Affirmеd in part, reversed in part, and remanded by published opinion. Judge WILKINSON wrote the opinion, in which Chief Judge WILKINS and Judge GREGORY joined.
James Heiko brings suit against his former employer, Colombo Savings Bank, alleging a failure to promote and constructive discharge on the basis of disability. At the time of the alleged discrimination, Heiko suffered from end-stage renal disease — near complete kidney failure — and spent three afternoons per week, for a total of twelve hours, attached to a dialysis machine that removed fatal toxins from his blood. The district court granted summary judgment for Colombo, holding that Heiko was not disabled under the Americans with Disabilities Act (ADA) because the elimination of bodily waste is not a “major life activity.” See 42 U.S.C. § 12102(2)(A) (2000). It also held in the alternative that even if Heiko was disabled, he had not proffered faсts sufficient to support a finding of discrimination.
We hold that elimination of bodily waste is a “major life activity” within the meaning of the ADA. With respect to the allegations of discrimination, summary judgment was improper on the claim of failure to promote, because Heiko has presented a strong prima facie case of disability discrimination and considerable evidence of job qualifications superior to those of the person selected in his stead. Summary judgment was proper, however, on the allegation of constructive discharge. We therefore affirm in part, reverse in part, and remand for further proceedings.
I.
In January 1998, James Heiko commenced employment with Colombo Savings Bank as a Loan Assistant in the Loan Administration Department. Colombo is a small commercial bаnk in Maryland that employs approximately thirty people. Pri- or to joining Colombo, Heiko had received his undergraduate degree in mathematics in 1994. He had worked in the banking industry since 1990, most recently as a research representative with the Chase Manhattan Bank.
Heiko moved quickly through the ranks at Colombo. In April 1999,. the bank’s President and CEO, John Lane, approved Heiko’s promotion to Senior Operations Officer/Table-Funded Loan (TFL) Supervisor. With Lane’s approval, Heiko was again promoted in June 1999, this time to Assistant Vice President of Loan Administration. In this new capacity, Heiko handled a wide range of commercial lending responsibilities, including reviewing escrow *252 analyses, monitoring commercial loans, and preparing reports and audits. He also assumed some supervisory authority over various lower-level employees in Loan Administration.
Heiko had a variety of other duties at Colombo. Throughout the course of his tenure at the bank, he was often asked to tackle problems outside the Loan Administration Department. Among other things, he was responsible for creating a loan tracking device and a weekly loan report. He also participated in meetings on banking matters unrelated to his primary duties. Heiko received favorable performance evaluations, and in December 2000 Lane named him Employee of the Year at a bank holiday function.
Heiko had polycystic kidney disease when he joined Colombo. Several months after his promotion to Assistant Vice President, his condition deteriorated and he was diagnosed with end-stage renal disease. This disease renders the kidneys virtually inoperative. In a normal human body, the kidneys filter from the blood dangerous toxins that naturally build up over time, allowing these toxins to exit the body during urination. To avoid toxic waste buildup, and death within several months, end-stage renal disease must be treated with either a kidney transplant or dialysis.
Heiko began hemodialysis in November 1999. In this procedure, Heiko’s blood was pumped through a dialysis machine, which purged the toxins and returned the cleansed blood to his body. Heiko attached to the dialysis machine by inserting a needle into a fistula located in his arm. A fistula is a surgically-constructed connection between an artery and vein, designed to withstand frequent needle insertions and augment blood flow.
Heiko’s dialysis regimen required a substantial amount of time and forced him to rearrаnge his work schedule. He underwent dialysis three afternoons each week for four hours each day. To keep up a forty-hour work week, Heiko had to maintain irregular hours, working from 7:00 a.m. to 2:00 p.m. on the days he received dialysis.
