When determining cases involving chronic fatigue syndrome (CFS), the Social Security Administration would look for objective medical signs (via a comprehensive medical records review) that can support the existence of the diagnosis. The challenge in proving this condition is that many symptoms of CFS are subjective. Also known by the names immune dysfunction syndrome (CFIDS) or myalgic encephalomyelitis (ME) or chronic fatigue, CFS is a complex illness that is quite debilitating. It is estimated that more than a million Americans suffer from this condition. Up to 90% of them are undiagnosed. Though its exact cause is not known, contributory factors include stress, inflammation in the nervous system, compromised immune system, and/or exposure to the Epstein-Barr virus. It is found that women between ages 30 and 50 are more prone to develop this condition.
According to the Mayo Clinic, symptoms of CFS include extreme exhaustion that can last more than 24 hours after exercise, pain, sleep that is not refreshing, headaches, and loss of memory/concentration among other signs. Researchers in the field say that this disability is even more functionally debilitating than chronic congestive heart disease and cancer. This highlights the importance of ensuring disability benefits for people with CFS.
Disability applicants should:
- Provide objective evidence that can establish the condition.
- Request an opinion from their treating physician regarding their work-associated limitations.
What does Social Security require to arrive at a fair decision? CFS is not listed in the SSA’s Blue Book. However, Social Security Ruling 99-2p acknowledges that CFS is a medically determinable impairment and describes the various findings that can prove the diagnosis. At least four of the following symptoms must have persisted for 6 consecutive months.
- Atypical headaches
- Recurring sore throat
- Muscle pain
- Tender lymph nodes
- Problems with memory and concentration
- Pain in multiple joints without swelling or redness
- Fatigue unrelieved by sleep, and/or
- Illness after exertion, lasting 24 hours
Physicians must also rule out other possible causes of the above mentioned symptoms before making a CFS diagnosis. Given the significance of a longitudinal view of the medical evidence, and the nature and extent of treatment provided by various treating doctors, medical record review service becomes very helpful for attorneys representing the claimant. This helps them to develop a clear understanding of the clinical findings and the extent of the claimant’s disability. The SSA would accept any of the following laboratory findings as evidence for the presence of a “medically determinable impairment (MDI)”.
- Abnormal MRI brain scan
- Tilt table testing that shows neurally mediated hypotension
- Elevated antibody titers to Epstein-Barr virus
- Results of psychological testing
It is mandatory that the medical evidence establishing CFS is provided by a licensed medical or osteopathic doctor. Apart from the doctor’s diagnosis of CFS, the clinic notes should show that the physician reviewed the claimant’s medical history and performed a physical exam. The physician’s report should include a complete medical history of the claimant, and all relevant positive as well as negative clinical and laboratory findings. If available, copies of lab results, and results of any mental status examination should also be provided. To decide whether the symptoms are totally disabling, Social Security will consider medical opinions as well as the statements of the claimant and third parties just as in the case of any other disability claim.
- In case the medical evidence alone clearly shows the claimant is disabled or not disabled, the SSA would decide the case on the basis of that information.
- If the medical evidence is not adequate, they would consider factors such as functional capacity in terms of the person’s disability, age, education, and work background.
- If the claimant is under age 18, they would consider whether he/she has an impairment that causes notable and severe functional limitations.
Working normally can become difficult or even impossible when a person develops chronic fatigue syndrome. That is why filing a disability insurance claim becomes necessary in most cases. Claimants who are represented by experienced attorneys stand a greater chance for winning their claim. Moreover, the entire application process becomes less stressful. Attorneys utilizing medical review services benefit from having all relevant medical information at hand that can be used to convince the SSA of the claimant’s debilitating disability and why he/she needs the benefits. With a clear idea of what evidence they have and what more is required for efficient representation, attorneys will ensure that the treating physicians submit all objective findings available that attest the patient’s condition.
