T. 6/8/92 SBO:MAF:RM:KF JUN 15 1992 Ms. Leonora L.

Guarraia General Deputy Assistant Secretary Office of the Assistant Secretary for Fair Housing and Equal Opportunity U.S. Department of Housing and Urban Development Washington, D.C. 20410-2000 Dear Ms. Guarraia: We have received your request for an interpretation of section 504 of the Rehabilitation Act of 1973, as amended. Specifically, you asked whether, for purposes of section 504, an individual with multiple chemical sensitivity should be considered an "individual with handicaps." The Department addressed a similar issue during the development of regulations to implement the Americans with Disabilities Act (ADA). The Department received numerous comments detailing how exposure to various environmental conditions restricts access for individuals who have a heightened sensitivity to a variety of chemical substances. The commenters asked that environmental illness be recognized as a disability covered by the ADA. The Department declined to state categorically that environmental illness is a disability. The preambles to both the title II rule (which covers State and local governments) and title III rule (which covers public accommodations and commercial facilities) state that the determination as to whether an impairment is a disability depends on whether, given the particular circumstances at issue, the impairment substantially limits one or more major life activities (or has a history of, or is regarded as having such an effect). Sometimes respiratory or neurological functioning is so severely affected that an cc: Records, CRS, Oneglia, Friedlander, Mather, Foster :udd:mather:ltr.guarraia 01-00923

individual will satisfy the requirements to be considered disabled. In other cases, individuals may be sensitive to environmental elements but their sensitivity will not rise to the level needed to constitute a disability. For example, their major life activity may be somewhat, but not substantially, impaired. In such circumstances, these types of sensitivities are not disabilities. (See 56 Fed. Reg. 35,699 (title II rule), and 56 Fed. Reg. 35,549 (title III rule).) The same analysis would apply under section 504. Decisions as to whether particular impairments are disabilities must be made on a case-by-case basis. Copies of the title II and title III rules are enclosed. I hope this information is helpful to you. Sincerely, Stewart B. Oneglia Chief Coordination and Review Section Civil Rights Division Enclosures (2) 01-00924

U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT WASHINGTON, D.C. 20410-2000 March 3, 1992 OFFICE OF THE ASSISTANT SECRETARY FOR FAIR HOUSING AND EQUAL OPPORTUNITY Ms. Stewart B. Oneglia Chief, Coordination and Review Section Civil Rights Division U.S. Department of Justice 10th and Pennsylvania Avenue, N.W. Washington, D.C. 20530 Dear Ms. Oneglia: During the past year, the Department of Housing and Urban Development (HUD) issued technical guidance on a controversial disability commonly referred to as Multiple Chemical Sensitivity or "environmental illness." Those who have Multiple Chemical Sensitivity claim to experience adverse reactions after extremely low levels of chemical exposure. The scientific community, as you are probably aware, does not recognize Multiple Chemical Sensitivity as a physical disability because there exists no concrete scientific proof that the illness has physical origins.

Both the scientific community and various advocacy groups for those who claim to have this disability are actively supplying me with literature supporting each position on the matter. I have enclosed the most recent information provided by the scientific community. This information suggests Multiple Chemical Sensitivity is an inaccurate term for the physical disability we previously described in our guidance; they claim the correct term is Chemical Sensitivity. I understand the Department of Justice, as the coordinating agency for Section 504 of the Rehabilitation Act of 1973, is developing guidance on this subject. It would be helpful if you would supply me with Justice's position on this matter so that HUD can be accurate and consistent in its own guidance. I may be reached on (202) 708-3855. Very sincerely yours, Leonora L. Guarraia General Deputy Assistant Secretary Enclosure 01-00925

bc ia BUSINESS COUNCIL ON INDOOR AIR 1225 19th Street. N.W., Suite 300, Washington, D.C. 20036 (202) 775-5887 February 6, 1992 Ms. Leonora L. Guarraia U.S. Department of Housing and Urban Development Fair Housing and Equal Opportunity 451 7th Street, S.W. Suite 5100 Washington, D.C. 20410 Dear Ms. Guarraia: Thank you for the opportunity to discuss your agency's position on

