By Vicki Walker
On April 30, the Social Security Administration (SSA) issued a
Ruling stating its disability benefits apply to CFS patients, just
as they do to other disabled Americas. While the new ruling will
hardly "open the floodgates" for CFS patients to garner
disability wages, it should make it easier for disabled CFS
patients to acquire their benefits at an earlier stage in the SSA
The five steps
SSA uses a "five-step sequential evaluation process"
to determine whether each individual is disabled within SSA's
strict guidelines. One of the requirements is that the claimant
has medical signs or laboratory findings which reflect their
At the outset, the "Policy Interpretation Ruling"
informs the reader that "CFS, when accompanied by appropriate
medical signs or laboratory findings, is a medically determinable
impairment that can be the basis for a finding of
'disability.'" It then gives examples of signs and lab
findings which can show that the patient has a medically
determinable impairment (MDI)-the first step a claimant must pass
in order to be found disabled within SSA policy.
Some examples are: swollen or tender lymph nodes, nonexudative
pharyngitis, muscle tenderness, tender points, abnormal MRI brain
scan, neurally mediated hypotension and persistent neurocognitive
impairment. SSA repeatedly clarifies that there may be other signs
or lab findings which, when consistent with the patient's medical
record, can be used as evidence for an MDI.
In the second step of SSA's sequential evaluation process, it must
be shown that the MDI is "severe." In this ruling, SSA
states that, once a finding of an MDI has been made, the patient's
symptoms can be used to measure the severity of the disability.
For example, "if fatigue, pain, neurocognitive problems or
other symptoms are found to cause a limitation or restriction
having more than a minimal effect on an individual's ability to
perform basic work activities, the adjudicator must find that the
individual has a 'severe' impairment."
In the third step, SSA must consider whether the claimant's
disability meets or equals a "listed" impairment. CFS is
not a listed impairment, but many CFS patients meet the criteria
for other impairments. For example, a judge in New Jersey recently
found a CFS claimant met the criteria for multiple sclerosis and
awarded disability on that basis. Many judges have found that CFS
patients who have overlapping depression meet that listing.
Overall SSA policy states that when a patient meets a particular
listing (along with the severity criteria), disability must be
If the claimant's disability is found to be severe, but does not
meet or equal a listed impairment, the evaluation process
The fourth step of the SSA sequential evaluation process requires
the adjudicator to determine whether the claimant can do his/her
past relevant work, and the fifth step requires proof that the
claimant cannot do any other type work that is available in the
economy. While these steps have a more subjective standard of
proof, the CFS Ruling does state that "younger
individuals" (age 18-49) may be disabled if they are unable
to work. SSA policy typically presumes that younger people can
find other types of work and disability benefits are often denied
on that basis.
Many CFS patients have experienced SSA adjudicators who have
ordered "consultative examinations" (CEs) with outside
medical sources who are uninformed about CFS or who seem like
hired guns to discredit their disability claims. The new Ruling
states, if the adjudicator finds the claimant's record to be
incomplete or inconsistent, the treating health care provider
should be contacted first to provide the needed information. Only
if the treating source is unable to satisfy the request should a
CE be ordered. The Ruling also explains that a CFS claimant's
medical record may contain conflicting evidence due to the
"complicated diagnostic process involved in these cases"
and any conflicts should first be resolved through the patient's
own doctor (rather than an outside CE).
And, finally, SSA offers the opportunity for claimants to submit
supporting statements from other medical sources, as well as
"third parties" such as neighbors, friends, relatives,
clergy, former employers, school teachers, and others who are
familiar with their functional limitations.
Overall the new Social Security Ruling should improve disabled CFS
patients' outcomes. The Program Operations Manual System (POMS),
the basic guidebook for handling disability claims, will be
revised shortly to reflect the Ruling. Training of SSA personnel
about the ruling, which is binding on adjudicators at all levels,
including administrative law judges, won't begin until July. Even
so, the Ruling should immediately become a critical part of any
CFS patient's claim for disability benefits.
Ruling to guide
If you are in the process of applying for SSDI payments,
reference Ruling 99-2p to ensure that the new rules are used to
review your case. The ruling will also guide decisions made in
Continuing Disability Reviews (CDRs) conducted by SSA.
While the Ruling will have no direct impact on cases involving
private long-term disability insurance, it eventually is expected
to influence decisions in those cases. An SSA determination of
disability on a non-psychiatric basis should make it more
difficult for private insurers to terminate benefits by lumping
CFS in with psychiatric illnesses.
For a copy of the Ruling
The complete Ruling is published on The CFIDS Associationís
web site (www.cfids.org)
under the "Disability" heading. It is also available
through the Association with a request for "SSA Ruling."
Vicki Walker is
Public Policy Coordinator for The CFIDS Association of America.
She is in her seventh year of service to the Association.