When an individual with Chronic Fatigue Syndrome (CFS), also known as Chronic Fatigue and Immune Dysfunction Syndrome (CFIDS), applies for Social Security disability benefits, SSA must decide whether he or she is disabled under the its regulations . SSA bases its decision on information you provide and other evidence, including information provided by the individual. The following guidelines will help you understand the kind of information SSA need to evaluate claims filed by individuals with CFS.
Definition Of Disability: Under Social Security law, an individual is considered disabled if he or she is unable to do any substantial gainful work activity because of a medical condition (or conditions), that has lasted, or can be expected to last, for at least 12 months, or that is expected to result in death; or, in the case of an individual under the age of 18, if he or she suffers from any medically determinable physical or mental impairment that results in marked and severe functional limitations. The medical condition or conditions must be shown to exist by means of medically acceptable clinical and laboratory findings. Under the law, symptoms alone cannot be the basis for a finding of disability, although the effects of symptoms may be an important factor in determining whether a person is disabled.
If the medical evidence alone shows that a person is clearly disabled, a decison is madebased on that information. Otherwise, consideration is given to other factors, such as functional capacity in light of the person's impairment(s), age, education, and work background. For a child under age 18, SSA will consider whether the child has an impairment that results in marked and severe functional limitations. For workers over the age of 50, it is often just as much a vocational question as a medical question in determing whether a person is disabled.
Information from you that will help SSA to determine the existence, severity, and duration of the person's impairment should include the patient's complete medical records, lab reports, and written reports by you indicasting the diagnoses, clinical findings, symptoms and functional limitations.
Your report should include a thorough medical history, and all pertinent clinical and laboratory findings (both positive and negative) from your examination of the person. Copies of laboratory results should be provided if available. Also, provide the results of any mental status examination, including any psychometric testing. Longitudinal clinical records and detailed historical notes discussing the course of the disorder, including treatment and response, are very useful for since SSA will be interested in the impact of the illness over a period of time. Additionally, any information you are able to provide contrasting your patient's medical condition and functional capabilities since the onset of CFS with that of his or her prior status would be helpful.
You should also include a statement of your opinion about what work-related activities the person can still do despite his/her impairment. Comment on both physical and mental functions and, to the extent possible, the reasons for your opinions, such as the clinical findings and/or your observations of the person. These opinions should reflect the person's abilities to perform work-related activities on a sustained basis, i.e., 8 hours/day and 5 days/week. Your descriptions of any functional limitations you noted throughout the time you treated the patient are very important.
Examples of work-related functions include: Physical work-related functions: Walking, tanding, sitting, lifting, pushing, pulling, reaching, carrying, and handling; Mental work-related functions: The ability to understand, remember, and carry out simple instructions, the ability to use appropriate judgment, and the ability to respond appropriately to supervision, co-workers, and usual work situations, including changes in a routine work setting.
Although you may reach a diagnosis of CFS on the basis of your patient's symptomatology (after ruling out other disorders), the Social Security law requires that a disabling impairment be documented by medically acceptable clinical and laboratory findings. Statements merely recounting the symptoms of the applicant or providing only a diagnosis will not establish a medical impairment for purposes of Social Security benefits. Thus, it is essential that you submit all objective findings available concerning your patient's condition, even if they relate to another disorder or establish that the person has a different condition.
