• Disabilities are mental or physical impairments that substantially limit one or more major life activities.

Disabilities are mental or physical impairments that substantially limit one or more major life activities.

Impairments are:

• Physiological disorders or conditions
• Cosmetic disfigurations
• Anatomical losses

If a particular procedure is purely cosmetic and elective, such as a nose job or tummy tuck, has no underlying condition involved, and the employee does not otherwise have an impairment, the employee would likely not have a disability.

If, on the other hand, a procedure is required to correct a cosmetic disfigurement, it could fall under the Americans with Disabilities Act (ADA). Some situations could start out being solely cosmetic but result in coverage under the ADA.

It would be impossible for the statute or the regulations to list all conditions that make up physical or mental impairments, and one medical condition may have very different effects on two individuals. The ADA regulations, however, provide the following examples of some kinds of impairments that will virtually always result in a determination of disability:

• Deafness
• Blindness
• Intellectual disabilities
• Partially or completely missing limbs
• Mobility impairment
• Autism
• Cancer
• Cerebral palsy
• Diabetes
• Epilepsy
• HIV infection
• Multiple sclerosis
• Muscular dystrophy
• Major depression
• Bipolar disorder
• Post-traumatic stress disorder
• Obsessive compulsive disorder
• Schizophrenia

This list is not comprehensive. The determination of whether someone has a disability is a fact-based inquiry. When an applicant or employee requests a workplace change due to a medical condition, the focus should be on the change, not the disability.

The ADA specifically excludes some conditions from being disabilities, such as transvestism, transsexualism, pedophilia, exhibitionism, voyeurism, gender identity disorders not resulting from physical impairments, other sexual behavior disorders, compulsive gambling, kleptomania, pyromania, or psychoactive substance use disorders resulting from current illegal use of drugs.

In August 2022, the Fourth Circuit Court of Appeals, however, was the first appellate court to hold that gender dysphoria can be a disability under the ADA. The case was Williams v Kincaid, No. 21-2030.

When the ADA was written in 1990, the medical community did not acknowledge gender dysphoria either as an independent diagnosis or as a subset of any other condition. The term “gender identity disorders” was removed from the most recent Diagnostic and Statistical Manual DSM (5th ed. 2013), and the diagnosis of “gender dysphoria” was added. This signals a difference between the definitions of the two terms — gender identity disorder and gender dysphoria. Now, the latter is “clinically significant distress” felt by some of those who experience “an incongruence between their gender identity and their assigned sex” that could result in intense anxiety, depression, suicidal ideation, and even suicide.”