Chronic Fatigue Syndrome and Qualifying for Social Security Disability Benefits

Can I get disability benefits if I am suffering from the effects of Chronic Fatigue Syndrome?

Author Attorney Greg Reed:
Updated: 1/18/2024

Chronic Fatigue Syndrome, commonly known as myalgic encephalomyelitis or ME/CFS, is a complicated long-term condition that affects many body systems. Individuals with CFS are so tired they cannot complete their normal daily activities. While physical activity makes the condition worse, CFS does not improve with rest.

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There is no specific listing for chronic fatigue syndrome in Social Security’s Blue Book but it’s still possible to receive Social Security Disability.

The Centers for Disease Control estimates that up to 2.5 million Americans have ME/CFS. Anyone can be afflicted, including children and teenagers, though it is most common in people in their 40s and 50s. Women tend to have ME/CFS more often than men.

People afflicted with chronic fatigue syndrome are likely to experience depression and social isolation and have increased work absences. They are also more likely to suffer from one of the following conditions:

•    Fibromyalgia
•   Chemical sensitivities
•   Tension headaches
•   Temporomandibular disorders, such as TMD or TMJ
•   Irritable Bowel Syndrome
•   Chronis prostatitis
•   Chronic pelvic pain
•   Interstitial cystitis

Any and a combination of these symptoms and conditions can make it difficult to maintain employment.

Qualifying for Disability Benefits for Chronic Fatigue Syndrome

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 Security’s 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
•    Fatigue that is unrelieved by sleep
•   Sore throat
•   Muscle soreness
•   Atypical headaches
•   Joint pain without swelling or redness
•   Deficits in memory or concentration
•   Illness after exertion that lasts 24 hours

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 Security’s listed impairments, you may be awarded benefits through a medical vocational allowance which considers a person’s age, education, work history and residual functional capacity (the physical and mental abilities you retain despite the limitations of your medical condition). It’s imperative that you ask your doctor for a written opinion about any work-related limitations you may have.

Your doctor’s statement should include details about your physical and mental limitations in the following:

•    lifting, carrying, pushing, and pulling
•   standing, sitting, and walking
•   maintaining concentration for extended periods
•   maintaining adequate attendance and punctuality, and
•   understanding, remembering, and carrying out simple and complex instructions.

It may be helpful to keep a daily log of the nature and severity of your symptoms which you can submit to Social Security.

Statements from family members, friends, or former co-workers, can also aid in documenting the extent of your impairments. Qualifying for Social Security Disability Income under a diagnosis of chronic fatigue syndrome is not easy. Enlisting the assistance of a qualified disability attorney can greatly increase your chances for a successful claim.

If you are 55 or older or have another medical condition you may get approval.

Social Security follows a set of rules to determine when the agency expects an applicant to learn a new job.

Applicants who are 55 or older often fall under a grid rule, which means they are not expected to learn a new job. For example, a 55-year-old applicant with no transferable skills might be found disabled. If you can’t go back to your old job, and you don’t have the skills to learn a new one, Social Security will likely grant you disability benefits.

You may also be eligible for Social Security Disability benefits if you have another medical condition; for example, diabetes or high blood pressure.

One disorder by itself may not match the requirements of an impairment as stated in Social Security’s Blue Book, but if you have more than one medical condition, Social Security must consider how those health issues combined limit your ability to hold a job and perform necessary daily tasks.

Social Security also has basic financial requirements.

Before you are eligible for Social Security disability benefits, you must satisfy some basic financial requirements.

You must: 1) have a disability that has lasted or is expected to last 12 months; and 2) you must have worked in a job where you paid Social Security taxes long enough and recently enough; and 3) you must not earn more than Substantial Gainful Activity (SGA), which is $1,550 per month in 2024 for nonblind applicants and $2,590 per month for blind applicants.

What if I don’t qualify for SSDI?

