A federal appeals court has overturned a lower court ruling and reinstated disability and retaliation charges filed by a nurse who was terminated after she refused to get a vaccine because of anxiety.

Aleka Ruggiero, who worked as a nurse at State College, Pennsylvania-based Mount Nittany Medical Center, suffers from severe anxiety and eosinophilic esophagitis, an inflammation of the esophagus, that limits her ability to perform certain life activities, such as eating, sleeping and engaging in social interactions, according to Tuesday’s ruling by the 3rd U.S. Circuit Court of Appeals in Philadelphia in Aleka Ruggiero v. Mount Nittany Medical Center; Mount Nittany Health System.

In April, 2015 Ms. Ruggiero received a memorandum from the medical center advising her that all clinical employees were required to receive a vaccine for tetanus, diphtheria and pertussis.

Ms. Ruggiero submitted a letter from her doctor saying she was medically exempt from receiving the vaccine because of severe anxiety related to her food allergies and the eosinophilic esophagitis.

Ms. Ruggiero asked that, as an accommodation, she be permitted to wear a mask instead of receiving the vaccine, but she was removed from work and formally terminated in July 2015, according to the ruling.

Ms. Ruggiero filed suit, stating her former employer had violated the Americans with Disabilities Act by failing to reasonably accommodate her, discriminating against her because of a disability and retaliating against her for requesting an accommodation.

The U.S. District Court in Scranton, Pennsylvania, granted the medical center’s motion to dismiss the case. Ms. Ruggiero appealed the dismissal, with the U.S. Equal Employment Opportunity Commission filing an amicus brief on her behalf.

A three-judge panel of the 3rd Circuit unanimously reinstated her charges. The facts in Ms. Ruggiero’s complaint “plausibly suggest” the medical center knew of her alleged disability and her desire for an accommodation, said the ruling

Her allegations also raise the “plausible inference” that the medical center “had failed to properly engage in the interactive process,” said the ruling, stating the center had rejected her requests for either an exemption from the vaccine requirement or permission to wear a mask without proposing an alternative.

The ruling also held that dismissal of Ms. Ruggiero’s discrimination claim was premature.

The case was remanded to the lower court for further proceedings.

The Americans with Disabilities Act Amendments Act of 2008 has resulted in more claims, but it has also changed the litigation landscape and led employers to focus more on accommodating workers instead of battling them over whether they are disabled.