CHRONIC FATIGUE SYNDROME
and FIBROMYALGIA
By Martha A. Churchill
The Social Security Administration does not include Chronic
Fatigue Syndrome (CFS) in its list of diseases. However, it
recognizes CFS as a real disease, and grants benefits if the
symptoms are severe enough.
The same is true for fibromyalgia. Some people think
fibromyalgia is practically the same disease as CFS, or a close
"cousin" of it.
Would you like to read the Social Security Administration's
"fact sheet" on CFS? It is written to guide the
health care professional, in providing the necessary
information. Just go to http://www.ssa.gov/odhome/cfsfacts.htm
to read this for yourself.
The Rose case:
One of the best cases on this subject is called Rose v.
Shalala, 34 F. 3d 13 (1st Cir. 1994). That case is about
Gary Rose, who worked as a grocery clerk before he was disabled
by CFS. The administrative law judge (ALJ) denied him benefits,
writing that Rose’s symptoms were not severe enough to stop
him from doing some kind of simple, sit-down job.
The federal appeals court took a different view of the
situation, though, and ruled that Rose should receive benefits.
For one thing, Rose’s treating doctor had written a report
showing that the man was bedridden for weeks at a time and was
"unable to participate in any kind of exercise because of
constant fatigue."
Soon after that, another treating doctor made a similar
finding. According to him, Rose had a general sick feeling,
which was quite disabling, along with a recurrent sore throat
and weight loss. This doctor, who specialized in internal
medicine and infectious disease, concluded that Rose was
"extremely fatigued and … not able to work." He
diagnosed CFS.
The federal court, reviewing the medical evidence, decided
the ALJ was wrong to deny benefits to Rose. CFS should be
recognized as a legitimate disease, the court wrote, even if
there is no "dipstick" laboratory test to diagnose it,
such as a blood test. In reaching its decision, the court
mentioned another case, called Sisco v. Department of HHS,
10 F.3d 739, 744 (10th Cir.1993).
CFS is not a disease that prevents someone from sitting,
standing, or lifting. It is a "non-exertional"
impairment, because it makes the person feel tired all the time.
POMS:
In 1993, Social Security issued a "POMS" guideline
(Program Operations Manual System) on CFS. The POMS policy says:
"Chronic Fatigue Syndrome (CFS), previously known as
Chronic Epstein-Barr Virus Syndrome, and also currently called
Chronic Fatigue and Immune Dysfunction Syndrome, is a systemic
disorder consisting of a complex of variable signs and symptoms
which may vary in duration and severity. The etiology and
pathology of the disorder have not been established. Although
there are no generally accepted criteria for the diagnosis of
cases of CFS, an operational concept is used by the medical
community. There is no specific treatment, and manifestations of
the syndrome are treated symptomatically.
"CFS is characterized by the presence of persistent
unexplained fatigue and by the chronicity of other symptoms. The
most prevalent symptoms include episodes of low-grade fever,
myalgias, headache, painful lymph nodes, and problems with
memory and concentration. These symptoms fluctuate in frequency
and severity and may be seen to continue over a period of many
months. Physical examination may be within normal limits.
Individual cases must be adjudicated on the basis of the
totality of the evidence, including the clinical course from the
onset of the illness, symptoms, signs, and laboratory findings.
Consideration should be given to onset duration, severity and
residual functional capacity following the sequential evaluation
process."
-POMS § DI 24575.005 (1993).
Depression
Some people with CFS become angry when they are asked to see
a therapist about possible depression. "You think this is all
in my head. But I have a real disease!" the person might
say.
However, there are many people with physical diseases who
become depressed because they can’t do the things they used to
do. Being sick is depressing! According to the Social Security
rules, if you have any illness or disability that can be
treated, you should make an attempt to get that treatment.
Depression is no exception, even if depression is not the reason
you are applying for Social Security.
Another problem is that people who are depressed can
sometimes have symptoms that are similar to CFS. For example, a
depressed person might sleep a lot, or lose weight. A depressed
person could experience a lot of aches and pains. There is no
harm checking to find out what is causing your symptoms;
otherwise, the Social Security judge might deny you benefits on
the grounds that you didn’t try every avenue to identify and
treat your symptoms. (Doctors are also watching for
possible sleep disorders whenever a patient says he or she feels
tired all the time.)
There is one more thing to consider, when it comes to
depression. The Social Security judge recognizes depression as a
disabling condition. If you want to get your benefits, what
difference does it make to you whether the judge granted you
benefits based on depression or CFS? Either way, you get the
same amount of money each month. You need the money to support
yourself, since you can’t work. If you really have CFS rather
than depression, so what if Social Security grants you the
benefits for the "wrong" reason? That is better than
not getting the benefits.
SKEPTICS
Some people think CFS and fibromyalgia are not real diseases,
and that people with those symptoms are just looking for an
excuse not to work.
However, there was once a time when people said the same
thing about Multiple Sclerosis. The symptoms of MS keep changing
all the time, and include some things that are similar to
hysteria. Eventually, a test was discovered to diagnose MS based
on an MRI scan. When the neurologist sees white spots on the
brain or spine, that means the person has MS. So, they are not
faking it, after all.
Some day, I hope it will be possible to diagnose CFS
accurately based on a simple blood test or urine specimen. But
until that day, we will just have to rely on the process of
elimination, and paying attention to the symptoms the person is
experiencing.
If you have CFS and you want to receive Social Security
because you cannot work, find a doctor who knows and understands
the condition. A report from a doctor will probably make all the
difference for the success of your application for benefits.
A FEW MORE CASES:
There are a few more cases about CFS and fibromyalgia that
are worth mentioning.
TIDWELL
Betty Tidwell had fibromyalgia, according to the federal
court. However, her symptoms were not bad enough to stop her
from working until after she no longer had "insured
status" for purposes of SSD. Tidwell v. Apfel, 161
F.3d 599 (1998).
SISCO
Linda Sisco got a lymph gland infection when she was 45 years
old. Gradually, her health deteriorated. She suffered from
severe muscle pains over her entire body, excessive fatigue,
headaches, and stomach nausea. The doctors didn’t know what to
do with her, so they called her a hypochondriac.
Over a ten-year period, she tried numerous pain medications.
She could read a light paperback, but only if she could rest it
on her chest rather than hold it up in her hands. She would read
a few pages, nap, then read a few more pages before falling back
to sleep. She could walk up to one block at a time, but only if
someone was available with a wheelchair at the end of the block.
The federal court decided she should receive benefits.
Sisco v. Dept. of HHS, 10 F. 3d 739 (10th Cir. 1993)
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