David Atkins v. Ken Salazar, Secretary ( 2011 )


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  •      Case: 10-60940     Document: 00511692251         Page: 1     Date Filed: 12/12/2011
    IN THE UNITED STATES COURT OF APPEALS
    FOR THE FIFTH CIRCUIT  United States Court of Appeals
    Fifth Circuit
    FILED
    December 12, 2011
    No. 10-60940                        Lyle W. Cayce
    Clerk
    DAVID A. ATKINS,
    Plaintiff – Appellant
    v.
    KEN SALAZAR, SECRETARY, DEPARTMENT OF THE INTERIOR,
    Defendant – Appellee
    Appeal from the United States District Court
    for the Northern District of Mississippi
    USDC 1:10-CV-40
    Before KING, GARZA, and GRAVES, Circuit Judges.
    PER CURIAM:*
    Plaintiff–Appellant David Atkins, a law enforcement park ranger, was
    transferred to a staff ranger position based on the conclusion of a medical review
    board constituted by the National Park Service (an agency of the Department of
    the Interior) that his uncontrolled diabetes could prevent him from safely
    performing his duties. Atkins filed suit under the Rehabilitation Act, claiming
    that his transfer amounted to discrimination on the basis of his alleged
    disability. The litigation focused on Atkins’s challenge to the Department of the
    *
    Pursuant to 5TH CIR. R. 47.5, the court has determined that this opinion should not
    be published and is not precedent except under the limited circumstances set forth in 5TH CIR.
    R. 47.5.4.
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    Interior’s affirmative defense that Atkins’s transfer was job-related and
    consistent with business necessity.          The district court granted summary
    judgment for the Department of the Interior, and Atkins appeals. We affirm.
    I. FACTUAL AND PROCEDURAL BACKGROUND
    A. Atkins’s Transfer
    In 1984, Plaintiff–Appellant David Atkins (“Atkins”) began employment
    at the National Park Service (“NPS”), an agency of the Department of the
    Interior (“Interior”), as a law enforcement park ranger (“park ranger”). Atkins
    was diagnosed with Type 1 diabetes in 1986.
    In March 1999, Interior promulgated new medical qualification standards
    (the “Standards”) for park rangers. The Standards were created pursuant to 5
    C.F.R. pt. 339, entitled “Medical Qualification Determinations,” which was
    promulgated, after a notice-and-comment process, in 1989.1 This regulation
    provides that executive agencies may establish medical standards for
    government-wide occupations. “Such standards must be justified on the basis
    that the duties of [a covered] position are arduous or hazardous, or require a
    certain level of health status or fitness because the nature of the position[]
    involve a high degree of responsibility toward the public or sensitive national
    security concerns.” 
    5 C.F.R. § 339.202
    . The regulation further requires that
    “[t]he rationale for establishing the standard must be documented. Standards
    established by . . . an agency must be:
    (a) Established by written directive and uniformly applied,
    1
    This regulation was promulgated pursuant to 
    5 U.S.C. § 3301
    , which provides that
    the President may:
    (1) prescribe such regulations for the admission of individuals into the civil
    service in the executive branch as will best promote the efficiency of that
    service;
    (2) ascertain the fitness of applicants as to age, health, character, knowledge,
    and ability for the employment sought; and
    (3) appoint and prescribe the duties of individuals to make inquiries for the
    purpose of this section.
    2
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    (b) Directly related to the actual requirements of the position.”
    
    Id.
    Agencies are, therefore, “authorize[d] to establish physical requirements
    for individual positions . . . when such requirements are considered essential for
    successful job performance. The requirements must be clearly supported by the
    actual duties of the position.” 
    5 C.F.R. § 339.203
    . Similarly, “[a]gencies may
    establish periodic [medical] examination . . . programs by written policies or
    directives to safeguard the health of employees whose work may subject them
    or others to significant health or safety risks due to occupational or
    environmental exposure or demands.” 
    5 C.F.R. § 339.205.2
     Again, “[t]he need for
    2
    The regulations explain that
    [a]n acceptable diagnosis [under the relevant medical standards] must include the following
    information, or parts identified by the agency as necessary and relevant:
    ...
    (e) An explanation of the impact of the medical condition on overall health and
    activities, including the basis for any conclusion that restrictions or
    accommodations are or are not warranted, and where they are warranted, an
    explanation of their therapeutic of risk [sic] avoiding value;
    (f) An explanation of the medical basis for any conclusion which indicates the
    likelihood that the individual is or is not expected to suffer sudden or subtle
    incapacitation by carrying out, with or without accommodation, the tasks or
    duties of a specific position;
    (g) Narrative explanation of the medical basis for any conclusion that the
    medical condition has or has not become static or well stabilized and the
    likelihood that the individual may experience sudden or subtle incapacitation
    as a result of the medical condition. In this context, “static or well-stabilized
    medical condition” means a medical condition which is not likely to change as
    a consequence of the natural progression of the condition, specifically as a result
    of the normal aging process, or in response to the work environment or the work
    itself. “Subtle incapacitation” means gradual, initially imperceptible
    impairment of physical or mental function whether reversible or not which is
    likely to result in performance or conduct deficiencies. “Sudden incapacitation”
    means abrupt onset of loss of control of physical or mental function.
    ...
    
    5 C.F.R. § 339.104
    (e)–(g).
    3
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    a medical evaluation program must be clearly supported by the nature of the
    work.” 
    Id.
    Following the directives of 5 C.F.R. pt. 339, NPS issued Director’s Order
    #57: Occupational Medical Standards, Health and Fitness (the “Order”) on
    March 1, 1999. The Order observed that a 1996 study conducted by Interior had
    proposed the adoption of new medical standards for park rangers. Consequently,
    NPS decided to “adopt appropriate medical standards . . . . [with] a specific goal
    [of] ensur[ing] that all employees assigned law enforcement, fire fighting, and
    other physically rigorous duties are able to safely perform those duties.” The
    Order made clear that “[a]n employee who does not meet the medical standards
    established for such work may not perform law enforcement or fire fighting work
    . . . unless the Medical Standards Board approves a request for reasonable
    accommodation.” Following the issuance of the Order, NPS issued the
    Standards.
    The Standards themselves cover a range of physiological requirements and
    include a nonexhaustive list of “medical conditions and/or physical impairments
    that may be disqualifying.” The Standards specifically provide that “[i]ndividual
    assessments will be made on a case-by-case basis to determine an individual's
    ability to meet the performance related requirements covered by these
    standards.” The relevant Standard for the instant case is the “Endocrine and
    Metabolic Systems Standard,” which deals with “excess[es] or deficienc[ies] in
    hormonal production [that] can produce metabolic disturbances affecting weight,
    stress adaptation, energy production, and a variety of symptoms or pathology
    such as elevated blood pressure, weakness, fatigue[,] and collapse.” Under this
    Standard, “[a]ny condition affecting normal hormonal/metabolic functioning and
    response that is likely to adversely affect safe and efficient job performance is
    4
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    generally disqualifying.” Among the listed “conditions which may result in
    disqualification” is “insulin dependent diabetes mellitus,” which Atkins has.