multiple chemical sensitivity (MCS or environmental illness). As I related at our meeting of January 9, the Department of Housing and Urban Development has clearly confused the definitions of chemical sensitivity or hypersensitivity and MCS. The two examples cited in Mr. Mansfield's letter are examples of the former, not the latter, as suggested by Mr. Mansfield. I have enclosed a copy of his letter for your reference. After consulting experts in the medical field, I would like to offer the following definitions: Chemical hypersensitivy is a state of ordered reactivity in which the body reacts with an exaggerated immune response to a foreign substance (some chemical agents, plant products, animal products). Symptoms may resemble hay fever, asthma, or contact dermatitis. The hypersensitivity reaction is repeatable with similar symptoms each time the individual is exposed to the same or a chemically similar substance. This medical condition can readily be confirmed by using well-recognized and accepted diagnostic techniques and laboratory studies. 01-00926

Ms. Leonora L. Guarraia February 6, 1992 Page 2 Chemical hypersensitivity should not be confused with symptoms produced by irritants such as sulfur dioxide, nuisance odors such as paint fumes, or unpleasant odors such as sewer gas.

Multiple chemical sensitivity has been described as an acquired disorder characterized by recurrent symptoms, referable to multiple organ systems, occurring in response to demonstrable exposure to many chemically unrelated compounds at doses far below those established in the general population to cause harmful effect. The American Medical Association, as recently as December 1991, and other medical societies, including the American Association of Allergy and Immunology, the American College of Physicians, and the American College of Occupational and Environmental Medicine, agree that to date there is inadequate scientific evidence to establish the existence of MCS as a disorder. Research is currently being conducted by a number of institutions and supported in part by federal agencies. For your information, I have enclosed BCIA's white paper on environmental illness, the American College of Physician's position on the syndrome, and a recent clinical study of 26 subjects demonstrating symptoms that have been attributed to the syndrome. We would greatly appreciate a correction of the guidance document sent previously to your district offices. I will call you in a week or so to discuss this request. Sincerely, Paul A. Cammer, Ph.D. President Enclosures 01-00927

bc ia BUSINESS COUNCIL ON INDOOR AIR 1225 19th Street, N.W., Suite 300, Washington, D.C. 20036 (202) 775-5887 May 1991 ENVIRONMENTAL ILLNESS "Environmental illness" is a term used to refer to a collection of general symptoms. It is a controversial human health phenomenon similar to other ill-defined syndromes which have been described for over 100 years and has attracted attention from such diverse groups as lawyers, physicians, insurance companies, scientists, industry, and Congress. It is known by at least 20 synonyms, including "multiple chemical sensitivity," "total allergy syndrome," and "twentieth-century disease." Those who suffer from environmental illness maintain that the condition is an acquired disorder resulting in an aversion to a wide variety of synthetic materials, ingested foods, and drugs resulting in symptoms that may be multiple and wide ranging. The concept of environmental illness is not a new issue. As early as the 1950's, it was postulated that environmental illness resulted from the failure of humans to adapt to modern-day synthetic materials.1-3 According to this theory, the influx of man-made materials has resulted in a new form of medically unexplained, specific sensitivity. Once sensitized, the person generally reacts to increasingly lower concentrations of the causative agent as well as to other chemicals and foods.1-3 This "spreading" effect is one area among many where the environmental illness theory is inconsistent with medically-accepted doctrine concerning allergic sensitivity to individual substances. Historically, the theory that environmental illness is caused by chemical contact has only weak support. This causation theory has received some attention in recent years, however, because of anecdotal reports of the suffering of certain individuals demonstrating symptoms attributed to this syndrome (e.g., nausea, headaches, dizziness), there are very few symptoms that have not been considered to be related to such an etiology.

