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Occupation and Industry Series:
Accommodating Service Members and Veterans with Post-Traumatic Stress Disorder (PTSD)

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Introduction

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.

Information about Combat-Related Post-Traumatic Stress Disorder (PTSD)

What is PTSD?

According to the DSM 5, PTSD is a trauma- and stress­or-related disorder caused by an individual’s exposure to actual or threatened death, serious injury, or sexual violence in one or more of the following ways:

The disturbance, regardless of its trigger, causes clinically significant distress or impairment in the indi­vidual’s social interactions, capacity to work or other important areas of functioning. It is not the physi­ological result of another medical condition, medication, drugs or alcohol (APA, 2013).

How many veterans have PTSD?

While exposure to a traumatic event is not uncommon, 7 - 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 11-20% of service members who return home from deployment in Afghanistan and Iraq have symptoms of PTSD.  Statistics also show that PTSD occurs in about 15% of Vietnam veterans, 12% of Gulf War veterans (National Center for PTSD, 2015).

What are the symptoms of PTSD?

Possible symptoms associated with PTSD are re-experiencing, avoidance, negative cognition and mood, and arousal. Re-experiencing involves spontaneous memories of the traumatic event, recurrent dreams related to it, flashbacks or other intense or prolonged psychological distress. Avoidance refers to avoiding the distressing memo­ries, thoughts, feelings or external reminders of the event. Negative cognitions and mood represents countless feelings, from a persistent and distorted sense of blame of self or others, to estrangement from others or markedly diminished interest in activities, to an inability to remember key aspects of the event. Arousal is marked by irritable, angry, aggressive, reckless or self-destructive behavior, sleep disturbances, hyper-vigilance or related problems (APA, 2013).

Most people have some stress-related reactions after a traumatic event; but, not everyone gets PTSD. PTSD symptoms usually start soon after the traumatic event, but they may not appear until months or years later. Individuals 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, 2015).

PTSD and the Americans with Disabilities Act

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.

Are employees with PTSD required to disclose their disability to their employers? 

No. Employees need only disclose their disability if/when they need an accommodation to perform the essential functions of the job. Applicants never have to disclose a disability on a job application, or in the job interview, unless they need an accommodation to assist them in the application or interview process (EEOC, 1992).

Can an employer ask an employee with PTSD to submit to a medical examination?

Yes, if the need for the medical examination is job-related and consistent with business necessity. Typically, employers will ask an employee with PTSD to submit to a medical examination (also called a fitness-for-duty exam) after the employee had an incident on the job that would lead the employer to believe that this employee is unable to perform the job, or to determine if the employee can safely return to work, and if any accommodations will be needed on the job (EEOC, 1992).

Special note: Pre-job offer medical examinations or inquiries are illegal under the ADA. People with PTSD (or any disability) do not have to submit to a medical exam or answer any medical questions until after they are conditionally offered a job (EEOC, 1992).

Do employees with PTSD pose a direct threat to themselves or others?

People who have PTSD do not necessarily pose a direct threat to themselves or others. Employees who control their conditions through medication or therapy probably pose no current risk. Even if direct threat exists, employers should reduce or eliminate the threat by providing an accommodation (EEOC, 1992).

How and when does a person with PTSD ask for an accommodation?

An employee with PTSD can ask for an accommodation at any time when he/she needs an accommodation to perform the essential functions of the job. The employee can make a request verbally or in writing and is responsible for providing documentation of a disability (EEOC, 1992).

Can an employer discipline an employee with PTSD who violates conduct or performance standards?

Yes, an employer can discipline an employee with PTSD who violates conduct standards or fails to meet performance standards, even if the behavior being exhibited is caused by the employee's disability. However, an employer is obligated to consider reasonable accommodations to help the employee with PTSD meet the conduct or performance standards (EEOC, 1992).

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.

Accommodating Veterans with PTSD

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:

  1. What limitations is the veteran with PTSD experiencing?
  2. How do these limitations affect the veteran and the veteran’s job performance?
  3. What specific job tasks are problematic as a result of these limitations?
  4. What accommodations are available to reduce or eliminate these problems? Are all potential resources being used to determine possible accommodations?
  5. Has the veteran with PTSD been consulted regarding possible accommodations?
  6. 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?
  7. Do supervisory personnel and employees need training regarding PTSD?

Accommodation Ideas:

Concentration:

Memory:

Organization:

Time Management / Completing Tasks:

Stress / Emotions:

Panic Attacks:

Sleep Disturbances:

Fatigue:

Attendance:

Coworker Interaction:

Working Effectively:

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:

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.

Products:

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.

Resources

References

American Psychiatric Association:  Diagnostic and Statistical Manual of Mental Disorders, Fifth edition. Arlington, VA, American Psychiatric Association, 2013.

EEOC Regulations To Implement the Equal Employment Provisions of the Americans With Disabilities Act, as Amended, 29 C.F.R. § 1630 (2011).

Equal Employment Opportunity Commission. (1992). A technical assistance manual on the employment provisions (Title I) of the Americans with Disabilities Act. Retrieved September 30, 2015, from http://AskJAN.org/links/ADAtam1.html

National Center for PTSD. (2015). What is PTSD? Retrieved September 30, 2015, from http://www.ptsd.va.gov/public/PTSD-overview/basics/index.asp

Updated 10/08/15

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