Heiko’s dialysis treatment caused him significant discomfort. According to Heiko, dialysis was “like having a part-time job.” Being attached to a dialysis machine was constricting, and often caused pain and swelling in his arm, where the needle attached to his fistula. After dialysis, he immediately went home to rest and felt exhausted for the remainder of the evening. He was usually able to take only baths because standing in the shower was to.o difficult. In the following mornings he would often feel the urge to vomit, and would frequently remain nauseous well into that day. Dialysis also necessitated changes to his diet, suсh as limitations on potassium intake, occasional fasting, and a reduction in fluid consumption. Heiko was once hospitalized for low potassium levels and had one of his kidneys removed in 2000. He also had several surgeries to build and repair his fistula.
After Heiko had begun dialysis, Heather Brown, Colombo’s Vice President of Loan Administration and Heiko’s immediate supervisor, began preparing to leave Colombo. Heiko was interested in her position, and discussed his desire for a promotion with Brown and Lane. In March 2001, however, Lane awarded the Vice President position to Sandy Rubin on Brown’s recommendation. Brown had considered only Rubin and Heiko for the position, but had not conducted interviews.
Prior to her promotion to Vice President, Rubin had been employed with Colombo for approximately eighteen months and had served as the head of Colombo’s *253 Mortgage Operations Department. She did not have a college degree, but had worked in banking since the mid-1970s. The Mortgage Operations Department handled mortgage loans and was initially distinct from Loan Administration, which was primarily concerned with commercial loans. Mortgage Operations was eventually subsumed into Loan Administration and Brown became Rubin’s supervisor. Rubin was not, however, familiar with certain types of management reports or with several of the computer programs utilized in the Loan Administration Department. After her promotion to Vice President, Heiko assisted in training her on various software applications and spreadsheet functions.
Upon learning that Rubin had received the promotion, Heiko apprоached both Lane and Brown to determine why he had not been named Vice President. According to Heiko, Lane referred to the number of hours the Vice President would need to work and noted that if Heiko was to receive a kidney transplant, he would have to be out of the office for four to six months. Heiko contends that he had informed Lane on numerous occasions that a kidney transplant would only require a six-week absence. When Heiko confronted Brown about Rubin’s promotion, she replied: “Look at your situation.”
Heiko warned Lane that promoting Rubin was a mistake and informed various Colombo officers that he would not work under her. Lane asked Heiko if he would, in addition to some of his current responsibilities, be interested in taking over Rubin’s former responsibility managing the Mortgage Operations Department, which was apparently in disarray. Heiko declined this lateral move.
In July 2001, Heiko instead transferred to the Loan Processing Department and began work as a loan processor. This move resulted in the loss of his Assistant Vice President title and his previous responsibilities, but not a diminution in his salary. Heiko was aware that he would no longer be considered an Assistant Vice President once he joined Loan Processing. On July 13, 2001, he was informed that he would not receive an annual pay raise.
Soon after, Heiko complained to several Colombo officers that the bank was discriminating against him on the basis of his kidney failure by not promoting him and later reducing his responsibilities. He also relayed this complaint to Lane, and they discussed the matter. Around the same time, Heiko informed Colombo that he had been searching for new employment.
In early August of 2001, Lane informed Heiko that the Loan Processing Department was overstaffed and that the only available position was as his executive assistant. Heiko accepted this position. Lane also told Heiko that he would not be needed before 7:30 a.m. This impacted Heiko’s total hours, because he still had to leave early for dialysis every other day. After several weeks as an executive assistant, Lane asked Heiko to move back to Loan Administration because a Loan Assistant position had become available. This was the position Heiko had occupied when he first joined Colombo.
Heiko resigned from Colombo in October 2001, after accepting employment elsewhere. In June 2003, he recеived a kidney transplant and does not now require dialysis. Sandy Rubin, meanwhile, did not fare well as the Vice President of Loan Administration. In January 2002, Lane demoted Rubin to her former position and cut her salary. She resigned in February 2002 after Colombo decided to terminate her employment.
