Full Opinion (html_with_citations)

                                RECOMMENDED FOR PUBLICATION
                                Pursuant to Sixth Circuit I.O.P. 32.1(b)
                                       File Name: 24a0192p.06

                    UNITED STATES COURT OF APPEALS
                                  FOR THE SIXTH CIRCUIT



                                                             ┐
 AIMEE STURGILL,
                                                             │
                                   Plaintiff-Appellant,      │
                                                              >        No. 24-1011
                                                             │
       v.                                                    │
                                                             │
 AMERICAN RED CROSS,                                         │
                                  Defendant-Appellee.        │
                                                             ┘

  Appeal from the United States District Court for the Eastern District of Michigan at Detroit.
                   No. 2:22-cv-11837—Paul D. Borman, District Judge.

                                     Argued: July 24, 2024

                             Decided and Filed: August 21, 2024

                   Before: GILMAN, GRIFFIN, and MATHIS, Circuit Judges.
                                   _________________

                                            COUNSEL

ARGUED: Colin H. Wilkin, HURWITZ LAW, PLLC, Ann Arbor, Michigan, for Appellant.
Constantinos G. Panagopoulos, BALLARD SPAHR LLP, Washington, D.C., for Appellee.
ON BRIEF: Colin H. Wilkin, HURWITZ LAW, PLLC, Ann Arbor, Michigan, for Appellant.
Constantinos G. Panagopoulos, Sara Rangiah, BALLARD SPAHR LLP, Washington, D.C., for
Appellee.
                                      _________________

                                             OPINION
                                      _________________

      GRIFFIN, Circuit Judge.

      Citing a conflict with her religious beliefs, plaintiff Aimee Sturgill objected to defendant
American Red Cross’s mandate that she become vaccinated against COVID-19. The Red Cross
 No. 24-1011                          Sturgill v. Am. Red Cross                                Page 2


denied her request for an accommodation, concluding that she was medically—not religiously—
opposed to the vaccine and then terminated her employment. Sturgill alleges the Red Cross’s
decision reflects a failure to accommodate her religious beliefs, in violation of Title VII of the
Civil Rights Act of 1964. The district court dismissed her complaint under Federal Rule of Civil
Procedure 12(b)(6), holding that she did not plausibly allege a prima facie case sufficient to
support a failure-to-accommodate claim. Elevating the pleading standard to require a prima facie
case was erroneous. However, the district court correctly held that Sturgill did not separately set
forth a disparate-treatment claim. We therefore affirm in part, reverse in part, and remand for
further proceedings.

                                                    I.

                                                    A.

           In the motion-to-dismiss posture, we take as true the facts alleged in plaintiff’s complaint.
Mynatt v. United States,
45 F.4th 889
, 893 (6th Cir. 2022). The relevant facts are set forth in the
operative complaint and in the documents attached to the Red Cross’s motion to dismiss that
Sturgill refers to in her complaint and that are central to her claims—Sturgill’s requests for
accommodation and the Red Cross’s denials. See Bassett v. NCAA,
528 F.3d 426, 430
 (6th Cir.
2008).

           During the COVID-19 pandemic, the Red Cross mandated that certain employees
become vaccinated against COVID-19. Sturgill was a registered nurse for the Red Cross and
subject to the vaccination requirement. She is a devout Christian who makes “daily decisions,
including those regarding her vaccination status and other medical decisions, through prayer and
by reading scripture.” After doing so in response to the Red Cross’s vaccine mandate, she
concluded that complying with that employment requirement would clash with her religious
beliefs.

