Why Cfs/me Disability Claims Are Complicated
CFS/ME claims can be difficult to prove since many physicians are reluctant to make a diagnosis without diagnostic testing that can produce evidence of the condition. Insurance companies are notorious for denying long-term disability claims.
The doctors hired by long-term disability providers will often contradict the diagnosis. They will typically report that the symptoms are not debilitating, therefore, leaving the affected individual without the disability benefits they deserve. CFS/ME disability claims can be extremely complex. Having a disability lawyer in your corner is the best way to increase your chances of a favorable decision.
An Me/cfs Claimant Should Not Participate In A Standard Functional Capacity Evaluation Scheduled By The Ltd Insurer
Private LTD insurance companies often try to schedule standard functional capacity evaluations performed in ME/CFS cases) to determine whether an ME/CFS claimant has the physical capacity to work. Use of the FCE for that purpose has been discredited for a variety of reasons 25.
On February 20, 2019, Richard Podell, M.D. conducted a search of the National Library of Medicine database searching keywords: Functional Capacity Evaluation, Chronic Fatigue Syndrome and located 11 citations and found there were zero studies published that claim to demonstrate any validity for the FCE as standardly used to predict or certify whether a person with chronic fatigue syndrome is well enough to be able to work. Dr. Podell has written extensively on the topic and has useful information on his website regarding documenting disability in ME/CFS cases26.
If an LTD carrier demands the ME/CFS claimant attend a standard FCE, a treating physician should prepare a letter explaining any deleterious effect that test will have on the patient’s health. The most common effect of a prolonged standard FCE is post exertional malaise, and exacerbation of other physical and cognitive ME/CFS symptoms27.
Does Chronic Fatigue Syndrome Qualify For Social Security Disability
The Social Security Administration issued a ruling recognizing chronic fatigue syndrome as a legit medical illness. If you meet the technical requirements for Social Security disability benefits, you can apply for it with this condition. The SSA says chronic fatigue syndrome constitutes a medically determinable impairment when accompanied by medical signs or laboratory findings.
You must prove CFS prevents you from working at least 12 months to get SSD benefits for chronic fatigue syndrome. Still, this illness doesnt garner automatic approval. First, the SSA reviews all your medical evidence and determines whether you can perform your past work. If you cant do your old job, they will look for any other work you can do before making a decision.
You may need to complete a Residual Functional Capacity Assessment as part of your medical exam. The RFC is a report stating how your health issues limit your ability to complete certain job-related tasks. If you need frequent breaks during the day to rest, most employers wouldnt be able to accommodate you. This makes performing your required job duties for 40 hours per week more challenging. If you have severe pain and weakness, many job tasks become difficult to impossible for you to handle. Carrying heaving objects, frequently standing, stooping or staying on your feet all day are just a few examples.
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While Some People With Mild Cases Of Chronic Fatigue Syndrome May Be Able To Continue Working Many Individuals With Severe Symptoms Cannot
Though there is no specific listing for chronic fatigue syndrome in Social Securitys Blue Book, it is still possible though difficult to receive Social Security Disability benefits. The Social Security Administration is skeptical of all claims of ME/CFS and rarely approves them at the initial or reconsideration stage. In order to qualify for disability benefits, you must prove you have experienced of at least four of the following symptoms for six consecutive months:
- Swollen lymph nodes
- Joint pain without swelling or redness
- Deficits in memory or concentration
- Illness after exertion that lasts 24 hours
Is Chronic Fatigue A Disability In Canada
If the doctor diagnoses you with chronic fatigue, you may be entitled to disability benefits. These benefits may be entitled to you through the Canada Pension Plan. To qualify for this plan, you must have paid for the last 6 years payroll taxes and made contributions to the plan. For you to be awarded any benefits, you must also prove that your condition is severe and has made it impossible for you to work.
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Medical Evidence Substantiates Your Symptoms
When determining whether your Chronic Fatigue Syndrome/ Myalgic Encephalomyelitis is disabling, the insurance company will likely want the opinions of your treating doctor. The insurance company may weigh its decision very heavily on your doctors opinion so your doctors support is key.
Your insurance company will conduct a broad review of your medical records to assess your diagnosis and symptoms. Your insurance company is most likely to look for evaluations by a physician, including:
- A thorough history
- Specific workups to determine a differential diagnosis and
- Referrals to appropriate specialists to rule out other causes to the individuals symptoms.
The history should be thorough documenting the onset and progression of the individuals disease and the severity of their symptoms, particularly their fatigue and post-exertional malaise.
