Opinion ID: 2994956
Heading Depth: 2
Heading Rank: 2

Heading: Establishment of a Disability under

Text: the ADA
We first examine whether a jury could find that Mr. Lawson is disabled within the meaning of the ADA, such that he could establish the first part of his prima facie case. In an effort to prove that he was disabled under the Act’s definition, Mr. Lawson contended in the district court that his diabetes substantially limited him in the major life activity of eating. We now address his arguments in this regard. The ADA defines a disability as: (1) a physical or mental impairment that substantially limits one or more of the major life activities of an individual, (2) a record of such an impairment, or (3) being regarded as having such an impairment. 42 U.S.C. sec. 12102(2). With regard to the first method of demonstrating a disability, whether an individual has a physical or mental impairment that substantially limits one or more of the major life activities, the Supreme Court of the United States has instructed us to address the following inquiries: First, we consider whether [the individual’s claimed disability] was a physical impairment. Second, we identify the life activity upon which [the individual] relies . . . and determine whether it constitutes a major life activity under the ADA. Third, tying the two statutory phrases together, we ask whether the impairment substantially limited the major life activity. Bragdon v. Abbott, 524 U.S. 624, 631 (1998). We have no difficulty in determining that Mr. Lawson’s insulin-dependent diabetes and related medical conditions are physical impairments under the Act. As the district court noted, Mr. Lawson’s diabetes affects many of the organ systems in his body, including his metabolic, vascular, urinary, and reproductive systems as well as his joints and eyes, and negatively impacts his depression and high blood pressure. R.60 at 29; see also 45 C.F.R. sec. 84.3(j)(2)(i) (defining [p]hysical or mental impairment). We also conclude that eating is a major life activity as defined by the ADA. Equal Employment Opportunity Commission regulations interpreting the ADA define major life activity by providing a non-exhaustive list that includes functions such as caring for one’s self, performing manual tasks, walking, seeing, hearing, speaking, breathing, learning, and working. 29 C.F.R. sec. 1630.2(i); see also Sinkler v. Midwest Prop. Mgmt. Ltd. P’ship, 209 F.3d 678, 683 (7th Cir. 2000); cf. Bragdon, 524 U.S. at 638-39 (citing similarly worded Rehabilitation Act regulations). Such activities need not have a public or economic character to them; they must simply be central to the life process itself. Bragdon, 524 U.S. at 638. Clearly, the ability to eat is integral to one’s daily existence, as much or more so than the activities listed in the implementing regulations. As a result, we hold that eating constitutes a major life activity for purposes of the ADA. See Forest City Daly Hous., Inc. v. Town of North Hempstead, 175 F.3d 144, 151 (2d Cir. 1999) (eating is a major life activity for purposes of ADA coverage); Land v. Baptist Med. Ctr., 164 F.3d 423, 424 (8th Cir. 1999) (same); Erjavac v. Holy Family Health Plus, 13 F. Supp.2d 737, 746-47 (N.D. Ill. 1998) (same). The protections of the Act only apply, however, when it is demonstrated that the disability of the individual substantially limits a major life activity such as eating. The Supreme Court has held that, in determining whether a claimed disability is substantially limiting, we must examine the plaintiff’s condition as it exists after corrective or mitigating measures used to combat the impairment are taken into account. See Sutton, 527 U.S. at 482. Therefore, in Mr. Lawson’s case, we must consider the beneficial effects of his diabetes medication in determining whether his diabetic condition substantially limits his ability to eat. Here, we cannot accept the district court’s conclusion that Mr. Lawson could be substantially limited in his ability to eat only if his actual physical ability to ingest food is restricted. R.60 at 36. This construction of the statutory phrase substantially limits conflicts with the Supreme Court’s recognition that the ADA addresses substantial limitations on major life activities, not utter inabilities. Bragdon, 524 U.S. at 641. The district court failed to consider the extent of the restrictions imposed by Mr. Lawson’s treatment regimen and the consequences of noncompliance with that regimen. In doing so, the court prevented Mr. Lawson from showing that, although he is not incapable of ingesting food, his diabetes produces a substantial limitation on his ability to perform the basic life function of eating. The record contains undisputed testimony that, even when taking insulin, Mr. Lawson’s ability to regulate his blood sugar and metabolize food is difficult, erratic, and substantially limited. R.58, Ex.1 at 4 para. 18. Additionally, Lawson cannot simply eat when and where he wants to, or exert himself without concern for the effect the exertion will have on his glucose levels. . . . [Instead, he] must always concern himself with the availability of food, the timing of when he eats, and the type and quantity of food he eats. Id. para. 15. Moreover, the district court’s