    Pursuant to this Standard, a medical review of Atkins was conducted on
    June 27, 2000. Following the review, on July 29, 2000, Atkins was found not to
    be medically qualified to serve as a park ranger due to his poor vision, his
    history of asthma, and his diabetic condition.3 Atkins appealed this decision, and
    on July 31, 2002, NPS’s Medical Review Board (“MRB”) granted him a medical
    waiver, since his “diabetic condition . . . [was] becoming well controlled.” The
    waiver, however, also established several “reasonable accommodations” that
    Atkins would have to meet, including HA1C testing4 at intervals recommended
    by Atkins’s physician, more frequent blood testing while on duty, an exercise
    program, and the use of an insulin pump. A subsequent 2003 medical review
    found that Atkins was still not medically fit for his job due to his poor eyesight
    and diabetes, but the MRB granted him a second waiver on June 30, 2003,
    subject to approximately the same conditions as the first waiver. Atkins was
    medically reviewed again in 2005 and was found once again not to be medically
    qualified to serve as a park ranger and was placed on light duty status.5
    In placing Atkins on light duty, the MRB explained to Atkins that he was
    not in compliance with the requirements of his previous waiver. In particular,
    the MRB observed, the examining physician had reported that Atkins’s most
    recent HA1C test showed an elevated level of 9.4%, meaning that Atkins’s
    diabetes did “not appear to be well controlled.” The MRB further observed that
    3
    Neither Atkins’s vision nor asthma are at issue in the instant suit.
    4
    “HA1C” testing—also called “A1C” testing and “A1c” testing—refers to a blood test
    that tracks the amount of glucose in blood over a two to three month period. The test is often
    used to measure diabetics’ success at controlling blood-glucose levels over a period of time.
    5
    Atkins would later describe his duties in this time as “mainly sitting in the office
    doing dispatch work and working on a patrol car. . . . [and not] doing any shift work, any night
    work, anything like that.”
    5
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    Atkins was also at risk for hypoglycemia, which is a state of lowered glucose
    levels that is capable of “affect[ing] attention, concentration, thinking, judgment,
    decision-making, reaction time[,] and hand-eye coordination, along with causing
    irritability, confusion[,] and rapid changes in [an individual’s] level of
    consciousness.” In particular, the MRB noted that “the risk of hypoglycemia is
    higher for individuals who use insulin, especially . . . an insulin pump.” For park
    rangers, with their “arduous and hazardous” duties, often “performed under
    variable and unpredictable working conditions . . . includ[ing] unplanned
    mealtimes [and the] possibility of missed meals,” there is “potential for
    hypoglycemia.”6
    Atkins appeared before the MRB to appeal the denial of his waiver. While
    the MRB recognized that Atkins had performed his duties without incident, one
    MRB member summarized NPS’s concerns as follows:
    [T]he absence of documented real-life situations regarding low
    blood-sugar levels does not minimize safety risks and certainly
    doesn’t minimize the concerns that the [NPS] has with regards to
    your ability to perform the full range of law-enforcement duties
    safely and efficiently. . . . [T]he question is whether or not [your
    blood-sugar fluctuations are] prima facie evidence that your
    condition is not static and stabilized. And right now, if you look at
    our regulations, your conditions, your condition is not static or
    stabilized.
    Atkins admitted, in response, that the nature of his work prevented him from
    eating regularly or healthily: “[U]nfortunately doing what a lot of law-
    enforcement people do . . . our diet’s not exactly the greatest thing in the world,
    6
    Atkins himself recognizes that his duties as a law enforcement park ranger involved
    varied and arduous physical activities: “Patrolling the park by foot or vehicle[;] . . . ma[king]
    arrests, issu[ing] tickets, . . . handl[ing] all incidents given to [him;] . . . handl[ing] Emergency
    Medical Services [as a] First Responder on numerous incidents including numerous motor
    vehicle accidents[; and] . . . [working] as a wild land firefighter . . . .” Atkins also recognized
    that he often carried out his work alone, stating that “[a]s far as rangers go, sometimes there
    will be three others on, sometimes you’ll be the only one. . . . [S]ometimes we ride together and
    a lot of times we’re in cars by ourselves.”
    6
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    because if you’re on patrol and you’re the only one working, you can’t exactly go
    someplace and have a decent meal. So you run through a fast-food place.”
    The MRB’s physician remarked that Atkins’s blood sugar fluctuated
    wildly: “[B]etween March 14th and April 13, there were seven [on-the-job]
    episodes where your blood sugar was below 50[mg/dl]7 in that just about one-
    month period, seven times. . . . The mid morning [reading] varies from 40[mg/dl]
    to 232[mg/dl]. I’ll just read some of them: 132, 105, 232, 142, 84, 204, 40, 124, 77.
    That’s a lot of variability in a short span of time.” Another MRB member noted
    that “[t]here has to be some point in time when those low blood-sugar levels
    become fewer and fewer.”
    Of particular concern to the MRB was that Atkins might be unable to feel
    when his blood-glucose levels were perilously low:
    DR. SALADINO: So you do feel it when you’re 42[mg/dl] or
    47[mg/dl] or . . .
    MR. ATKINS: Well, yeah, you can feel your system. I mean, like I
    said, you start to get a little shaking, you’ll start to maybe just feel
    – I don’t know how to explain it all together.
    DR. SALADINO: Did you know that sometimes diabetics lose that
    feeling after 20 years? They stop feeling the lows until they get like
    very low?
    ...
    DR. SALADINO: That’s what I’m worried about, that maybe you’re
    not feeling these lows. Feeling twitchy; I don’t know.
    The MRB’s concern was clear: Atkins might not sense the onset of an
    incapacitating hypoglycemic event and, therefore, fail to take appropriate action.
    7
    The measurement “mg/dl” represents the number of milligrams per deciliter of glucose
    in the blood. This is another measure for variations in a diabetic’s blood-glucose levels. The
    United States Department of Health and Human Services has indicated that a blood-glucose
    measurement below 70 mg/dl is a strong indicator of a hypoglycemia. See U.S. DEPT. HEALTH
    & HUMAN SERVS., NATIONAL DIABETES INFORMATION CLEARINGHOUSE (NDIC) –
    HYPOGLYCEMIA, http://diabetes.niddk.nih.gov/dm/pubs/hypoglycemia/ (“When people think
    their blood glucose is too low, they should check the blood glucose level of a blood sample using
    a meter. If the level is below 70 mg/dl, . . . [a] quick-fix food[] should be consumed right away
    to raise blood glucose . . . .”).