Heiko filed suit against Colombo in state court in March 2003 alleging discrimina *254 tion on the basis of his kidney failure, in violation of Article 1, § 27-19 of the Montgomery County Code (2004). The parties agreed that § 27-19 was to be interpreted consistent with the federal ADA. As relevant here, Heiko contended that he was covered under the definition of “disability” set forth in the ADA because his end-stage renal disease rendered him “substantially limit[ed]” in the “major life activit[y]” of eliminating bodily waste. See 42 U.S.C. § 12102(2)(A). Colombo removed the suit to federal court on the basis of diversity jurisdiction. See 28 U.S.C. § 1441 (2000).
The district сourt granted summary judgment for Colombo. It held that waste elimination was not a major life activity, and that Heiko was therefore not disabled. It also held that even if he had a disability, Heiko had not set forth facts sufficient to permit findings of discriminatory failure to promote or constructive discharge. Heiko appeals.
II.
The threshold question before us is whether Heiko is disabled within the meaning of the ADA. A court may resolve this issue as a matter of law.
See Hooven-Lewis v. Caldera,
The ADA provides that an individual has a disability if, inter alia, he suffers from “a physical or mental impairment that substantially limits one or more of [his] major life activities.” 42 U.S.C. § 12102(2)(A). Heiko is thus required to make a three-part showing. He must prove (1) that he has a physical or mental impairment, (2) that this impairment implicates at least one major life activity, and (3) that the limitation is substantial.
See Toyota Motor Mfg., Ky., Inc. v. Williams,
A.
The ADA does not define the term “major life activities.”
Torcasio v. Murray,
Heiko contends that his kidney failure severely impacted his ability to eliminate bodily waste. Under the framework presented above, we conclude that waste elimination qualifies as a major life activity. The elimination of bodily waste is basic to any person’s daily regimen. It is also a daily activity that the average person can accomplish with little effort,
see Rohan,
It is therefore not surprising that every circuit court to address the issue has concluded that waste elimination is a major life activity. For example, in
Fiscus v. Wal-Mart Stores, Inc.,
The district court reasoned,- however, that waste elimination was not a major life activity because it was merely a characteristic of Heiko’s kidney failure. This was not correct. The
impairment
in this case is Heiko’s kidney failure. The
effect of
this impairment is an inability to eliminate waste naturally.
See also Fiscus,
Were the district court correct, the ADA would not cover major life activities
*256
that are closely linked with serious disabilities. For еxample, the Supreme Court in
Toyota
explicitly noted that “major life activities” is “a category that includes such basic abilities as walking, seeing, and hearing.”
This does not mean, however, that every example of organ failure will be equated with a major life activity. In this case, kidney failure is a physical impairment with a direct effect on waste elimination, an activity of critical importance that the average individual can easily perform.
See Rohan,
Nor do we accept Colombo’s contention that recognizing waste elimination as a major life activity would effectively read out the separate statutory requirement that a plaintiff prove he is substantially limited. To be sure, recognition of a major life activity gives rise to the implication that certain impairments are by their very nature substantially limiting: the major life activity of seeing, for example, is always substantially limited by blindness.
See, e.g., Runnebaum v. NationsBank of Md., N.A.,
B.
We thus turn to whether Heiko’s kidney failure “substantially limit[ed]” his ability to eliminate waste. 42 U.S.C. § 12102(2)(A). The statutory term “substantially” means “considerаble or to a large degree.”
Toyota Motor Mfg.,
Among the factors courts should consider in making the substantial limitation determination are the impairment’s “nature and severity” and “expected duration.” 29 C.F.R. § 1630.2(j)(2)(i)-(ii);
see also Pollard,
Whether Heiko is substantially limited in a major life activity is thus determined by examining the unique facts and circumstances surrounding his particular impairment.