characterization of the impact that Mr. Lawson’s diabetes has on his ability to eat, described in its opinion as requiring simple dietary restrictions, R.60 at 37, belies the severity of the restrictions that he must follow if he is to avoid dire and immediate consequences. On a daily basis, Mr. Lawson must endure the discomfort of multiple blood tests to monitor his blood glucose levels. He also must adjust his food intake and level of exertion to take into account fluctuations in blood sugar. When his blood sugar drops, he must stop all other activities and find the kinds of food that will bring his levels back to normal or he will experience disabling episodes of dizziness, weakness, loss of mentation and concentration, and a deterioration of bodily functions. R.58, Ex.1 at 4 para. 14. Mr. Lawson’s physician characterized the measures he must take to manage his disease as a perpetual, multi-faceted and demanding treatment regime requiring continued vigilance. Id. at 3 para. 11. If Mr. Lawson fails to adhere strictly to this demanding regimen, the consequences could be dire: he could experience debilitating, and potentially life-threatening, symptoms. This evidence is sufficient for a jury to find that Mr. Lawson is substantially limited with respect to the major life activity of eating. See, e.g., Sutton, 527 U.S. at 491 (defining substantially limits as meaning considerable or specified to a large degree) (citation and internal quotation marks omitted). It is the severity of these limitations on his ability to eat that distinguishes Mr. Lawson’s situation from that of other individuals who must follow the simple dietary restrictions that medical conditions sometimes entail. See, e.g., Weber v. Strippit, 186 F.3d 907, 914 (8th Cir. 1999) (unspecified dietary restrictions prescribed for treatment of heart disease were moderate limitation[ ] on eating), cert. denied, 120 S. Ct. 794 (2000); Land, 164 F.3d at 425 (child with peanut allergy was not substantially limited in eating because allergy impacted her life only ’a little bit’ and only prohibited her from eating foods containing peanuts or their derivatives); Shields v. Robinson-Van Vuren Assocs., Inc., No. 98CIV8785DLC, 2000 WL 565191, at -5 (S.D.N.Y. Nov. 8, 2000) (person controlling diabetes with diet and exercise alone not substantially limited in ability to eat when only impact involved modifications to diet and eating habits, which were not severe enough); Ingles v. Neiman Marcus Group, 974 F. Supp. 996, 1001-02 (S.D. Tex. 1997) (person who managed non-insulin- dependent diabetes with oral medications and a ’normal, good, healthy diet’ with meals at regular intervals was not substantially limited in eating). Instead, Mr. Lawson’s severe dietary restrictions, and the dangerous consequences that could result from a failure to maintain them, are more analogous to other cases in which the potential for a substantial limitation on the ability to eat was found. See, e.g., Erjavac, 13 F. Supp.2d at 746 (issue of fact raised when insulin-dependent diabetic, viewed in treated form, must eat constantly to prevent blood sugar fluctuations, must stop all other activities and pursue . . . food[ ] when blood sugar drops, and must self-inject insulin several times a day); Gonsalves v. J.F. Fredericks Tool Co., 964 F. Supp. 616, 621 (D. Conn. 1997) (genuine issue of fact created when affidavit and deposition testimony produced evidence that diabetic plaintiff had difficulty eating and dizziness and blurry vision when his blood sugar level became high); Coghlan v. H.J. Heinz Co., 851 F. Supp. 808, 814-15 (N.D. Tex. 1994) (genuine issue of fact created when insulin-dependent diabetic, viewed in treated form, experienced hypoglycemia, creating debilitating state, that could only be alleviated by eating), rev’d on other grounds, Washington v. HCA Health Servs. of Texas, Inc., 152 F.3d 464, 469 (5th Cir. 1998), vacated, 527 U.S. 1032 (1999). These same considerations--the demands of the regimen and the effects of noncompliance--also make this case quite unlike the situation before the Supreme Court in Sutton. The wearing of corrective lenses to neutralize the effects of myopia, at issue in Sutton, 527 U.S. at 475, involves none of the coordination of multi- faceted factors or the constant vigilance that, according to this record, Mr. Lawson must demonstrate on a daily basis. Moreover, in Sutton, the Supreme Court noted that any negative side effects suffered by an individual resulting from the use of mitigating measures must be taken into consideration. Id. at 484; see also Moore v. J.B. Hunt Transport, Inc., 221 F.3d 944, 952 n.4 (7th Cir. 2000); Krocka v. City of Chicago, 203 F.3d 507, 513 (7th Cir. 2000). As we have previously noted, the multiple insulin injections that Mr. Lawson takes each day can cause symptoms of hypoglycemia, creating a condition where the level of glucose in his blood is too low. When Mr. Lawson’s blood sugar is reduced to such low levels, he suffers from symptoms including slur[red] speech, profuse sweating, paleness, shaking, unsteady walk, and fruity odor breath. R.41, Ex.2 at 4 para. 25. These symptoms will lead to dizziness, weakness, loss of mentation and concentration, and a deterioration of bodily functions if Mr. Lawson does not eat