Occupation and Industry Series:
Accommodating Service Members and Veterans with Post-Traumatic Stress Disorder (PTSD)
JAN's Occupation and Industry Series is designed to help employers determine effective accommodations for their employees with disabilities and comply with title I of the Americans with Disabilities Act (ADA). Each publication in the series addresses a specific occupation or industry and provides information about that occupation or industry, ADA issues, accommodation ideas, and resources for additional information.
The Occupation and Industry Series is a starting point in the accommodation process and may not address every situation. Accommodations should be made on a case by case basis, considering each employee's individual limitations and accommodation needs. Employers are encouraged to contact JAN to discuss specific situations in more detail.
For information on assistive technology and other accommodation ideas, visit JAN's Searchable Online Accommodation Resource (SOAR) at http://AskJAN.org/soar.
What is PTSD?
PTSD is an anxiety disorder that can develop in response to a traumatic event that has caused intense fear, helplessness, or horror (NAMI, n.d.).
How many veterans have PTSD?
While exposure to a traumatic event is not uncommon, about 8% of the American population will develop PTSD at some point in their lives. Among military veterans, PTSD is quite common. Due to the daily exposure to potentially traumatic events, recent data suggest that approximately one in every five service members who return home from deployment in Afghanistan and Iraq have symptoms of PTSD or depression (America's Heroes at Work, n.d.).
Employees who are veterans of previous military conflicts may benefit from this information as well (NAMI, n.d.; America's Heroes at Work, 2009). Statistics from the National Center for PTSD (2007) show that PTSD occurs in about 30% of Vietnam veterans, 10% of Gulf War veterans, and 6% to 11% of veterans of the Afghanistan war.
What are the symptoms of PTSD?
Possible symptoms associated with PTSD are flashbacks, stress reactions, and avoidance behavior. A flashback is the re-experiencing of the ordeal, intrusive memories, and nightmares (America’s Heroes at Work, 2009). A stress reaction may be provoked when an individual experiences an incident or situation that reminds him or her of the traumatic event (America’s Heroes at Work, 2009). Avoidance of people, places, and activities that are reminders of the trauma is a significant characteristic of PTSD (National Center for PTSD, 2007). Symptoms may also include feeling disconnected from others, emotional “numbing,” sleep disturbances, problems with concentration, and irritability and/or angry outbursts. Being very alert and watchful to danger, feeling “on edge,” experiencing exaggerated jumpiness, and/or being easily startled may also be associated with PTSD (Anxiety Disorder Association of America, n.d.).
Although many persons involved in traumatic events experience a brief state of anxiety and depression after the occurrence, those with PTSD experience many of the symptoms listed above for well over a month and cannot function as they were able to prior to the event. Signs and symptoms of PTSD usually begin within several months of the event. However, symptoms may not occur until many months or even years following the trauma. Those who develop PTSD may not experience all of the symptoms and behaviors listed above.
How is PTSD treated?
PTSD treatment often combines both medication and psychotherapy, including individual, group, and family therapies. This combined approach can help improve symptoms and teach skills to better cope with the traumatic event and its aftermath (National Center for PTSD, 2007).
Is PTSD a disability under the ADA?
The ADA does not contain a list of medical conditions that constitute disabilities. Instead, the ADA has a general definition of disability that each person must meet (EEOC, 1992). Therefore, some people with PTSD will have a disability under the ADA and some will not.
A person has a disability if he/she has a physical or mental impairment that substantially limits one or more major life activities, a record of such an impairment, or is regarded as having such an impairment (EEOC, 1992). For additional information on the ADA definition of disability, go to JAN's Accommodation and Compliance Series: The ADA Amendments Act of 2008 at http://AskJAN.org/bulletins/adaaa1.htm.
Where can employers get additional information about PTSD and the ADA?
JAN provides resources on mental health impairments and the ADA at http://AskJAN.org/media/psyc.htm. This includes accommodation ideas, information on the ADA and its amendments, and guidance from the Equal Employment Opportunity Commission. Two EEOC guidances that may be helpful working through the accommodation process are: The ADA and Psychiatric Disabilities at http://www.eeoc.gov/policy/docs/psych.html and The ADA: Applying Performance and Conduct Standards to Employees with Disabilities at http://www.eeoc.gov/facts/performance-conduct.html.