While there is a broad variety of claims regarding the initiation of environmental illness, there are no reliable statistics estimating its prevalence. Some people cite the National Academy of Sciences (NAS) as estimating the incidence of environmental illness in the United States. NAS has stated, however, that they have never made this statement or published such a conclusion.4 01-00928 -2Numerous professional medical associations have examined available information regarding environmental illness and the diagnostic criteria that have been proposed by clinical ecologists (practitioners who diagnose and treat this phenomenon). These medical groups have generally found deficiencies in the scientific evidence for the syndrome as a distinct clinical entity.5-13 Moreover, in double-blind studies, the treatment (i.e., provocation- neutralization) of individuals by clinical ecologists has not been indicated to relieve symptoms any better than placebo treatment.14-15 Additionally, the implication of a role for environmental illness in immune system dysfunction has been criticized on both theoretical and empirical grounds. Dr. Abba Terr (Division of Immunology, Stanford University Medical School), whose views on environmental illness have been supported by the American College of Physicians and the American Academy of Allergy and Immunology, states the following: The pattern of symptomatology is too wide ranging, nonspecific, and variable to suggest a single pathogenetic mechanism, immunologic, or otherwise. The now well-established pathways for immunologic mediated forms of hypersensitivity each produce specific patterns of tissue inflammation and corresponding organ dysfunction, whereas no clinical or histopathologic evidence of inflammation has been demonstrated in patients with [environmental illness].16 Though the medical profession expresses doubt that environmental illness is, in fact, a distinct clinical entity, it is clear that a small but significant number of people display symptoms from whatever cause that do not conform to our present

understanding of allergic disease.17-21 While chemical exposure has often been attributed as the cause of the symptoms, other factors such as biological contaminants, noise, lighting, interpersonal relationships, stress, work station design, and psychological factors22,23 have not been ruled out. Whatever the actual causes of environmental illness, baseline research aimed at identifying the nature of claims for the etiology of symptoms is necessary. Recommendations Because of the controversy surrounding environmental illness it is premature to develop any governmental policy based on the vague and anecdotal information currently available. Accordingly, the initial focus of environmental illness research should be to seek clarification of the medical/physiological/psychological nature of the syndrome. To this end, a few state governments are conducting reviews of environmental illness and NAS has conducted a workshop to discuss environmental illness-related research needs. 01-00929 -3All people deserve quality medical care including correct diagnosis and appropriate treatment. Our nascent understanding of environmental illness, however, does not allow us to determine proper diagnosis or treatment. Therefore, it is of paramount importance that these issues for environmental illness be resolved and the significance of environmental exposure, if any, be established. To address this issue, only research of the soundest scientific design should be supported, employing double-blind, placebo-controlled techniques. A research agenda could include the following: (1) (2) definition of the syndrome to be studied; investigation of the role of specific toxicologic (e.g., immunological) mechanisms for environmental illness or for the syndrome defined; determination of specific, measurable health effects, if any, that can be scientifically attributed to exposure to specific chemical substances and an estimation of the dose

(3)

necessary to produce these symptoms; (3a) determination of specific, measurable health effects, if any, that can be scientifically attributed to exposure to a variety of unrelated chemicals and an estimation of the dose necessary to produce these symptoms; determination of the role of biological contaminants in contributing to symptoms; determination of the clinical relationship, if any, between chemical hypersensitivity and environmental illness; and development of an epidemiological study of symptoms and clinical findings attributed to environmental illness, determining a distribution of prevalence by age, sex, race, education, occupational history, psychiatric status, and geographical region (this would include determination of age at onset of environmental illness). In addition, the natural history of environmental illness should be studied and documented.

(4) (5)

(6)

01-00930

-4References 1. Randolph, T.G. (1952). Sensitivity to petroleum including its derivatives and antecedents [Abstract]. J Lab Clin Med. 40: 931-932. 2. Randolph, T.G. (1954). Allergic-type reactions to industrial solvents and liquid fuels; mosquito abatement fogs and mists; motor exhausts; indoor utility gas and oil fumes; chemical additives of foods and drugs; and synthetic drugs and cosmetics. J Lab Clin Med. 44: 910. Randolph, T.G. (1955). Depressions caused by home exposure to gas and combustion products of gas, oil, and coal. J Lab Clin Med. 46: 942.