    7
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    As the MRB explained, in such an event, the risks to the public, other NPS
    employees, and Atkins himself could be serious:
    One of the concerns [that NPS has with diabetic law enforcement
    park rangers] is that you’ve got to be able to react and respond
    appropriately in time-sensitive situations, and it requires the ability
    to use good judgment. Even though you’ve got rescue meds, always
    remember that there is a lag time between the time you take your
    particular rescue medication and the time for that to act on your
    system. So in essence, if there was a critical situation that required
    your involvement and you had low blood-sugar and you took a candy
    bar, it really wouldn’t be of any value. You’d pretty much be
    incapacitated if there was a significant issue.
    Following this hearing, on August 12, 2005, the MRB informed Atkins that
    he would not be granted a third waiver.8 The MRB based its decision on several
    factors:
    1.     That Atkins’s “diabetic condition . . . [wa]s not well
    controlled.”
    2.     That Atkins “had several incidents of hypoglycemia,”
    including seven episodes from March 14, 2005, to April 13,
    2005, and eleven episodes from January 22, 2005, to February
    21, 2005.
    3.     That despite close monitoring by his personal physician and
    the use of an insulin pump, Atkins’s “diabetes [was] not static
    and stable as outlined in 5 CFR [Part] 339, Medical
    Qualification Determinations.”9
    8
    In making its determination, the MRB considered “[Atkins’s] blood glucose logs over
    the last year; one exercise log; medical reports from [Atkins’s physician]; [HA1C] lab
    results; . . . the specific job requirements and environmental conditions of [Atkins’s] position
    at the time of the medical review; documentation submitted by [Atkins] to include [a physical
    fitness exam]; [Atkins’s] testimony to the MRB; written documentation from [Atkins’s]
    supervisor and others on [Atkins’s] behalf; the waiver granted to [Atkins] on July, 2002; and
    the [MRB]’s knowledge of the duties of a Park Ranger.”
    9
    The terms “static” and “stable” have specific meanings:
    In this context, “static or well-stabilized medical condition” means a medical
    condition which is not likely to change as a consequence of the natural
    progression of the condition, specifically as a result of the normal aging process,
    or in response to the work environment or the work itself.
    8
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    4.     That Atkins “ha[d] not been diligent in monitoring [his] blood
    sugar levels . . . as required by [his] initial waiver.”
    5.     That Atkins’s “blood sugar fluctuations [were] largely due to
    [his] failure to maintain a proper diet and nutrition as
    required to control [his] diabetes,” and that while “[Atkins’s
    personal physician had] hoped to stabilize [his HA1C levels
    at] ‘the American Diabetes Association recommended goal for
    this value [of] less than or equal to 7.0[%] and th[at this]
    w[ould] be [her] personal goal for [Atkins’s] level of control,’”
    “most of [Atkins’s HA1C] levels ha[d] consistently remained
    above 8.0[%] and as high as 10.2[%], which demonstrate[d]
    [that Atkins] ha[d] not controlled [his] diabetes.”10
    6.     That Atkins had failed to submit exercise logs as required by
    his initial waiver.
    7.     That Atkins “ha[d] not provided documentation on a quarterly
    basis . . . that [his] diabetic condition [was] continuing to be
    controlled through use of the insulin pump on a quarterly
    basis as required by [his] initial waiver.”
    Following the MRB’s determination, NPS revoked Atkins’s law
    enforcement commission on September 6, 2005, and on March 20, 2006, offered
    him a staff ranger position (a non-law enforcement position) at the same pay
    grade and duty location. Atkins accepted that offer and continues to hold this
    position today.
    Atkins filed a discrimination complaint challenging his transfer to staff
    ranger with Interior’s Equal Employment Office on October 18, 2005, alleging
    that the NPS wrongly removed him from his position because he was an insulin
    dependant diabetic. Following a hearing, the Administrative Law Judge decided
    that Atkins had not been discriminated against, and on July 2, 2007, Interior
    issued a Final Agency Decision affirming the Administrative Law Judge’s
    findings. Atkins v. Kempthorne, 353 F. App’x 934, 935–36 (5th Cir. 2009). Atkins
    
    5 C.F.R. § 339.104
    (g).
    10
    As Interior explained in its appellate brief, “[H]A1C readings were the best available
    objective evidence to determine Atkins’[s] blood sugar levels and to determine whether or not
    his diabetes was under control.”
    9
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    appealed Interior’s decision to the Equal Employment Opportunity Commission
    on August 6, 2007. After initially failing to properly exhaust his administrative
    remedies, see 
    id. at 936
    , Atkins later properly filed a discrimination suit against
    Interior, in the District Court for the Northern District of Mississippi on
    February 22, 2010. This is the case we consider.
    B. The Present Case
    Atkins sued Interior under the Rehabilitation Act, 
    29 U.S.C. § 791
    . The
    Rehabilitation Act itself incorporates the standards of the Americans with
    Disabilities Act of 1990, 
    42 U.S.C. § 12111
     et seq., (“ADA”) for determining
    whether there has been impermissible “nonaffirmative action employment
    discrimination.” See 
    29 U.S.C. § 791
    (g). The ADA prohibits discrimination
    against “a qualified individual on the basis of a disability in regard to job
    application procedures, the hiring, advancement or discharge of employees,
    employee compensation, job training, and other terms, conditions, and privileges
    of employment.” 
    42 U.S.C. § 12112
    (a).11 An ADA claim has three components:
    “[A] plaintiff must prove that 1) he has a ‘disability’; 2) he is ‘qualified’ for the
    job; and 3) an adverse employment decision was made solely because of his
    disability.” Turco v. Hoechst Celanese Corp., 
    101 F.3d 1090
    , 1092 (5th Cir. 1996)
    (per curiam) (citing Rizzo v. Children’s World Learning Ctrs., Inc., 
    84 F.3d 758
    ,
    763 (5th Cir. 1996)). “An individual has a disability under the [ADA] if he or she
    (1) has a physical or mental impairment that substantially limits one or more
    major life activities; (2) has a record of such impairment, or (3) is regarded as
    having such impairment.” Stewart v. City of Houston Police Dept., 372 F. App’x
    475, 477 (5th Cir. 2010) (citations and internal footnotes omitted).
    Among the various kinds of discrimination prohibited under the ADA is
    11
    As the events at issue in this case took place from 2000 to 2005, the 2008
    Amendments to the ADA are not relevant.
    10
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    using qualification standards, employment tests or other selection
    criteria that screen out or tend to screen out an individual with a
    disability or a class of individuals with disabilities unless the
    standard, test or other selection criteria, as used by the covered
    entity, is shown to be job-related for the position in question and is
    consistent with business necessity.
    
    42 U.S.C. § 12112
    (b)(6).12
    Atkins contended that his diabetes is a disability that “substantially limits
    his major life activities of eating, caring for himself[,] and metabolizing food.”
    However, despite his disability, Atkins alleged that he is a “qualified person with
    a disability and has met all of the requirements of a law enforcement ranger.”
