Effective April 3, 2014, the Social Security Administration changed its ruling about how it will evaluate chronic fatigue syndrome. But what does it really mean? How does change the prospects of those who suffer from chronic fatigue syndrome for being approved for disability benefits?
To understand the significance of the new ruling that the SSA issued in early April 2014, let’s begin with some background on the prior rule, SSR 99-2p.
In April 1999, SSA issued a new rule, SSR 99-2p that offered hope to individuals trying to obtain disability benefits based on CFS. Previously, SSA routinely denied disability claims based on CFS because of skepticism about the disease. SSR 99-2p was a formal recognition that CFS is a legitimate medical disorder that can be the basis for a finding of disability.
The New Rule: What’s Different?
The new rule reflects advances in medical knowledge, adopting new considerations derived from the 2003 Canadian Consensus Criteria as well as guidelines developed in 2011 by a private international group. In particular, it adopts the latter’s inclusion of myalgic encephalomyelitis as a subtype of CFS.
Even though this ruling continues to emphasize the distinction between criteria for a diagnosis of CFS versus what’s necessary to qualify for disability, once other causes have been excluded, a physician can base a diagnosis on a person’s reported symptoms alone.
The new ruling reviews the diagnostic symptoms (four of which are required by the CDC definition of CFS), and then gives priority to post-exertional malaise, as well as other possible symptoms.
The new ruling also acknowledges co-occurring conditions beyond those set forth in SSR 99-2p, which were limited to Fibromyalgia, chemical sensitivities and Gulf War syndrome. These newly added co-occurring conditions include: myofascial pain syndrome, temporomandibular joint syndrome, irritable bowel syndrome, interstitial cystitis, Raynaud’s, migraines and others.
Another important change in the new ruling is the elimination of neurocognitive problems from the initial list of possible CFS symptoms. That doesn’t mean these aren’t significant, but these symptoms will not be considered for the purpose of establishing a medically determinable impairment (something that will potentially result in disability benefits) unless documented by psychological testing.
Finally, while affirming the laboratory tests included in the old ruling, the new ruling explicitly recognizes that test results in the normal range may be characteristic of many people with CFS.
Conclusion
The new ruling, SSR 14-p1 is a step in the right direction, but modestly so. It will not dramatically alter who is found disabled –medical evidence and severe limits on functioning in one’s daily life that are the hallmark of CFS will still need to be present in order to make a strong case. But it moves the dial forward in recognizing the pervasiveness (and continuing mystery) of this severe cluster of illnesses.
The new ruling may be viewed online at Federal Register.
Cheryl Coon specializes in the practice of social security disability law with the law firm of Swanson, Thomas, Coon & Newton in Portland Oregon. She represents clients throughout Oregon and SW Washington in initial applications through federal court appeals, in particular representing many clients diagnosed with CFS/ME, fibromyalgia, interstitial cystitis, irritable bowel syndrome and related mental health issues. She can be reached at ccoon@stc-law.com or by phone at (503) 228-5222. Her disability blog is at http://www.tcnf.legal/practice-areas/social-security/