Very interesting article by disability lawyers regarding USA social security criteria for people with M.E. and/or fibromyalgia.
"I. What is CFS?
In determining a case of CFS, the first portions of this section (A. and B1.) largely follow the 1994 CDC definition, the text of which can be found on page 3 of the Ruling. Following the CDC definition, the Ruling makes clear that a “physician should make a diagnosis of CFS ‘only after alternative medical and psychiatric causes of chronic fatiguing illness have been excluded.” Also, the Ruling makes an important addition to the CFS Case Definition by noting that post-exertional malaise lasting more than 24 hours “…may be the most common secondary symptom.” So it will be very important for patients and doctors to document this symptom/sign.
However, in section B2., “Other Symptoms”, the Ruling expands the list of CFS diagnostic symptoms as more recently outlined in the Canadian Criteria and the International Consensus Criteria:“Other Symptoms. Within these parameters, the CDC case definition, CCC, and ICC describe a wide range of other symptoms a person with CFS may exhibit:
•Muscle weakness;
•Disturbed sleep patterns (for example, insomnia, prolonged sleeping, frequent awakenings, or vivid dreams or nightmares);
•Visual difficulties (for example, trouble focusing, impaired depth perception, severe photosensitivity, or eye pain);
•Orthostatic intolerance (for example, lightheadedness, fainting, dizziness, or increased fatigue with prolonged standing);
•Respiratory difficulties (for example, labored breathing or sudden breathlessness);
•Cardiovascular abnormalities (for example, palpitations with or without cardiac arrhythmias);
•Gastrointestinal discomfort (for example, nausea, bloating, or abdominal pain); and
•Urinary or bladder problems (for example, urinary frequency, nocturia, dysuria, or pain in the bladder region).”
As will be seen later, the inclusion of these common elements of CFS allows for an increased ability to provide medical evidence of the illness in terms of the necessary documentation of medical signs and laboratory testing.
In the last subsection 3 is the following text:
“Co-occurring Conditions. People with CFS may have co-occurring conditions, such as fibromyalgia (FM), myofascial pain syndrome, temporomandibular joint syndrome, irritable bowel syndrome, interstitial cystitis, Raynaud's phenomenon, migraines, chronic lymphocytic thyroiditis, or Sjogren's syndrome. Co-occurring conditions may also include new allergies or sensitivities to foods, odors, chemicals, medications, noise, vibrations, or touch, or the loss of thermostatic stability (for example, chills, night sweats, or intolerance of extreme temperatures).”
Here, again, the new Ruling (based on the more recent CFS/ME and ME definitions) includes many more of the essential elements of the illness that increase the physician’s ability to provide medical documentation. Many of these “co-occuring conditions” are essential symptoms of CFS and their documentation add to diagnostic clarity. Notably, multiple sensitivities and loss of thermostatic stability have for years been known to patients and educated clinicians, but are now just being fully recognized.
Other conditions that may explain symptoms similar to CFS:
The Ruling reads: “Additionally, several other disorders (including, but not limited to FM, multiple chemical sensitivity, and Gulf War Syndrome, as well as various forms of depression, and some neurological and psychological disorders) may share characteristics similar to those of CFS. When there is evidence of the potential presence of another disorder that may adequately explain the person's symptoms, it may be necessary to pursue additional medical or other development. As mentioned, if we cannot find that the person has an MDI of CFS but there is evidence of another MDI, we will not evaluate the impairment under this SSR. Instead, we will evaluate it under the rules that apply for that impairment.”
Therefore, in documenting a diagnosed case of CFS, the treating physician(s) should not only document any co-occuring conditions, but also should be sure to, if possible, clearly differentiate CFS from other conditions that may share over-lapping symptoms."
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