    “NPS disqualified [him] because of a medical qualification standard that it used
    to declare Atkins’s diabetes ‘uncontrolled’ and inconsistent with his law
    enforcement duties,” and therefore his demotion was prohibited discrimination.
    Atkins made two related claims in this regard. First, Atkins alleged that
    Interior’s revocation of his law enforcement commission because of his diabetes
    was improper because it was “done without substantial evidence or any evidence
    whatsoever that would show that [Atkins] could not [meet] his essential duties
    [as a park ranger].” In other words, Atkins argued that Interior demoted him
    because “[Atkins] has diabetes and [Interior] acted on stereotype and speculation
    instead of [Atkins]’s abilities,” an impermissible form of discrimination. Second,
    Atkins alleged that Interior “regarded [Atkins] as having a disability which
    substantially limits life activities . . . . [and] incorrectly assumed that with
    diabetes it was impossible for [Atkins] to perform the essential functions of a law
    enforcement ranger with or without reasonable accommodation.” Put differently,
    Interior inaccurately “perceived [Atkins’s] diabetes as being uncontrolled and a
    12
    “Qualification standards means the personal and professional attributes including
    the skill, experience, education, physical, medical, safety and other requirements established
    by a covered entity as requirements which an individual must meet in order to be eligible for
    the position held or desired.” 
    29 C.F.R. § 1630.2
    (q).
    11
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    direct threat to himself or others,” due to a “qualification standard that screens
    out those with diabetes regardless of how qualified they are to perform the job
    [in question].”
    In response to Atkins’s complaint, Interior filed a pre-answer motion to
    dismiss or for summary judgment, in the alternative, with several attached
    documents. Interior made several counter-arguments. First, Interior argued that
    Atkins was not disabled because he “does not have an impairment that affects
    a major life activity such as performing manual tasks, walking, seeing, hearing,
    [etc.] . . . .” Second, Interior contended that Atkins was not perceived as disabled
    by NPS since “none of his supervisors regard[ed] him as disabled.” Third,
    Interior asserted that Interior “provided legitimate[,] nondiscriminatory reasons
    for its actions . . . [that Atkins] cannot show . . . are pretext.” Namely, NPS had
    a “legitimate, nondiscriminatory” interest in “the safety of the public and its
    workers.”13
    In his response to Interior’s motion, Atkins argued that he did have a
    “physical impairment, diabetes, that ‘substantially limits several [major] life
    activities, including eating for himself and metabolizing food.’” Atkins also
    contended that Interior had misunderstood his claim: “[T]his is not a burden
    case; Atkins’s claims arise under [the Rehabilitation Act].” Accordingly, Atkins
    argued, NPS’s “adoption of a diabetes qualification was not . . . subject to . . .
    McDonnell Douglas proof that the standards were a pretext for discrimination.”
    Rather, “when a qualification standard screens out people who are . . . disab[led],
    the plain language of the ADA require[s] the defendant . . . to plead and prove
    as an affirmative defense that its qualification was job-related and consistent
    with business necessity.” See 
    42 U.S.C. § 12113
    (a). Thus, Atkins asserted that
    13
    While Interior does not directly cite McDonnell Douglas Corp. v. Green, 
    411 U.S. 792
    (1973), the references to a “legitimate, nondiscriminatory reason” for Atkins’s demotion and
    Atkins’s inability to show a pretext for NPS’s decision are part of the McDonnell Douglas
    framework for analyzing discrimination claims. See 
    id.
     at 802–03.
    12
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    Interior, by failing to understand his argument, “ha[d] not presented and argued
    any evidence relevant to the . . . issues of job relatedness and business necessity,”
    a proper affirmative defense to a Rehabilitation Act claim. Atkins also noted that
    Interior’s reference to Atkins’s purported inability to do his job safely indirectly
    invoked a second affirmative defense under the ADA, that “‘a[] [disabled]
    individual shall not pose a direct threat to the health or safety of individuals in
    the workplace.’” See 
    42 U.S.C. § 12113
    (b). Atkins concluded that because Interior
    had the “burden of proceeding with evidence” under these affirmative defenses
    and had not done so, neither dismissal of his claim nor summary judgment was
    proper.
    Interior responded to Atkins’s arguments by directly stating that Atkins
    was a “direct threat to himself, fellow officers, and the public.” After Interior
    submitted this brief, Atkins requested leave to file a sur-reply since “[Interior]
    ha[d] improperly raised in [its] reply brief a significant new basis for summary
    judgment against [Atkins]: the affirmative defense that the adverse action
    against [Atkins] was based on Atkin’s being a direct threat to himself, his co-
    workers and the public.” The motion was granted and both Atkins and Interior
    exchanged further briefs which dealt with the direct threat defense and the
    business necessity defense to a lesser extent.
    After both sides submitted these various briefs, the district court went on
    to consider Interior’s original motion to dismiss and its attached exhibits.
    Following Federal Rule of Civil Procedure 12(d), the district court treated the
    motion to dismiss as a motion for summary judgment. See Atkins v. Salazar, No.
    1:10CV40-SA-JAD, 
    2010 WL 3937960
    , at *3 (N.D. Miss., Oct. 5, 2010); see
    also Fed. R. Civ. P. 12(d), 56(c). The district court found that “there [wa]s a
    genuine issue of material fact as to whether [Atkins] is substantially limited in
    the major life activity of eating such that he may be disabled under the
    Rehabilitation Act.” 
    Id. at *4
    .
    13
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    The district court then turned to the question of whether the NPS
    guidelines were “a qualification standard that screens out or tends to screen out
    disabled persons,” noting that the ADA, and therefore the Rehabilitation Act,
    affords “employer[s] an affirmative business-necessity defense to claims
    challenging the application of an otherwise problematic standard.” 
    Id. at *5
    .
    Reviewing the evidence, the district court found that “[the NPS medical]
    standard [under which Atkins was demoted] was not created arbitrarily, but
    rather was based upon evidence of a safety risk posed by hypoglycemia in insulin
    dependent diabetics, a risk which prevents the effective functioning of a law
    enforcement Park Ranger.” 
    Id. at *7
    . The district court then granted summary
    judgment for Interior on the business necessity defense, concluding that NPS’s
    “Medical      Standards       medically      disqualifying      those     with     uncontrolled
    insulin-dependent diabetes are job-related and consistent with [the] business
    necessity [defense].” 
    Id.
