ADA Covers Gender Dysphoria
On appeal, the U.S. Court of Appeals for the Fourth Circuit reversed the dismissal of the plaintiff’s claims. Noting that it was an issue of first impression for the federal appellate courts, the Fourth Circuit held that gender dysphoria is not excluded from the ADA’s protections. In doing so, the appellate court highlighted “Congress’ command to construe the ADA as broadly as the text permits.” The appellate court also concluded that the plaintiff’s claim should survive because she sufficiently alleged that her condition had a physical basis. It then remanded the case to the district court for further proceedings.
Medical Advances Render the ADA’s Exclusion Inapplicable
The Fourth Circuit first analyzed the plaintiff’s argument that gender dysphoria “categorically” is not a gender identity disorder excluded by the ADA. Because the ADA does not define gender identity disorders, the appellate court examined a medical text in use at the time of the ADA’s enactment. The court placed importance on the treatment of gender identity disorders in the 1990 version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R). At that time, “the gender identity disorder diagnosis marked being transgender as a mental illness,” the court summarized. However, the gender dysphoria diagnosis did not exist.
Since 1990, there have been substantial advances in medical understanding, the appellate court explained. Hence, the most recent DSM-5 removed the “obsolete” gender identity disorder diagnosis and added the gender dysphoria diagnosis, which involves “clinically significant distress.” This revision shows that there is a meaningful difference between the two terms, the Fourth Circuit concluded.
The Fourth Circuit also found support for its holding in the ADA’s 2008 amendments. Because Congress specified that the statute should be construed to provide “maximum protection” for the disabled, the appellate court declined to adopt an “unnecessarily restrictive” reading of the ADA. “We cannot add to the ADA’s list of exclusions when Congress has not chosen to do so itself,” the court explained.
Plaintiff Also Covered Because of a Physical Impairment
The Fourth Circuit also considered the plaintiff’s alternative argument that her condition is covered by the ADA because it results from a physical impairment. Given the broad scope of the ADA, the Fourth Circuit held that the plaintiff had pled sufficient facts to avoid dismissal. The Fourth Circuit acknowledged that courts do not generally have the expertise to determine the causes of gender dysphoria. Thus, it found that “at this early stage, to dismiss a case based on such ‘unknowns’ would be wholly ‘premature and speculative.’” “In particular, the need for hormone therapy may well indicate that her gender dysphoria has some physical basis,” the court held.
Dissent: “Lingual Gymnastics” Cannot Save ADA Claim
But the Fourth Circuit’s panel decision was not unanimous. The dissent argued that applying the plain language of the statute and basic principles of statutory construction should result in the dismissal of the plaintiff’s ADA claim. Like the majority, the dissent focused on the gender identity disorder exclusion and examined the meaning of this term when the ADA was enacted. After analyzing the 1990 version of the DSM, the dissent concluded that “when the ADA was signed into law, gender identity disorder was understood to include what [the plaintiff] alleges to be gender dysphoria.”
Although the dissent emphasized that it was not making a value judgment about those with gender dysphoria or the broader transgender community, the opinion included strong criticism of the plaintiff’s position. Quoting Lewis Carroll’s Through the Looking Glass, the dissent said that the plaintiff was not permitted, “like Humpty Dumpty, to use a word and declare it means just what I choose it to mean.”
The dissent also rejected the plaintiff’s claim that her disorder resulted from a physical impairment. The plaintiff’s allegations about hormone therapy are insufficient because they concern a medical treatment—not a physical impairment—as required by the ADA, the dissent concluded.
After the issuance of the decision, the defendants petitioned for rehearing en banc. But after a close vote, the Fourth Circuit denied the petition for rehearing.
Section Leaders Agree with the Fourth Circuit’s Conclusion
“Whether you look at the object and purpose of the ADA or adopt a more textualist approach, it is clear that the Fourth Circuit panel reached the correct conclusion,” posits Nicholas Brancolini, Beverly Hills, CA, cochair of the Section’s LGBT Law & Litigator Committee. The plaintiff’s “mistreatment was in direct conflict with the ADA’s goal,” he elaborates. Further, “the defendants relied on ADA exclusions which do not include gender dysphoria,” he explains.
The plaintiff may have also benefited from the procedural posture of the case on appeal. “The circuit was reversing a motion to dismiss, so there was a very low threshold for the plaintiff to overcome,” notes Rebecca Sha, Jefferson, LA, cochair of the Section’s Diversity, Equity & Inclusion Committee. Additionally, “the ADA amendments really did expand the definition of disability, and the appellate court was dealing with an exclusion in a statute whose purpose is very broad,” Sha maintains. Ultimately, “the combination of the two—the procedural posture and the ADA amendments—led to the Fourth Circuit’s ruling,” she contends.
The ADA amendments also likely had a significant impact on this outcome. “Congress’s 2008 amendments to the ADA explicitly called for the broadest construction of the definition of disability,” Brancolini notes. “If there is any doubt, you have to find that the ADA covers a disability,” agrees Sha.
More Litigation Expected over Gender Dysphoria
The Fourth Circuit pointed out that it was the first federal appellate court to examine whether the ADA covers gender dysphoria. But U.S. District Courts for the Southern District of Illinois, District of Massachusetts, District of Idaho, and Eastern District of Pennsylvania have likewise held that gender dysphoria is protected by the ADA. Contrastingly, U.S. District Courts for the Southern District of Ohio and Middle District of Georgia have concluded that gender dysphoria is excluded from the ADA’s definition of disability.
“This is an increasing area of litigation, and a growing number of district court decisions are coming in on it,” observes Sha. Section leaders predict that this trend will continue and that more circuit courts will weigh in on whether the ADA applies to gender dysphoria. The Fourth Circuit is “taking a leading role, and certain circuits will follow suit,” Sha anticipates.
But other federal appellate decisions do not necessarily mean legal harmony. “While some circuits may follow suit, I suspect there are a number of rightwing activist circuits, like the Fifth Circuit, which will relish the opportunity to split from the Fourth Circuit’s decision,” Brancolini remarks. “Rightwing activist judges have demonstrated an interest in limiting the rights of transgender folks by judicial fiat,” he asserts. “I suspect a number of rightwing circuits feel confident that a circuit split provides the conservative supermajority on the U.S. Supreme Court an opportunity to endorse their conservative interpretation, regardless of the ADA’s purpose, history, or language,” Brancolini predicts.
Employers Should Assume Medical Conditions Qualify
Williams breaks new ground at the federal appellate level in finding that gender dysphoria is an ADA-recognized disability, even if other circuits might later decide otherwise. Regardless, Sha reiterates advice that she regularly gives employers: “With the ADA, it is important that employers give the benefit of the doubt to employees,” Sha counsels. “Do not question medical diagnoses. Employers should listen to what employees’ doctors are saying and engage in an interactive process with employees,” she recommends.