Providing Medical Evidence to the Social Security Administration for Individuals with Chronic Fatigue Syndrome
When an individual with Chronic Fatigue Syndrome (CFS), also known as Chronic Fatigue and Immune Dysfunction Syndrome (CFIDS), applies for Social Security disability benefits, the Social Security Administration (SSA) must decide whether the claimant is disabled under the law. Social Security bases its decision on information provided by the claimant and his or her medical health providers. The following guidelines will help you understand the kind of information Social Security needs to evaluate disability claims for Chronic Fatigue Syndrome
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(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 Social Security’s decision whether a person is disabled. If the medical evidence alone shows that a person is clearly disabled or not disabled, Social Security decides the case on that information. Otherwise, Social Security goes 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, Social Security considers whether the child has an impairment that results in marked and severe functional limitations.
What Social Security Needs From the Claimant’s Medical Providers
Social Security needs information from the claimant’s doctors, therapists and other medical providers that will help it to determine the existence, severity, and duration of the claimant’s impairment(s).
The medical provider’s record or narrative report should include a thorough medical history, and all pertinent clinical and laboratory findings (both positive and negative) from the provider’s examination of the patient. Copies of laboratory results should be provided if available. Also, the medical health professionals should 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 Social Security since it is interested in the impact of the illness over a period of time. Additionally, any information the medical provider is able to provide contrasting the patient’s medical condition and functional capabilities since the onset of CFS with that of his or her prior status would be helpful.
The medical provider should also include a statement of his or her opinion about what work-related activities the claimant can still do despite his or her impairment. This assessment should include opinions about both physical and mental functions and, to the extent possible, the reasons for the opinions, such as the clinical findings and/or personal observations of the claimant. These opinions should reflect the patient’s abilities to perform work-related activities on a sustained basis (i.e., 8 hours/day and 5 days/week). Descriptions of any functional limitations noted throughout the time the provider 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.
Social Security 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
Social Security’s adjudication team (the ones who decide whether the claimant qualifies for disability) 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 one or more of the claimant’s medical providers to find out if they have the needed information. If the provider does not, the team may ask the provider 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 a medical health professional may reach a diagnosis of CFS on the basis of the patient’s symptomatology (after ruling out other disorders), the Social Security rules and regulations require 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. Social Security must have reports documenting objective clinical and laboratory findings. Thus, it is essential that the claimant or his/her provider submit all objective findings available concerning the patient’s condition, even if they relate to another disorder or establish that the person has a different condition.
Chronic Fatigue Syndrome Attorney
If you have Chronic Fatigue Syndrome and are unable to work, you may be eligible for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) benefits. Mr. Ortiz is a Board Certified Social Security Attorney and he has experience handling claims for CFS. Call 850-308-7833 for a free case evaluation and to schedule a free consultation.