What is a TBI?
A traumatic brain injury (TBI) is defined as a blow or jolt to the head or a penetrating head injury that disrupts the function of the brain. Not all blows or jolts to the head result in a TBI. The severity of such an injury may range from mild/concussion (i.e., a brief change in mental status or consciousness) to "severe," (i.e., an extended period of unconsciousness or amnesia after the injury). A TBI can result in short or long-term problems, although most people with TBI are able to function independently.
What Is PTSD?
Post-Traumatic Stress Disorder (PTSD) is an anxiety disorder that can develop in response to exposure to an extreme traumatic event. These traumatic events may include military combat, violent personal assaults (e.g., rape, mugging, robbery), terrorist attacks, natural or man-made disasters, or horrific accidents. The event, directly experienced or witnessed in another person, involves actual or threatened death, serious injury or threat to one's physical integrity. The person's response to the event is one of intense fear or helplessness.
What are some possible behaviors associated with PTSD?
Many people with PTSD repeatedly re-experience their ordeal in the form of flashback episodes, intrusive recollections of the event and nightmares. A stress reaction may be provoked when individuals are exposed to events or situations that remind them of the traumatic event. Avoidance of those triggering cues is a very significant feature of PTSD. Feeling detached from others and emotional numbing are common. Symptoms of PTSD may also include difficulty sleeping, problems concentrating, irritability, being hyper-alert to danger, feeling "on edge," and an exaggerated startle response. PTSD symptoms usually emerge within a few months of the traumatic event, however symptoms may emerge many months or even years following a traumatic event.
Are all TBIs severe?
No. "TBI" is an umbrella term that spans a wide continuum of symptoms and severity. In fact, the large majority (80%) of combat head injuries sustained in Operation Iraqi Freedom and Operation Enduring Freedom are mild concussions as opposed to severe, debilitating TBI.
What should employers expect from a person with PTSD? Will they have violent outbursts?
PTSD develops differently in different people. Some returning Service Members with PTSD may suffer from memory deficits, lack of concentration, time management issues, disorganization, panic attacks, sleep disturbance and outbursts of anger, among other challenges - all of which can interfere with everyday activities inside and outside of the workplace. Most symptoms will decrease over time. People, by virtue of having a diagnosed PTSD condition, do not pose a direct threat to themselves or others. Employees who manage their symptoms through medication or psychotherapy are very unlikely to pose a threat. Employers may help reduce the overall stress in the work environment or mitigate known vulnerabilities to stress by providing a job accommodation.
What should employers expect from National Guard and Reservists who return to their jobs with TBI and/or PTSD?
As TBI and PTSD are the signature injuries of the Global War on Terror, it is possible that many National Guard and Reservists will return to their civilian jobs with these conditions. However the effects of TBI and PTSD vary widely from person to person depending upon the severity of one's injury or traumatic experience.
Are TBI and PTSD conditions that are exclusive to veterans?
TBI and PTSD within our military populations are getting a great deal of well-deserved attention. However the conditions are not new -- or exclusive to Veterans. Some first responders, for example, are among the millions of people who experience post-traumatic stress. And according to the Brain Injury Association of America, more than 1.4 million people sustain a brain injury every year in the United States. The America's Heroes at Work initiative is designed to help any employee with TBI, PTSD and other invisible conditions succeed on the job.
Why does employment play such an important role in the recovery of transitioning service members with TBI and/or PTSD?
Employment enables many people with disabilities, including those with TBI and/or PTSD, to fully participate in society. For example, employment provides income that is key to individual and family economic well-being, and builds skills for future well-being. It also provides greater social interaction and connections that can reduce isolation and build social capital. Finally, employment provides a valued social role in our society and helps create a sense of personal efficacy and social integration that contributes to life satisfaction. According to the National Council on Disability, people who regain employment following the onset of a disability report greater life satisfaction and better adjustment than do people who are not employed. For these reasons, gainful employment can be one important component in the recovery and rehabilitation of returning Service Members with TBI and/or PTSD.
What should employers know about disability laws?
Employers should be aware of the federal and state laws that protect individuals with disabilities from discrimination in employment and the job application process. To learn more about your responsibilities under these laws, including the Americans with Disabilities Act (ADA).
