When an individual with Chronic Fatigue Syndrome (CFS), also known as Chronic Fatigue and Immune Dysfunction Syndrome (CFIDS), applies for Social Security disability benefits, we must decide whether he or she is disabled under the law. We base our decision on information you provide and other evidence, including information provided by the individual. The following guidelines will help you understand the kind of information we need to evaluate claims filed by individuals with CFS.
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 our decision whether a person is disabled.
If the medical evidence alone shows that a person is clearly disabled or not disabled, we decide the case on that information. Otherwise, we go 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, we generally consider the child's ability to function independently, appropriately, and effectively in an age-appropriate manner.
SSA 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.
Our adjudication team 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 you to find out if you have the needed information. If you do not, they may ask you 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 you may reach a diagnosis of CFS on the basis of your patient's symptomatology (after ruling out other disorders), the Social Security law requires 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. We must have reports documenting your objective clinical and laboratory findings. Thus, it is essential that you submit all objective findings available concerning your patient's condition, even if they relate to another disorder or establish that the person has a different condition.