           So Sturgill sent a detailed letter to the Red Cross seeking a religious exemption.
That letter informed the Red Cross that her “sincerely held religious belief for [her]
accommodation stems from the biblical teaching of [her] religious spiritual leader Jesus Christ,”
and it quoted several different scriptures—including 1 Corinthians 6:19–20; 1 Corinthians 3:17;
 No. 24-1011                       Sturgill v. Am. Red Cross                                Page 3


1 Timothy 4:8; 2 Timothy 1:7; and Romans 2:14–15—supporting her belief that she is the
“steward[] of God’s blessing of life” and thus was required to “tak[e] the utmost care for [her]
body . . . to continue to honor God and the temple he gave [her].” She also believed that “[t]he
ingredients in the vaccine[] can cause serious harm and even death to [her] body,” which was “a
VERY important concern” given her “blood clotting disorder.”

       The Red Cross denied Sturgill’s request. In its view, she: (1) “failed to identify a
religious belief, practice, or observance that prohibits [her] from being vaccinated against
COVID-19”; (2) did “not explain whether [her] belief, practice, or observance prohibits all
potentially harmful ingredients from being ingested, and if not, why not”; (3) relied “on
inaccurate factual statements to form the basis of [her] religious belief, specifically, [her]
suggestion that the vaccine is not safe”; (4) “stated that [her] religious beliefs prevent [her] from
receiving the COVID-19 vaccine” even though she “received a three-dose series of Hepatitis B
vaccine”; and (5) cited “factors that are not appropriate bases for a religious accommodation
request, such as [her] blood clotting disorder, which can be asserted in a request for a medical
accommodation.” It then gave Sturgill a chance to seek reconsideration by submitting additional
information.

       Plaintiff did just that, again detailing her request for an accommodation on religious
grounds. That appeal letter reiterated to the Red Cross that she makes decisions “with a heart of
faith and trust[s] that such decisions should always rest between the Christian ([Sturgill]) and
[her] Maker.” And that decision-making process led her to conclude that because “[her] body is
the temple of the Holy Spirit, . . . taking the COVID-19 vaccine[] would be defiling [her] body
. . . with unwanted intrusions” and would “go against [her] conscience.” Sturgill also explained
why her opposition to the COVID-19 vaccine here was not inconsistent with her having
previously received other vaccines: “As a believer who may have had childhood vaccines or
even a Hepatitis B vaccine many years ago, that does not contradict or negate the veracity of my
individual belief and my desire to abstain from the COVID-19 vaccine. My individual views
continue to be modified over time as I grow in spiritual maturity and knowledge of God.”

       After considering Sturgill’s additional information, the Red Cross denied her appeal. It
concluded that Sturgill’s religious beliefs regarding the COVID-19 vaccine were not sincerely
 No. 24-1011                        Sturgill v. Am. Red Cross                                  Page 4


held because she failed to identify a specific “religious belief, practice[,] or observance [that]
deems the COVID-[19] vaccine[] defiling.”               The Red Cross then terminated Sturgill’s
employment.

                                                  B.

        Sturgill’s operative complaint asserts one claim under Title VII—that the Red Cross
failed to reasonably accommodate her sincerely held religious beliefs when it fired her for
refusing to comply with its vaccine mandate. The Red Cross moved to dismiss for failure to
state a claim under Federal Rule of Civil Procedure 12(b)(6). While that motion remained
pending, the parties continued (and fought over) discovery, and the Red Cross moved for
summary judgment under Federal Rule of Civil Procedure 56. The district court then granted
defendant’s motion to dismiss, without mentioning the pending Rule 56 motion.

        Two aspects of the district court’s opinion are relevant to this appeal. First, the district
court held that plaintiff’s complaint did not adequately plead facts establishing the prima facie
elements of a Title VII religious-accommodation claim—specifically, that she did not hold a
sincere religious belief that conflicts with an employment requirement. Second, it concluded that
she pleaded only a cause of action for failure to accommodate and not a standalone disparate-
treatment claim. On appeal, plaintiff challenges both holdings.

                                                  II.

        We first consider whether Sturgill plausibly alleged that the Red Cross violated Title
VII’s religious-accommodation requirements. “Plainly she pled such facts.” Lucky v. Landmark
Med. of Mich., P.C.,
103 F.4th 1241
, 1243 (6th Cir. 2024).

