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Fourth Circuit Rules Employees With Gender Dysphoria Protected Under Americans With Disabilities Act – Discrimination, Disability & Sexual Harassment


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On August 16, 2022, the Fourth Circuit Court of Appeals issued
its landmark decision, Williams v. Kincaid, holding that gender
dysphoria qualifies as a disability under the Americans with
Disabilities Act (ADA) and Rehabilitation Act. The Fourth Circuit
is the first Federal Court of Appeals to make this ruling.


Ms. Williams, a transgender woman with gender dysphoria, was
incarcerated in a Virginia correctional facility. She alleged that
the defendants violated the ADA when they transferred her from
women’s housing to men’s housing after discovering she was
a transgender woman. Ms. Williams further asserted that defendants
delayed her medical treatment for gender dysphoria and that she
experienced harassment by inmates and prison officials. After her
release, Ms. Williams filed a lawsuit under Section 1983 alleging
violations of the ADA, the Rehabilitation Act, and Virginia common
law. Upon consideration of a motion to dismiss, the trial court
dismissed Ms. Williams’ ADA and Rehabilitation Act claims
because it held that gender dysphoria did not constitute a

On appeal to the Fourth Circuit, the defendants conceded that
gender dysphoria met the definition of a “disability.”
The ADA broadly defines “disability” as “a physical
or mental impairment that substantially limits one or more major
life activities of such individual.” 42 U.S.C. §
12102(1)(A). However, the ADA excludes from this definition
“gender identity disorders not resulting from physical
impairments.” Id. § 12211(b). Based on this
exclusion, defendants argued that Ms. Williams’ claims under
the statutes failed. The Fourth Circuit rejected this argument and
reversed and remanded the matter to the trial court for further

Is “Gender Dysphoria” Covered Under the ADA?

The Fourth Circuit indicated the ADA and Rehabilitation Act
provide identical protection “with respect to the matters at
issue in this case.” The Court, therefore, combined the two
claims and principally analyzed the ADA claim.

In reaching its decision, the Fourth Circuit looked towards the
medical community to facilitate its interpretation of “gender
dysphoria” under the ADA umbrella. The World Professional
Association for Transgender Health Standards of Care defines
“gender dysphoria” as a “discomfort or distress that
is caused by a discrepancy between a person’s gender identity
and that person’s sex assigned at birth.” The Court
further assessed the American Psychiatric Association’s
definition of “gender dysphoria”—the
“clinically significant distress” felt by some of those
who experience “an incongruence between their gender identity
and their assigned sex.”

After analyzing Supreme Court precedent, Circuit Court
precedent, congressional intent, and advances in the medical
community, the Fourth Circuit determined gender dysphoria is
encompassed by the Act, and does not fall within the “gender
identity disorders” which Congress intended to exclude from
the Act’s protections. Notably, “gender dysphoria”
did not exist as a diagnosis in 1990 when Congress enacted the ADA.
The Court further emphasized that “a diagnosis of gender
dysphoria, unlike that of ‘gender identity disorder,’
concerns itself with distress and other disabling
symptoms, rather than simply being transgender.

The Fourth Circuit also agreed with Ms. Williams’
alternative argument—even if “gender dysphoria” and
“gender identity disorder” were not categorically
distinct, her gender dysphoria, as alleged in the complaint, falls
within the ADA’s safe harbor for “gender identity
disorders . . . resulting from physical impairments.”
In Williams’ case specifically, her long tenure of hormone
therapy persuaded the Court to hold that the allegations set forth
in the complaint warranted an inference that her gender dysphoria
results from physical impairments. As a result, the Fourth Circuit
held that the district court erred in dismissing the claims on this
alterative basis.

Employers’ Obligations Under the ADA and the Effect of the
Williams Decision

Employers are obligated to engage in the interactive process
with employees who are qualified individuals with a disability
under the ADA. The Act covers individuals who are qualified to
perform the essential functions of the job with or without
reasonable accommodation. It is important to note that ADA
protections also extend to individuals who have a record of a
substantially limiting impairment and individuals who are regarded
as having a substantially limiting impairment. This ruling also
affords employees with gender dysphoria the ADA’s protections
against harassment, retaliation, and discrimination.

The Fourth Circuit encompasses Maryland, North Carolina, South
Carolina, Virginia, and West Virginia. Employers with employees in
these five states should train Human Resources personnel on any
types of medical procedures or treatments associated with gender
dysphoria as such qualified individuals will be entitled to the
interactive process and a reasonable accommodation. By way of
example, accommodations could branch from medical treatments,
hormone therapy, leaves of absences, shift assignments, housing
sponsored by employers, and restroom usage. Employers should begin
to understand where accommodations may need to be afforded for
employees with gender dysphoria. An expanded definition calls for a
careful look at compliance.

The content of this article is intended to provide a general
guide to the subject matter. Specialist advice should be sought
about your specific circumstances.

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