Fred Gutermuth always had shaky hands, but in 2005 the shaking got so bad it began to interfere with his work as a water treatment operator. "I couldn't read my own handwriting," says Gutermuth, 64, of Virginia Beach, VA, a retired US Navy corpsman who was diagnosed with benign essential tremor in 2010. "Some days working on the computer was impossible. I couldn't move the mouse or type. It definitely affected my job."

Gutermuth talked to his supervisor, who advised him to visit the human resources (HR) department. He approached them with trepidation, worried they'd say the solution would be to fire him. Instead, HR gave him paperwork for his doctor to fill out and provided voice-recognition software for his computer as a "reasonable accommodation" under the Americans with Disabilities Act (ADA).

"The people at human resources were very understanding," says Gutermuth, who was unaware of an ADA provision that requires employers to offer accommodations to qualified employees with physical or mental disabilities that allow them to perform essential job functions unless the accommodation would impose an "undue hardship." Based on his experience, Gutermuth advises, "If you have a human resources department, go speak to someone there. When you do, they'll have to work with you. Don't be afraid."

Renee Smith, who works for a patient advocacy group in Colorado, knows all about the ADA and its protections, but she has not told her employer that she has multiple sclerosis (MS) and she doesn't intend to. "I feel once you disclose, it's a bell you can't unring," says Smith (not her real name), who is in her twenties and was diagnosed in 2015. "You're not quite sure how people will react. If you miss a deadline, will they think it's because of the MS or because anyone can forget things?"

As these two stories illustrate, some people are comfortable disclosing their condition to employers while others are not. For many people with neurologic conditions, disclosing is a difficult decision, especially if their diagnosis doesn't affect their work. They may fear being labeled unfit or unable—or worse, being fired—despite protections put in place by the ADA, the Family and Medical Leave Act, and a host of state and local discrimination laws.

The choice to disclose is largely personal, based on your condition, work environment, and professional relationships, says Christopher J. Kuczynski, assistant legal counsel and director of the ADA/Genetic Information Nondiscrimination Act Policy Division at the US Equal Employment Opportunity Commission (EEOC). "If you think you're going to need accommodations to do the job and do it safely, you should disclose your diagnosis before the need arises or a safety concern presents itself," advises Kuczynski. Those accommodations could mean adjusting the height of desks and other office equipment, installing screen magnifiers or telecommunications for the deaf, providing a different computer keyboard or mouse, or allowing a person to work from home or make schedule adjustments.

If an employee doesn't disclose but is then disciplined or fired for performance reasons, revealing a hidden diagnosis at that point will have no effect. The disciplinary action or termination will stand, says Mark J. Heyrman, retired clinical professor of law at the University of Chicago Law School.

"If the employer says, 'You were late too much' or 'You didn't do [this task] as well as we wanted you to,' they can fire you if they didn't know you have a disability," he says. "If you know your condition is going to affect any aspect of your employment, you must tell them. If you don't, [employers] can say, 'We didn't know she had a handicap. We just saw this poor performance.'"

Disclosing a medical diagnosis early can be important with conditions likely to impact the quality of your work at some point—such as MS, which has an unpredictable path. "Most employers try to be understanding if they know you have a medical condition before you start having performance problems," says Cynthia Marcotte Stamer, a board-certified labor and employment lawyer in Dallas-Fort Worth. "If you tell them after your performance falters, you're less protected both legally and operationally."

When considering whether to disclose, ask yourself, "Can I do the job as described?" says Rosalind Joffe, a career coach for people with chronic illness and co-author of Women, Work, and Autoimmune Disease: Keep Working, Girlfriend! (Demos Health, 2008). If the answer is no, you should think about disclosing your condition or consider another job, says Joffe.

"For example, you could be a highly capable nurse, but if you're unable to perform some tasks some of the time, you won't be able to do the job as expected," says Joffe, who is on the board of directors of the Massachusetts Health Quality Partners, a nonprofit group that works to improve health care in the state. "If you have a job with tight, inflexible deadlines and you have a waxing and waning condition that makes it impossible to predict your capacity the next day, it seems unlikely that you'll be able to do this particular job as described."

Joffe understands why some people hesitate to disclose. She knows one woman with a chronic condition who asked for accommodations, and her boss told her, "It's a good thing you didn't tell me before because I probably wouldn't have hired you. But now I see you're a good employee and we'll make this work."

There's also the chance an employer will be angry if after months or years on the job you disclose you have a chronic illness that now requires accommodations. If that happens, Joffe says, point out that your disability hadn't been a problem previously. "You're choosing to talk about it now because your symptoms have progressed to the point where you need to work differently to continue to be as productive as you've always been."

For people with epilepsy, being open about their condition can help address the stigma around the disease, says John D. Hixson, MD, associate professor of neurology at the University of California San Francisco and the San Francisco VA Medical Center, and a neurologist who treats epilepsy patients. "In the ideal workplace, you'd disclose as you would any medical condition, such as diabetes or asthma, which don't seem to have the same stigma," Dr. Hixson says. "It takes a great deal of courage to disclose, but in the end it's probably the best thing for your health."

That proved true for an employee at Petra Integrated Construction Strategies, a construction company that focuses on health care real estate, in La Palma, CA. When she disclosed her condition, the president of the company, Craig Beam, and staffers volunteered for training in how to respond to a seizure and recognize environmental factors that could trigger one.

"This reassured not only our employee but the staff who worked around her because everyone would know what to do," says Beam, who has served on the advisory board to the director of the National Institutes of Health and was CEO of the World Heart Federation and chairman of the board for the American Heart Association.

