Social Security Disability & Chronic Fatigue Syndrome (CFS, CFIDS)

Chronic fatigue syndrome (CFS) is a condition that causes severe and ongoing tiredness that is not improved by rest and does not result from another underlying disease. The exact cause of CFS is unknown, though theories include exposure to the Epstein-Barr virus or a disruption in the body's immune system. Age, gender, exposure to prior illnesses, and stress are also thought to play a role.

In addition to fatigue, CFS symptoms can include sore throat, headache, low-grade fever, painful joints, memory or concentration problems, swollen glands, and generalized muscle weakness. CFS has also been known as chronic fatigue and immune dysfunction syndrome (CFIDS) and myalgic encephalomyelitis (ME).

How Does Social Security Define CFS?

Social Security refers, in part, to the Center for Disease Control (CDC) to evaluate CFS. The CDS defines CFS as persistent fatigue that has a definite date of onset, has no other mental or physical cause, is not alleviated by rest or sleep, and substantially interferes with work, school, social, or personal activities. The diagnosis also requires that you experience at least four of the following symptoms for at least six months:

• memory or concentration problems that cause a serious reduction in your activities
• frequent sore throats
• tender lymph nodes in the neck or under the arm
• muscle pain
• pain in multiple joints without redness or swelling
• headaches of a different quality than before onset of chronic fatigue
• sleep that does not refresh you, and
• a general feeling of being unwell that lasts at least 24 hours following a period of exertion.

Your medical records must contain documentation that satisfies the above criteria for a diagnosis of CFS and that shows these symptoms did not begin before the onset of your chronic fatigue.

What Medical Records Do I Need to Prove CFS?

Social Security Ruling 14-1p lays out the requirements for CFS to be evaluated. The ruling states that CFS must first be established as a "medically determinable impairment" (MDI) by medical signs and/or laboratory findings. In particular, Social Security has listed the following as examples of objective medical evidence that can establish that you have an MDI, particularly if they are documented over a half a year or more:

• swollen or sore lymph nodes on physical examination
• sore throat without exudate (fluid)
• ongoing muscular pain exhibited during repeated examinations
• the presence of positive tender points
• positive test for Epstein-Barr virus
• abnormal MRI, and
• abnormal exercise stress test, and
• abnormal sleep studies.

CFS can be a difficult disease to document clinically, as medical tests and laboratory results do not always reflect the degree of the illness. Therefore, it is important to understand that Social Security will not approve a disability claim based on the description of symptoms alone, though how symptoms affect your daily life is considered in the decision.

How Does Social Security Assess Whether I Am Disabled by CFS?

If Social Security concludes that you have a medically determinable impairment, and your chronic fatigue is severe, Social Security will next determine whether the physical or mental limitations caused by CFS make you disabled and unable to work a full-time job. To do that, it will develop a residual functional capacity (RFC) assessment for you.

To help Social Security develop an accurate RFC, you need to provide them with your medical records that date back to when the symptoms of your CFS first began. These records should include all lab test results, hospitalizations, doctor visits and reports, and a complete list of medications and their side effects.

In light of your documented symptoms, Social Security might develop an RFC for you that states that due to persistent fatigue, you need to take frequent breaks throughout the day to rest as needed. Because most employers would not accommodate this limitation, it would be difficult for you to perform most jobs.

If you suffer from documented muscle pain and weakness, your RFC may also include limitations on certain work-related physical activities as well. For example, your RFC may state that you cannot lift or carry objects that weigh more than 10 pounds. This limitation would prevent you from doing jobs that required physical exertion, such as some factory work, warehouse work, and most janitorial positions.

Mental illness, such as anxiety and depression, is often associated with CFS. If you are seeing a therapist or psychologist for treatment of a mental illness, you should report this to Social Security and provide them with the treatment notes from your provider. Social Security will use the records to prepare a mental RFC that addresses your ability to perform the mental tasks required for work. For example, if you suffer from severe anxiety or depression, you may have difficulty concentrating on your work or even showing up for work on a regular basis. Anxiety and depression can also interfere with the ability to interact with coworkers. Social Security will consider the severity of these symptoms when determining their limiting effect on your ability to work.

CFS can also cause significant difficulties with memory and understanding and processing information. If you suffer from these symptoms, a mental RFC might state that you have significant difficulty following basic instructions or are unable to complete tasks in an acceptable amount of time. According to Social Security, limitations that cause a 20% reduction in your productivity (or more) would prevent any employment at all. (For more information, see our article on qualifying for disability due to reduced productivity.)

You should ask your treating physician, including your psychiatrist or psychologist, to fill out an RFC form that details their opinions of your work-related limitations. Although Social Security must consider the opinions of your doctors, they will assign them weight only they are supported by objective medical evidence. For more information, see our section on how Social Security analyzes your RFC.

Basic Requirements for Disability

In addition to the medical finding that you are unable to work, above, you must not be earning more than about $1,500 per month from work, and your illness must prevent you from working for at least a year. In addition, if you're applying for SSDI, you must have worked long enough for employers who pay taxes to Social Security. For more information, see SSDI requirements.

If you're applying for SSI, you don't need a qualifying work history, but you do need to be of limited means—you must meet Social Security's low income and asset tests. For more information, see SSI requirements.

_{Updated December 28, 2022}