Chronic Fatigue Syndrome in Social Security Disability Claims
By Pitt Dickey

Are you more tired than you used to be?  For most people, getting older means slowing down.    It's a natural part of the aging process.  You get tired. You rest.  You feel better.   But what if you got tired and  never got over being exhausted?    Unfortunately fatigue can reach pathological levels that are so intense that it can prevent a person from being able to work.    This condition is called Chronic Fatigue Syndrome.  The Social Security Administration (SSA) recognizes Chronic Fatigue Syndrome  as a grounds for the payment of Disability Insurance Benefits if the condition is severe enough. Chronic Fatigue Syndrome (CFS)    is much  more than just being tired. It is a medical condition. The SSA has established a ruling for evaluating CFS based upon standards  established by the federal Center for Disease Control and Prevention (CDC). The Social Security Administration (SSA) uses these guidelines to evaluate disability claims based upon Chronic Fatigue Syndrome. This column will take a look how the SSA evaluates CFS in connection with Disability Insurance Benefits claims.

To obtain disability benefits, the SSA requires that the claimant have a "medically determinable impairment".  Such an impairment must be shown by "medical evidence, consisting of medical signs, symptoms and laboratory findings." Disability payments can never be based solely on the claimant's report of what his symptoms are.  There must always be medical evidence to support those symptoms.  Unfortunately many people who lose their jobs due to illness also lose their health insurance. They  fall into a Catch 22 situation where they can't get medical treatment due to financial reasons which means they lack medical documentation of their health problems. If a person doesn't have medical documentation of his health problems, obtaining disability benefits can be extremely difficult.  However, that is an issue for another column on another day.

The SSA defines Chronic Fatigue Syndrome as "a systemic disorder consisting of a complex of symptoms that may vary in incidence, duration, and severity. It is characterized in part by prolonged fatigue that lasts 6 months or more that results in substantial reduction in previous levels of occupational, educational, social or personal activities. In accordance with the criteria established by the CDC, a physician should make a diagnosis of CFC only after alternative medical and psychiatric causes of chronic fatiguing illness have been excluded."

The SSA's definition of CFS is the "presence of a clinically evaluated, persistent or relapsing chronic fatigue that is of new or definite onset (i.e. has not been lifelong), cannot be explained by another physical or mental disorder, is not the result of ongoing exertion." The patient must also have at least 4 of the following medical signs  which must have lasted at least 6 consecutive months and did not precede the date of the fatigue.

The medical signs of CFS  are as follows:" 1. Self reported impairment of short term memory or concentration severe enough to cause a substantial reduction in previous levels of occupational, educational, social or personal activities;  2. Sore throat;  3. Tender cervical or axillary lymph nodes; 4. Muscle pain; 5. Multi-joint pain without joint swelling or redness; 6. Headaches of a new type, pattern or severity; 6. Unrefreshing sleep; 7.  Post exertional malaise lasting more than 24 hours. 

The SSA notes that a person with CFS can have a variety of symptoms including "muscle weakness, swollen underarm glands, sleep disturbances, visual difficulties (trouble focusing or severe photosensitivity) lightheadedness or increased fatigue on standing, difficulty in comprehending and processing information, fainting, dizziness, and mental problems such as depression, irritability or anxiety." 

There is no specific cause established yet for CFS.  The SSA will rely on medical signs and laboratory tests  found by physicians to establish whether the patient has CFS as a medically determinable impairment.  Medical signs which can support a finding of CFS include "swollen or tender lymph nodes on physical examination, nonexudative pharyngitis, persistent reproducible muscle tenderness or repeated exam including positive tender points."

There is no specific lab test which is accepted by the SSA  as a positive diagnosis for CFS. The SSA will consider lab tests that can support a finding of CFS to include "an elevated antibody titer to Epstein-Barr virus; abnormal MRI brain scan, neurally mediated hypotension shown on a tilt table test, abnormal exercise stress test, and  abnormal sleep test."

Mental findings which can support CFS include ongoing problems with "short term memory, information processing, visual-spatial difficulties, comprehension, concentration, speech, word finding, and calculation." A diagnosis of anxiety or  depression can also support a finding of CFS. 

The SSA recognizes that CFS can vary in frequency and severity over long periods of time.  The SSA will review the patient's medical records from at least 12 months prior to the application for disability benefits unless the onset date is less than 12 months from the application for disability benefits.  Because the frequency and severity of CFS tends to vary, the SSA will generally require a person who is awarded Social Security disability benefits due to CFS to have a SSA  review of his health after the benefits are awarded to determine if his condition has improved.

Copyright © Pitt Dickey 02/13/2004