     Atkins appeals the district court’s grant of summary
    judgment.14
    Atkins appeals the district court’s grant of summary judgment to Interior
    on two bases. First, Atkins argues that the district court’s grant of summary
    judgment for Interior sua sponte was improper because it was based on the
    business necessity defense that, Atkins claims, Interior failed to present
    evidence on or arguments for in its motion for summary judgment. Atkins argues
    that the district court failed to notify the parties of its decision to rely on that
    14
    In his appellate brief, Atkins states that “some language in the district court’s opinion
    suggests that it was also concerned with whether Mr. Atkins posed a direct threat,”
    referencing the “direct threat” affirmative defense. In particular, Atkins points to the district
    court’s statement that “the law does not require NPS to put the lives of Atkins, his fellow Park
    Rangers, and the citizens they serve at risk by taking the chance that he will not experience
    a hypoglycemic episode on the job.” Atkins, 
    2010 WL 3937960
    , at *7. This language, however,
    is ambiguous and does not directly reference the direct threat affirmative defense. Accordingly,
    we do not consider the direct threat defense on appeal, concluding that the district court based
    its grant of summary judgment on business necessity alone.
    14
    Case: 10-60940     Document: 00511692251      Page: 15    Date Filed: 12/12/2011
    No. 10-60940
    defense. Second, Atkins contends that Interior’s evidence in support of its motion
    does not support granting summary judgment on the business necessity defense.
    II. DISCUSSION
    We review grants of summary judgment de novo. Kemp v. Holder, 
    610 F.3d 231
    , 234 (5th Cir. 2010) (citing LeMaire v. La. Dep’t of Transp. & Dev., 
    480 F.3d 383
    , 386 (5th Cir. 2007)). Summary judgment is appropriate “if the movant
    shows that there is no genuine dispute as to any material fact and the movant
    is entitled to judgment as a matter of law.” Fed. R. Civ. P. 56(a). There is no
    genuine issue for trial “[i]f the record, taken as a whole, could not lead a rational
    trier of fact to find for the non-moving party.” Kipps v. Caillier, 
    197 F.3d 765
    ,
    768 (5th Cir. 1999). We consider the facts and evidence presented in the light
    most favorable to the non-moving party, which is Atkins in this case. Breaux v.
    Halliburton Energy Servs., 
    562 F.3d 358
    , 364 (5th Cir. 2009).
    “[D]istrict courts are widely acknowledged to possess the power to enter
    summary judgments sua sponte, so long as the losing party was on notice that
    she had to come forward with all of her evidence.” Celotex Corp. v. Catrett, 
    477 U.S. 317
    , 326 (1986). We review for harmless error a district court’s improper
    entry of summary judgment sua sponte without notice. O’Hara v. Gen. Motors
    Corp., 
    508 F.3d 753
    , 764 (5th Cir. 2007); see also Washington v. Resolution Trust
    Co., 
    68 F.3d 935
     (5th Cir. 1995). A district court’s grant of summary judgment
    sua sponte is “considered harmless if the nonmovant has no additional evidence
    or if all of the nonmovant’s additional evidence is reviewed by the appellate court
    and none of the evidence presents a genuine issue of material fact.” Leatherman
    v. Tarrant Cnty. Narcotics Intelligence & Coordination Unit, 
    28 F.3d 1388
    , 1398
    (5th Cir. 1994) (emphasis omitted). Consequently, even if the district court
    wrongly granted summary judgment to Interior—that is, without notice on a
    basis not argued by Interior—such error may be harmless if the record is
    adequately developed to support a summary judgment decision.
    15
    Case: 10-60940       Document: 00511692251          Page: 16      Date Filed: 12/12/2011
    No. 10-60940
    A. The District Court’s Grant of Summary Judgment Sua Sponte
    We first address Atkins’s contention that the district court wrongly
    granted summary judgment sua sponte to Interior on the basis of the business
    necessity defense.15 Put simply, “[s]ummary judgment is improper if ‘[t]here was
    no reason for the [nonmoving party] to suspect that the court was about to rule
    on the motion.’” Resolution Trust Corp. v. Sharif-Munir-Davidson Dev. Corp.,
    
    992 F.2d 1398
    , 1402 (5th Cir. 1993) (quoting Kibort v. Hampton, 
    538 F.2d 90
    , 91
    (5th Cir. 1976)). Under this standard, “we have vacated summary judgements
    [sic] and remanded for further proceedings where the district court provided no
    notice prior to granting summary judgment sua sponte, even where summary
    judgment may have been appropriate on the merits.” Leatherman, 
    28 F.3d at 1398
    .16
    15
    Federal Rule of Civil Procedure 56(f) was amended on April 28, 2010, with an
    effective date of December 1, 2010 (after the district court’s decision on October 5, 2010), to
    provide that a district court may grant a motion for summary judgment “on grounds not raised
    by a party,” if the court has given the parties “notice and a reasonable time to respond.” Fed.
    R. Civ. P. 56(f). The advisory committee notes explain that this modification “brings into Rule
    56[’s] text a number of related procedures that have grown up in practice.” Prior to this
    addition, the general rule was that a district court was required to give ten days’ notice prior
    to granting summary judgment on a basis not urged in a pending summary judgment motion.
    See, e.g., Judwin Props., Inc. v. U.S. Fire Ins. Co., 
    973 F.2d 432
    , 436–37 (5th Cir. 1992). This
    previous rule was grounded in a strict reading of the text of the pre-2009 version of Federal
    Rule 56(c), which provided that the nonmoving party must be served with a summary
    judgment motion at least ten days prior to the time fixed for the hearing, so as to afford the
    nonmoving party “an opportunity to respond and to develop the record in opposition to
    requested summary judgment.” John Deere Co. v. Am. Nat’l Bank, Stafford, 
    809 F.2d 1190
    ,
    1192 & n.2 (5th Cir. 1987).
    16
    The impetus for the requirement of notice is that nonmovants must be “on notice to
    present [relevant] arguments . . . in their response[s] to [movants’s] summary judgment
    motion[s], [otherwise] . . . the court [will] not have the benefit of the parties’ arguments.”
    Lozano v. Ocwen Fed. Bank, FSB, 
    489 F.3d 636
    , 641 (5th Cir. 2007). The key is that “the basis
    on which the motion is granted . . . [must be] raised in a manner sufficient to make the
    nonmoving party aware that failure to present evidence on the issue could be grounds for
    summary judgment.” Loughman v. Sw. Bell Tel. Co., 
    131 F.3d 140
    , 
    1997 WL 759294
    , at *3 (5th
    Cir. Oct. 28, 1997) (per curiam).
    16
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    No. 10-60940
    Atkins’s basic argument against the district court’s grant of summary
    judgment sua sponte is that Interior never argued the business necessity defense
    in its initial briefing in support of summary judgment. Rather, Atkins contends,
    Interior argued that Atkins’s inability to meet the NPS’s medical standards was
    a legitimate, nondiscriminatory reason for his dismissal under the burden-
    shifting standard of McDonnell Douglas. As Atkins argued in his response to
    Interior’s motion for summary judgment, when “the evidence establishes that an
    employer openly discriminates against an individual it is not necessary to apply
    the mechanical formula of McDonnell Douglas to establish an inference of
    discrimination.” Rizzo, 
    84 F.3d at 762
     (quoting Moore v. U.S.D.A., 
    55 F.3d 991
    ,
    995 (5th Cir. 1995)); see also Trans World Airlines, Inc. v. Thurston, 
    469 U.S. 111
    , 121 (1985) (“[T]he McDonnell Douglas test is inapplicable where the
    plaintiff presents direct evidence of discrimination.”).17 Since Interior provided
    no other arguments in support of its position, Atkins concludes that the district
    court incorrectly granted summary judgment sua sponte without notice on a
    legal basis and facts different from those argued by Interior, effectively
    preventing him from addressing the business necessity defense.
