Providing Medical Evidence to the Social Security Administration for Individuals with Chronic Fatigue Syndrome - FACT SHEET
A Guide For Health Professionals
When an individual with Chronic Fatigue
Syndrome (CFS), also known as Chronic Fatigue and Immune Dysfunction Syndrome
(CFIDS), applies for Social Security disability benefits, we must decide
whether he or she is disabled under the law. We base our 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 we 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
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
from any medically determinable physical or mental impairment that
results in marked and severe functional limitations.
The medical condition(s) 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 our decision whether a person is disabled. If the medical evidence alone shows that a person is clearly disabled or not disabled, we decide the case on that information. Otherwise, we go on to consider 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, we consider whether the child has an impairment that results in marked and severe functional limitations.
What We Need From You
We need information from you that will help us to determine the existence, severity, and duration of the person's impairment(s).
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 us since we are 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. Tell us your opinions about 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, standing, 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.
We can pay a reasonable amount for reports (or copies) of medical evidence requested from physicians/psychologists, hospitals, and other non-Federal providers of medical services.
Evaluating Disability For Persons With CFS
Our adjudication team consists of a physician or psychologist and a specially trained disability examiner working in the disability determination services (DDS) in the State in which the claimant lives. In evaluating disability for persons with CFS, the team looks at all of the available evidence, including the clinical course from the onset of the illness, and considers the impact of the illness on each affected body system.
If the team believes there is not enough information to make a decision, they may call or write you to find out if you have the needed information. If you do not, they may ask you or, in some circumstances, an independent medical source, to provide the information by performing tests or an examination for a fee paid by the DDS.
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. We must have reports documenting your objective clinical and laboratory findings. 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.
SSA Pub. No. 64-063