In a victory for the rights of transgender people, the U.S Court of Appeals for the Fourth Circuit held in Williams v. Kincaid that gender dysphoria is a “disability” that is covered under the Americans with Disabilities Act (ADA), 42 U.S.C. § 12101 et seq. This precedent-setting decision expands rights for transgender people to be free from discrimination in employment, public accommodation, transportation and the justice system. Williams is the first federal appellate court to rule in this way, in a decision that is binding for all federal courts in Maryland, Virginia, West Virginia, North Carolina, and South Carolina. The decision represents a significant step forward in statutory protections for transgender individuals.
The case concerned Kesha Williams, a transgender woman with gender dysphoria who was incarcerated at a detention facility in Fairfax County, VA. Although initially assigned to the women’s section of the prison, officials moved her to the men’s section once they discovered she was transgender. There, male inmates and prison officials subjected her to harassment and the detention center failed to provide Ms. Williams with prescribed hormone treatments, leading to “significant mental and emotional distress.” Upon her release, Ms. Williams filed a lawsuit against the prison officials, alleging among other things that they had violated her rights under the ADA. Ms. Williams argued that her gender dysphoria constituted a disability under the ADA and that the detention center had discriminated against her due to her disability.
On appeal, the Fourth Circuit majority ruled in favor of Ms. Williams, holding that gender dysphoria qualified as a disability under the ADA. Congress had specifically excluded “gender identity disorders” from coverage under the ADA when it was originally enacted in 1990, however at that time the Diagnostic and Statistical Manual of Mental Disorders (DSM) defined gender identity disorder as a mental illness. In 2013, the American Psychiatric Association removed “gender identity disorders” from the DSM and added diagnostic criteria for “gender dysphoria,” which is the “clinically significant distress” felt by those who experience “an incongruence between their gender identity and their assigned sex.” The Fourth Circuit reasoned that there was a “meaningful difference” between those definitions that resulted from a “significant shift in medical understanding,” specifically that “gender dysphoria . . . concerns itself primarily with distress and other disabling symptoms, rather than simply being transgender.” Consequently, the Fourth Circuit held that as a matter of statutory construction, gender dysphoria is not a “gender identity disorder” and thus not excluded from ADA coverage.
U.S. Circuit Judge Diana Gribbon-Motz wrote for the majority: “Put simply, while the older DSM pathologized the very existence of transgender people, the recent DSM-5’s diagnosis of gender dysphoria takes as a given that being transgender is not a disability and affirms that a transgender person’s medical needs are just as deserving of treatment and protection as anyone else’s.”
The Fourth Circuit further considered whether gender dysphoria could be considered a disability under the ADA's safe harbor for “gender identity disorders . . . resulting from physical impairments.” Ms. Williams alleged that the medical treatment for her gender dysphoria consisted primarily of hormone therapy, which the Fourth Circuit held to be sufficient to raise a reasonable inference that her gender dysphoria results from a physical impairment. Regulations promulgated by the Equal Employment Opportunity Commission (EEOC) define a disability arising from a physical impairment as “[a]ny physiological disorder or condition . . . affecting one or more body systems, such as neurological . . . and endocrine.” 28 C.F.R. § 35.108(b)(1)(i)).
Importantly, the case is the first federal appellate court decision to hold that gender dysphoria is a covered disability under the ADA and provides significant expansion of statutory protections for transgender people. Previously, a handful of district court decisions had reached similar results. Moreover, the Department of Justice under both the Obama and Trump administrations interpreted the ADA to cover gender dysphoria - in 2015, the Obama administration DOJ filed a supplemental statement of interest in Blatt vs. Cabela’s Retail, Inc. arguing that gender dysphoria results from a physical impairment and thus didn’t fall within the statutory exclusions for the ADA. In 2017, the DOJ under Trump submitted two statements of interest in two separate cases supporting coverage of gender dysphoria under the ADA. Thus, the Williams decision represents the momentum to expand protections for transgender individuals, providing them with opportunities to seek accommodations and legal protections afforded under the ADA. For example, transgender people with a diagnosis of gender dysphoria will be able to seek accommodations from employers and places of accommodation for necessary medical treatments and transition-related care.
Correia & Puth represents transgender individuals confronting discrimination in employment, public accommodations, and in the health care setting. If you have faced discrimination, denial of care, or harassment, please contact us today.