3.

4.

Omenn, G.S. (1989). Letter to The Amicus Journal; Goldstein, B.D. (1989). Letter to The Amicus Journal; Silbergeld, E. (1989). Letter to The Amicus Journal. Golbert, T.M. (1975). A review of controversial diagnostic and therapeutic techniques employed in allergy. J Allergy Clin Immunol. 56: 170-190. Grieco, M.N. (1982). Controversial practices in allergy. J Amer Med Assoc. 247: 3106-3111. Van Metre, T.E. (1983). Critique of controversial and unproven procedures for diagnosis and therapy of allergic diseases. Pediat Clin North Am. 30: 807-817. Health Care Financing Administration. (1983). Medicare program. Exclusion from medicare coverage of certain food allergy tests and treatments. Fed. Reg. 48: 162, 37716-37722. American Academy of Allergy and Immunology. (1981). Position Statements - Controversial Techniques. J Allergy Clin Immunol. 67: 333-338. American Academy of Allergy and Immunology. (1986). Position Statements - Clinical Ecology. J Allergy Clin Immunol. 78: 269-270. American Academy of Allergy and Immunology. (1986). Position statements - Candidiasis hypersensitivity syndrome. J Allergy Clin Immunol. 78: 271-273. California Medical Association Scientific Board Task Force on Clinical Ecology. 1986. Clinical Ecology - A Critical Appraisal. West J Med. 144: 239-245.

5.

6. 7.

8.

9.

10.

11.

12.

01-00931 13. 14. -5American College of Physicians. (1989). Clinical Ecology. Annals of Internal Medicine. 111: 2. Jewett, D.L., Phil, D., Fein, G. and Greenberg, M.H. (1990). A Double-Blind Study of Symptom Provocation to

Determine Food Sensitivity. The New England Journal of Medicine 323: 7. 15. 16. 17. Kailia, E.W. and Collier, R. (1971). Relieving therapy for antigen exposure. J Amer Med Assoc. 217: 78. Terr, A.I. (1987). Clinical Ecology. Journal of Allergy and Clinical Immunology. 79(3): 423-426. Randolph, T.G. (1962). Human Ecology and Susceptibility to the Chemical Environment. Charles C Thomas, Publisher. Springfield, IL. Dickey, L.D. (1976). Clinical Ecology. Charles C. Thomas, Publisher Springfield, IL. Bell, I.R. (1982). Clinical Ecology: A New Medical Approach to Environmental Illness. Common Knowledge Press. Bolinas, CA. Committee on Environmental Hypersensitivities. (1985). Report of the Ad Hoc Committee on Environmental Hypersensitivity Disorders. Ministry of Health. Toronto, Ontario. Cullen, M.R. (1987). The Worker with Multiple Chemical Hypersensitivities: An Overview. State Art Rev Occup Med. 2: 655-661. Black, D.W., Rathe, A. and Goldstein, R.B. (1990). Environmental Illness: A Controlled Study of 26 Subjects with '20th Century Disease.' J. American Medical Association. 264: 24. Ashford, N.A. and Miller, C.S. (1989). Chemical Sensitivity. A Report to the New Jersey State Department of Health.

18. 19.

20.

21.

22.

23.

