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ENews: Volume 12, Issue 4, Fourth Quarter, 2014

The JAN E-News is a quarterly online newsletter. Its purpose is to keep subscribers informed about low-cost and innovative accommodation approaches; the latest trends in assistive technologies; announcements of upcoming JAN presentations, media events, trainings, and Webcasts; and legislative and policy updates promoting the employment success of people with disabilities.

An e-mail announcement is sent to an opt-in list when a new issue is available. Please use the links at the end of this document to subscribe or unsubscribe.


  1. Making Pre-employment Testing Accessible: WellPoint Offers a Best Practice
  2. Requests For Medical Documentation and the ADA
  3. October is Dwarfism Awareness Month
  4. Eating Disorders and the Workplace
  5. Accommodating Employees with Keratoconus
  6. JAN Blog Growing
  7. JAN Releases New Resources
  8. E-vents
  9. JAN Exhibit and Training Schedule
  10. Subscribe to JAN Newsletter

1 - Making Pre-employment Testing Accessible: WellPoint Offers a Best Practice

In the workplace, employers increasingly use pre-employment testing to predict the employment success of their applicants. These tests are designed to overcome the hiring challenge articulated in a recent Forbes article stating: "Many job candidates give a good interview, but can they actually demonstrate the skills in order to do a great job before they get hired?"

With the recent implementation of new Section 503 regulations for federal contractors, the accessibility of pre-employment tests has come into question. Section 503 prohibits federal contractors and subcontractors from discriminating in employment against individuals with disabilities, and requires these employers to take affirmative action to recruit, hire, promote, and retain these individuals. Thus, if the pre-employment test design or testing process is not accessible for people with disabilities, it may be discriminatory, or at the very least, will not meet the affirmative action requirements of federal contractors.

What are some of the accessibility issues with pre-employment testing? At the Job Accommodation Network (JAN), consultants have fielded numerous calls indicating a variety of barriers posed by pre-employment tests. For example, people who have dexterity issues or a cognitive impairment are timed out of the process before they are able to complete the test. An applicant who is blind and uses a screen reader cannot use the screen reader to complete the test as there are interoperability challenges. An individual with a sight impairment requires a larger text font than is offered by the test. 

In order to better understand the challenges and the solutions to making pre-employment tests accessible, I spoke with a representative from WellPoint, a national company known for being inclusive of people with disabilities and a collaborator and customer of JAN. WellPoint is a health care company that strives to be "America's valued health partner." This insurance and health care industry employer frequently uses pre-employment tests for entry level or front line personnel. These tests are conducted to understand the level of hard skills applicants will bring to the job including customer service etiquette, using a computer, and calculating numbers. WellPoint generously shared with us its best practices for insuring its pre-employment process is accessible for people with disabilities.

The first page of WellPoint's accessible jobs portal contains a notification of its commitment to hiring individuals with disabilities. Consequently, if an individual needs an accommodation for the application process or during the pre-employment testing phase, he or she is encouraged to email WellPoint's Human Resource Department to request the accommodation. This request then goes to a specialized unit for consideration. Once the request is received, the accommodation specialist begins working with a third-party vendor who was hired to provide testing. We have found larger companies often use vendors or third-party administrators to conduct testing of candidates. In WellPoint's case, the third-party vendor is LOMA.

WellPoint charges the testing vendor to provide the appropriate accommodation based upon the needs of the applicant. WellPoint simply sends the name of the candidate to the vendor and then the vendor works with the individual to insure he/she is able to complete the test. LOMA's tests are designed so that the timing feature can be modified and the text font can be easily enlarged. WellPoint reports these are the most frequent accommodations requested. The disabilities most often resulting in these requests are deafness and blindness.  

If the accommodation cannot be provided by a technical modification of the test, then the candidate's name is sent back to the employer. WellPoint then works to resolve the issue by making other accommodations. WellPoint states the most challenging accommodation issue is when the person's assistive technology is not compatible with the testing technology. However, between WellPoint and its vendor, they have been able to successfully resolve requests for accommodation, even if it means developing an alternate assessment that evaluates the same capabilities or competencies as the LOMA tests. In rare cases, WellPoint will waive a test when appropriate.