The workup may include, without limitation, laboratory/blood tests to document: the presence of viruses such as Epstein Barr and Human Herpesvirus-6 bacterial infections, which are thought to trigger or contribute to Chronic Fatigue Syndrome/Myalgic Encephalomyelitis and elevated cytokine levels commonly found in patients with Chronic Fatigue Syndrome/Myalgic Encephalomyelitis.
Your doctors reports should focus on the frequency and severity of your symptoms their direct observations of you during office visits and your specific restrictions and limitations that prevent you from working.
Disability Evaluation Under Social Security
The Social Security Administration has prepared an online guide Disability Evaluation Under Social Securityexternal icon to provide physicians and other health professionals with an understanding of how its disability programs are administered. The guide explains how these programs work and lists the kinds of information that health professionals can provide to help ensure sound decisions on claims. It also includes links to the Listing of Impairments that SSA uses as part of the disability determination process.
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How Do I Get Fibromyalgia Disability Benefits
Chronic fatigue syndrome/fibromyalgia can make it difficult, if not impossible, to do things around your home and work. If you no longer can work or your doctor has told you to apply for disability before you apply for benefits, you should:
Getting these things in order before the application, as well as hiring an experienced disability attorney, will ensure a smoother process when filing your fibromyalgia disability benefits claim.
Write A Personal Narrative
It is often beneficial to explain how your individual symptoms prevent you from performing your job duties by preparing a detailed, written narrative for the insurance company. In many cases, it is helpful if the narrative addresses all of your symptoms by listing them separately first.
Since many symptoms of Chronic Fatigue Syndrome/Myalgic Encephalomyelitis are subjective in nature, your narrative can also address the severity of your symptoms, as well as any factors that may trigger or exacerbate your symptoms.
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What Medical Evidence Will Help Me Get Approved For Fibromyalgia Disability Benefits
Fibromyalgia is a medically determinable impairment which will be recognized by the Social Security Administration if diagnosed by a licensed physician who uses the American College of Rheumatology Criteria for the classification of fibromyalgia.
Additionally, the Social Security Administration will also consider medical evidence pursuant to SSR 06-3p. The Social Security Administration will look at your medical records and will take a longitudinal view of your treatment notes and your symptoms. Thats one of the reasons why its important to give an accurate description to your physician of the difficulties that you are having between each visit so that those difficulties are reflected in your medical records.
The Social Security Administration doesnt make it easy for those who suffer from fibromyalgia to get the Social Security Disability benefits that they deserve. If you have been diagnosed with fibromyalgia and your physician tells you that you are no longer able to work, you may be eligible for Social Security Disability benefits. Contact fibromyalgia disability attorney Nancy Cavey today to learn more!
Your Medical Providers Must Also Rule Out Other Possible Causes Of Your Symptoms Before Diagnosing Cfs
You should provide all medical records pertaining to your condition to Social Security, including doctors notes, results of x-rays, MRIs, and other tests, and records from any hospitalizations. If you suffer from any other mental or physical conditions, be sure to include records concerning those impairments as well. Even if you cannot match the criteria of one of Social Securitys listed impairments, you may be awarded benefits through a medical vocational allowance which considers a persons age, education, work history and residual functional capacity . Its imperative that you ask your doctor for a written opinion about any work-related limitations you may have.
Proving Chronic Fatigue Syndrome And Disability
An insurance claim for short-term and long-term disability benefits does not require proof of causation to succeed. A claimant need only provide medical evidence supported by their doctor or specialist to support their claim for disability.
In making an insurance claim after a car accident, showing the cause of chronic fatigue syndrome as a direct result of the car accident is difficult. In some cases, chronic fatigue syndrome is accompanied by a diagnosis of chronic pain or fibromyalgia and psychological problems. The onset or increase of symptoms relating to chronic fatigue syndrome may result in an aggravation of chronic pain and depression arising out of a car accident. These aggravating symptoms are also considered caused by the car accident.
What Medical Conditions Qualify For Disability Benefits
Any medical condition can qualify for disability benefits. Generally speaking, most disability benefits programs in Canada do not give benefits based on a medical diagnosis. Rather, they provide benefits based on the level of disability caused by the medical condition. So the focus will always be on the level of disability caused by your medical condition, rather than only the name of your medical condition or diagnosis. To qualify for benefits, you must show that the level of disability from your medical condition meets the eligibility criteria of the disability benefits plan in question.
Following is a list of common medical conditions that qualify for disability benefits. For each of these conditions we discuss the unique challenges you will face.
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Is Chronic Fatigue A Disability
Dealing with something like chronic fatigue can be frustrating. You may get the sense that people around you are skeptical or at least do not understand what youre going through. This is especially true when you find yourself unable to work or engage in the activities that you wish you could do.
But is this a disability, and can you get government benefits for chronic fatigue? Is it possible to get Social Security Disability benefits due to your condition?