    Atkins’s argument is unavailing. First, while Interior recognizes on appeal
    that it failed to raise the affirmative defense of business necessity in its opening
    brief, Atkins himself raised the business necessity defense in his summary
    judgment response brief:
    [T]he defendant’s adoption of a diabetes qualification standard was
    not a business decision entitled to the Court’s deference subject to
    17
    We observe that Atkins’s argument in this regard is mistaken. Interior initially
    defended by arguing that Atkins was not disabled because of his diabetes. Accordingly, under
    the McDonnell Douglas framework, there was no direct evidence that Atkins was actually
    dismissed because of a disability. Assuming arguendo that Atkins was able to make out a
    prima facie case of discrimination, Interior’s burden in response would be “to articulate some
    legitimate, nondiscriminatory reason for the employee’s rejection.” McDonnell Douglas, 
    411 U.S. at 802
    .
    17
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    No. 10-60940
    Atkins’s McDonnell Douglas proof that the standards were a pretext
    for discrimination. On the contrary, whenever a qualification
    standard screens out people who are or tend to have a disability, the
    plain language of the ADA requires the defendant (if it seeks to
    avoid liability) to plead and prove, as an affirmative defense, that its
    qualification standard was job-related and consistent with business
    necessity.
    In that brief, Atkins further explained that “Interior ha[d] not presented and
    argued any evidence relevant to the . . . issues of job relatedness and business
    necessity.” Atkins went on to discuss the business necessity defense for several
    pages. He concluded that if “NPS chooses to defend this case on the basis of
    business necessity it has the burden of proceeding with evidence, not Atkins.” All
    this suggests that Atkins was aware of the business necessity defense and
    argued against it despite Interior’s failure to raise the defense in its opening
    brief.
    Moreover, Interior made repeated reference to facts relevant to the
    business necessity defense in its opening brief. For example, Interior explained
    that NPS’s “legitimate, nondiscriminatory reason” for requiring medical
    standards and demoting Atkins “is the safety of the public and its workers. By
    its very nature, law enforcement work is unpredictable and sometimes
    dangerous. Any condition that can quickly render a law enforcement officer
    confused or unconscious puts that officer, fellow officers, and the public in
    danger.” Interior further argued that because “[Atkins]’s uncontrolled diabetes
    [could] affect attention, concentration, thinking, judgment, decision making,
    reaction time, hand-eye coordination, cause confusion, irritability, and rapid
    changes in level of consciousness, he clearly posed a safety threat in a potentially
    arduous and dangerous law enforcement assignment.” Thus, Interior asserted,
    NPS’s demotion of Atkins was a “good faith effort[] to follow their medical
    standards that applied to all Park Rangers in law enforcement positions with
    arduous duties,” and these standards were “implemented to protect employees,
    18
    Case: 10-60940       Document: 00511692251         Page: 19     Date Filed: 12/12/2011
    No. 10-60940
    [Atkins]’s co-workers, the general public and [Atkins] himself.” Such facts, as
    well as any other evidence in the record, could be considered by the district court
    when making its summary judgment determination. See United States v.
    Houston Pipeline Co., 
    37 F.3d 224
    , 227 (“[T]he district judge is not compelled to
    limit the basis for summary judgment to those facts listed in the motion for
    summary judgment.”) (quoting Daniels v. Morris, 
    746 F.2d 271
    , 276 (5th Cir.
    1984)); see also Cripe, 261 F.3d at 886 n.9 (“Although the [defendant in this ADA
    suit] has mislabeled its argument and identified the wrong standard, such error
    does not cause us to hold that it waived the ‘business necessity’ defense. The
    [defendant] argued the relevant facts before the district court; that sufficiently
    put the plaintiffs and the court on notice of the actual issue the defendant should
    have specified.”).
    Given that Interior raised the business necessity defense in its reply brief
    to Atkins’s summary judgment response brief, there may be concerns that Atkins
    did not have the opportunity to present either evidence or arguments in response
    to Interior’s argument—that Interior would effectively have the final word on
    the business necessity defense. See Loughman, 
    1997 WL 759294
    , at *3–4
    (reversing sua sponte grant of summary judgment on grounds that plaintiff
    failed to show an adverse employment action under the ADA when defendant
    argued in its summary judgment brief that plaintiff was not a “qualified
    individual with a disability” and raised the failure-of-proof argument only its
    reply brief).18 The concern is inapposite in this case. Atkins filed a sur-reply in
    18
    Cf. O’Hara v. Gen. Motors Corp., 
    508 F.3d 753
    , 763–64 (5th Cir. 2007) (“[W]e note
    that GM [General Motors] did not move for summary judgment on either [of two of the
    O’Haras’] claims. The O’Haras argue that the district court erred by granting summary
    judgment on these claims sua sponte without giving them . . . notice . . . . We reject this
    argument because this Circuit recognizes a harmless error exception to the ten day notice
    rule. . . . Any error by the district court in considering the O’Haras’ additional claims on
    summary judgment was harmless. The O’Haras placed these claims at issue by raising them
    in their January 2006 reply brief to GM’s motion for summary judgment, to which they
    attached a 500-page appendix. They re-asserted these claims in their sur-reply brief in March
    19
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    No. 10-60940
    which he reiterated that “NPS could have tried to mount a defense against
    [Atkins’s] § 12112(b)(6) claim with evidence of job relatedness and business
    necessity under § 12113(a) . . . but NPS did not.”
    In sum, Atkins raised the business necessity himself in his reply brief and
    later elaborated upon it in his sur-reply. Whether or not he had formal notice
    from the district court, Atkins was aware that the defense was at play and had
    a full opportunity to argue against it and present whatever relevant evidence he
    had. Notice from the district court that it intended to rely on the affirmative
    defenses would have made no difference to Atkins’s briefing and so the lack of
    notice caused Atkins no harm. Moreover, a sua sponte grant of summary
    judgment without notice is proper “if all of the nonmovant’s additional evidence
    is reviewed by the appellate court and none of the evidence presents a genuine
    issue of material fact,” Leatherman, 
    28 F.3d at 1398
    . As we discuss in the next
    section, we also hold that Interior was able to establish the business necessity
    defense. We, therefore, hold that the district court did not err in considering the
    business necessity defense in spite of its lack of notice to the parties when
    granting summary judgment and any error it may have made was harmless.