So, some best practices resulting from my conversation with a WellPoint representative are as follows:

- Louis E. Orslene, MPIA, MSW, Co-Director

2 - Requests For Medical Documentation and the ADA

Medical documentation may be requested when an individual makes it known to his or her employer that an accommodation is needed at work. Upon receiving a request for accommodation, it is a common practice for employers to request medical information as part of the interactive process. However, the Equal Employment Opportunity Commission (EEOC) has stated that documentation should only be necessary when the disability and need for accommodation are not known or obvious. Therefore, the amount of documentation allowed will depend upon the situation and how much information is already known about the impairment, functional limitations, and accommodations. An employer may not ask for documentation that is unrelated to the request for accommodation, this includes asking for an employee's complete medical records. Full records are likely to contain information unrelated to the reasonable accommodation request.

JAN Consultants respond to a variety of questions related to requesting medical documentation under the ADA. Here are some examples of common questions and responses:

Q: Is an employer required to request medical documentation as part of the interactive process under the ADA?

A: No. Employers may request sufficient documentation when the disability and/or need for accommodation is not known or obvious, but are not required to do so to provide an accommodation. The individual who requested the accommodation is often the best source of information about his or her medical impairment and limitations. Use logical judgment in deciding when to request the information. If the disability and need for accommodation are obvious, move-on to identify and implement accommodation solutions.

Q: When is medical documentation sufficient to determine if the employee has a disability and needs an accommodation?

A: Documentation is sufficient if it substantiates that the individual has a disability and needs the reasonable accommodation requested. Sufficient medical documentation should describe the nature, severity, and duration of the impairment, the activity or activities that the impairment limits, the extent to which the impairment limits the employee's ability to perform the activity or activities, and should also substantiate why the requested reasonable accommodation is needed.

For a sample request for medical information, see JAN's Medical Inquiry in Response to an Accommodation Request at http://AskJAN.org/media/Medical.htm. Employers should customize this form on a case-by-case basis depending on the information that is needed.

For EEOC's guidance on medical documentation in response to an accommodation request, see question 6 in Reasonable Accommodation and Undue Hardship under the ADA at http://www.eeoc.gov/policy/docs/accommodation.html.

Q: What if the documentation provided is insufficient?

A: This is when the request for information may need to be clearer. Sometimes employers include a job description and simply ask the provider to comment on what the employee can or cannot do. This may not be effective. Instead, explain why the documentation was insufficient and ask specific job-related questions about how the impairment affects job performance and why the employee is requesting accommodation. Allow the individual the opportunity to return the additional information in a timely manner.

Q: Can employers require that documentation related to an accommodation request come from a medical doctor?

A: According to the EEOC, medical documentation may be requested from an appropriate health care or rehabilitation professional. The provider does not have to be a medical doctor (MD). Examples may include doctors (including psychiatrists), psychologists, nurses, physical therapists, occupational therapists, speech therapists, vocational rehabilitation specialists, and licensed mental health professionals, among others.

Q: If additional information is needed, how much time do employees have to provide it? What if they do not return the information that is needed?

A: Under the ADA, there is no set timeframe for providing medical documentation to support a request for accommodation. However, employers may have a reasonable accommodation policy that includes a timeframe for employees to respond. Allowing anywhere from ten to fifteen business days may be reasonable.

If an employee does not provide the information in a timely manner, it is up to the employer's discretion how to handle the situation, but we often suggest informing the employee in writing that the information was not received and that the employer is unable to proceed with the accommodation process until the information is received and reviewed.

Q: In response to an accommodation request, can an employer require an employee to sign a medical release to grant consent to obtain the employee's complete medical records?

A: According to the EEOC, in most situations under the ADA, an employer cannot request a person's complete medical records because the records are likely to also contain information unrelated to the disability and need for accommodation. Employers should not use a medical release form that constitutes a general release for all medical records. It is suggested that the employer allow the individual the opportunity to obtain the information directly from his or her healthcare provider. In this case, a separate release will not be necessary. If the employer must communicate directly with the provider for clarification, then either the employee may sign the consent provided by his or her healthcare provider, or the employer may ask the employee to sign a limited release that specifies the information to be requested.

Q: If an employee exhausts leave under the Family and Medical Leave Act (FMLA), may an employer request new medical documentation to support the need for a leave extension as an accommodation under the ADA?

A: An employee may be asked to provide additional medical information to support the continuing need for leave if the information provided for FMLA purposes does not constitute sufficient documentation under the ADA.

Q: If an employer makes adjustments for employees without disabilities, like flexible scheduling or telework, can medical documentation be required to afford employees with disabilities these same adjustments?

A: Employers should remember that if this type of flexibility is available to all employees as a matter of policy or practice, employees with disabilities should not have to jump through unnecessary hoops by providing medical documentation to receive the same benefit, even if needed because of a disability. If the employee with a disability qualifies for the benefit, he or she should be entitled to it, just like any other employee.