01-00932

June 6, 1991 OFFICE OF THE ASSISTANT SECRETARY FOR FAIR HOUSING AND EQUAL OPPORTUNITY MEMORANDUM FOR: All Regional PHEO Directors FROM: Leonora L. Illegible General Deputy Assistant Secretary for Fair Housing and Equal Opportunity, ED SUBJECT: Technical Guidance Memorandum 91-3: Multiple Chemical Sensitivity Disorder HUD has recently seen an increase in housing discrimination complaints from people with Multiple Chemical Sensitivity Disorder (MCSD), sometimes referred to as "environmental illness." HUD presently recognizes MCSD as a "handicap" under the Fair Housing Act. People with this disability are also considered "individuals with handicaps" under Section 304 of the Rehabilitation Act of 1973. Accordingly, PHEO investigators should become familiar with this disability and how those who have this disability are protected by the law. MCSD is a condition, the origin of which is currently unknown. Adverse symptoms are caused by exposure to various chemical substances at exposure levels so low that for most people, they are considered harmless. Symptoms appear after a person with MCSD comes into contact with the air, water, food, medication or surface that contains the chemicals to which the individual is sensitive. The most common substances that are believed to cause adverse reactions in people with MCSD are solvents and other volatile compounds, pesticides, formaldehyde, natural gas, disinfectants, detergents, plastics, tobacco smoke, and perfumes. The adverse reactions of individuals with MCSD often include extreme tiredness and an inability to carry out major life activities such as manual tasks and walking. For housing providers, acts which are necessary and accepted business practices, such as cleaning, painting, exterminating the building or fertilizing the lawn, may be threatening events to people with MCSD since exposure to the various chemicals involved can cause severe symptoms.

As with other handicaps, housing providers are required by the Fair Housing Act to provide reasonable accommodations to individuals with MCSD. Housing providers are also required to comply with all other requirements of the Fair Housing Act including the obligation to permit people to make, at their own expense, reasonable modifications to the existing premises, if the proposed modifications are necessary to afford them the full enjoyment of the housing premises. 01-00933 INTERNAL:NOT FOR RELEASE) Additionally, under Section 504 of the Rehabilitation Act of 1973, housing providers who receive Federal financial assistance are required to modify their housing policies and practices to ensure that these policies and practices do not discriminate on the basis of handicap against qualified individuals with MCSD. Housing providers who receive Federal financial assistance are also obligated to carry out all other requirements of Section 504. This includes operating each housing program or activity receiving Federal financial assistance so that the program or activity, when viewed in its entirety, is readily accessible to individuals with handicaps. Because people with MCSD suffer adverse reactions as a result of exposure to a wide variety of substances, reasonable accommodations for this disability, as with all disabilities, should be based on the particular circumstances of the tenant or applicant. To the extent that the elements which trigger adverse reactions in the individual can be identified, requests for reasonable accommodations may be sought to enable the individual to minimize or avoid exposure to these elements. Although the reasonableness of a particular accommodation request will depend on the circumstances of the individual and an assessment of the feasibility, practicality, and burdens involved in making the accommodation, it is possible to provide examples of accommodations which are considered reasonable: -- A tenant with MCSD has a sensitivity to chemical pesticides. He requests that the housing provider notify him in advance before fumigating the apartment building and substitute boric acid for the chemicals

normally used to spray his apartment. -- An applicant with MCSD has a sensitivity to the chemicals found in certain types of carpeting. She inquires about an available apartment located in a building in which all the apartments have wall-to-wall carpeting. She requests that the housing provider inform her as to the type of carpeting used throughout the building so that she may determine whether the apartment would suit her needs before renting it. If you have any questions about this guidance, please contact Mary-Jean Moore, Section 504 Branch Chief, Office of HUD Program Compliance at FTS 458-0015 (TDD). 01-00934

U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT WASHINGTON, D.C. 20410-2000 OFFICE OF THE ASSISTANT SECRETARY September 6, 1991 FOR FAIR HOUSING AND EQUAL OPPORTUNITY Paul A. Cammer, Ph.D. President Business Council On Indoor Air 1225 19th Street, N.W., Suite 300 Washington, D.C. 20036 Dear Dr. Cammer: Thank you for your letter of July 16, 1991 regarding the Department's policy on multiple chemical sensitivity and its guidance on this issue to regional and field offices. As noted in the Department's letter to Senator Lautanberg, HUD presently recognizes Multiple Chemical Sensitivity Disorder (MCSD), sometimes referred to as "environmental illness," as a "handicap" under the Fair Housing Act. People with this