immediately. R.58, Ex.1 at 4 para. 14. The evidence thus shows that, every day of his life, Mr. Lawson must deal with the concern that the insulin he injects to treat his illness will itself bring about debilitating symptoms that can only be ameliorated by immediately eating certain foods. In explaining why mitigating measures should be taken into account in defining an ADA disability, Sutton indicated that [a] diabetic whose illness does not impair his or her daily activities, after utilizing medical remedies such as insulin, should not be considered disabled. Id. at 483. This statement does not mean, however, that no diabetic can ever be considered disabled under the ADA’s meaning. Such an approach would contradict the Court’s view that whether a person is disabled under the ADA is an individualized inquiry based on the particular circumstances of each case. See id. Moreover, as we have explained, the particular nature of Mr. Lawson’s diabetes, even after treatment, could be said to significantly impair his daily activities, unlike the situation in Sutton. Additionally, in Davidson v. Midelfort Clinic, Ltd., 133 F.3d 499 (7th Cir. 1998), this court also noted that in determining whether an impairment can be said to substantially limit the major life activity of the individual, a court ought to consider the nature and severity of the limitations, the actual or expected duration of the impairment, and the actual or anticipated long-term impact of the impairment. See id. at 506 n.3 (citing 29 C.F.R. sec. 1630.2(j)(2)). The record before us establishes that Mr. Lawson’s impairment is serious and severe. He has a life-long medical history of Type I diabetes, he suffers from a number of diabetes-related medical problems, and the very medication that he uses to control his diabetes causes severe symptoms that have potentially life-threatening consequences. The duration of the illness also seems to be well-established. Mr. Lawson was diagnosed with Type I diabetes soon after birth, a disease that will remain with him throughout his life. With respect to prognosis, Dr. Skierczynski predicted to a reasonable degree of medical certainty that even with continuous medical treatment and monitoring of his disease, Lawson has not been able to properly control his blood sugar levels for several years . . . and his medical condition will continue to deteriorate over time as a direct consequence of his diabetes. R.58, Ex.1 at 5 para. 19. From all the evidence in the record, a jury could find that the prescribed treatment Mr. Lawson must take to survive with diabetes causes symptoms that substantially limit the major life activity of eating. Therefore, the district court erred in holding that Mr. Lawson could not establish an issue of fact regarding the first part of his prima facie case under the McDonnell Douglas test.
As we have noted, the ADA also defines a disability as a record of a physical or mental impairment that substantially limits one or more of the major life activities. See 42 U.S.C. sec. 12102(2)(B). We believe that sufficient evidence exists that there is a record that Mr. Lawson’s diabetes has limited substantially his ability to work in a broad class of jobs. See Sutton, 527 U.S. at 491. Mr. Lawson testified that, in his younger years, he was in and out of hospitals quite a bit. R.41, Ex.3 at 32. He also indicated that he had frequent insulin reactions that caused him to drop items, get the shakes, headaches, and occasionally . . . pass out. Id. Dr. Skierczynski stated that Mr. Lawson continues to experience hyperglycemia and hypoglycemia and, indeed, endured a severe hypoglycemic reaction in 1995, when he became confused and briefly lost consciousness. R.58, Ex.1 at 2 para. 6(f). The record also contains evidence of numerous chronic or recurring medical conditions symptomatic of Mr. Lawson’s diabetes. Additionally, there is evidence that these maladies inhibited Mr. Lawson’s ability to maintain any significant employment for a number of years. Mr. Lawson maintains that soon after his high school graduation, between 1985 and 1986, he had to quit his job with a small construction company when he had a serious insulin reaction and could no longer work. R.41, Ex.2 at 2 para. 7. Moreover, in August 1986, Mr. Lawson’s application for SSDI benefits was granted, and he continued to receive total disability benefits until November 1998. During that 12-year period, the Social Security Administration (SSA) reviewed Mr. Lawson’s medical condition every two years and determined that he continued to meet its definition of disability, allowing Mr. Lawson continually to receive benefits./9 We believe that a jury could conclude, from this evidence, that Mr. Lawson can show that a record exists indicating that his diabetes has limited substantially his ability to work./10 Important in this determination is Mr. Lawson’s receipt of disability payments under the Social Security Act and the facts surrounding that determination. The Social Security Act provides income replacement to an individual who is under a disability, a term defined as an inability to engage in any substantial gainful activity by reason of any . . . physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months. 