JAN offers tools that may be useful to employers in the process of requesting medical documentation. See JAN's Medical Inquiry in Response to an Accommodation Request at http://AskJAN.org/media/Medical.htm and JAN's Practical Guidance for Medical Professionals: Providing Sufficient Medical Documentation in Support of a Patient's Accommodation Request at http://askjan.org/media/medprofessionsfact.doc.

For more information or questions related to medical documentation or inquiries and the ADA, please contact JAN to speak with a Consultant.

- Tracie DeFreitas, M.S., Lead Consultant, ADA Specialist

3 - October is Dwarfism Awareness Month

October is Dwarfism Awareness Month.  According to Little People of America, Inc., a support group for people of short stature and their families, there are over 200 distinct types of dwarfism.  As someone with Bloom's Syndrome, I identify.

In the world of employment, our presence is notable for our accomplishments in much the same way as those of our colleagues. Often the fact that we may need to use a foot rest under our desk, or a stool to reach the coffee maker, or request that the heavy milk jug in the fridge is permanently housed on the bottom shelf of the staff refrigerator, is just a side note.

Many accommodations like the ones mentioned above cost little to no money to put in play.  Others that may cost a little more, like buying the type of appliances that have function keys on the front of the appliance, rather than on top, can, if planned this way from the very beginning, cost less than making accommodations after the fact.

Tax incentives can make a large difference when making an employee bathroom, break/lunch room, or staff vehicle accessible.
For more information on making the workplace more welcoming and functional for employees of short stature, contact the Job Accommodation Network at: (800) 526-7234 (v) or (877) 781-9403 (tty).

4 - Eating Disorders and the Workplace

While there are a variety of eating disorders according to the DSM-5, the conditions that most commonly affect adults are Anorexia Nervosa and Bulimia Nervosa, respectively referred to as anorexia and bulimia.  Defining characteristics of anorexia include restriction of energy intake (food), intense fear of gaining weight, and disturbance in the way in which one's body weight or shape is experienced.  Unlike individuals with anorexia, individuals with bulimia engage in binge eating episodes followed by compensatory behaviors such as self-induced vomiting, the use of laxatives, and excessive exercise (American Psychiatric Association, 2013).  Bulimia and anorexia both have a lifetime prevalence of about 0.6 percent of the U.S. population according to the National Institute of Mental Health (NIMH).

Under the ADA, many people with eating disorders would qualify as having a disability, as they would be substantially limited in the major activity of eating, which could ultimately affect several other major life activities.  If an employee disclosed the presence of an eating disorder, an employer may need to consider what accommodations could be provided absent undue hardship.  Leave for treatment and therapy may be needed, and in severe cases leave for hospitalization may be necessary. 

The "A-Z of Disabilities" tab at the top of the JAN homepage leads to a list of medical conditions that we continue to make additions to.  Watch for a soon-to-be-added publication on Eating Disorders, which will include more detailed information and examples.  In the meantime, contact JAN directly if you need assistance with specific accommodation questions concerning eating disorders.

5 - Accommodating Employees with Keratoconus

Keratoconus, sometimes abbreviated as KC, is an eye condition in which the shape of the eye changes causing blurry, cloudy, or distorted vision as well as sensitivity to light and problems with glare.  Many people with keratoconus have a history of nearsightedness as well.  In fact, some individuals first learn of their condition through evaluations to see if they are a candidate for LASIK surgery.  Vision impairment from keratoconus may be relatively mild at first and is often treated with eyeglasses or contact lenses at the early stages.  In some cases, those with keratoconus may be fitted with custom contact lenses that are specially made to correct their vision and are fitted to their unique eye shape.  As the condition progresses, other treatments such as surgery to apply corneal inserts or treatments to reshape the cornea in other ways or corneal transplants may be needed.

The changes in eye shape in people with keratoconus result from weakening of the tissue of the cornea, the clear tissue covering the front part of the eye.  As the tissues weakens it also becomes thinner.  The thin parts of the affected cornea then begin to bulge forward forming a cone-like shape.  Keratoconus is a progressive eye condition, meaning that the changes in the shape of the eye tend to become more pronounced over time resulting in continuing changes in vision. Most people who develop keratoconus in one eye, will also eventually develop keratoconus in their other eye too.  When both eyes are affected, the condition may progress at different rates in each eye.  The changes may be gradual or more sudden.  Even though keratoconus is generally considered to be a progressive condition, changes in eye shape sometimes stop before more invasive treatments are needed.