        To survive a motion to dismiss under Rule 12(b)(6), a plaintiff must allege facts that, if
accepted as true, are sufficient “to raise a right to relief above the speculative level” and to state a
“claim to relief that is plausible on its face.” Bell Atl. Corp. v. Twombly,
550 U.S. 544, 555, 570
(2007). That means the “factual content . . . allows the court to draw the reasonable inference
that the defendant is liable for the misconduct alleged.” Ctr. for Bio-Ethical Reform, Inc. v.
Napolitano,
648 F.3d 365, 369
 (6th Cir. 2011) (internal quotation marks omitted).
 No. 24-1011                      Sturgill v. Am. Red Cross                                Page 5


“The plausibility standard is not akin to a ‘probability requirement,’ but it asks for more than a
sheer possibility that a defendant has acted unlawfully.” Ashcroft v. Iqbal,
556 U.S. 662, 678
(2009) (citation omitted). If a plaintiff does not “nudge[] the[] claim[] across the line from
conceivable to plausible, the[] complaint must be dismissed.” Twombly,
550 U.S. at 570
. When
considering a motion to dismiss, we must accept as true all factual allegations, but need not
accept any legal conclusions. Napolitano,
648 F.3d at 369
. And we must take care to read the
complaint’s allegations “as a whole.” Matrixx Initiatives, Inc. v. Siracusano,
563 U.S. 27, 47
(2011). We review de novo a district court’s grant of a motion to dismiss. Lipman v. Budish,
974 F.3d 726
, 740 (6th Cir. 2020).

       Title VII prohibits an employer from “discharg[ing] any individual . . . because of such
individual’s . . . religion.” 42 U.S.C. § 2000e-2(a)(1). “The term ‘religion’ includes all aspects
of religious observance and practice, as well as belief, unless an employer demonstrates that he is
unable to reasonably accommodate to an employee’s . . . religious observance or practice without
undue hardship on the conduct of the employer’s business.” Id. § 2000e(j). “The heart of the
failure-to-accommodate claim is that an employer discharges (or otherwise discriminates against)
an employee for failing a job-related requirement instead of abiding by its ‘statutory obligation to
make reasonable accommodation for the religious observances’ of its employees.” Savel v.
MetroHealth Sys.,
96 F.4th 932
, 943–44 (6th Cir. 2024) (quoting Trans World Airlines, Inc. v.
Hardison,
432 U.S. 63, 75, 97
 (1977)).

       The central question “is whether [Sturgill] pled facts supporting an inference that her
refusal to be vaccinated for Covid was an ‘aspect’ of her ‘religious observance’ or ‘practice’ or
‘belief.’” Lucky, 103 F.4th at 1243 (citation omitted). Sturgill alleged both in her complaint and
in response to the Red Cross’s vaccination requirement that, as a Christian, she makes “daily
decisions . . . through prayer and by reading scripture.” She “begin[s her] decision-making with
hearts of faith,” and honors the Bible’s commands that our “bodies are temples of the Holy
Spirit,” that “[i]f anyone destroys God’s temple, God will destroy him,” and that Christians must
“take the utmost care of our own bodies.” In her words: “My body is the temple of the Holy
Spirit, and taking the COVID-19 vaccine, would be defiling my body.” Her operative complaint
also sets forth her concern that the ingredients contained in the COVID-19 vaccine “can cause
 No. 24-1011                             Sturgill v. Am. Red Cross                                          Page 6


serious harm and even death to [her] body.” Simply, her complaint plausibly alleges that she
prayed about whether to take the COVID-19 vaccine and concluded that not taking it would
“honor God and the temple he gave [her].” Thus, as stated in the complaint, Sturgill’s “sincerely
held religious beliefs prevent her from receiving the COVID-19 vaccination.” As in Lucky, these
“allegations were almost self-evidently enough to establish, at the pleadings stage, that her
refusal to receive the vaccine was an ‘aspect’ of her religious observance or belief.” Id.; see also
Savel, 96 F.4th at 944.