See Toyota Motor Mfg.,
Reviewing Heiko’s end-stage renal disease and dialysis under this individualized framework, we conclude that Heiko was substantially limited in his ability to eliminate waste. Indeed, no reasonable jury could conclude otherwise. In order to accomplish the equivalent of urination, Heiko had to insert a needle into his surgically-fashioned fistula and tether himself to a dialysis machine three afternoons per week, for a total of twelve hours. This did not include travel time to and from the dialysis center, or the time required to set up the dialysis еquipment. Dialysis also unyieldingly set the terms of his daily schedule. While he was able to work a forty-hour week, his condition required him to arrive at work by 7:00 a.m. every other day. And whereas urination does not have side effects, after dialysis Heiko felt nauseous and depleted, unable even to stand in the shower. These aspects of his renal failure and concomitant treatment dramatically “distinguish [him] from the general population” in the major life activity of waste elimination.
Rohan,
Heiko’s impairment was also neither fleeting or temporary,
Rohan,
*258 C.
In sum, plaintiffs end-stage renal disease is his physical impairment, the elimination of waste is the major life activity that is limited, and the limitation was a substantial one because Heiko was required to spend at least four hours, three days a week undergoing dialysis in order to remove waste from his body. Considering Heiko’s circumstances through any broader lens on disability only reconfirms a close textual analysis under the statute. We can hardly believe that Congress wished to leave outside the purview of the ADA an individuаl determined to. surmount a real disability and make a constructive contribution to the workplace. The ADA was designed to protect the “truly disabled, but genuinely capable.”
See Halperin,
III.
We next address the district court’s grant of summary judgment to Colombo on Heiko’s failure to promote and constructive discharge claims. We conclude that summary judgment was improper on the claim of failure to promote, which presents a jury question. As to Heiko’s constructive discharge contention, the district court properly awarded summary judgment to the employer.
A.
Heiko first alleges that Colombo did not promote him to Vice President of Lоan Administration because of his end-stage renal disease. Colombo contends that it promoted Sandy Rubin instead of Heiko due to her superior qualifications. Because Colombo disclaims any suggestion that its decision was founded on Heiko’s disability, this case is properly analyzed under the familiar framework set forth in
McDonnell Douglas Corp. v. Green,
Under
McDonnell Douglas,
the plaintiff must first make out a prima facie case of discrimination.
See Anderson v. Westinghouse Savannah River Co.,
B.
There can be no doubt in this ease that Heiko has established at least á prima facie inference of discrimination, and that Colombo has successfully rebutted it by responding that it selected Rubin over Heiko due to her superior qualifications.
See Evans v. Techs. Applications & Serv. Co.,
In conducting this analysis, we are mindful that wе assess relative job qualifications based on the criteria that the employer has established as relevant to the position in question.
See Anderson,
Construing the facts in favor of Heiko, as we must, we conclude that a reasonable factfinder could determine that Colombo’s explanation for its promotion decision is “unworthy of credence.”
Burdine,
First, a reasonable factfinder could determine that by the time of Rubin’s promоtion, Heiko had comparatively greater experience with both the Loan Administration Department and commercial lending, one of the primary banking areas handled by that department. Heiko had been employed with Colombo for over three years, all in Loan Administration. His duties as Senior Operations Officer/TFL Supervisor and Assistant Vice President of Loan Administration both required intimate knowledge of commercial lending practices and procedures. Nor was Heiko unacquainted with mortgage lending, as illustrated by the fact that he was asked to manage the *260 Mortgage Operations Department after Rubin was promoted.
Rubin, by contrast, had worked in the banking industry since the mid-1970s, but her specialty was mortgage loans. She had only started with Colombo in August 1999, a year and a half before her eventual promotion to Vice President. Colombo does not dispute thаt she initially reported to Heiko when she first joined the bank. While Rubin’s Mortgage Operations Department was merged under Loan Administration before she was promoted to Vice President, her main responsibilities continued to concern mortgage lending. According to Heiko, Rubin informed him that she had not dealt with commercial loan documents recently in her career. President Lane himself noted that Rubin needed to enhance her understanding of commercial lending practices. And as of her 2000 performance evaluation, one of her “principal weaknesses” was that she was still in the process of learning “the bank’s philosophy.” She was not, for example, familiar with several of Loan Administration’s management reports. Heiko was.