Every person with keratoconus is different.  Some employees with this condition, particularly those who are in the early stages, may not need any accommodation apart from time off for treatment or monitoring of their condition.  Others may be able to self-accommodate if given flexibility to adjust the lighting near their workstation.  Generally speaking however, accommodation needs of employees with keratoconus are likely to be similar to those of employees with other conditions resulting in low vision and photosensitivity.  The following link to information on accommodations for employees with vision impairment may be a good place to start when exploring accommodation ideas. http://askjan.org/media/visi.htm . Since computer access is a typical accommodation need, this link may also be helpful: http://askjan.org/soar/vision/readcomp.html.

As for photosensitivity, accommodating a person who is sensitive to light can take quite a bit of trial and error. It can be challenging to get enough light to work without triggering sensitivity symptoms. If the person knows what types of lighting and lamps work for them in other settings, there is a chance that similar lighting arrangement might be helpful at work. Below are suggestions that JAN consultants often make regarding accommodations for photosensitivity in office settings.

  1. Consider allowing telework for some or all of the week so that the employee may work in a setting where he or she can more easily control lighting.
  2. Consider use of floor to ceiling cubical walls so that fluorescent light is blocked from reaching the employee's work station.  Other options to block out overhead lighting include an office with a door, a cubicle roof, or even a patio umbrella installed over one's desk.
  3. Consider installing filters in fluorescent light fixtures to reduce the negative effects of fluorescent lights. Turning off overhead lights and using lamps may allow more control over lighting, especially for employees who need to work in low light.
  4. Consider use of full spectrum lighting to supplement natural light near employee's workstation if the individual does better with natural or full spectrum light.  If the individual is sensitive to full spectrum, natural light, or UV, consider other options.
  5. For individuals who are sensitive to flickering, consider use of alternative lighting such as incandescent or LED lighting.
  6. Consider modifying dress codes to allow the employee to wear items to help reduce the effects of fluorescent light, such as sunglasses or hats with brims.
  7. Explore accommodations to enhance concentration such as reducing background noise or allowing the employee to listen to music through headphones while working.
  8. If the person does better with natural light, try to place him near a window.
  9. If the person needs more control over the light in his workspace or is sensitive to UV, windows can be problematic.  Consider moving the person away from windows or installing appropriate window coverings.

At later stages of keratoconus, more time off for treatment and recovery from surgeries may be needed.  Another accommodation that may be needed as the condition progresses is a modified schedule to allow for use of public transportation or other means of alternative transportation or to accommodate limitations related to night driving.  Depending on the situation, telework may be another accommodation to consider when commuting issues arise.  You can find more information about telework in the JAN website at http://askjan.org/topics/telework.htm

For more information on accommodating employees with keratoconus, please contact JAN.

Another resource providing information, support, and advocacy for individuals with keratoconus is the National Keratoconus Foundation (NKCF).  You can find the NKCF online at http://www.nkcf.org/


MedlinePlus A service of the U.S. National Library of Medicine National Institutes of Health. (2002). Retrieved October 29, 2014 from http://www.nlm.nih.gov/medlineplus/ency/article/001013.htm

NKCF National Keratoconus Foundation. (2014). http://www.nkcf.org/

Teresa Goddard, M.S., Senior Consultant, Sensory Team

6 - JAN Blog Growing

The Ask JAN Blog provides an opportunity for you to share with others your workplace accommodation solutions. JAN receives over 40,000 contacts per year – conversations with all of you that help us better understand what’s working effectively in your workplaces. We have a great deal to learn from one another. We encourage you to share your experiences and interact with the JAN staff. Your accommodation success stories can benefit many others around the Nation. Enjoy the new postings!

Become a part of the new JAN blogging community!

7 - JAN Releases New Resources

8 - E-vents

9 - JAN Exhibit and Training Schedule

Events of particular interest: Get the most up-to-date and comprehensive training on employing people with disabilities. To view the complete JAN travel schedule go to JAN-on-the-Road.

10 - Subscribe to JAN Newsletter

To subscribe to or unsubscribe from JAN Updates:

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This document was developed by the Job Accommodation Network, funded by a cooperative agreement from the U.S. Department of Labor, Office of Disability Employment Policy (DOL079RP20426). The opinions expressed herein do not necessarily reflect the position or policy of the U.S. Department of Labor. Nor does mention of tradenames, commercial products, or organizations imply endorsement by the U.S. Department of Labor.


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