Disability Determination for Chronic Fatigue Syndrome (CFS)

Getting Social Security disability benefits for CFS is difficult unless you have other medical signs based on objective medical evidence.

Chronic fatigue syndrome (CFS) is a disorder that results in significant, unexplained fatigue. The level of fatigue experienced by a CFS patient is unusual because it doesn't improve with bed rest, it is not the result of simple overexertion, and it is severe enough to produce a considerable decline in your level of activity.  

Chronic fatigue syndrome can be difficult to diagnose. Generally, doctors diagnose a person with CFS after ruling out other diseases through the use of blood tests or laboratory testing. Besides fatigue, typical symptoms of CFS include a decreased memory or inability to concentrate, tenderness in the lymph nodes, a sore throat, muscular weakness, joint pain, headaches, exhaustion after performing exercise that was considered easy in the past, and excessive tiredness even after getting plenty of sleep.

Medical Evidence Necessary to Prove CFS

Fatigue is the classic symptom of CFS. Since fatigue is usually self-reported and cannot be verified by a doctor, this can make it more complicated to receive disability benefits based on CFS. Fortunately, the Social Security Administration (SSA) has provided some guidance in this area. In the SSA's policy ruling on chronic fatigue syndrome (SSR 14-1p), the agency stated that it will not grant disability benefits based only on your self-reported symptoms. Instead, there must be additional signs based on objective medical evidence or laboratory testing that confirm the presence of CFS.

Examples of Medical Signs Used to Support a Diagnosis of CFS

The SSA requires at least one of the following signs of CFS to be present in your medical records when reviewing your disability claim. These medical signs must have been documented by medical professionals over a period of at least six months.

  • Lymph nodes that are swollen or tender to the touch.
  • Nonexudative pharyngitis (a type of sore throat).
  • Ongoing muscular tenderness that can be replicated on several examinations, along with positive tender points, or
  • Other objective medical evidence that is consistent with accepted medical practice.

Examples of Laboratory Tests Used to Support a Diagnosis of CFS

The SSA accepts the following tests as medical evidence supporting the existence of CFS:

  • An atypical MRI (magnetic resonance imaging) of the brain.
  • The presence of a Epstein-Barr virus (EBV) infection above certain levels.
  • Neurally mediated hypotension (low blood pressure), or
  • Other laboratory testing that is consistent with accepted medical practice.

Meeting a Disability Listing If You Have CFS

One way to qualify for disability benefits is to meet the SSA's official description of an impairment (called an impairment listing). Unfortunately, chronic fatigue syndrome is not included as a listing in the Social Security Administration's (SSA) disability listings. Therefore, according to the SSA's policy ruling on chronic fatigue syndrome, if you have been diagnosed only with CFS, and you have not been diagnosed with any other types of mental or physical disorders, then you will be unable to receive disability benefits by meeting a disability listing.  (But see below on how to qualify for disability based on a reduced functional capacity.)

However, if you have a combination of disorders, then the SSA might be able to apply the disability listings. For example, if you have been diagnosed with both CFS and depression, the SSA will consider whether your medical evidence meets, or is equivalent to, the requirements of Listing 12.04, Affective Disorders (Depression).  

Determining Your Residual Functional Capacity If You Have CFS

When you are unable to meet a disability listing, the SSA will evaluate your  residual functional capacity  (RFC) in deciding whether you should receive disability benefits. Your RFC is based on all the evidence submitted to the SSA, including what your doctor says you are able and not able to do. Your physical RFC describes what types of physical activities you can perform during a 40-hour work week. This includes your ability to sit, stand, walk, lift, carry, reach, handle objects, understand and remember instructions, work with others, and use appropriate judgment.  The fatigue you experience with CFS would likely reduce your ability to perform many activities.  If physical your RFC demonstrates that you are unable to perform even sedentary work (sitting for 6 hours per day and walking/standing for 2 hours per day), you will be found disabled.

If you suffer from  severe short-term memory and concentration problems or  severe depression, you should also receive a mental RFC.  These mental impairments must be documented by medical professionals using psychological tests or mental status examinations. If your mental RFC says that you cannot perform jobs that require simple short-term memory, then the SSA would likely find that you are disabled, since that would prevent you from working in most occupations.

The SSA also will take into consideration your age and education in determining what jobs you can perform. If you are over age 50 and have limited education, then it is more likely that you will be found disabled according to the SSA's guidelines on medical-vocational allowances.

Medical Evidence Required

Your medical record should include medical examinations, psychological examinations, any treatment you received for CFS, your response to treatment, and reports from medical professionals of how your CFS has limited your ability to perform work tasks on a sustained basis (8 hours per day for 5 days a week).

It is common with chronic fatigue syndrome that your symptoms and medical signs may decrease and vary over an extended period of time. Because of this, it is important that you submit all documentation of your CFS even if your symptoms began long before your date of application.  

Since CFS usually has a definite onset date, your medical professional should provide an opinion contrasting how you have functioned with and without the symptoms of CFS.

The Difference Between CFS and Fibromyalgia

Persons who have CFS and fibromyalgia may have very similar symptoms. According to the SSA, if you have positive tender points, but you do not have the required number of tender points to meet the American College of Rheumatology  standards for fibromyalgia, then you may still try to satisfy the requirements for CFS to get disability.

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