Social Security Issues New Ruling For Chronic Fatigue Syndrome

SSR 14-1p clarifies the policy on how SSA develops evidence to establish that a person has a medically determinable impairment (MDI) of Chronic Fatigue Syndrome (CFS) and how this impairment is evaluated in disability claims and continuing disability reviews under titles II and XVI the Social Security Act (Act).  

Under the CDC case definition, the hallmark of CFS is the presence of clinically evaluated, persistent or relapsing chronic fatigue that:

  1. Is of new or definite onset (that is, has not been lifelong);
  2. Cannot be explained by another physical or mental disorder;
  3. Is not the result of ongoing exertion;
  4. Is not substantially alleviated by rest; and
  5. Results in substantial reduction in previous levels of occupational, educational, social, or personal activities.

The CDC case definition requires the concurrence of 4 or more specific symptoms that persisted or recurred during 6 or more consecutive months of illness and did not pre-date the fatigue:

  • Postexertional malaise lasting more than 24 hours (which may be the most common secondary symptom);
  • Self-reported impairment(s) 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; and
  • Waking unrefreshed.

Within these parameters, the CDC case definition, CCC, and ICC describe a wide range of other symptoms a person with CFS may exhibit:

  • Muscle weakness;
  • Disturbed sleep patterns (for example, insomnia, prolonged sleeping, frequent awakenings, or vivid dreams or nightmares);
  • Visual difficulties (for example, trouble focusing, impaired depth perception, severe photosensitivity, or eye pain);
  • Orthostatic intolerance (for example, lightheadedness, fainting, dizziness, or increased fatigue with prolonged standing);
  • Respiratory difficulties (for example, labored breathing or sudden breathlessness);
  • Cardiovascular abnormalities (for example, palpitations with or without cardiac arrhythmias);
  • Gastrointestinal discomfort (for example, nausea, bloating, or abdominal pain); and
  • Urinary or bladder problems (for example, urinary frequency, nocturia, dysuria, or pain in the bladder region).

People 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. Co-occurring conditions may also include new allergies or sensitivities to foods, odors, chemicals, medications, noise, vibrations, or touch, or the loss of thermostatic stability (for example, chills, night sweats, or intolerance of extreme temperatures).

A person can establish that he or she has an medically determinable impairment (MDI) of CFS by providing appropriate evidence from an acceptable medical source, laboratory findings and mental limitations.   In cases in which CFS is alleged, SSA generally needs longitudinal evidence because medical signs, symptoms, and laboratory findings of CFS fluctuate in frequency and severity and often continue over a period of many months or years.  This evidence can be obtained from acceptable medical sources, nonmedical, and lay persons to document severity and functional limitations.