Note: Veterans with PTSD may develop some of the limitations discussed below, but seldom develop all of them. Also, the degree of limitation will vary among individuals. Be aware that not all veterans with PTSD will need accommodations to perform their jobs and many others may only need a few accommodations. The following is only a sample of the possibilities available. Numerous other accommodation solutions may exist.
Questions to Consider:
- What limitations is the veteran with PTSD experiencing?
- How do these limitations affect the veteran and the veteran’s job performance?
- What specific job tasks are problematic as a result of these limitations?
- What accommodations are available to reduce or eliminate these problems? Are all potential resources being used to determine possible accommodations?
- Has the veteran with PTSD been consulted regarding possible accommodations?
- Once accommodations are in place, would it be useful to meet with the veteran with PTSD to evaluate the effectiveness of the accommodations and to determine whether additional accommodations are needed?
- Do supervisory personnel and employees need training regarding PTSD?
- Increase natural lighting or provide full spectrum lighting
- Reduce clutter in the workspace
- Restructure job to include only essential functions
- Reduce distractions in the work environment
- Provide space enclosures or a private space
- Allow the veteran to play soothing music using a headset
- Provide a noise cancelling headset
- Divide large assignments into smaller goal oriented tasks or steps
- Plan for uninterrupted work time
- Provide written instructions
- Use a wall calendar
- Use a daily or weekly task list
- Provide verbal prompts and reminders
- Use electronic organizers or hand held devices
- Allow the veteran to tape record meetings
- Provide written as well as verbal instructions
- Provide printed minutes of each meeting
- Allow additional training time for new duties
- Provide reminders of important deadlines via e-mails, memos, and weekly supervision
- Provide mentor for daily guidance
- Use notebooks, planners, or sticky notes to record information for easy retrieval
- Provide cues to assist in location of items by using labels, color coding, or bulletin boards
Time Management / Completing Tasks:
- Make daily TO-DO lists and check items off as they are completed
- Provide organizational tools such as electronic schedulers, pace setters, memo recorders, software organizers, calendars
- Divide large assignments into smaller tasks and steps
- Schedule weekly meetings with supervisor, manager, or mentor to determine if goals are being met
- Remind employee of important deadlines via memos or e-mail
- Assign a mentor to assist with determining goals, providing daily guidelines, reminding of important deadlines
- Consider providing training on time management
Coping with Stress:
- Allow longer or more frequent work breaks as needed
- Provide backup coverage for when the veteran needs to take breaks
- Provide additional time to learn new responsibilities
- Restructure job to include only essential functions during times of stress
- Assign a supervisor, manager, or mentor to answer the veteran's questions
- Allow for time off for counseling
Working Effectively with Coworkers:
- Encourage the veteran to walk away from frustrating situations and confrontations
- Allow the veteran to work from home part-time
- Provide partitions or closed doors to allow for privacy
- Provide disability awareness training to coworkers and supervisors
Dealing with Emotions:
- Encourage use of stress management techniques to deal with frustration
- Allow the presence of a support animal
- Allow telephone calls during work hours to doctors and others for needed support
- Use a mentor or supervisor to alert the veteran when his/her behavior is becoming unprofessional or inappropriate
- Allow frequent breaks
- Refer to employee assistance programs (EAP) and veterans' centers
- Allow for a flexible start time
- Combine regularly scheduled short breaks into one longer break
- Provide a place for the veteran to sleep during break
- Allow the veteran to work one consistent schedule
- Provide a device such as a Doze Alert or other alarms to keep the veteran alert
Absenteeism and Tardiness:
- Allow for a flexible start time or end time or work from home
- Provide straight shift or permanent schedule
- Count one occurrence for all PTSD-related absences
- Allow the veteran to make up the time missed
- Allow the veteran to take a break and go to a place where s/he feels comfortable to use relaxation techniques or contact a support person
- Identify and remove environmental triggers such as particular smells or noises
- Allow the presence of a support animal
Two common issues that JAN receives inquiries on are: (1) what accommodations will work for individuals with PTSD when workplaces are implementing substantial changes, and (2) what accommodations will help supervisors work effectively with individuals with PTSD. Many accommodation ideas are born from effective management techniques. When organizations are implementing workplace changes, it is important that key personnel recognize that a change in the environment or in supervisors may be difficult. Maintaining open channels of communication to ensure any transitions are smooth, and providing short weekly or monthly meetings with employees to discuss workplace issues can be helpful.
