Employees with Chronic 

Fatigue Syndrome

Accommodation and Compliance Series
Practical Solutions • Workplace Success

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Preface

The Job Accommodation Network (JAN) is a service of the Office of Disability 

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Authored by Beth Loy, Ph.D. Updated 03/22/10.
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JAN’S ACCOMMODATION AND COMPLIANCE SERIES

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://askjan.org/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, 2006b). Typically, women 

are diagnosed with CFS two to four times as often as men (Mayo Clinic Staff, 2007).

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, n.d.). 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 postexertional malaise lasting more than 24 hours (National Center for Infectious Diseases, 

n.d.).

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.
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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, 2007). 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, 2006a). 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.
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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://askjan.org/corner/vol02iss04.htm.

When requesting an accommodation, do employees with CFS have to tell their 

employers that they have CFS?

Under the ADA, when an employee requests an accommodation, an employer can 

require sufficient medical documentation to determine whether the employee has a 

disability and needs the requested accommodation. According to the Equal Employment 

Opportunity Commission (EEOC), sufficient medical documentation can include the 

name of the medical condition. The employee may want to begin by giving a more 

general description of the condition, such as saying “I have chronic fatigue syndrome,” 

and see if that suffices. However, such a limited description does not tell the employer 

that the individual has an impairment that substantially limits a major life activity 

because it is vague.

To increase the chance that the employer will settle for the use of a vague term, the 

employee may want to provide a letter from his/her doctor that confirms the existence of 

"chronic fatigue syndrome,” but then goes on to give concrete information about how the 

condition substantially limits a major life activity. The inclusion of concrete information 

may satisfy the employer. However, if the employer insists on knowing the diagnosis 

and the individual refuses to divulge it, the employer probably has a valid reason to 

refuse to provide the requested accommodation.
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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:

Cognitive: 

• Provide written job instructions when possible 

• Prioritize job assignments and provide more structure

• Allow flexible work hours and allow a self-pace workload

• Allow periodic rest periods to reorient 

• Provide memory aids, such as schedulers or organizers 

• Minimize distractions 

• Reduce job stress 

Depression and Anxiety: 

• Reduce distractions in work environment

• Provide to-do lists and written instructions

• Remind employee of important deadlines and meetings

• Allow time off for counseling

• Provide clear expectations of responsibilities and consequences
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• Provide sensitivity training to co-workers

• Allow breaks to use stress management techniques

• Develop strategies to deal with work problems before they arise 

• Allow telephone calls during work hours to doctors and others for support 

• Provide information on counseling and employee assistance programs

Fatigue/Weakness:

• Reduce or eliminate physical exertion and workplace stress

• Schedule periodic rest breaks away from the workstation

• Allow a flexible work schedule and flexible use of leave time

• Allow work from home

• Implement ergonomic workstation design

• Provide a scooter or other mobility aid if walking cannot be reduced

Migraine Headaches:

• Provide task lighting

• Eliminate fluorescent lighting

• Use computer monitor glare guards

• Reduce noise with sound absorbent baffles/partitions, environmental sound 

machines, and headsets 

• Provide alternate work space to reduce visual and auditory distractions

• Implement a "fragrance-free" workplace policy

• Provide air purification devices

• Allow flexible work hours

• Allow periodic rest breaks

• Allow work from home

Photosensitivity: 

• Minimize outdoor activities between the peak hours of 10:00 am and 4:00 pm

• Avoid reflective surfaces such as sand, snow, and concrete 

• Provide clothing to block UV rays

• Provide “waterproof” sun-protective agents such as sunblocks or sunscreens

• Install low wattage overhead lights 

• Provide task lighting 

• Replace fluorescent lighting with full spectrum or natural lighting

• Eliminate blinking and flickering lights

• Install adjustable window blinds and light filters

Sleep Disorder: 

• Allow flexible work hours and frequent short breaks

• Allow work from home
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Temperature Sensitivity:

• Modify work-site temperature and maintain the ventilation system

• Modify dress code 

• Use fan/air-conditioner or heater at the workstation and redirect vents

• Allow flexible scheduling and work from home during extremely hot or cold 

weather 

• 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-athome 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.
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Products:

There are numerous products that can be used to accommodate people with limitations. 

