Many claims for disability benefits based on CFS/FM also consist of a mental component. Social Security as developed evaluative criteria for CFS and FM. The following information must form the basis for the application.
- Your doctor must indicated that you have a “medically determinable impairment” of Chronic Fatigue Syndrome. This diagnosis should be supported by the presentation of symptoms including extreme fatigue. The Policy Interpretation describes the the fatigue as, “ characterized in part by prolonged fatigue that lasts 6 months or more and that results in substantial reduction in previous levels of occupational, educational, social, or personal activities.”
- The diagnosis of depression and anxiety may also be considered clinical signs and symptoms related to CFS. “Within these parameters, an individual with CFS can also exhibit a wide range of other manifestations, such as... mental problems (e.g., depression,irritability, anxiety)”. It should be noted that the Policy Interpretation states, “a physician should make a diagnosis of CFS "only after alternative medical and psychiatric causes of chronic fatiguing illness have been excluded" (, 121:953-9, 1994).” As a result of this, many claims for benefits arising out of a diagnosis of CFS are approved based on a psychiatric diagnosis depending on the severity of the depression or anxiety. A separate evaluation by a psychiatrist or psychologist may be needed to assist in determining whether the depression and anxiety alone qualify you for benefits.
If you have a Long Term Disability policy, it is highly likely that there is a 2 year limitation on benefits for mental impairments. In that situation, it's best to push for a finding of eligibility based on the physical condition of CFS so your LTD company doesn't limit your benefits.
- Laboratory findings of high Epstein-Barr titer is consistent with SSA's Evaluative Criteria. The Policy states:
Examples of laboratory findings that establish the existence of a medically determinable impairment.
At this time, there are no specific laboratory findings that are widely accepted as being associated with CFS. However, the absence of a definitive test does not preclude reliance upon certain laboratory findings to establish the existence of a medically determinable impairment in persons with CFS. Therefore, the following laboratory findings establish the existence of a medically determinable impairment in individuals with CFS:
1.) 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;
Medical development will require specific documentation to verify the symptoms presented to your doctor. SSA looks for indications of the following signs and symptoms:
The Policy states:
Additionally, the current CDC definition of CFS requires the concurrence of 4 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; and
- Postexertional malaise lasting more than 24 hours.
A report from your treating physician should contain records that are consistent with this Policy Interpretation. A report should be obtained from any source treating your depression and anxiety to indicate that the mental conditions arise from the CFS symptom complex. Again, it needs to be established that the physical impairment of CFS presents some mental impairment, and that the CFS is the disabling impairment. This will reduce the chances that the LTD company will not limit benefits to 2 years.
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