Supervisors can also implement management techniques that support an inclusive workplace culture while simultaneously providing accommodations. Techniques include the following:
- Provide positive praise and reinforcement,
- Provide day-to-day guidance and feedback,
- Provide written job instructions via email,
- Develop clear expectations of responsibilities and the consequences of not meeting performance standards,
- Schedule consistent meetings with employee to set goals and review progress,
- Allow for open communication,
- Establish written long term and short term goals,
- Develop strategies to deal with conflict,
- Develop a procedure to evaluate the effectiveness of the accommodation,
- Educate all employees on their right to accommodations,
- Provide sensitivity training to coworkers and supervisors,
- Do not mandate that employees attend work related social functions, and
- Encourage all employees to move non-work related conversations out of work areas.
Situations and Solutions:
A veteran with PTSD who was employed as a computer programmer had difficulty communicating with a supervisor. Due to a previous incident, the employee’s stress reaction was triggered by meetings with the supervisor. Instead of reporting to the supervisor for a weekly meeting on progress, the supervisor now pulls a report completed by the employee that shows progress on certain projects. A call-in policy where the employee was required to speak to her supervisor to report an absence was also modified. Now the employee calls an extension that was set up for the purpose of reporting absences.
A veteran who has PTSD was returning to civilian work. He was assigned to a cubicle in an office setting. Because of the cubicle’s placement, the employee had no choice but to have his back to the opening, which caused him to have flashbacks from when he was in combat. The individual was accommodated with a mirror that was attached to his computer monitor so that he could see when coworkers enter his workspace.
A retired Army medic, who is now a nurse, had difficulty managing stress in the workplace due to her PTSD. Her stress intolerance was intensified when she heard the emergency medical helicopter arrive and depart from the hospital where she works. The nurse was reassigned to a vacant position on a unit that is farthest from the heli-pad. Because she could no longer hear the helicopter, she was able to effectively manage her job stress.
A sales representative with PTSD was reprimanded for arriving to work late because she had difficulty traveling during peak traffic times. She recently returned from National Guard service. She was accommodated by changing her start time to an hour later so she could avoid peak traffic times, and she was allowed to work from home two days a week.
A veteran with bipolar and PTSD had issues with his medication and needed time off from work, approximately half a day, in order to take care of his medical appointments. The employee had been on the job for seven months and had used his accrued time. He was accommodated with unpaid, intermittent leave under the ADA.
A veteran with PTSD had difficulty sleeping because of nightmares and focusing while having to multitask. He also experienced mood swings and lost his temper several times at work. He had not been disciplined for the outbursts, but decided it was time to disclose his disability and ask for accommodations. Because the optimal time for disclosing a disability and asking for an accommodation is before problems at work become too far advanced, a consultant at JAN provided technical assistance on how to disclose a disability and write an accommodation request letter.
There are numerous products that can be used to accommodate people with limitations. JAN's Searchable Online Accommodation Resource (SOAR) at http://AskJAN.org/soar is designed to let users explore various accommodation options. Many product vendor lists are accessible through this system; however, upon request JAN provides these lists and many more that are not available on the Web site. Contact JAN directly if you have specific accommodation situations, are looking for products, need vendor information, or are seeking a referral.
America's Heroes at Work. (n.d.). Frequently asked questions about post-traumatic stress disorder (ptsd) & employment. Retrieved June 28, 2010, from http://www.americasheroesatwork.gov/resources/factsheets/FAQPTSD/
Anxiety Disorders Association of America. (n.d.). Post traumatic stress disorder PTSD. Retrieved June 28, 2010, from http://www.adaa.org/understanding-anxiety/posttraumatic-stress-disorder-ptsd
Equal Employment Opportunity Commission. (1992). A technical assistance manual on the employment provisions (Title I) of the Americans with Disabilities Act. Retrieved June 28, 2010, from http://AskJAN.org/links/ADAtam1.html
National Alliance on Mental Illness. (n.d.). Post traumatic stress disorder. Retrieved June 28, 2010, from http://www.nami.org/Template.cfm?Section=By_Illness&Template=/TaggedPage/TaggedPageDisplay.cfm&TPLID=54&ContentID=68642
National Center for PTSD. (2007). What is PTSD? Retrieved June 28, 2010, from http://www.ptsd.va.gov/public/pages/what-is-ptsd.asp