Social Security Benefits for Chronic Fatigue Syndrome

November 23, 2015

Chronic fatigue syndrome (CFS) is a disorder that is characterized by profound fatigue that is not improved by rest. It may be worsened by physical or mental activities and it may include symptoms such as weaknesses, muscle pain, impaired memory and concentration and insomnia according to the Centers for Disease Control and Prevention. There is not yet a definitive cause for CFS, but there is also the possibility that it has multiple causes.

Qualifying for Social Security Disability with chronic fatigue syndrome

In order to qualify for SSD, a person must have a disabling condition that renders them unable to do any substantial gainful activity. This condition or condition must have lasted, or be expected to last for at least 12 months or is expected to result in death.

The medical condition must be able to be proven through clinical and laboratory findings rather than by symptoms. The medical evidence alone must show that a person is disabled or is not disabled as the case is decided on the medical evidence. Because CFS is such a difficult to diagnose condition, and the fact that it has only recently been accepted as an actual condition by the medical community, the Social Security Administration has updated their policy for evaluating patients with CFS in 2014. This SSA policy interpretation ruling stipulates that one or more of the following medical signs be clinically documented over at least a six month period to establish the existence of chronic fatigue syndrome:

  • Palpably swollen or tender lymph nodes on physical examination;
  • Nonexudative pharyngitis;
  • Persistent, reproducible muscle tenderness on repeated examinations, including the presence of positive tender points; or
  • Any other medical signs that are consistent with medically accepted clinical practice and are consistent with the other evidence in the case record. For example, the CCC and ICC explain that an acute infectious inflammatory event may precede the onset of CFS, and that other medical signs may be present, including the following:
  • Frequent viral infections with prolonged recovery;
  • Sinusitis;
  • Ataxia;
  • Extreme pallor; and
  • Pronounced weight change

Laboratory findings to establish the existence of CFS

Although the absence of any of these lab results does not preclude the existence of CFS, the following findings can help establish chronic fatigue syndrome in a patient:

  • An elevated antibody titer to Epstein-Barr virus (EBV) capsid antigen equal to or greater than 1:5120, or early antigen equal to or greater than 1:640;
  • An abnormal magnetic resonance imaging (MRI) brain scan;
  • Neurally mediated hypotension as shown by tilt table testing or another clinically accepted form of testing; or
  • Any other laboratory findings that are consistent with medically accepted clinical practice and are consistent with the other evidence in the case record (for example, an abnormal exercise stress test or abnormal sleep studies, appropriately evaluated and consistent with the other evidence in the case record).

Additional support for healthcare professionals trying to provide medical evidence of chronic fatigue syndrome

The Social Security Administration has published a fact sheet on CFS for healthcare professionals: “Providing Medical Evidence to the Social Security Administration for Individuals with Chronic Fatigue Syndrome.”  This document explains how CFS is defined, what the SSA needs to see from your doctor and how patients with FCS are evaluated for disability.

How your work history factors in to your eligibility for disability benefits

In addition to the medical information about your health condition, the SSA will also rely on information about your work history. The SSA does not grant disability benefits based solely on having a medical condition. It bases its approval or denial of an application based on how much the condition poses functional limitations on the applicant’s ability to perform significant gainful activity, whether those limitations will allow the applicant to pursue a different type of work activity, or if those limitations are significant enough that they will be unable to perform any type of work activity in order to support themselves.

Clearly, qualifying with a condition as challenging as chronic fatigue will require the services of an experienced Philadelphia SSD attorney from the law office of Larry Pitt & Associates. You reap the benefits of our years of experience helping countless clients before you get approved for disability benefits.

If you have questions about applying for social security disability benefits with chronic fatigue syndrome, please feel free to contact the Philadelphia SSD lawyers at Larry Pitt & Associates to set up a consultation to discuss your case. We have multiple offices serving Berks, Bucks, Chester, Delaware, Montgomery and Philadelphia Counties.