Second, Rubin’s lack of knowledge about the inner workings оf Loan Administration was made evident in her comparative unfamiliarity with the computer programs critical to that department. In a job description for the Vice President position, Colombo listed the following as the first job specification: “Must be computer literate. Must have spreadsheet and word processing experience.” Heather Brown expressly acknowledged that Heiko had computer skills that outmatched Rubin’s. He had taken undergraduate courses in computer science, was versatile in numerous software programs, and had used advanced software applications in a variety of special projects, such as his creation of a loan tracking device. He was also familiar with predecessor versions of the bank’s data processing system. Rubin had no such experience, and Colombo does not dispute that upon Rubin’s promotion to Vice President, both Heiko and Brown had to train her on spreadsheet software. While Colombo presently appears to suggest that computer experience was not a relevant criterion for selecting a Vice President, a jury could certainly conclude otherwise in light of the fact that it was listed as the first job specification for the position.
See Dennis,
Third, Heiko was on the rise at Colombo. His success at the bank translated into a swift series of promotions prior to the time when he began dialysis. A little over a year after he started in Loan Administratiоn, he was elevated to Senior Operations Officer/TFL Supervisor, a position that required a wide range of customer service and computer skills, as well as “[wjorking knowledge of the financial institution’s commercial and consumer lending procedures.” Several months later, in June 1999, John Lane named him Assistant Vice President of Loan Administration. Lane announced the promotion in a congratulatory memorandum circulated to the entire bank, writing that Heiko “has shown outstanding leadership and knows how to be a team player.” Heather Brown had recommended Heiko for this promotion in part because of his “positive attitude.” In his new capacity as Assistant Vice President, Heiko assumed an even greater number of responsibilities, including supervising various employees in Loan Administration. In July 1999, Heathеr Brown recommended him for a five percent pay increase, noting that Heiko was “responsible for day-to-day operations” in Loan Administration, and that he was a “very hard working individual” who was “loyal and supportive of Colombo.”
*261 Lastly, Heiko's performance evaluations illustrate his professional momentum, and provide another critical point of comparison with Sandy Rubin. In 1999, Rubin was given a 53 out of 60, and Heather Brown rated Heiko a 44 out of 60. Brown did note, however, that “Jim is a very organized individual who is willing to help others achieve their goals,” and that he had undertaken several projects outside of his normal job responsibilities. By 2000, Colombo’s assessment of the two had changed. In that year, Brown gave Heiko a 53 of 60, writing that he was a “team player” whose customer service had improved. Shе also recommended that he be given further managerial training and more supervisory responsibility. Rubin, by comparison, was given a 50 out of 60, and her evaluator wrote that her “weakness[es] would be a continual learning process of the bank’s philosophy and knowledge of overall banking.”
While Colombo does point to areas in Heiko’s performance evaluations suggesting that he could improve his interpersonal skills, there is ample evidence pointing in precisely the opposite direction. Brown, for example, testified that Heiko’s interpersonal skills had improved since his 2000 performance evaluation. Heiko was also named Employee of the Year in December 2000. Though Colombo contends that it gave Heiko this award for “humanitarian” reasons, a jury could certainly believe that bestowing such an award at a company-wide gathering to an employee moving his way up the corporate ladder was not solely a token gesture.
Colombo’s primary defense of its promotion decision is that Rubin was chosen because she had greater management expertise due to her previous jobs at other banks and her role in the Mortgage Operations Department. But this does not “conclusively reveal[ ] some other, nondiserimi-natory reason for [Colombo’s] decision.”