JAN's Searchable Online Accommodation Resource (SOAR) at http://askjan.org/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.
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Resources

Job Accommodation Network

West Virginia University

PO Box 6080 

Morgantown, WV 26506-6080

Toll Free: (800)526-7234

TTY: (877)781-9403

Fax: (304)293-5407

jan@askjan.org

http://askjan.org

The Job Accommodation Network (JAN) is a free consulting service that provides 

information about job accommodations, the Americans with Disabilities Act (ADA), and 

the employability of people with disabilities. 

Office of Disability Employment Policy

200 Constitution Avenue, NW, Room S-1303

Washington, DC 20210

Toll Free: (866)633-7365

TTY: (877)889-5627

Fax: (202)693-7888

http://www.dol.gov/odep/

The Office of Disability Employment Policy (ODEP) is an agency within the U.S. 

Department of Labor. ODEP provides national leadership to increase employment 

opportunities for adults and youth with disabilities while striving to eliminate barriers to 

employment. 

Centers for Disease Control and Prevention

1600 Clifton Rd NE

Atlanta, GA 30333

Toll Free: (800)311-3435

Direct: (404)498-1515

http://www.cdc.gov

The Centers for Disease Control and Prevention are dedicated to protecting the health 

and safety of people - at home and abroad, providing credible information to enhance 

health decisions, and promoting health through strong partnerships.

Chronic Fatigue Immune Dysfunction Association of America

CFIDS Association of America

PO Box 220398

Charlotte, NC 28222-0398

Direct: (704)365-2343

Fax: (704)365-9755
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cfids@cfids.org

http://www.cfids.org

The CFIDS Association of America is the nation's leading charitable organization 

dedicated to conquering CFIDS, also known as chronic fatigue syndrome (CFS) and 

myalgic encephalomyelitis (M.E.). 

International Association for CFS/ME

27 N. Wacker Drive Suite 416

Chicago, IL 60606

Direct: (847)258-7248

Fax: (847)579-0975

Admin@iacfsme.org

http://www.iacfsme.org

IACFS/ME is a membership organization for clinicians as well as research and health 

care workers professionally engaged in CFS activities. 

National Chronic Fatigue and Fibromyalgia Syndrome Association

PO Box 18426

Kansas City, MO 64133

Direct: (816)737-1341

information@ncfsfa.org

http://www.ncfsfa.org

NCFFSA is an organization that educates and informs the public, patients and their 

families, and health professionals about the nature and impact of FMS. Services include 

response to inquiries, educational and resource materials, and referrals. 

National Organization for Rare Disorders 

55 Kenosia Avenue

PO Box 1968

Danbury, CT 06813-1968

Toll Free: (800)999-6673

Direct: (203)744-0100

TTY: (203)797-9590

Fax: (203)798-2291

orphan@rarediseases.org

http://www.rarediseases.org/

NORD is a unique federation of voluntary health organizations dedicated to helping 

people with rare "orphan" diseases and assisting the organizations that serve them. 

NORD is committed to the identification, treatment, and cure of rare disorders through 

programs of education, advocacy, research, and service.
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References

Chronic fatigue syndrome. Immunological Investigations, vol. 26, pages 269-273, 1997.

Equal Employment Opportunity Commission. (1992). A technical assistance manual on 

the employment provisions (title I) of the Americans with Disabilities Act. 

Retrieved September 5, 2008, from http://askjan.org/links/ADAtam1.html 

Mayo Clinic Staff. (2007). CFS. Retrieved September 5, 2008, from 

http://www.mayoclinic.com/invoke.cfm?id=DS00395

National Center for Infectious Diseases. (n.d.). Chronic fatigue syndrome. Retrieved 

September 5, 2008, from http://www.cdc.gov/ncidod/diseases/cfs/

National Center for Infectious Diseases. (2006a). Chronic fatigue syndrome: Treatment 

of patients with chronic fatigue syndrome. Retrieved July 1, 2005, from 

http://www.cdc.gov/cfs/cfstreatment.htm

National Center for Infectious Diseases. (2006b). Who is at risk? Retrieved July 1, 2005, 

from http://www.cdc.gov/cfs/cfsatrisk.htm
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This document was developed by the Job Accommodation Network, funded by a 

contract agreement from the U.S. Department of Labor, Office of Disability Employment 

Policy (DOL079RP20426). The opinions expressed herein do not necessarily reflect the 

position or policy of the U.S. Department of Labor. Nor does mention of trade names, 

commercial products, or organizations imply endorsement by the U.S. Department of 

Labor.