         Relying in part on the district court’s opinion in Lucky that we have since reversed, the
district court held that plaintiff “has not pled that she holds a sincere religious belief that
conflicts with” defendant’s employment requirement that she become vaccinated against
COVID-19. See Lucky v. Landmark Med. of Mich., P.C.,
2023 WL 7095085
 (E.D. Mich. Oct.
26, 2023). That is a holding borne out not of Twombly’s and Iqbal’s plausibility requirement but
from the prima facie evidentiary standard applicable only when evaluating motions for summary
judgment under Rule 56.1 Under that traditional burden-shifting approach, the employee must
first prove a prima facie case of religious discrimination by establishing three elements: (1) the
employee holds a sincere religious belief that conflicts with an employment requirement; (2) the
employee informed the employer about that conflict; and (3) the employer took an adverse
employment action against the employee for failing to comply with the conflicting employment
requirement. See Virts v. Consol. Freightways Corp. of Del.,
285 F.3d 508, 516
 (6th Cir. 2002).
Upon such a showing, the burden shifts to the employer to demonstrate “that it could not
reasonably accommodate the employee without undue hardship.”
Id.

         A prima facie case, however, “is an evidentiary standard, not a pleading requirement” and
is one that may “not be transposed into a rigid pleading standard for discrimination cases.”

         1
           Plaintiff asserts we need not address the district court’s prima-facie-based approach, arguing additionally
that her complaint set forth direct evidence of discrimination—i.e., “proof that, if believed, compels the conclusion
that unlawful discrimination was at least a motivating factor in the employer’s actions,” Kuhn v. Washtenaw County,
709 F.3d 612, 624
 (6th Cir. 2013) (internal quotation marks omitted)—because the Red Cross “refused to engage in
the interactive process and told Plaintiff that she was not religious because ‘our records reflect that you have
received a three-dose series of Hepatitis B vaccine.’” But she did not make this argument below, and regardless, the
issue before us is not whether plaintiff established direct (or indirect) evidence of discrimination sufficient to
withstand a motion for summary judgment. Rather, it is whether she plausibly alleged a violation of her Title VII
rights to survive a motion to dismiss.
 No. 24-1011                            Sturgill v. Am. Red Cross                                        Page 7


Swierkiewicz v. Sorema N. A.,
534 U.S. 506, 510, 512
 (2002). Twombly’s and Iqbal’s adoption
of the plausible-pleading standard did not disturb Swierkiewicz’s holding. See Keys v. Humana,
Inc.,
684 F.3d 605, 609
 (6th Cir. 2012). So as we have recently reiterated in other cases
involving religious objections to an employer’s COVID-19 vaccine mandate, “[a] plaintiff does
not have to allege specific facts establishing a prima facie case of discrimination in their
complaint.” Savel, 96 F.4th at 943; see also Lucky, 103 F.4th at 1244. To be sure, the
complaints in Savel and Lucky did not have extensive documents attached that may be
considered at this stage like we have here, as the Red Cross noted at oral argument; but that
distinction does not make a difference given what those documents set forth. The district court’s
element-by-element examination of whether plaintiff established a prima facie case for failure to
accommodate was therefore erroneous.