Are TBI and PTSD considered disabilities under the Americans with Disabilities Act (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. Therefore, some people with TBI and/or PTSD 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. For more information about how to determine whether a person has a disability under the ADA, visit www.eeoc.gov/policy/docs/902cm.html.
Are employees with TBI and/aor PTSD required to disclose their disability to employers?
No. Employees need only disclose their disability if/when they need an accommodation to perform the essential functions of the job. Applicants never have to disclose a disability on a job application, or in the job interview, unless they need an accommodation to assist them in the application or interview process.
What promising practices can DOL recommend to employers who might be hesitant to hire a veteran wtih TBI and/or PTSD?
Most employers know that hiring Veterans with disabilities is the right thing to do, however due to stigma and fear of the unknown, some may be hesitant to hire Veterans with head injuries and psychological conditions such as PTSD. But employers needn't be nervous. In addition to making reasonable workplace accommodations, employers can leverage a variety of promising practices to create a positive, successful workplace experience for disabled Veterans and transitioning Service Members. These include job coaching, mentoring, customized employment, natural workplace supports, and simple physical accommodations such as alarm clocks, task lists and alternate lighting. In addition, they might try easing into Veterans' employment by offering short-term internships with the possibility of permanent employment, job sharing options or other kinds of flexible workplace schedules.
How can employers help people with PTSD do their jobs more efficiently?
A variety of promising practices can help people with PTSD succeed in the workplace, such as scheduled rest breaks to prevent stimulus overload, job coaching and job sharing.
How can employers help people with a TBI do their jobs more efficiently?
Although recovery from mild brain injuries (concussions) is generally uncomplicated and complete, some individuals continue to experience cognitive or mood difficulties. A variety of promising practices can help people with TBI manage these symptoms such as schedule-reminders (telephone, pagers, alarm clocks), scheduled rest breaks to prevent stimulus overload and fatigue, work task checklists, job coaching and job sharing. As a rule, the time period needed for workplace accommodations can often be short.
Are workplace accommodations for people with TBI and/or PTSD expensive?
As a rule, reasonable workplace accommodations for people with disabilities or combat-related injuries are low cost, or no cost. The Job Accommodation Network (JAN), a service of the U.S. Department of Labor's Office of Disability Employment Policy, recently interviewed 1,182 employers from a range of industries. The study revealed that 46 percent of employers' workplace accommodations cost absolutely nothing, while 45 percent experienced a low, one-time cost of around $500. Additionally, employers reported direct and indirect benefits from making accommodations such as employee retention, increased productivity, reduced training costs, improved company morale, and more. The major lesson? For little or no cost, employers can meet the needs of people with disabilities while enjoying benefits that extend to coworkers and to the company as a whole.
Support and Resources:
What should employers do if they suspect an employee is struggling with the effects of TBI and/or PTSD?
Employers must realize that, once they hire a Veteran with a disability, they are not alone. A wealth of support services exist to help them respond to the unique needs of their employees with disabilities or combat-related injuries. If available, a company's Employee Assistance Program (EAP) is a good place to seek counsel and assistance for workers struggling with TBI, PTSD and other disabilities. And to learn the types of workplace accommodations they should implement, employers can call the Job Accommodation Network (JAN), a free consulting service that provides individualized worksite accommodations solutions and technical assistance regarding the Americans with Disabilities Act (ADA) and other disability related legislation.
Hiring Disabled Veterans:
Why should employers hire diabled veterans?
Veterans make excellent employees for a variety of reasons (including leadership, teamwork experience and their accelerated learning curve). In addition, there are often tax incentives available to help employers cover the cost of accommodations for employees with disabilities and to make their places of business accessible. Of course, hiring Veterans with disabilities is simply the right thing to do.
Tax Benefits and Other Financial Incentive:
What are the tax incentives for hiring a disabled veteran?
There are several tax incentives available to help employers cover the cost of accommodations for employees with disabilities and to make their places of business accessible. These include the Small Business Tax Credit (IRS Code Section 44, Disabled Access Credit), the Architectural/Transportation Tax Deduction (IRS Code Section 190, Barrier Removal), the Work Opportunity Tax Credit (WOTC) and the Welfare to Work Tax Credit (WtWTC).
From America's Heroes at Work. Used with permission.