The Social Security Administration (SSA) is generally skeptical of disability claims based solely on chronic fatigue syndrome (CFS). Claims are rarely approved at the initial or reconsideration levels, and even at the hearing level, most Administrative Law Judges (ALJs) are reluctant to pay benefits except in the most compelling cases.
In cases involving chronic fatigue syndrome, Social Security regulations require that objective medical signs and laboratory findings support the existence of the diagnosis. Self-reported symptoms alone are not enough, despite the subjective nature of many symptoms of CFS. In addition to providing objective evidence of your condition, it's critical that you request an opinion from your treating doctor regarding your work-related limitations.
Chronic Fatigue Syndrome: Symptoms, Causes, and Treatment
Chronic fatigue syndrome, also known as chronic fatigue and immune dysfunction syndrome (CFIDS) or myalgic encephalomyelitis (ME), is a complex illness marked by a wide variety of symptoms. Although there is no known cause for CFS, it is frequently associated with stress, a compromised immune system, inflammation in the nervous system, and/or exposure to the Epstein-Barr virus. Age and gender appear to play a part too, as women between 30 and 50 are at increased risk for the disease.
As the name suggests, chronic fatigue syndrome is characterized by persistent tiredness that cannot be relieved with rest. Psychological manifestations of CFS are common and include depression, anxiety, or irritability. In addition, a range of cognitive deficits collectively referred to as "brain fog" can consist of confusion, forgetfulness, or speech and language issues. The symptoms of CFS are usually severe enough to cause substantial disruptions with one's work, school, or personal activities.
The diagnostic criteria set forth by the Center for Disease Control (CDC) and endorsed by Social Security require thatat least four of the following symptoms persist for six consecutive months:
- recurring sore throat
- atypical headaches
- muscle pain
- marked deficits in memory or concentration
- tender lymph nodes
- pain in multiple joints without redness or swelling
- fatigue unrelieved by sleep, and/or
- illness after exertion, lasting 24 hours.
In addition, physicians should rule out other possible causes of the symptoms before diagnosing CFS. While there's no known cure for CFS, individual symptoms are often improved with treatment.
How Social Security Evaluates Chronic Fatigue Syndrome Cases
Social Security does not have a Blue Book listing for chronic fatigue syndrome, a fact that shouldn't surprise the many sufferers of CFS used to dealing with suspicion about their disease. In rare cases, Social Security may find that your CFS is medically equivalent to a Blue Book-listed impairment, such as Listing 14.06B for undifferentiated or mixed connective tissue disease. (Read more about medical equivalency and the Blue Book.)
The vast majority of successful disability applicants with CFS, however, are awarded benefits based on a "medical-vocational allowance," which considers one's age, education, work history, and residual functional capacity (RFC) in deciding whether full-time work is possible. Your RFC is a description of the maximum physical and mental abilities you retain in spite of your impairments.
Social Security Ruling 14-1p, issued in April 2014, prescribes how claims for CFS should be evaluated. The ruling states that although CFS can be a disabling condition, it first must be established as a “medically determinable impairment” (MDI) by appropriate medical signs or laboratory findings.
What's a Medically Determinable Impairment?
One or more of the following medical signs, clinically documented for no less than six consecutive months, will generally be considered evidence that CFS is a medically determinable impairment:
- tender or swollen lymph nodes on exam
- nonexudative pharyngitis (a dry sore throat)
- chronic and reproducible muscle tenderness over multiple exams, with positive tender points
- positive mental status exam findings, and/or
- any other indicators of CFS that are medically accepted and consistent with the evidence in your case.
Although the ruling notes the absence of any definitive lab testing for CFS, it provides that any of the following laboratory findings will establish the presence of a MDI:
- elevated antibody titers to Epstein-Barr virus
- abnormal MRI brain scan
- tilt table testing showing neurally mediated hypotension, and/or
- results of psychological testing.
Under Social Security Ruling 14-1p, medical evidence of CFS must come from a licensed medical or osteopathic doctor. However, your doctor's diagnosis of CFS will not, by itself, prove the existence of a medically determinable impairment. The clinic notes must show that your physician reviewed your medical history and performed a physical exam. If your doctor’s records aren't consistent with a diagnosis of CFS, Social Security may decide you don’t suffer from a MDI.
If your medical records simply don’t contain enough evidence for the SSA to determine whether you have a MDI, Social Security may try to recontact your treating doctor for more information or arrange for you to attend a free consultative examination.
Getting a Medical-Vocational Allowance
Once a medically determinable impairment has been established, Social Security evaluates the severity of your condition based on the medical evidence, your subjective reports, third-party reports, and any other evidence you provide. If Social Security finds that your symptoms are severe enough to prevent any full-time employment, you'll be approved for disability benefits. For more on this, see Nolo's article on how Social Security decides whether you're entitled to a medical-vocational allowance,
How to Develop the Medical Evidence in a CFS Case
Gathering the proper medical evidence is essential to prove a disability claim based on CFS. First, you should submit to Social Security all medical records relevant to your condition, including doctor's clinic notes, the results of x-rays, MRIs, and other testing, and the records from any hospitalizations. If you suffer from other mental or physical conditions in addition to CFS, provide records of those impairments as well.
Next, it's critical that you ask your treating primary care physician or specialist for an opinion about your work-related limitations. Your doctor can write a letter or fill out an RFC form that addresses your physical and mental limitations in the following areas:
- lifting, carrying, pushing, and pulling
- standing, sitting, and walking
- maintaining concentration for extended periods
- maintaining adequate attendance and punctuality, and
- understanding, remembering, and carrying out simple and complex instructions.
A good supporting opinion from a treating doctor listing deficits in these areas can quickly turn a losing disability case into a winning one.
Some lawyers also recommend that their clients keep a daily log of the nature and severity or their symptoms, and submit a copy to Social Security prior to the hearing. Statements from third parties, including family members, neighbors, or former co-workers, can also prove helpful in documenting the extent of your impairments.
Contact an Experienced Disability Attorney
Claims based on CFS are notoriously difficult to win, but you can greatly improve your chances by contacting an experienced disability attorney to represent you. Fill out our consultation form to find a trusted attorney in your area.