        So too was its disregard of Sturgill’s stated religious reason for seeking an
accommodation because the request was, in the district court’s view, “medical in nature.” Such
reasoning is contrary to our First Amendment jurisprudence, which commands that courts may
not question the veracity of one’s religious beliefs. See Hernandez v. Comm’r,
490 U.S. 680, 699
 (1989) (“It is not within the judicial ken to question the centrality of particular beliefs or
practices to a faith, or the validity of particular litigants’ interpretations of those creeds.”);
Thomas v. Rev. Bd. of Ind. Emp. Sec. Div.,
450 U.S. 707, 714
 (1981) (“[R]eligious beliefs need
not be acceptable, logical, consistent, or comprehensible to others in order to merit First
Amendment protection.”). Nor was she required, as urged by the Red Cross, to “cite[] to any
tenet of the Lutheran church that opposes western medicine in general or the COVID vaccine
specifically.” See Lucky, 103 F.4th at 1243 (“Nor did the district court have any basis for its
insistence that Lucky explain how her religion has a specific tenet or principle that does not
permit her to be vaccinated.” (internal quotation marks omitted)). The same is just as applicable
to the district court’s finding that Sturgill failed to address whether her prior receipt of the
Hepatitis B vaccine aligned with her religious beliefs.2 See id.; see also Thomas,
450 U.S. at 714


        2
         In any event, she did provide the Red Cross with such an explanation: “As a believer who may have had
childhood vaccines or even a Hepatitis B vaccine many years ago, that does not contradict or negate the veracity of
my individual belief and my desire to abstain from the Covid-19 vaccine. My individual views continue to be
modified over time as I grow in spiritual maturity and knowledge of God.”
 No. 24-1011                       Sturgill v. Am. Red Cross                                Page 8


([“R]eligious beliefs need not be . . . consistent . . . in order to merit First Amendment
protection.”).

       But even if the district court’s reasoning can be interpreted as honoring Sturgill’s faith,
the district court’s parsing of plaintiff’s complaint to conclude her objection was “clearly
medical” and not religious failed to read and accept her complaint “as a whole.” See Matrixx,
563 U.S. at 47
. The district court, for example, cast off plaintiff’s many religious-in-nature
allegations as “legal conclusion[s] couched as . . . factual allegation[s].” True, as the district
court noted, parts of her complaint do link her refusal to take the COVID-19 vaccine to her
concern about its safety, which drove defendant to reject her accommodation request. Yet those
apprehensions (regardless of validity) must be understood within the broader context of the
complaint, which makes clear that what forms Sturgill’s protective view of her body are the
tenets of her Christian faith. That faith instructs her to treat her body as a temple and not do
anything that would “defile” it. And one plausible way to read her complaint is that by placing
into her body a substance that she believes can cause injury, she would not honor God’s
command to the contrary. She thus need not, as the Red Cross protests, “provide a reason as to
whether her aversion to the COVID-19 vaccine derives from a religious belief about vaccines in
general, or whether her religion imposes a limitation solely to the COVID-19 vaccine.”

       In sum, that there may be both religious and secular reasons for an act does not elevate
the latter over the former, especially at the pleading stage. See Ringhofer v. Mayo Clinic,
Ambulance,
102 F.4th 894
, 901 (8th Cir. 2024) (explaining in a COVID-19 vaccine religious
exemption case that “[a]s EEOC Guidance says, ‘overlap between a religious and [a secular]
view does not place it outside the scope of Title VII’s religious protections, as long as the view is
part of a comprehensive religious belief system’” (quoting EEOC Compliance Manual § 12-
I(A)(1) (Jan. 15, 2021))); Callahan v. Woods,
658 F.2d 679, 684
 (9th Cir. 1981) (“[A]
coincidence of religious and secular claims in no way extinguishes the weight appropriately
accorded the religious one.”). The Red Cross’s proffered “obvious alternative explanation” for
Sturgill’s accommodation request—that it was rooted in medicine, not religion—is one we
“cannot simply credit” at this stage. Nat’l Rifle Ass’n of Am. v. Vullo,
602 U.S. 175, 195
 (2024)
(citation omitted).
 No. 24-1011                        Sturgill v. Am. Red Cross                               Page 9


       On that point, the Red Cross asserts that how it responded to Sturgill shows the balance
that employers must consider when evaluating requests for reasonable accommodations that have
blended medical and religious foundations. To what end is an employer to go, the Red Cross
asks, if an employee claims she cannot perform work on a particular day based on environmental
concerns that could “harm her body?” That is a fair concern. But the procedural posture and
specific facts alleged here mean that we need not define the outer limits of Title VII’s scope on
this point. Rather, we leave it to the parties to factually probe plaintiff’s claims and defendant’s
actions during discovery, to the district court to test those facts at summary judgment, and then
ultimately (if her claim survives summary judgment) to a jury to resolve those facts at trial.

