How Does the Social Security Administration Decide if I Qualify for Disability Benefits for Chronic Fatigue Syndrome?
If you have chronic fatigue, Social Security disability benefits may be available to you. To determine whether you are disabled by chronic fatigue, the Social Security Administration will consider whether your chronic fatigue qualifies as a severe medically determinable impairment at Step 2 of the Sequential Evaluation Process. See Chronic Fatigue Syndrome as a Medically Determinable Severe Impairment. If your chronic fatigue qualifies at Step 2, the Social Security Administration considers whether your chronic fatigue is severe enough to equal a listing at Step 3 of the Sequential Evaluation Process. See Winning Social Security Disability Benefits for Chronic Fatigue by Equaling a Listing.
If your chronic fatigue is not severe enough to equal a listing, the Social Security Administration must assess your residual functional capacity (RFC) (the work you can still do, despite your chronic fatigue), to determine whether you qualify for benefits at Step 4 and Step 5 of the Sequential Evaluation Process. See Residual Functional Capacity Assessment for Chronic Fatigue Syndrome.
Chronic fatigue is also known as chronic fatigue syndrome (CFS) and immune dysfunction syndrome (CFIDS). It is a very misunderstood disorder, and has been the center of much debate. It has no known proven causes, no definite tests to prove its validity, and no known cures.
It is a complex disorder that is has many signs and symptoms. The most common symptom is extreme fatigue for no reason that is not improved by rest and may get worse with light physical or mental activity.
Over one million people in the United States have been diagnosed with chronic fatigue.
The general pattern is that the person experiences “flu-like” symptoms that do not go away. This usually occurs during a period of great stress in the person’s life. When it first occurs, people think it will pass like the flu.
The Center for Disease Control Definition
You must have a medically determinable impairment that is severe to satisfy Step 2 of the Sequential Evaluation Process. The Social Security Administration has ruled that chronic fatigue can constitute a medically determinable impairment if a diagnosis is made under the current Center for Disease Control (CDC) diagnostic criteria for chronic fatigue.
The Center for Disease Control defines chronic fatigue as the presence of clinically evaluated, persistent or relapsing chronic fatigue that is new or has a definite beginning (that is, it has not been lifelong) that cannot be explained by any other diagnosed physical or mental disorder, or the result of ongoing exertion. Chronic fatigue is not substantially alleviated by rest, and it results in substantial reduction of previous levels of occupational, educational, social, or personal activities.
Additionally, the current definition of chronic fatigue requires four or more of the following symptoms, all of which must have persisted or recurred during 6 or more consecutive months of illness and must not have pre-dated the fatigue:
- Self-reported impairment in short-term memory or concentration severe enough to cause substantial reduction in previous levels of occupational, educational, social, or personal activities.
- Sore throat.
- Tender cervical or axillary lymph nodes.
- Muscle pain.
- Multi-joint pain without joint swelling or redness.
- Headaches of a new type, pattern, or severity.
- Unrefreshing sleep.
- Postexertional malaise lasting more than 24 hours.
Chronic fatigue syndrome usually must be present for at least six months before it is diagnosed and can last for years.
Medical Signs or Laboratory Findings
In addition to the Center for Disease Control criteria, the Social Security Administration requires the presence of medical signs or laboratory findings to demonstrate that a claimant with chronic fatigue syndrome has a medically determinable impairment.
However, no specific etiology or pathology has been established for chronic fatigue. Therefore, any possible signs and laboratory findings to establish the existence of a medically determinable impairment are only examples and are not all-inclusive.
For purposes of Social Security disability evaluation, one or more of the following medical signs clinically documented over a period of at least 6 consecutive months establishes the existence of a medically determinable impairment for individuals with CFS:
- 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.
- Any other medical signs that are consistent with medically accepted clinical practice and are consistent with the other evidence in the case record.
Therefore, the following laboratory findings establish the existence of a medically determinable impairment in individuals with chronic fatigue:
- 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.
- 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.
Individuals with chronic fatigue may also exhibit medical signs, such as anxiety or depression, indicative of the existence of a mental disorder. When such medical signs are present and appropriately documented, the existence of a medically determinable impairment is established.
To determine whether you are disabled at Step 3 of the Sequential Evaluation Process, the Social Security Administration usually considers whether your impairment is severe enough to meet or a listing. The Social Security Administration has developed rules called Listing of Impairments for most common impairments. The listing for a particular impairment describes a degree of severity that the Social Security Administration presumes would prevent a person from performing substantial work. If your impairment is severe enough to meet or equal the listing, you will be considered disabled.
The Social Security Administration has no listing for chronic fatigue syndrome. Since CFS is not a listed impairment, you cannot be cannot be found to meet a listed impairment based on your CFS alone. However, the specific findings in your case should be compared to any pertinent listing to determine whether “medical equivalence” may exist. In other words, you may be entitled to Social Security disability benefits if the severity of your condition equals an existing listing for a different impairment.
If you have psychological problems related to CFS, they should be evaluated under the mental disorders listings. The Social Security Administration should consider whether your impairments meet or equal the severity of a mental listing. See Can I Get Social Security Disability Benefits for Depression, Bipolar Disorder, or Mania? and Can I Get Social Security Disability Benefits for Anxiety, Phobias, Panic Attacks, Obsessive Compulsive Disorder, or PTSD?