    B. The Business Necessity Defense
    We now arrive at the second issue, whether the district court’s decision to
    grant summary judgment on the business necessity defense was correct. We hold
    that the district court’s grant of summary judgment in favor of Interior on the
    basis of the business necessity defense was correct.
    Section 12112(b)(6) of the ADA creates an affirmative defense for
    qualification standards shown to be “job-related for the position in question and
    2006, which was filed with a 400-page appendix. Under these circumstances, the O’Haras were
    afforded an adequate opportunity to present the evidence supporting their claims and . . .
    additional . . . notice would not have served any valid purpose.”)
    20
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    No. 10-60940
    [] consistent with business necessity.” The ADA further explains this defense as
    follows:
    It may be a defense to a charge of discrimination under this chapter
    that an alleged application of qualification standards, tests, or
    selection criteria that screen out or tend to screen out or otherwise
    deny a job or benefit to an individual with a disability has been
    shown to be job-related and consistent with business necessity, and
    such performance cannot be accomplished by reasonable
    accommodation, as required under this subchapter.
    
    42 U.S.C. § 12113
    (a); cf. Chevron U.S.A. Inc. v. Echazabal, 
    536 U.S. 73
    , 78 (2002)
    (explaining that sections 12112(b)(6) and 12113 create an affirmative defense for
    standards shown to be job-related for the position in question and consistent
    with business necessity). “Once an employee shows that a qualification standard
    tends to screen out an individual with a disability, the employer shoulders the
    burden of proving that the challenged standard is job-related and consistent
    with business necessity.” Rohr v. Salt River Project Agric. Imp. and Power Dist.,
    
    555 F.3d 850
    , 862 (9th Cir. 2009); cf. Rizzo, 213 F.3d at 218 (“[Under the ADA,]
    it is the employee’s burden to prove that he is a qualified individual with a
    disability . . . , and it is the employer’s burden to establish [an affirmative
    defense].”).
    To show a business necessity defense, a defendant must prove by a
    preponderance of the evidence that its qualification standards are: (1) uniformly
    applied; (2) job-related for the position in question; (3) consistent with business
    necessity; and (4) cannot be met by a person with plaintiff’s disability even with
    a reasonable accommodation. See, e.g., Fifth Circuit Pattern Jury Instructions
    11.7.4. For a qualification to be “job-related,” “the employer must demonstrate
    that the qualification standard is necessary and related to ‘the specific skills and
    physical requirements of the sought-after position.’” Cripe v. City of San Jose,
    
    261 F.3d 877
    , 890 (9th Cir. 2001) (quoting Belk v. Sw. Bell Tel. Co., 
    194 F.3d 946
    ,
    951 (8th Cir.1999)). Similarly, for a qualification standard to be “consistent with
    21
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    No. 10-60940
    business necessity,” the employer must show that it “substantially promote[s]”
    the business’s needs. Bates v. United Parcel Service, Inc., 
    511 F.3d 974
    , 996 (9th
    Cir. 2007) (en banc) (quoting Cripe, 
    261 F.3d at 890
    ). We have stated, concerning
    safety-based qualification standards, that
    [i]n evaluating whether the risks addressed by a safety-based
    qualification standard constitute a business necessity, the court
    should take into account the magnitude of possible harm as well as
    the probability of occurrence. The acceptable probability of an
    incident will vary with the potential hazard posed by the particular
    position: a probability that might be tolerable in an ordinary job
    might be intolerable for a position involving atomic reactors, for
    example. In short, the probability of the occurrence is discounted by
    the magnitude of its consequences.
    E.E.O.C. v. Exxon Corp., 
    203 F.3d 871
    , 875 (5th Cir. 2000).
    The record before us strongly supports a finding of business necessity on
    the part of Interior. The NPS Standards are clearly job-related for a park ranger.
    Detterline v. Salazar, 320 F. App’x 853, 858 (10th Cir. 2009) (noting that “the
    NPS requirements are reasonable and appropriate because Law Enforcement
    Park Rangers are subject to physical demands that might not be applicable to
    other NPS employment positions”). The Standards “are designed to ensure that
    employees performing law enforcement are physically able to perform that duty
    and that their performance does not constitute a threat to the health and well
    being of themselves, their fellow employees, and park visitors.” (emphasis
    added). Atkins himself acknowledged that he was responsible for a range of
    physically challenging and often isolated activities: “Patrolling the park by foot
    or vehicle[,] . . . ma[king] arrests, issu[ing] tickets, . . . handl[ing] all incidents
    given to [him,] . . . handl[ing] Emergency Medical Services [as a] First Responder
    on numerous incidents including numerous motor vehicle accidents[, and] . . .
    [working] as a wild land firefighter . . . .”
    The specific Standard under which Atkins was transferred is congruent
    with NPS’s legitimate concern with ensuring the safety of the public and its
    22
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    No. 10-60940
    employees, focusing on diabetes’s propensity to “produce metabolic disturbances
    affecting weight, stress adaptation, energy production, and a variety of
    symptoms or pathology such as elevated blood pressure, weakness, fatigue and
    collapse,” all impediments to safely performing the work of a park ranger. It is
    clear, then, that the Standard’s focus on the physical consequences of
    uncontrolled diabetes was “related to the specific skills and requirements” of
    being a park ranger and, therefore, job-related. Cripe, 
    261 F.3d at 890
     (internal
    quotation marks and citation omitted).
    The Standards also “substantially promote[d]” NPS’s needs, “consistent
    with business necessity.” Bates, 
    511 F.3d at 996
    . As noted above, the Standards
    are “designed to ensure that employees performing law enforcement are
    physically able to perform that duty and that their performance does not
    constitute a threat to the health and well being of themselves, their fellow
    employees, and park visitors.” Moreover, as the MRB explained, hypoglycemic
    events may have serious consequences for a law enforcement officer:
    One of the concerns [that NPS has with diabetic park rangers] is
    that you’ve got to be able to react and respond appropriately in time-
    sensitive situations, and it requires the ability to use good
    judgment. Even though you’ve got rescue meds, always remember
    that there is a lag time between the time you take your particular
    rescue medication and the time for that to act on your system. So in
    essence, if there was a critical situation that required your
    involvement and you had low blood-sugar and you took a candy bar,
    it really wouldn’t be of any value. You’d pretty much be
    incapacitated if there was a significant issue.
    NPS is not required to wait until after there is an emergency to take action
    protective of the public and its employees.19
    19
    See, e.g., Wilkerson v. Shinseki, 
    606 F.3d 1256
    , 1264–65 (10th Cir. 2010) (“As long as
    the need to perform in an emergency is a realistic component of the job, the employer should
    be able to ‘establish reasonable physical qualifications’ to ensure that an emergency situation
    can be dealt with safely and efficiently by the employee, especially in situations . . . where the
    physical safety of others may be at risk.”) (citing Se. Cmty. Coll. v. Davis, 
    442 U.S. 397
    , 414
    23
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    No. 10-60940
    That Atkins did not experience an on-the-job incident is fortunate, but
    does not affect our conclusion. Other circuits, in the context of uncontrolled
    diabetes, have “recognized that where the [diabetic]’s medical condition is
    uncontrolled, of an unlimited duration, and capable of causing serious harm,
    injury may be considered likely to occur,” even without evidence of prior
    incidents on the job. Cf. Darnell v. Thermafiber, Inc., 
    417 F.3d 657
    , 662 (7th Cir.
