By Robert J. Osborne, Esq.

Chronic Fatigue Syndrome (CFS) has been characterized as a syndrome that causes prolonged fatigue lasting six months or more, resulting in a substantial reduction in previous levels of occupational, educational, social, or personal activities. CFS is a systemic disorder that may vary in frequency, duration, and severity. The distinguishing characteristic of CFS is the presence of clinically evaluated, persistent, or relapsing chronic fatigue that:

• Is of new or definite onset (that is, has not been lifelong);
• Cannot be explained by another physical or mental disorder;
• Is not the result of ongoing exertion;
• Is not substantially alleviated by rest; and
• Results in substantial reduction in previous levels of occupational, educational, social, or personal activities.

CFS may result in additional symptoms, some more common than others. These include, but are not limited to:

• A feeling of not being yourself after exertion that lasts more than 24 hours;
• Impairment(s) 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; and
• Waking unrefreshed.

Once the SSA establishes that a person has a medically determinable impairment (MDI) of CFS, the Social Security Administration (SSA) will consider this MDI in the sequential evaluation process to determine whether the person is disabled.

The SSA must establish the severity of the impairment(s). The SSA determines the severity of a person’s impairment(s) based on the totality of medical signs, symptoms, and laboratory findings, and the effects of the impairment(s), including any related symptoms, on the person’s ability to function.

Establishing a Medically Determinable Impairment of CFS

However, the SSA will not rely upon the physician’s diagnosis alone. The evidence has to show that the physician reviewed the person’s medical history and conducted a physical exam. The SSA will review the physician’s treatment notes to see if the notes are consistent with the diagnosis of CFS.

Additionally, the SSA will look at the physician’s treatment notes to determine whether the person’s symptoms have improved, worsened, or remained stable. Further, the SSA will use the physician’s treatment notes to establish the physician’s assessment of the person’s strength and ability to function.

In addition to a licensed physician diagnosing CFS, this diagnosis must not be inconsistent with the other evidence in the person’s case record. Statutory and regulatory provisions require that, for evaluation of claims of disability under the Social Security Act, there must also be medical signs or laboratory findings before the SSA can find that a person has an MDI of CFS.

One or more of the following medical signs, clinically documented over a period of at least six consecutive months help establish the existence of an MDI of 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; or
• Any other medical signs that are consistent with medically accepted clinical practice and are consistent with the other evidence in the case record.

At this time, the SSA cannot identify specific laboratory findings that are widely accepted as being associated with CFS. Additionally, many people with CFS will have normal laboratory test results. However, the following laboratory findings establish the existence of an MDI in people with CFS:

• An elevated antibody titer to Epstein‑Barr virus capsid antigen equal to or greater than 1:5120, or early antigen equal to or greater than 1:640;
• An abnormal magnetic resonance imaging 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.

Documenting CFS

When a person alleges that he or she has CFS, the SSA generally needs evidence over a few months because medical signs, symptoms, and laboratory findings of CFS fluctuate in frequency and severity and often continue over time. The SSA will want to see clinical records reflecting ongoing medical evaluation and treatment from a person’s medical sources, especially treating sources. Such records can help a lot in documenting the presence of any medical signs or laboratory findings, as well as the person’s ability to function over time.

A person should ensure that his or her records contain detailed medical observations, information about treatment, the person’s response to treatment, and a detailed description of how the impairment limits the person’s ability to function.