On April 3, 2014 Social Security published a new SSR on Chronic Fatigue Syndrome (CFS), SSR 14-1 p. This replaced the prior ruling on CFS, SSR 99-2p.
Section I of the new ruling defines CFS. In general the Centers for Disease Control and Prevention (CDC) define CFS in part as a syndrome that causes symptoms of prolonged chronic fatigue lasting six months or longer. There need to be certain signs and symptoms associated with the disease, which result in a substantial reduction of previous levels of occupational, social, educational, or personal activities.
The ruling explains that “[p]eople with CFS may have co-occurring conditions, such as fibromyalgia (FM), myofascial pain syndrome, temporomandibular joint syndrome, irritable bowel syndrome, interstitial cystitis, Raynaud’s phenomenon, migraines, chronic lymphocytic thyroiditis, or Sjogren’s syndrome.
Section II of the ruling explains how a person can establish a medically determinable impairment (MDI) of CFS. There need to be certain laboratory findings and medical signs in order to establish the impairment. As usual, a credentialed treating physician (an MD or DO) is considered an “acceptable medical source.”
The ruling also recognizes that person with CFS may also experience mental limitations as well. It explains “[so]me people with CFS report ongoing problems with short-term memory, information processing, visual-spatial difficulties, comprehension, concentration, speech, word-finding, calculation, and other symptoms suggesting persistent neurocognitive impairment. When ongoing deficits in these areas have been documented by mental status examination or psychological testing, such findings may constitute medical signs or (in the case of psychological testing) laboratory findings that establish the presence of an MDI.”
Section III of the ruling explains how SSA will document the existence of CFS. Longitudinal clinical records are important, as are evidence from acceptable medical sources (which may also include psychologists as well as MDs and DOs). They will also consider evidence from non-medical sources with respect to a person’s day-to-day functioning. This may include evidence from family, neighbors, past employers, rehabilitations counselors, etc.
Section IV of the ruling explains the two-step process of how SSA will evaluate a person’s statements about his or her symptoms and functional limitations. The first step is to determine if there are medical signs and findings which could be reasonably expected to produce the fatigue or other alleged symptoms. If so, the first step is satisfied.
In the second step, SSA will evaluate the intensity and persistence of the person’s symptoms to determine the extent to which they limit the person’s capacity for work.
Section V of the ruling explains how SSA will determine whether or not the person is disabled based on the MDI of CFS. They will look at the severity of the impairment to determine whether it equals the severity of a listed impairment (listed impairments are precisely defined impairments which qualify a person for disability if certain strict medical requirements are met), or whether the impairment prevents the person from doing his or her prior employment or any work existing in significant numbers in the national economy.
Section VI explains how SSA will consider CFS in the sequential evaluation process.
In the first step, SSA will consider the person’s work activities. If the person is doing substantial gainful activity, then they will be found “not disabled.”
In the second step, SSA will determine whether or not the person’s condition is “severe”; that is, whether or not it causes limitations or restrictions, and whether these have more than a minimal effect on the person’s ability to do basic work activities.
In the third step, SSA will look at whether or not the person’s condition is medically equivalent to a listed impairment. Because CFS is not a listed impairment, SSA cannot find that a person who has CFS alone meets a listed impairment. However, SSA will look at specific findings for any other impairments. For example, if the person has psychological manifestations related to CFS, SSA will look at the mental impairment listings to determine medical equivalence.
In the fourth step (if the third step is not met), SSA will make an assessment of the person’s RFC, or residual functional capacity. See my post from March 20th, 2014 for more on residual functional capacity. Basically, SSA will determine how the person’s impairment-related symptoms affect his or her functional capacity. If the person’s RFC precludes performance of his or her past relevant work, then SSA will proceed to step five.
In the fifth step, SSA will determine whether the person’s functional limitations prevent him or her from doing other work. SSA will apply vocational considerations in determining the person’s ability to do other work. If SSA finds that the person cannot do other work, they will be found “disabled.”
This material should not be construed as legal advice for any particular fact situation, but is intended for general informational purposes only. For advice specific to any individual situation, an experienced attorney should be contacted.