disability are also considered "individuals with handicaps" under Section 504 of the Rehabilitation Act of 1973. Accordingly, the Department has instructed its regional and field investigators to become familiar with this disability which is extremely complex and difficult to comprehend. Individuals with MCSD are protected by the law and the Department has provided its regional offices with some general guidelines to ensure compliance with non-discrimination laws and regulations. As with other handicaps, housing providers are required by the Fair Housing Act to provide reasonable accommodations to individuals with MCSD. Housing providers are also required to comply with all other requirements of the Fair Housing Act including the obligation to permit people to make, at their own expense, reasonable modifications to the existing premises, if the proposed modifications may be necessary to afford them the full enjoyment of the housing premises. Additionally, under Section 504 of the Rehabilitation Act of 1973, housing providers who receive Federal financial assistance are required to modify their housing policies and practices to ensure that these policies and practices do not discriminate on the basis of handicap against qualified individuals with MCSD. Housing providers who receive Federal financial assistance are also obligated to carry out all other requirements of Section 504. This includes operating each housing program or activity receiving Federal financial assistance so that the program or activity, when viewed in its entirety, is readily accessible to individuals with handicaps. 01-00935 2 Finally, because people with MCSD suffer adverse reactions as a result of exposure to a wide variety of substances, reasonable accommodations for this disability, as with all disabilities, should be based on the particular circumstances of the tenant or applicant. To the extent that the elements which trigger adverse reactions in the individual can be identified, requests for reasonable accommodations may be sought to enable the individual to minimize or avoid exposure to these elements. Although the reasonableness of a particular accommodation request will depend on the circumstances of the individual and an

assessment of the feasibility, practicality, and burdens involved in making the accommodation, it is possible to provide examples of accommodations which are considered reasonable: -- A tenant with MCSD has a sensitivity to chemical pesticides. He requests that the housing provider notify him in advance before fumigating the apartment building and substitute boric acid for the chemicals normally used to spray his apartment. -- An applicant with MCSD has a sensitivity to the chemicals found in certain types of carpeting. She inquires about an available apartment located in a building in which all the apartments have wall-to-wall carpeting. She requests that the housing provider inform her as to the type of carpeting used throughout the building so that she may determine whether the apartment would suit her needs before renting it. I hope the information provided is helpful. Very sincerely yours, Gordon H. Mansfield Assistant Secretary 01-00936

U.S. Department of Housing and Urban Development Washington, D.C. 20410-1000

OFFICE OF THE ASSISTANT SECRETARY FOR LEGISLATION AND CONGRESSIONAL RELATIONS Honorable Frank R. Lautenberg United States Senate Washington, D.C. 20510-3002 Dear Senator Lautenberg: Thank you for your letter of October 11, 1990 regarding your constituent, Mary Lamielle, and her request that the Department of Housing and Urban Development (HUD) prepare a written policy acknowledging those people who are chemically sensitive as a disabled population deserving reasonable accommodation with regard to exposure to chemicals. HUD presently recognizes Multiple Chemical Sensitivity (MCS) as a disability entitling those with chemical sensitivities to reasonable accommodation under Section 504 of the Rehabilitation Act of 1973. People with MCS are also recognized as disabled under Title VIII of the Fair Housing Amendments Act of 1988. However, because of the unique nature of MCS and the limitless variety of chemical sensitivities possible, HUD has not written a policy that sets forth specific required reasonable accommodation for this disability. Instead, we have acknowledged chemical sensitivity as a disability and accommodated those with various hypersensitivities on a case-by-case basis. As with all disabilities, housing providers are required to provide reasonable accommodations to chemically sensitive individuals, unless those accommodations would cause an undue financial and administrative burden or would result in a fundamental alteration in the nature of the program or activity. Information about MCS has been disseminated at recent HUD Section 504 Town Meetings in an effort to make housing providers more aware of the needs of those with this disability. To better assure that HUD staff and the public are aware of the need to treat this condition as a disability, HUD is also planning to issue formal guidance on this matter to its Regional and Field Offices. 01-00937 2

HUD welcomes any information that the National Center for Environmental Health Strategies can provide and will keep Ms. Lamielle informed as new guidance is issued. I hope that this information has been helpful. Very sincerely yours, Timothy L. Coyle Assistant Secretary 01-00938