Inflammatory bowel disease (IBD) is a group of inflammatory conditions of the large intestine and/or small intestine. It is estimated that more than 1 million Americans suffer from IBD. Symptoms of IBD may not only cause marked restrictions and limitations on routine daily activities and social functioning, but may also be severe enough to affect the ability to perform occupational duties. The direct costs are considerable, but the indirect effects of these illnesses on the lives of patients in their working years have yet to be completely described. This chapter is intended to give clinicians insight into relevant legislation and governmental agencies that can assist patients in preserving their productivity and well-being.

Some of the most common symptoms of IBD include abdominal pain, nausea, vomiting, diarrhea, anemia, fatigue, and exhaustion. These symptoms can cause restrictions and limitations that may include, but are not limited to, the following:

The symptoms of IBD, as set forth in the previous section, affect not only a patient’s ability to engage in activities of daily living, but also their ability to work. This results in the patient looking to their physician not only for treatment of IBD, but also for assistance with legal claims. Whether the patient needs approval of sick leave, approval of leave under the Family Medical Leave Act (FMLA), or an accommodation at work under the Americans with Disabilities Act (ADA) or is filing an application for disability benefits, the treating physician has a crucial role to play.

Medical information is at the heart of all of the above-mentioned issues, which can be as crucial to your patient’s quality of life as the medical treatment provided. These issues can determine, for example, whether a patient gets to keep a job, maintain health insurance, obtain monthly disability income, or even lose their homes.
Not only the patient but also the employer, the insurance company, and government agencies are looking to the treating physician for answers.

Treating physicians should be responsive to the legal needs of their patients that depend on medical information. At such time, as a patient makes it known to his treating physician that he or she is having symptoms that are making it difficult to work, it is particularly important to include in the clinical records of the visit the relevant subjective symptoms such as pain and fatigue related by the patient, as well as reported limitations on activities such as walking or lifting and side effects of medication. In addition, as appropriate, physicians should include their opinions as to limitations on activities.

It is also important that physicians accurately complete forms related to these issues that address limitations on work activities such as frequency of bathroom breaks, severity and frequency of abdominal pain, and severity of fatigue, among other questions. The answers to these questions are not always obvious and may not be objectively quantifiable. To appropriately complete these forms may require additional time spent obtaining this information from the patient, and physicians can, if necessary, charge reasonable fees for these services. To do this properly, the physician must also protect their patient’s right to privacy. No information should be sent out without proper written authorization from the patient as required by the Health Insurance Portability and Accountability Act (HIPAA). When third-party forms addressing work limitations are completed, it is recommended that physicians not only keep a copy of these forms in the patient’s chart, but also provide the patient a copy of these forms.

The ADA was created with the purpose of reducing discrimination in the workplace on the basis of disabilities. Specifically, the ADA of 2008 makes it unlawful to discriminate in employment against a qualified individual with a disability. The ADA also outlaws discrimination against individuals with disabilities in state and local government services, public accommodations, transportation, and telecommunications. Employment discrimination protection is enforced by the Equal Employment Opportunity Commission (EEOC) and state and local civil rights enforcement agencies that work with the commission.

Job discrimination against people with disabilities is illegal if practiced by private employers, local governments, employment agencies, labor organizations, and labor-management committees. Federal employees are similarly protected by a separate federal law, the Rehabilitation Act of 1973, and state employees are generally entitled to similar protection under state law. The part of the ADA enforced by the EEOC outlaws job discrimination by all private employers with 15 or more employees after July 26, 1994.

Under the ADA, those with disabilities who are qualified for a job are protected from discrimination on the basis of disability. Physical or mental impairments that substantially limit a major life activity is considered a protected disability under the ADA. The ADA can also protect individuals who have a history of disability or when an employer believes an individual has a disability that they may not actually have.

To be protected under the ADA, there must be a record of a substantial, as opposed to a minor, impairment. A substantial impairment is one that significantly limits or restricts a major life activity such as hearing, seeing, speaking, walking, breathing, performing manual tasks, caring for oneself, learning, or working.

Those with disabilities must also be qualified to perform the essential functions or duties of a job, with or without reasonable accommodation, in order to be protected by the ADA. This requires two elements. First, the employer’s requirements
for the job, such as education, employment experience, skills, or licenses, must be met. Second, the employee must be able to perform the essential functions of the job with or without reasonable accommodation.

The definition of reasonable accommodation, as defined by the U.S. EEOC, is as follows:

Reasonable accommodation is any change or adjustment to a job or work environment that permits a qualified applicant or employee with a disability to participate in the job application process, to perform the essential functions of a job, or to enjoy benefits and privileges of employment equal to those enjoyed by employees without disabilities. Examples of reasonable accommodation for symptoms of IBD may include the following:

An employer is required to provide a reasonable accommodation to a qualified applicant or employee with a disability unless the employer can show that the accommodation would be an undue hardship—that is, that it would require significant difficulty or expense.

The ADA makes it unlawful to discriminate in all employment practices such as the following:

It is also unlawful for an employer to retaliate against an employee for asserting rights under the ADA. The Act also protects those discriminated against due to a family, business, social, or other relationship or association with an individual with a disability.

Employers cannot ask prospective candidates or employees if they are disabled or about the nature or severity of their disability, but can ask if they are able to perform the duties of the job with or without reasonable accommodation. An employer can also ask individuals to describe or to demonstrate how, with or without reasonable accommodation, they will perform the duties of the job.