Accommodation and Compliance Series:
Employees with Multiple Sclerosis
JAN’s Accommodation and Compliance Series is designed to help employers determine effective accommodations and comply with Title I of the Americans with Disabilities Act (ADA). Each publication in the series addresses a specific medical condition and provides information about the condition, ADA information, accommodation ideas, and resources for additional information.
The Accommodation and Compliance 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.
How prevalent is MS?
According to the National Multiple Sclerosis Society, approximately 400,000 Americans acknowledge having MS, and every week about 200 people are diagnosed. Worldwide, MS occurs with much greater frequency in higher latitudes (above 40° latitude) away from the equator, than in lower latitudes, closer to the equator (National Multiple Sclerosis Society, n.d.).
MS is more common among Caucasians (particularly those of northern European ancestry) than other races, and is almost unheard of in some populations, such as Eskimos. Certain outbreaks or clusters of MS have been identified, but their significance is not known. In certain populations, a genetic marker has been linked to MS. A particular genetic trait occurs more frequently in people with MS than in those who do not have the disease (National Multiple Sclerosis Society, n.d.).
The average age of onset is usually between 20 and 50, although it also can occur in older individuals. MS is twice as common in women compared to men (National Multiple Sclerosis Society, n.d.).
What is MS?
MS is a chronic autoimmune 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 neurologic symptoms occurring at different locations throughout the body. The progress, severity, and specific symptoms of MS in any one person cannot yet be predicted, but advances in research and treatment are giving hope to those affected by the disease (National Multiple Sclerosis Society, n.d.).
What are the symptoms of MS?
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. Possible symptoms include fatigue, loss of coordination, muscle weakness, spasticity, numbness, slurred speech, visual difficulties, paralysis, muscle cramps, bladder or bowel problems, and sexual dysfunction (National Multiple Sclerosis Society, n.d.).
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 (National Multiple Sclerosis Society, n.d.).
What causes MS?
Studies show that MS is the result of a number of factors rather than a single factor. Most likely, genetics plays a role in determining a person's susceptibility to MS. The disease is not entirely genetically controlled, although first-degree relatives of individuals with MS have a 20- to 40-fold increased risk of developing the disease. Exposure to environmental factors, such as a virus or bacteria, also plays a role, although the specific factors have not yet been identified. Another likely factor is a defective regulation of the normal immune response that leads to unwarranted attacks by the body's defense mechanisms (an auto-immune process) (National Multiple Sclerosis Society, n.d.).
How is MS treated?
According to the National Multiple Sclerosis Society, there are currently several federally approved medications that treat MS. Four of them: Avonex, Betaseron, Rebif, and Copaxone have been shown to be effective in modifying the natural course of relapsing MS. Clinical experience suggests they are most effective if taken early in the disease. Another drug, Novantrone, is effective in slowing down MS that is rapidly worsening or becoming progressive. Steriods may be used to shorten acute attacks. Many other therapies are being clinically tested, and researchers feel hopeful that more treatments for MS will be available in the near future. In addition to medications, there are also many therapies to moderate or relieve MS symptoms, including physical therapy, exercise, vocational and cognitive rehabilitation, attention to diet, adequate rest, and counseling (National Multiple Sclerosis Society, n.d.).
Is MS 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 on a case by case basis (EEOC Regulations . . . , 2011). 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 an impairment (EEOC Regulations . . . , 2011).
However, according to the Equal Employment Opportunity Commission (EEOC), the individualized assessment of virtually all people with MS will result in a determination of disability under the ADA; given its inherent nature, MS will almost always be found to substantially limit the major life activity of neurological function (EEOC Regulations . . . , 2011).
When requesting an accommodation, do employees with MS have to tell their employers that they have MS?
Under the ADA, when an employee requests an accommodation, an employer can require sufficient medical documentation to determine whether the employee has a disability and needs the requested accommodation. According to the EEOC, sufficient medical documentation can include the name of the medical condition (EEOC, 2000). The employee may want to begin by giving a more general description of the condition, such as saying “I have a neurological impairment,” and see if that suffices. However, such a limited description does not tell the employer that the individual has an impairment that substantially limits a major life activity because it is vague.
To increase the chance that the employer will settle for the use of a vague term, the employee may want to provide a letter from his/her doctor that confirms the existence of a "neurological impairment,” but then goes on to give concrete information about how the condition substantially limits a major life activity. The inclusion of concrete information may satisfy the employer. However, if the employer insists on knowing the diagnosis and the individual refuses to divulge it, the employer probably has a valid reason to refuse to provide the requested accommodation.
