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Accommodation and Compliance Series:
Employees with Chronic Fatigue Syndrome
By Beth Loy, Ph.D.

Preface

Introduction

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://www.jan.wvu.edu/soar.

Information about Chronic Fatigue Syndrome (CFS)

How prevalent is CFS?

It is estimated that perhaps as many as half a million persons in the United States have a CFS-like condition (National Center for Infectious Diseases, 2005c). Typically, women are diagnosed with CFS two to four times as often as men (Mayo Clinic Staff, 2005).

What is CFS?

In order to receive a diagnosis of CFS, a patient must satisfy two criteria. First, an individual must have severe chronic fatigue of six months or longer duration with other known medical conditions excluded by clinical diagnosis (National Center for Infectious Diseases, 2005a). Second, an individual must concurrently have four or more of the following symptoms: substantial impairment in short-term memory or concentration; sore throat; tender lymph nodes; muscle pain; multi-joint pain without swelling or redness; headaches of a new type, pattern, or severity; unrefreshing sleep; and post-exertional malaise lasting more than 24 hours (National Center for Infectious Diseases, 2005a).

What are the symptoms of CFS?

In addition to the primary defining symptoms of CFS, some CFS patients have reported a number of other symptoms. They include abdominal pain, alcohol intolerance, bloating, chest pain, chronic cough, diarrhea, dizziness, dry eyes or mouth, earaches, irregular heartbeat, jaw pain, morning stiffness, nausea, night sweats, photosensitivity, shortness of breath, skin sensations, tingling sensations, and weight loss. A majority of CFS patients also report mild to moderate symptoms of anxiety or depression.

What causes CFS?

CFS may occur after an infection such as a cold or viral syndrome, and it can start during or shortly after a period of high stress or come on gradually without any clear starting point or any obvious cause (Mayo Clinic Staff, 2005). Research about CFS indicates the possibility that sudden onset CFS might be related to an infectious disease, while gradual onset CFS may be triggered by factors such as physical environment or stress (Chronic fatigue . . ., 1997).

How is CFS treated?

A variety of therapeutic approaches have been described as benefiting patients with CFS, and because no cause for CFS has been identified and the cause remains unknown, treatment programs are directed at relief of symptoms (National Center for Infectious Diseases, 2005b). There is no proven cure for CFS, although lifestyle modifications may make symptoms more manageable. The treatment of CFS focuses on symptom management, e.g., aspirin and ibuprofen for pain and headache relief. Some individuals with CFS benefit from a healthy diet; antidepressant, antianxiety, and sleep disorder drugs; and behavioral therapy. In addition, relaxation and stress reduction techniques may be beneficial.

CFS and the Americans with Disabilities Act

Is CFS 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 CFS 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 more information about how to determine whether a person has a disability under the ADA, visit http://www.jan.wvu.edu/corner/vol02iss04.htm.

Accommodating Employees with CFS

(Note: People with CFS 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 CFS 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 employee with CFS experiencing?

2. How do these limitations affect the employee and the employee'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 possible resources being used to determine possible accommodations?

5. Has the employee with CFS been consulted regarding possible accommodations?

6. Once accommodations are in place, would it be useful to meet with the employee with CFS to evaluate the effectiveness of the accommodations and to determine whether additional accommodations are needed?

7. Do supervisory personnel and employees need training regarding CFS?

Accommodation Ideas:

Large Blue Triangle Bullet Cognitive:

Small Triangle Blue Bullet Provide written job instructions when possible
Small Triangle Blue Bullet Prioritize job assignments and provide more structure
Small Triangle Blue Bullet Allow flexible work hours and allow a self-pace workload
Small Triangle Blue Bullet Allow periodic rest periods to reorient
Small Triangle Blue Bullet Provide memory aids, such as schedulers or organizers
Small Triangle Blue Bullet Minimize distractions
Small Triangle Blue Bullet Reduce job stress

Large Blue Triangle Bullet Depression and Anxiety:

Small Triangle Blue Bullet Reduce distractions in work environment
Small Triangle Blue Bullet Provide to-do lists and written instructions
Small Triangle Blue Bullet Remind employee of important deadlines and meetings
Small Triangle Blue Bullet Allow time off for counseling
Small Triangle Blue Bullet Provide clear expectations of responsibilities and consequences
Small Triangle Blue Bullet Provide sensitivity training to co-workers
Small Triangle Blue Bullet Allow breaks to use stress management techniques
Small Triangle Blue Bullet Develop strategies to deal with work problems before they arise
Small Triangle Blue Bullet Allow telephone calls during work hours to doctors and others for support
Small Triangle Blue Bullet Provide information on counseling and employee assistance programs

Large Blue Triangle Bullet Fatigue/Weakness:

Small Triangle Blue Bullet Reduce or eliminate physical exertion and workplace stress
Small Triangle Blue Bullet Schedule periodic rest breaks away from the workstation
Small Triangle Blue Bullet Allow a flexible work schedule and flexible use of leave time
Small Triangle Blue Bullet Allow work from home
Small Triangle Blue Bullet Implement ergonomic workstation design
Small Triangle Blue Bullet Provide a scooter or other mobility aid if walking cannot be reduced