Reeves,
In short, a reasonable factfinder could conclude that Heiko was poised for the Vice President position and displayed aptitude for his chosen profession. He began dialysis shortly after becoming an Assistant Vice President, and was thereafter denied a promotion, which was instead given to a fellow employee who lacked many of his qualifications. We therefore conclude that Heiko has made a sufficient showing that Colombo’s explanation for its promotion decision was pretextual. While no single factor is dispositive, taken in combination they suggest that Heiko was discernibly better qualified than Rubin. When a plaintiff asserts job qualifications that are similar or only slightly superior to those of the person eventually selected, the promotion decision remains vested in the sound business judgment of the employer.
See Dennis,
IV.
We now turn to Heiko’s constructive discharge claim. Heiko contends that he was forced to leave Colombo because the bank reduced his responsibilities and made his workday unbearable. To prove constructive discharge, a plaintiff must at the outset show that his employer “deliberately made [his] working conditions intolerable in an effort to induce [him] to quit.”
Matvia v. Bald Head Island Mgmt., Inc.,
On the record before us, Heiko has not shown a deliberate intent on the part of Colombo to force him to leave.
See Honor,
While Heiko was progressively asked to undertake tasks more menial than those to which he was accustomed, he does not contend that such duties were inappropriate for someone who did not occupy an Assistant Vice President position. And though he did not receive an annual raise, he does not suggest that the salary he received was incommensurate with his reduced responsibilities at that time.
Far from revealing that the bank deliberately intended to force him to leave, *263 Colombo’s actions squarely indicate that it exercised commendable patience with an employee who was frustrated, perhaps justifiably, over not receiving a promotion. And while Heiko suggests that the bank could have adopted a restructuring proposal that might have created a new position for him, it surely cannot be the case that deliberateness may be proven by an otherwise benign business decision concerning internal corporate configuration.
Even if Heiko could prove that Colombo deliberately intended to force him out, he still cannot show that the work environment at the bank was objectively intolerable.
See Munday,
V.
The Americans with Disabilities Act and parallel state and local statutes reflect our national commitment that disabled persons should lead lives that, to the extent possible, are unencumbered by the disabilities that have befallen them. An individual’s impairment should not operate to restrain his professional aspirations when in spite of his limitations, he has dedicated himself to his craft and sought advancement in his field. In the face of formidable obstacles, plaintiff persisted in his desire to develop his banking skills. While the ADA protects only a limited segment of our population, James Heiko fits clearly within its bounds. And though Colombo at times appears to have been appreciative of Heiko’s work, there is sufficient evidence for a jury to conclude that its denial of a promotion was made on a prohibited basis. Accordingly, the judgment is therefore
AFFIRMED IN PART, REVERSED IN PART, AND REMANDED.
Notes
. Thе degree of deference, if any, that is due to the EEOC's regulations remains an open question.
See Albertson’s, Inc. v. Kirkingburg,
. Colombo’s reliance on
Furnish v. SVI Systems, Inc.,
. We express no view on whether other plaintiffs with end-stage renal disease will be substantially limited in a major life activity. Like all others claiming an impairment under the Act, they must prove “the extent of the limitation in terms of their own experience.”
Albertson's, 527
U.S. at 567,
. Colombo does not contend that promoting an individual who was required to leave the office three afternoons per week was an accommodation that "would impose an undue hardship" on its operations. 42 U.S.C. § 12112(b)(5)(A); see also Montgomery County, Md., Code art. 1, § 27-6(bb). We therefore express no opinion on whether small businesses like Colombo, whose enterprise requires interaction with customers and supervision of emplоyees during normal business hours, are required to accommodate disabilities in such a fashion.
. Heiko also points to various statements by Colombo officers that he argues may be probative of discriminatory bias. For example, Lane allegedly made a reference to the time Heiko would need to be out for a kidney transplant, and Brown said “Look at your situation" when he asked why Rubin was promoted. Because we conclude that Heiko's prima facie case and his evidence of superior qualifications fairly rebut Colombo’s asserted non-discriminatoiy rationale,
Reeves,