over the body, or in just one main region. Most people with FMS say that at least some degree of pain is always present. The pain generally is present in all four quadrants of the body for at least three months. Some factors that effect pain are level of activity, the weather, a personís sleep patterns and stress. Besides chronic pain, other symptoms include extreme fatigue, sleep disorders, mood changes, impaired memory, dizziness, severe headaches, and irritable bowel/bladder. FMS affects 2-4% of the total population and can be seen in people of all ages, but is more often diagnosed in women in their 20s and 30s.

Because FMS affects people in different ways and with varying degrees of severity, the accommodation process must be handled on a case-by-case basis. FMS may be considered disabling for some employees and not for others. Not all people with FMS will need accommodations to perform their jobs and many others may need only a few accommodations.

Possible Limitations/Issues for Employees with FMS:
Difficulty Concentrating
Depression and Anxiety
Fatigue/Weakness
Fine Motor Impairment
Gross Motor
Impairment
Migraine Headaches
Respiratory Difficulties
Skin Irritations
Sleep Disorder
Temperature Sensitivity

Examples with Accommodations from JAN:

A guidance counselor for a large high school experienced severe bouts of irritable bowl syndrome, depression, and fatigue as a result of FMS. He experienced difficulty in opening the heavy doors to the entrance of the school and had to make frequent trips to the bathroom. The individual's employer complained that he was spending too much of his time away from his office and therefore was not available for students. The employer moved the employee's office to a location closer to the faculty restroom, added an automatic entry system to the main doors, and allowed flexible leave time so the employee could keep appointments with his therapist.

A nurse with FMS working in a county health clinic experienced a great deal of fatigue and pain at work. The nurse typically worked evening shifts but her doctor recommended a schedule change so she could regulate her sleep patterns. Accommodations suggestions included changing her shift from evening to day, restructuring the work schedule to eliminate working two consecutive twelve hour shifts, reducing the number of hours worked to part time, and taking frequent rest breaks

Reference: Job Accommodation Network (http://www.jan.wvu.edu/media/Fibro.html)

Multiple Sclerosis (MS)

MS is a chronic disease of the central nervous system. It causes destruction of myelin (a protein that forms a protective coating around nerve cells) in the central nervous system. When myelin is destroyed signals traveling through the nerve cells are interrupted or delayed, resulting in various neurological symptoms occurring at different locations throughout the body. MS is often characterized by a pattern of exacerbation and remission. Symptoms may be mild, such as numbness in the limbs, or severe, such as paralysis or loss of vision. The initial symptoms of MS are most often difficulty walking; abnormal sensations such as numbness or "pins and needles"; and pain and loss of vision due to optic neuritis, an inflammation of the optic nerve. Less common initial symptoms may include tremor; lack of coordination; slurred speech; sudden onset of paralysis, similar to a stroke; and decline in cognitive function.

Possible Limitations/Issues for Employees with MS
Activities of Daily Living
Cognitive Impairment
Fatigue/Weakness
Fine Motor Impairment
Gross Motor Impairment
Heat Sensitivity
Speech Impairment
Vision Impairment

Examples with Accommodations from JAN:

An engineer with MS was experiencing heat sensitivity. She was provided a private office where the temperature could be lower than in the rest of the facility. She was also encouraged to communicate with coworkers by telephone or email when possible to reduce the amount of walking she had to do.

An attorney with MS was having difficulty carrying documents to meetings at various locations due to upper extremity weakness. His employer purchased a portable cart that was easy to get in and out of his car.

Reference: Job Accommodation Network: http://www.jan.wvu.edu/media/MS.html)

Lupus

Lupus is a chronic, autoimmune disease that causes inflammation of various parts of the body, especially the skin, joints, blood and kidneys. The immune system -- designed to protect the body against viruses, bacteria and other foreign materials -- produces antibodies that attack the person's own tissues and organs. The more common symptoms of lupus include joint and muscle pain, extreme fatigue, persistent low-grade fever (less than 101įF), "butterfly" rash across the bridge of the nose and cheeks, weight loss, hair loss, photosensitivity (sun or light sensitivity), pleurisy (pain in the chest on deep breathing), headache and mouth or nose ulcers.

For most people, lupus is a mild disease affecting only a few organs. For others, it may cause serious and even life-threatening problems. Sunlight, infection, injury, surgery, stress and exhaustion can trigger lupus "flares" (active states of the disease). Lupus affects 1 out of every 185 Americans. Although lupus can occur at any age -- and in either sex -- 90% of those living with lupus are female; a diagnosis is most often made during the child-bearing years, between the ages of 15 and 45. African Americans, Latinos, Asians and Native Americans are at particular risk.

Possible Limitations/Issues for Employees with Lupus
Activities of Daily Living
Cognitive Impairment
Fatigue/Weakness
Sleep Disorder
Fine Motor Impairment
Gross Motor Impairment
Migraine Headaches
Photosensitivity
Respiratory Difficulties
Seizure Activity
Skin Irritations
Stress
Temperature Sensitivity

Examples with Accommodations From JAN:

A claims representative with lupus was sensitive to fluorescent light in his office and to the radiation emitted from his computer monitor. The overhead lights were changed from fluorescent to broad spectrum by using a special filter that fit onto the existing light fixture. The individual was also accommodated with a glare guard and flicker-free monitor.

A systems analyst with lupus had migraine headaches. The individual was moved from a cubicle office to a separate workspace away from distractions and noise. She was then able to use task lighting instead of overhead fluorescent lighting and adjust the temperature control when necessary.

Reference: Job Accommodation Network (http://www.jan.wvu.edu/media/lupus.html)

Epilepsy

Epilepsy is a chronic medical condition produced by temporary changes in the electrical function of the brain, causing seizures which affect awareness, movement, or sensation.

Possible Limitations/Issues for Employees with Epilepsy:
  • Limitations in Cognitive/Neurological Abilities: memory, disorientation/ disorganization, time management/performing or completing tasks
  • Trouble Using Office Equipment: phone, copier, fax, computer, alarm system
  • Limitations in Motor Abilities: driving, balancing/climbing, fatigue
  • Limitations Associated with Photosensitivity: using computer, alternative lighting
  • Limitations in Sensory Abilities: Seeing/Hearing/Communicating (during seizure)
Other Limitations: attendance/absenteeism, schedule issues, exhibiting appropriate behavior, avoiding seizures on the job

Example with Accommodations from JAN:

An administrator needed an emergency alerting system as an accommodation. JAN suggested using a two-way radio. JAN suggested creating a plan of action. The approx. accommodation cost is $100.

Reference: Job Accommodation Network (http://www.jan.wvu.edu/media/Epilepsy.html)

Additional information on Chronic Health Problems and how to accommodate them can be found at the JAN (Job Accommodation Network) web site: http://www.jan.wvu.edu.


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Last Revised August 27, 2003.
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