Chronic Fatigue Syndrome
Chronic Fatigue Syndome (CFS) is, according to the National Institutes of Health (NIH), "a disorder that causes extreme fatigue”. What distinguishes this type of fatigue caused by CFS from other causes of fatigue is that CFS type fatigue is not the result of physical exertion and is not relieved by rest. There are no clinical tests or laboratory studies to confirm the existence of CFS. Even so, the Social Security Administration has recognized CFS as a medical impairment and has acknowledged that with appropriate evidence, it can serve as the basis for an award of Social Security Disability benefits.
The Social Security Administration has issued a Social Security Ruling (SSR 14-1p) on April 3, 2014 in an effort to clarify its policy regarding CFS and the methodology it employs in determining whether a disability claim, alleging CFS as the basis for an award of disability, will succeed. The Social Security Administration’s policy dealing with CFS is largely based on the criteria set out by the Centers for Disease Control and Prevention (CDC).
Like the CDC, the Social Security Administration requires that first the chronic fatigue be clinically evaluated by a physician. Additionally the chronic fatigue must be either persistent or relapsing but not life long. Finally, the chronic fatigue must have resulted in a substantial reduction of previous levels of functioning (including personal, work, school or social). There is also a requirement that there exist for at least 6 or more consecutive months 4 or more of the following: postexertional malaise last over 24 hours; short term memory problems or concentration problems which interfere with work, personal school or social activities; sore throat; tender cervical or axillary lymph nodes; muscle pain; multiple joint pain without swelling or redness; headaches of a new type; and waking unrefreshed.
Interestingly, the Social Security Administration notes that other diseases or syndromes may exist at the same time as CFS. These other “co-morbidities” include fibromyalgia; irritable bowel syndrome; migraines: temporomandibular joint dysfunction to name a few.
The Social Security Administration requires the existence of medical “signs” or laboratory findings in order to establish a medical impairment. As stated above, there are no precise medical signs (signs are something which can be observed apart from statements) to diagnosis CFS. That said the Social Security Administration has listed in SSR 14-1p several signs that it thinks are “helpful” in arriving at a diagnoses CFS. These signs include palpably tender or swollen lymph nodes; nonexudative pharyngitis (dry sore throat); tender points and/or reproducible muscular tenderness; frequent viral infections; ataxia (an unsteady wide based gait); extreme pallor and weight change. Laboratory findings include an abnormal brain MRI and the presence of an Epstein-Barr virus. Also included in the determination of whether a person has CFS could be mental limitations.
Applying the above, the Social Security Administration uses the 5-step sequential evaluation process to determine whether the claim of CFS is proven. At Step-2, it must be shown that the CFS is a severe impairment. That is whether the fatigue has more than a minimal effect on a person’s ability to perform basic work activity. If that is proven by a preponderance of the evidence, then an analysis must be made of whether the chronic fatigue is a listing level impairment.
There is no exact listing for CFS. However, CFS may equal a listing. The Commissioner offers the example of listing 14.06B. Listing 14.06B is the listing for repeated manifestations of mixed or undifferentiated connective tissue disorder. Another example of “equaling” a listing is considering listing 12.00. Listing 12.00 includes all of the listings for mental impairments. It is well known that CFS may cause or exacerbate mental disorders.
If no listings are equaled then an analysis must be made of residual functional capacity of the individual and whether that individual can return to his/her past relevant work (work performed in the last 15 years) given the limitations contained within the residual functional capacity. If that individual can return to his/her past relevant work then there is a finding of no disability. If the individual cannot return to his/her past relevant work then a determination must be made as to whether that individual can perform any work which exists in significant numbers in several regions throughout the United States. If work does not exist then there is a finding of disability.