Large Blue Triangle Bullet Migraine Headaches:

Small Triangle Blue Bullet Provide task lighting
Small Triangle Blue Bullet Eliminate fluorescent lighting
Small Triangle Blue Bullet Use computer monitor glare guards
Small Triangle Blue Bullet Reduce noise with sound absorbent baffles/partitions, environmental sound machines, and headsets
Small Triangle Blue Bullet Provide alternate work space to reduce visual and auditory distractions
Small Triangle Blue Bullet Implement a "fragrance-free" workplace policy
Small Triangle Blue Bullet Provide air purification devices
Small Triangle Blue Bullet Allow flexible work hours
Small Triangle Blue Bullet Allow periodic rest breaks
Small Triangle Blue Bullet Allow work from home

Large Blue Triangle Bullet Photosensitivity:

Small Triangle Blue Bullet Minimize outdoor activities between the peak hours of 10:00 am and 4:00 pm
Small Triangle Blue Bullet Avoid reflective surfaces such as sand, snow, and concrete
Small Triangle Blue Bullet Provide clothing to block UV rays
Small Triangle Blue Bullet Provide "waterproof" sun-protective agents such as sunblocks or sunscreens
Small Triangle Blue Bullet Install low wattage overhead lights
Small Triangle Blue Bullet Provide task lighting
Small Triangle Blue Bullet Replace fluorescent lighting with full spectrum or natural lighting
Small Triangle Blue Bullet Eliminate blinking and flickering lights
Small Triangle Blue Bullet Install adjustable window blinds and light filters

Large Blue Triangle Bullet Sleep Disorder:

Small Triangle Blue Bullet Allow flexible work hours and frequent short breaks
Small Triangle Blue Bullet Allow work from home

Large Blue Triangle Bullet Temperature Sensitivity:

Small Triangle Blue Bullet Modify work-site temperature and maintain the ventilation system
Small Triangle Blue Bullet Modify dress code
Small Triangle Blue Bullet Use fan/air-conditioner or heater at the workstation and redirect vents
Small Triangle Blue Bullet Allow flexible scheduling and work from home during extremely hot or cold weather
Small Triangle Blue Bullet Provide an office with separate temperature control

Situations and Solutions:

A customer service representative with CFS and memory and concentration problems had difficulty answering some customer questions. She was accommodated with written materials to help her remember information and a private office to reduce distractions.

A design engineer with CFS had difficulty working fulltime. He was allowed to work-at-home three days a week.

A student with CFS had difficulty keeping up with class notes. He was accommodated with a laptop computer to use in class.

An operating-room nurse with CFS had difficulty rotating schedules. She was accommodated with a permanent day schedule.

A teacher with CFS 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 daycare director with CFS had difficulty getting to work on time and maintaining a fulltime schedule. She was allowed a later start time and a part-time schedule.

A flight attendant with CFS was missing a lot of work due to fatigue. Her doctor recommended that she reduce the amount of traveling she was doing. She wanted to continue working fulltime so requested reassignment to an office job.

A school psychologist with CFS was having difficulty working at full production. She was allowed to schedule appointments in the morning, which gave her uninterrupted time in the afternoon to complete paperwork. She was also allowed to schedule several short rest breaks throughout the day and use of sick leave as needed.

A social worker with CFS 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.

Products:

There are numerous products that can be used to accommodate people with limitations. JAN's Searchable Online Accommodation Resource (SOAR) at http://www.jan.wvu.edu/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

Equal Employment Opportunity Commission. (1992). A technical assistance manual on the employment provisions (title I) of the Americans with Disabilities Act. Retrieved April 29, 2005, from http://www.jan.wvu.edu/links/ADAtam1.html

Missouri Chronic Fatigue Syndrome Rehabilitation Research and Training Center (n.d.). General chronic fatigue syndrome. Retrieved July 1, 2005, from http://marrtc.missouri.edu/conditions/general.html

National Chronic Fatigue Syndrome Foundation. (2003a). Chronic Fatigue Syndrome 101. Retrieved July 1, 2005, from http://www.chronic fatigue syndrome.org.sg/101/101.html

National Chronic Fatigue Syndrome Foundation. (2003b). Chronic Fatigue Syndrome answers. Retrieved July 1, 2005, from http://www.chronic fatigue syndrome.org/conditions/onlinebrochures/Chronic Fatigue Syndrome_Answers_brochure.pdf

National Chronic Fatigue Syndrome Foundation. (2004a). The facts about chronic fatigue syndrome. Retrieved July 1, 2005, from http://www.chronic fatigue syndrome.org/resources/gettingstarted/default.asp

National Chronic Fatigue Syndrome Foundation. (2004b). Principles of chronic fatigue syndrome management. Retrieved July 1, 2005, from http://www.chronic fatigue syndrome.org/resources/gettingstarted/management.asp

If you have a question about accommodations and/or the employment provisions of the Americans with Disabilities Act (ADA), click here:
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