42 U.S.C. sec. 423(d)(1)(A). To obtain an award of SSDI benefits, Mr. Lawson had to demonstrate that he is not only unable to do his previous work but cannot, considering his age, education, and work experience, engage in any other kind of substantial gainful work which exists in the national economy . . . . 42 U.S.C. sec. 423(d)(2)(A). The Supreme Court has held that evidence of the receipt of SSDI benefits regarding a claimed disability should not be a dispositive factor in ADA disability determinations. See Cleveland v. Policy Mgmt. Sys. Corp., 526 U.S. 795, 802-05 (1999). The Court also has indicated, however, that an SSA determination of disability can be relevant and significant evidence in showing that a disability exists for ADA purposes. See id. at 806; see also Feldman v. American Mem’l Life Ins. Co., 196 F.3d 783, 791 (7th Cir. 1999); Weigel, 122 F.3d at 467-68. More specifically, in Cleveland, the Supreme Court noted that because of differences in the mechanics of the SSA and ADA determinations of disability, a person could be considered disabled by the SSA but yet also be a qualified individual with a disability according to the ADA. See id. at 802-03. Yet it also explained that the two acts were similar enough in this regard to require a person, seeking to show that he is qualified to perform a job under the ADA’s meaning, to provide a sufficient explanation as to how this does not conflict with the SSA’s determination that he was unable to work. Id. at 806. Moreover, some of the differences cited by the Court in Cleveland between the SSA and ADA disability determinations are not applicable to Mr. Lawson in deciding whether he can satisfy the first prong of the prima facie case. The Court noted that the SSA does not take into account the idea of reasonable accommodation in its disability determination, meaning that an otherwise disabled person according to the SSA could be qualified under the ADA when such an accommodation is considered. Id. at 803. The reasonable accommodation principle may be relevant at trial regarding the second element of Mr. Lawson’s prima facie case, whether he is qualified for the position sought. But see Feldman v. American Mem’l Life Ins. Co., 196 F.3d 783, 790 (7th Cir. 1999) (explaining that the severity of a disability may change over time such that an individual is totally disabled when applying for SSDI, but later [is] a qualified individual at the time of the employment decision disputed in an ADA suit). However, it does not affect the basic definition of a disability according to the two acts. In fact, the language considered by the SSA and the ADA in defining disability with regard to the ability to work, without taking into account the ADA’s reference to reasonable accommodation, is somewhat similar. Compare 42 U.S.C. sec. 423(d)(2)(A) (regarding SSDI benefits, person must demonstrate that he cannot engage in any . . . kind of substantial gainful work which exists in the national economy) with Sutton, 527 U.S. at 491 (person disabled under ADA if substantially limited in ability to hold a broad class of jobs). Additionally, the Court explained that, because the SSA often uses presumptions in its disability findings, particularly by automatically finding that a disability exists if it is one of a number of listed impairment[s], a determination that someone is disabled under the SSA’s administrative rules may not mean that he is also disabled according to the ADA’s more fact- intensive inquiry. Id. at 804. However, although there was uncertainty over this point during oral argument, it appears that Mr. Lawson’s insulin- dependent diabetes is not a listed impairment under the SSA and that a more individualized determination was necessary to allow his receipt of SSDI benefits. Lastly, the district court noted that Mr. Lawson’s brief employment with two companies between 1986 and 1991 showed that Social Security’s determination that Lawson should be on total disability is not tantamount to a conclusion that he was substantially limited in his ability to work. R.60 at 42. We do not disagree that Mr. Lawson’s employment in these jobs makes it somewhat less likely that he can demonstrate a record of disability during this time period. However, we believe that such limited work activity does not provide sufficient justification to take this question out of the hands of the jury, in light of all of the evidence presented in this case. Mr. Lawson’s receipt of SSA benefits over a twelve-year period from 1986 to 1998, and the factual circumstances surrounding it, constitute significant evidence that his diabetic condition rendered him unable to work in a broad class of jobs during that time. Although this evidence is not dispositive of the issue, and is not the only factor upon which we rely in this determination, it gives force to Mr. Lawson’s claim that a record of disability exists. Mr. Lawson’s evidence, taken as a whole, is sufficient for a jury to find he has a record of diabetes substantially limiting his ability to work. Therefore, the district court’s determination that Mr. Lawson could not show that he was disabled in this regard under the ADA was also in error. This provides another reason why summary judgment was improper on the ground that the first element of Mr. Lawson’s prima facie case could not be met.