    2005) (“[Diabetic plaintiff] argues that the fact that he worked at the plant for
    10 months without experiencing an episode makes it doubtful that an injury is
    likely to occur. However, an employee with a health condition who has
    experienced no on-the-job episodes can still pose a direct threat to workplace
    safety.”). As we noted above, “the probability of the occurrence is discounted by
    the magnitude of its consequences.” See Exxon Corp., 
    203 F.3d at 875
    . The
    consequences of Atkins experiencing hypoglycemia while carrying out a
    dangerous arrest, responding to a medical emergency, or fighting a fire are
    sufficiently large to justify NPS’s revocation of his law enforcement condition on
    the basis of even a small risk of hypoglycemia.
    NPS did not reach the conclusion that demoting Atkins was a business
    necessity haphazardly; it followed a uniform pattern application. The Standards
    rely on “[i]ndividualized assessments [to] be made on a case-by-case basis.” This
    is the kind of analysis we have required in other cases: “‘An individualized
    assessment of the effect of an impairment is particularly necessary when the
    impairment is one whose symptoms vary widely from person to person,’”
    Rodriguez v. ConAgra Grocery Pros. Co., 
    436 F.3d 468
    , 482 (5th Cir. 2006)
    (quoting Toyota Motor Mfg. Ky. Inc. v. Williams, 
    534 U.S. 184
    , 199 (2002)), and
    this assessment must be linked to the employee’s “ability to perform the
    essential functions of [the job].” Kapche v. City of San Antonio, 
    304 F.3d 493
    , 499
    (1979)).
    24
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    No. 10-60940
    (5th Cir. 2002).
    Notably, NPS has not sought simply to exclude diabetics from serving as
    park rangers. See Kapche, 304 F.3d at 500 (holding that summary
    disqualification of police officer because of diabetic status was improper and that
    an “individualized assessment of an [applicant]’s present ability to safely
    perform the essential functions of [a] police officer is required”). Rather, as the
    Manager of NPS’s Medical Standards Program explained, for park rangers,
    “diabetes in and of itself is not nor has it ever been considered a disqualifying
    condition. Indeed, several Park Rangers who are Type 1 Insulin Dependent
    diabetics are medically qualified to perform their law enforcement duties.”
    Rather, the Standards are concerned with the “safety and health risks [posed by]
    Park Rangers whose diabetes is not controlled or unstable.” Park rangers with
    diabetes who are medically qualified for duty have “the ability to stabilize their
    blood sugar at acceptable levels.” Park rangers like Atkins, however, “whose
    particular medical conditions are not under control[,] . . . have been determined
    not to be medically qualified to perform law enforcement duties.”
    In determining, after two prior assessments, that “Atkins failed to meet
    the medical requirements imposed by 5 C.F.R. Part 339 on Park Rangers” in his
    third review, NPS relied on a wide range of medical and other data, collected
    over the course of a year. The MRB specifically found that Atkins had been
    routinely experiencing hypoglycemic events during his work as a park ranger,
    including seven events in one month-long period and eleven events during
    another. Indeed, the physician on the MRB specifically remarked that Atkins’s
    blood-glucose levels fluctuated wildly even during shorter periods of time. The
    record indicates that there was a legitimate concern that Atkins might be unable
    to even sense the approach of a hypoglycemic episode and therefore unable to
    prevent it. Moreover, the actual work of a park ranger in rural Mississippi, with
    25
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    No. 10-60940
    its long hours, unpredictable schedule, and absence of suitable dietary options,
    left Atkins especially vulnerable to a hypoglycemic episode.
    Atkins’s personal efforts to control his diabetes offered little solace, either.
    “[Atkins’s personal physician had] hoped to stabilize [his HA1C levels at] ‘the
    American Diabetes Association recommended goal for this value [of] less than
    or equal to 7.0[%] and th[at this] w[ould] be [her] personal goal for [Atkins's]
    level of control.’” But “most of [Atkins’s HA1C] levels ha[d] consistently
    remained above 8.0[%] and as high as 10.2[%], demonstrat[ing] [that Atkins]
    ha[d] not controlled [his] diabetes.”
    Atkins’s argument that a “uniform application” demands that “[Interior]
    needed to come forward with . . . evidence of symptoms marking the point at
    which it would ordinarily determine that metabolic dysfunction was likely to
    have adverse effects on safety and efficiency, and evidence that [Interior] applied
    that cut-off point” is unpersuasive. Atkins cites no statutory, regulatory, or case
    authority for this proposition. Interior was allowed to make a holistic
    determination, based on medical evidence substantial in amount and
    significance, that Atkins’s fluctuating blood-glucose levels posed a significant
    risk to the public, other NPS employees, and Atkins himself. Indeed, Atkins
    received, and failed, three individualized assessments consistent with Interior’s
    regulatory requirements.
    Finally, no reasonable accommodation would cure the problems posed by
    a park ranger with “uncontrolled” diabetes like Atkins, at least not without
    inflicting “undue hardship” on NPS. See Bates, 
    511 F.3d at
    996–97.20 In spite of
    20
    The ADA states that
    ‘reasonable accommodation’ may include . . . job restructuring, part-time or
    modified work schedules, reassignment to a vacant position, acquisition or
    modification of equipment or devices, appropriate adjustment or modifications
    of examinations, training materials or policies, the provision of qualified readers
    or interpreters, and other similar accommodations for individuals with
    disabilities.
    26
    Case: 10-60940        Document: 00511692251   Page: 27   Date Filed: 12/12/2011
    No. 10-60940
    two previous waivers with specific accommodations, instructions, and
    benchmarks, Atkins was unable to mitigate his fluctuating blood-glucose levels.
    NPS was rightly concerned that there was a significant “likelihood that [Atkins
    might] experience sudden or subtle incapacitation as a result of [his] medical
    condition,” indicating that his diabetic condition was neither “static or well
    stabilized ,” 
    5 C.F.R. § 339.104
    (g), the key requirement behind his previous two
    waivers.
    In conclusion, then, the record supports the district court’s conclusion that
    there was no genuine issue of material fact regarding the business necessity
    defense and its grant of summary judgment in favor of Interior was proper.
    III. CONCLUSION
    For the foregoing reasons, we AFFIRM the district court’s grant of
    summary judgment in favor of the Department of the Interior. All pending
    motions are DENIED.
    
    42 U.S.C. § 12111
    (9).
    27