Help From A Lawyer With Expertise In Disability Insurance
Disability insurance law is complex, making hiring an experienced disability attorney important. All disability lawyers at this law firm focus on disability insurance claims, and we have expertise in disability insurance law.
That means we have:
And, we never charge fees or costs unless our clients get paid.
The firm can help at any stage of your disability insurance claim, including:
- Submitting a disability insurance claim
- Appealing a long-term disability denial
- Negotiating a lump-sum settlement or
- Filing a lawsuit against your disability insurance company.
Because federal law applies to most disability insurance claims, our lawyers are able to represent clients across the country.
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Winning Disability Benefits For Chronic Fatigue Syndrome
Are you suffering from the long-term symptoms of Chronic Fatigue Syndrome? Does your illness prevent you from fulfilling your duties at work? Are you wondering how to win disability benefits for Chronic Fatigue syndrome?
If you have started to apply for long-term disability benefits or are considering beginning the process to lift the financial weight off your shoulders, you probably already know that winning disability benefits is no walk in the park. Because insurance companies consider Chronic Fatigue Syndrome an invisible medical condition, you will have to prepare diligently for this fight.You might have already managed the long-term symptoms, endured the social stigmas, and slugged through the difficult process of gaining a formal doctors diagnosis for Chronic Fatigue Syndrome. The last thing you want now is a bureaucratic nightmare on top of your debilitating long-term illness. We can help you avoid that extra pain and prepare you for the singular challenge of applying for long-term disability benefitsJust because Chronic Fatigue Syndrome isnt a leading cause of disability from the workplace in Canada doesnt mean you shouldnt get the benefits from the insurance youve already paid for. If you are suffering from Chronic Fatigue Syndrome in Canada, I can help you take first steps towards securing the support that you are entitled to. This article is part of our series examining medical conditions and disability benefits.
Get Help With Ssdi For Chronic Fatigue Syndrome
Getting SSDI for chronic fatigue syndrome is not easy. It is important to work with a skilled New Hampshire SSDI attorney to fill out the application correctly and maximize your chances at being approved.
If you suffer from chronic fatigue syndrome, call a Manchester Social Security attorney at Keefe Disability Law today to learn how we may be able to help you.
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When To See The Doctor
Dont misjudge CFS as AIDS or HIV, where you may prefer to stay anonymous its not contagious! So, be open and communicative about your symptoms with family and your doctor.
Remember, at the very beginning, patients dont look bad so before seeing a GP or a family doctor think carefully of the signs.
Being partying for a few days will make you sick the same with some extra night shifts at work take a few more days to restore, and youll be okay.
Also, its about unexplained muscle pain. You may stop working out when something goes wrong and look at your lifestyle from the other perspective. As a premeditative go to a massage specialist or see a rheumatologist .
What I meant in the above said find the reasons to exclude other diseases which may be causing you CFS-like symptoms.
It wont take years to check yourself before consultation about a CFS, you need to provide a list of specialists youve already seen. To save time for you and the doctor, its best to maintain a daily journal.
A final point dont listen to friends or a family who are not helpful or not available to see you and listen to you. They will mostly tell you to look good and blame you that you are lazy. But if extreme tiredness is chasing you for months, plan a doctors appointment.
Tip: Although some believe it does, remember the science has not proven that Hyperbaric Oxygen Therapy helps in the treatment of CFS.
History and Research Basis of Chronic Fatigue Syndrome
Men vs Women
Beware Of Insurer Attempts To Characterize Your Disability As A Mental Disorder
Most long term disability group policies limit benefits to two years when the disability is caused or contributed to by a mental illness. Insurance companies frequently use these provisions as a shield because the symptoms of CFS/ME are often similar to symptoms of depression. It is much harder for your insurance company to make this claim when your treating doctor has followed the proper diagnostic criteria and performed the right tests to rule out other conditions.
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Winning Social Security Disability Benefits For Chronic Fatigue Syndrome By Equaling A Listing
To determine whether you are disabled at Step 3 of the Sequential Evaluation Process, the Social Security Administration usually considers whether your impairment is severe enough to meet or a listing. The Social Security Administration has developed rules called Listing of Impairmentsfor most common impairments. The listing for a particular impairment describes a degree of severity that the Social Security Administration presumes would prevent a person from performing substantial work. If your impairment is severe enough to meet or equal the listing, you will be considered disabled.
The Social Security Administration has no listing for chronic fatigue syndrome. Since CFS is not a listed impairment, you cannot be cannot be found to meet a listed impairment based on your CFS alone. However, the specific findings in your case should be compared to any pertinent listing to determine whether medical equivalence may exist. In other words, you may be entitled to Social Security disability benefits if the severity of your condition equals an existing listing for a different impairment.