Transparency Helps

"The advantage to disclosing your condition is that both employer and employee can set expectations," he says. "This may mean a special schedule, accommodation for physical therapy, or other medical requirements. Depending on the position, arrangements can be made to accommodate any problem."

Many employees worry that these special accommodations could cause resentment among their co-workers, but Stamer says that has not been her experience. In fact, she says, in most cases employees who disclose feel overwhelming relief. Employers typically try to provide accommodations, and co-workers are usually understanding.

Renee Smith, who has chosen not to tell her employer about her MS, believes most of her co-workers would support her if she did reveal her condition. She also knows others with MS who have been open with their employers without negative impact. It's usually such a non-issue, she says, that employees will "disclose at a performance review, and by the next one, [the boss] forgot."

Still, she says, this is her personal decision. It may change if her needs change.

Possible Steps

Anyone dissatisfied with an employer's accommodations can file a complaint with the EEOC and seek a "right to sue" letter. The EEOC will then investigate the claim and decide if there is cause for action.

Just filing a complaint often resolves problems, says Stamer, as many of them result from misunderstandings. Or the complaint may spark faster action as higher-level executives are drawn in. The EEOC also will suggest both parties work with a mediator to settle on a mutually agreeable accommodation or other resolution that solves the dispute.

But often employers and employees can work out an arrangement on their own, Kuczynski says. That's good, as such legal disputes can drag on for years with no guarantee of a satisfactory outcome for the employee.

Discrimination cases in general are challenging, says law professor Heyrman, as the burden of proof is on the person with the disability, who also must shoulder legal costs that will only be recouped if he or she wins the case. "You have to be able to show the employer did something because you had a disability," he says, noting this is particularly difficult if a person isn't offered a job after disclosing a medical condition in an interview. "Even if the real reason they didn't hire you is because you told them you have a neurologic condition, they can easily say, 'We had a better candidate,' or they can give six other reasons."

After Janine Rhodes, 36, had a stroke a few years ago, her doctors advised her to leave her high-stress advertising job. She knew she'd need to seek reasonable accommodations from a new employer. "I'm still able to produce, but I need to be more intentional and careful," she says. "People are uncomfortable and confused by strokes. I didn't want that to take over potential employers' mindsets. If they knew I'd had a stroke, would they always be worried about me?"

Ultimately, disclosure was easy when her prospective boss turned out to be a colleague who knew of her past work and her stroke. "Because she knew my history and reputation, it didn't seem like a major risk," says Rhodes (not her real name). "I was riding on my credentials."

Modifying Rhodes' work schedule—including allowing her to work from home if needed—was part of the hiring process. Still, a year into her job at a Colorado nonprofit, only the human resources staff and her boss know about her stroke. "My department head does not know, the people who sit next to me, the people I work with [don't know]," Rhodes says.

Timing Matters

By law, employers cannot ask about medical conditions before offering somebody a job, but they can after one has been accepted if they ask the same questions of every incoming employee, Kuczynski says. The law also says employers can't retaliate against someone who discloses a condition after an offer.

"People with hidden disabilities may wonder, 'Is it a risk to me if I give the information pre-offer and perhaps don't get the job as a result? Or is there more of a risk if I get the job and then request a reasonable accommodation when I start working, which may affect my relationship with my employer, who may think I had not been forthcoming when I applied for the job?'" Kuczynski says. "There's no single answer to that."

Request a copy of the job description and review it carefully, advises Bruce H. Cohen, MD, FAAN, director of the NeuroDevelopmental Science Center at Children's Hospital Medical Center of Akron in Ohio. If you have any disability, no matter how minor, that might affect your ability to do the job, you may want to disclose it, he says. But it's a difficult decision. "If you don't disclose something that's relevant to the job description and it's discovered later, you may get fired." If you do disclose, he adds, the employer could claim you can't fulfill the requirements for the job.

Rhodes, who may share her full health story with co-workers someday, says, "Trust your gut, especially when you're figuring out who to tell. You have to read the room."

Actions to Consider Before Disclosing an Illness at Work

Keep these strategies in mind when discussing your illness with an employer. Once you have disclosed, set an example for how you want to be treated, says John D. Hixson, MD, associate professor of neurology at the University of California San Francisco, and a neurologist who treats people with epilepsy. Others will treat your illness the same way you do, he says. Send a message by demonstrating strength. That could also help eliminate any stigma associated with your condition.

Learn the law. Familiarize yourself with the Americans with Disabilities Act (ADA). A good place to start is the Equal Employment Opportunity Commission, says Cynthia Marcotte Stamer, a board-certified labor and employment lawyer. The Job Accommodation Network, or JAN, can also provide guidance.

Be prepared. Present the facts about your illness in a simple, straightforward way to minimize concern, says Patrick Corrigan, PsyD, professor of psychology at the Illinois Institute of Technology in Chicago and principal investigator for the National Consortium on Stigma and Empowerment. "You can share your experiences," he says, "but you don't have to relay everything that's ever happened to you." Rosalind Joffe, a career coach who counsels people living with chronic illness, agrees. "Try not to get emotional when discussing your illness with your employer," she says. If possible, bring a letter from your physician confirming a diagnosis and specifying the accommodations you need, advises Stamer.

Know what you need. Seek out information about reasonable accommodations ahead of time. Again, the EEOC and JAN can provide guidance, says Christopher J. Kuczynski, assistant legal counsel and director of the ADA/GINA (Genetic Information Nondiscrimination Act) Policy Division at the EEOC.

Follow protocol. Read the employee handbook and report your disability to the person or department in accordance with that policy, says Stamer, noting that the ADA also includes a provision that requires employers to keep medical information confidential except as necessary to implement any accommodation.