Note: People with MS 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 people with MS 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 employee with MS experiencing?
- How do these limitations affect the employee and the employee’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 possible resources being used to determine possible accommodations?
- Has the employee with MS been consulted regarding possible accommodations?
- Once accommodations are in place, would it be useful to meet with the employee with MS to evaluate the effectiveness of the accommodations and to determine whether additional accommodations are needed?
- Do supervisory personnel and employees need training regarding MS?
Activities of Daily Living:
- Allow use of a personal attendant at work
- Allow use of a service animal at work
- Make sure the facility is accessible
- Move workstation closer to the restroom
- Allow longer breaks
- Refer to appropriate community services
- Provide written job instructions when possible
- Prioritize job assignments
- Allow flexible work hours
- Allow periodic rest breaks to reorient
- Provide memory aids, such as schedulers or organizers
- Minimize distractions
- Allow a self-paced workload
- Reduce job stress
- Provide more structure
- Reduce or eliminate physical exertion and workplace stress
- Schedule periodic rest breaks away from the workstation
- Allow a flexible work schedule and flexible use of leave time
- Allow work from home
- Implement ergonomic workstation design
- Provide a scooter or other mobility aid if walking cannot be reduced
Fine Motor Impairment:
- Implement ergonomic workstation design
- Provide alternative computer access
- Provide alternative telephone access
- Provide arm supports
- Provide writing and grip aids
- Provide a page turner and a book holder
- Provide a note taker
Gross Motor Impairment:
- Modify the work-site to make it accessible
- Provide parking close to the work-site
- Provide an accessible entrance
- Install automatic door openers
- Provide an accessible restroom and break room
- Provide an accessible route of travel to other work areas used by the employee
- Modify the workstation to make it accessible
- Adjust desk height if wheelchair or scooter is used
- Make sure materials and equipment are within reach range
- Move workstation close to other work areas, office equipment, and break rooms
- Reduce work-site temperature
- Use cool vest or other cooling clothing
- Use fan/air-conditioner at the workstation
- Allow flexible scheduling and flexible use of leave time
- Allow work from home during hot weather
- Provide speech amplification, speech enhancement, or other communication device
- Use written communication, such as email or fax
- Transfer to a position that does not require a lot of communication
- Allow periodic rest breaks
- Magnify written material using hand/stand/optical magnifiers
- Provide large print material or screen reading software
- Control glare by adding a glare screen to the computer
- Install proper office lighting
- Allow frequent rest breaks
Situations and Solutions
A claims representative for a government agency was having difficulty reading files due to vision impairment caused by MS. His employer purchased a stand magnifier and added task lighting to his workstation.
A manager with MS working for a publishing company was having difficulty transferring from her wheelchair to the toilet in the employee restroom. Her employer installed additional grab bars.
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.
An operations clerk for a large distribution center was having difficulty working at full production due to fatigue caused by MS. Her employer moved her to a shift that was not as busy so caused less stress and made less physical demands of the clerk. The clerk was also able to take more frequent breaks on the new shift.
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.
A resource nurse with MS was having difficulty accessing her workstation. Her employer widened the floor space in her workstation to allow her easier access from her wheelchair and added an adjustable keyboard tray, monitor holder, and telephone tray. In addition, the employee was provided a flexible schedule so she could continue her medical treatment.
A clerical worker was having difficulty concentrating and remembering job tasks due to cognitive impairment caused by MS. Her employer added sound-baffle panels to reduce distractions in her work area. In addition, her employer gave her written job duties at the beginning of each day and provided a notebook that contained outlines of what each job duty entailed.
A teacher with MS was having difficulty communicating with students because his speech became soft and slurred when he was fatigued. He was given a personal speech amplifier so he would not have to strain to project his voice, and he was allowed to schedule his classes so he could take periodic breaks.
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.
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. (2000). Enforcement guidance on disability-related inquiries and medical examination of employees under the Americans with Disabilities Act. Retrieved December 21, 2011, from http://www.eeoc.gov/policy/docs/guidance-inquiries.html
National Multiple Sclerosis Society. (n.d.). FAQs about MS. Retrieved December 21, 2011, from http://www.nationalmssociety.org/about-multiple-sclerosis/what-we-know-about-ms/faqs-about-ms/index.aspx