       For these reasons, Sturgill’s complaint plausibly alleged that the Red Cross failed to
accommodate her religious objection to its COVID-19 vaccine mandate, and the district court
erred in holding to the contrary.

                                                 III.

       The other issue on appeal is whether plaintiff’s complaint set forth a religious-
discrimination claim based on disparate treatment in addition to her failure-to-accommodate
claim. We agree with the district court that Sturgill’s complaint sets forth only a claim for failure
to accommodate.

       We have long differentiated between “failure to accommodate” and “disparate treatment”
claims. See Reed v. Int’l Union, United Auto., Aerospace & Agric. Implement Workers of Am.,
569 F.3d 576, 579
 (6th Cir. 2009) (“There are two basic types of religious discrimination claims
that an individual may bring . . . under Title VII: disparate treatment claims and religious
accommodation claims.”); see also Hall v. Baptist Mem’l Health Care Corp.,
215 F.3d 618
, 627–
28 (6th Cir. 2000) (contrasting between the two claims). EEOC v. Abercrombie & Fitch Stores,
Inc.,
575 U.S. 768
, 774–75 (2015), does not require revisiting this approach. Cf. Savel, 96 F.4th
at 943 n.4.

       There, the Court considered, among other things, whether “a claim based on a failure to
accommodate an applicant’s religious practice must be raised as a disparate-impact claim,” or as
“a disparate-treatment claim,” and it concluded that “religious practice is one of the protected
 No. 24-1011                      Sturgill v. Am. Red Cross                              Page 10


characteristics that cannot be accorded disparate treatment and must be accommodated.”
Abercrombie, 575 U.S. at 774–75. This is because Congress defined “religion” broader than just
“belief” “so that discriminating against a particular religious practice would not be disparate
treatment though it might have disparate impact.” Id. at 774 (emphasis omitted). In other words,
a failure-to-accommodate claim is a type of disparate-treatment claim.

       In plaintiff’s view, Abercrombie means that her “failure to accommodate claim
encompasses a disparate treatment claim, which opens the door for” her to also assert a
disparate-treatment claim. We cannot agree. Abercrombie provides that there are “only two
categories” of Title VII discrimination claims, “disparate treatment and disparate impact,” and it
then “sort[s] religious accommodation claims under the disparate treatment umbrella.” Savel, 96
F.4th at 943 n.4. Put differently, our pre-Abercrombie “sorting” of the two types of disparate
treatment—failure to accommodate and general disparate treatment—survived Abercrombie.

       If plaintiff wanted to plead a disparate-treatment claim independent of her
accommodation claim, she could have done so. See, e.g., id. at 943–45 (analyzing claims for
failure to accommodate and disparate treatment for a COVID-19 vaccine policy separately). Yet
nothing in her complaint can be plausibly read to put the Red Cross on notice that she claimed it
treated her differently on account of her religious beliefs separate from her failure-to-
accommodate claim. She also could have sought leave to amend her complaint in response to
defendant’s motion to dismiss, yet she did not. And to the extent that she relies on her briefing
in response to that motion to support such an amendment, that response was not the vehicle to do
so. See Bates v. Green Farms Condo. Ass’n,
958 F.3d 470
, 483 (6th Cir. 2020).

       The district court therefore correctly held that plaintiff’s complaint did not set forth a
standalone disparate-treatment claim.

                                               IV.

       For these reasons, we affirm in part, reverse in part, and remand for further proceedings.