Press Release: CFS Guidelines Social Security Disability Insurance and SSI benef

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Source: 24-7

Date: June 26, 2010

URL:

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CFS finally recognized As 'Medical Impairment' under guidelines

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One of the battles often fought by persons with CFS trying to

obtain Social Security Disability Insurance and SSI benefits was

resolved with the adoption of Social Security Ruling 99-2p.

June 26, 2010 /24-7PressRelease/ -- One of the battles often fought

by persons with CFS trying to obtain Social Security Disability

Insurance and SSI benefitswas resolved with the adoption of Social

Security Ruling 99-2p. In this binding Ruling the Social Security

Administration set out guidelines for adjudicators and judges to

follow for claims based upon Chronic Fatigue Syndrome. This Ruling

removes at least one of the barriers faced by Claimants.

What was the issue?

The Social Security Act allows for SSDI or SSI benefits to be paid

to persons unable to work by reason of any medically determinable

physical or mental impairment (or combination of impairments).... "

(emphasis added) The Act and Regulations define the phrase " medically

determinable " as a condition that can be established by medical

evidence consisting of signs, symptoms and laboratory findings. It

cannot be based only on the Claimant's description of symptoms.

In claims based upon CFS there are obviously a lack of medical signs,

symptoms and laboratory findings. Therefore many claims were denied

on the failure to prove the existence of a " medically determinable

impairment. "

What does the ruling say?

The Ruling states unequivocally that CFS can be a medically

determinable impairment. It specifies medical signs and laboratory

findings that will now constitute proof of a medically determinable

impairment for persons suffering from CFS. However, whether the

Claimant is actually " totally disabled " is a separate determination

based upon the severity of functional limitations caused by the

disease. That is the same as in any claim based upon any other

medical problem.

This Ruling requires that any of the following medical signs, which

are clinically documented over a period of at least 6 consecutive

months, can establish a medically determinable impairment:

- palpably swollen or tender lymph nodes on physical examination;

- nonexudative pharyngitis;

- persistent, reproducible muscle tenderness on repeated examinations,

including the presence of positive tender points; or,

- other medical signs consistent with medically accepted clinical

practice which are consistent with the other evidence in the case

record.

The following laboratory findings can establish a medically

determinable impairment for individuals with CFS:

- an elevated antibody titer to Epstein-Barr virus capsid antigen

equal to or greater than 1:5120, or early antigen equal to or great

than 1:640;

- an abnormal MRI brain scan;

- neurally mediated hypotension as shown by tilt table testing or

another clinically accepted form of testing; or,

- other laboratory findings consistent with medically accepted

clinical practice such as abnormal sleep studies and abnormal

exercise stress tests that are consistent with other evidence in

the case record.

Finally, mental impairments documented by mental status examinations

or psychological testing can also establish the presence of a

medically determinable impairment.

What evidence can be used to show these signs and findings?

As in any claim for disability benefits the focus is upon the medical

evidence, especially the clinical records and test results from

treating sources. SSA will try to obtain all medical records,

generally beginning 12-months prior to the month of application. The

Ruling notes that conflicts in the medical evidence are not unusual

in cases involving CFS and clarification should be sought first from

the treating sources. Treating source opinions about the severity of

the impairment should be given deference if they are well supported

by medically acceptable clinical and laboratory techniques and are

not inconsistent with other evidence in the records. It is noted that

any information regarding functional abilities before and after the

onset of the impairment is helpful in evaluating the claim. Finally

third-party sources may be useful in determining the credibility of

the Claimant.

As in any claim, the focus is upon a longitudinal view of all of the

medical evidence. Claimants must be actively treating with medical

providers and must be completely describing all symptoms each time

they see the doctor. The doctors must keep careful, legible, notes

during each visit so that the signs and findings noted above can be

documented. In addition, the physician should be willing to provide

a written opinion to SSA regarding the patient's ability to sustain

even sedentary work activity on an 8 hour per day, 5 days per week

basis.

SSR 99-2p does not provide that every claim based upon CFS should be

approved. It does, however, set forth guidelines for evaluation of

these claims so that Claimants, physicians and representatives can

be assured of a fair evaluation of the impairment and its impact on

the individual.

Article provided by A. Rabin & Assoc

Visit us at http://www.rabinsslaw.com

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