If you haven’t worked long enough to earn enough work credits, or if you earn too much income, you may be eligible for disability benefits through another Social Security program, such as Supplemental Security Income (SSI), or from a long-term disability insurance plan through your employer or a privately purchased policy.

SSI is a program that pays monthly benefits to people with limited income and resources who are disabled, blind, or age 65 or older. SSI is based on income instead of work credits, and is financed by general funds of the U.S. Treasury.

I have long-term disability insurance – should I file a claim?

Yes, you should file a claim as soon as you become disabled.

Long-term disability insurance (LTD) is coverage that protects your income if you are unable to work due to illness or injury and is purchased as part of a group employment plan or privately through an insurance company. Policies pay between 50-60% of your salary and benefits continue until you return to work or for the number of years stated in the policy. However, LTD coverage is good only as long as you are employed, so do not quit your job before you file a claim, and be sure to check your policy’s definition of “disabled” as each policy will state the definition of “disabled” which is in use. Additionally, be aware that long-term disability insurance companies can require a claimant to also apply for SSDI.

How do I file for Social Security Disability benefits?

You can apply for Social Security Disability benefits online, over the phone, or in person at your local Social Security Administration office.

If your initial application is denied, don’t be discouraged. Approximately 65% of initial applications are denied, but you will have the opportunity to appeal.

There are four steps to the Social Security appeal process:

1.    File a Request for Reconsideration with the Social Security Administration to completely review the case.
2.    If you don’t agree with SSA’s response to your Request for Reconsideration, you can request a hearing before an Administrative Law Judge (ALJ). ALJs are attorneys who work for the Social Security Administration; they review SSDI cases and either uphold or overturn decisions to deny SSDI benefits. If you are not represented by an attorney at this point, now is the time to obtain legal counsel. This is a critical point in the process and will raise your chance for success.
3.    If an ALJ does not grant your claim, you can request that the Appeals Council review your case.
4.    Federal Court review. The final step in the appeal process is filing suit in U.S. District Court.

Do I need a disability attorney for SSDI?

Qualifying for Social Security Disability benefits is problematic because the requirements of Social Security’s impairment listing are very difficult to decipher.

Your chances for approval are increased significantly if you have an experienced disability attorney who can gather your necessary medical evidence and even write a brief explaining why you qualify. At each potential stage of the process, from the initial application stage, the reconsideration stage and the ALJ hearing stage, an attorney can assist you in completing the detailed forms and questionnaires required by Social Security, collecting and submitting relevant medical evidence, and preparing questionnaires for your doctors. At the ALJ hearing phase an attorney will not only continue to assure that the evidence is complete, but prepare you for questioning by the ALJ, prepare an argument on your behalf and question any doctors or vocational experts selected by the ALJ to testify at the hearing. At the Appeals Council and federal court level, a lawyer can present legal arguments to show your case was wrongfully denied. Fees charged by disability attorneys are regulated by federal law and are usually 25% of disability backpay you are owed. There are no out-of-pocket costs, and if you don’t win your case, you won’t be charged anything.

Do I need a disability attorney for a long-term disability insurance claim?

Whether you have a long-term disability insurance policy purchased through a private insurance broker or a group policy purchased with your employer, filing a claim for long-term insurance is a complex process.

The wording of LTD policies can be confusing and the laws and regulations which affect the two types of LTD insurance differ in their procedures for filing claims and appeals. An experienced LTD attorney with thorough knowledge of ERISA laws and regulations will avoid mistakes and increase your chance of success. An attorney will act on your behalf, completing your application and filing your claim in a timely manner. They can also negotiate a settlement or file an appeal for you. If it becomes necessary to file suit, an LTD attorney can prepare your case against an insurer. Most LTD attorneys handle cases on a contingency basis and charge approximately 25%-40% of a claimant’s past due benefits. You do not pay an attorney’s fee unless the attorney wins your case.

We had a client who suffered from medical conditions Northwestern Mutual had previously found to be disabling.

Those conditions included chronic fatigue with severe fatigue, widespread muscle/joint pain, recurrent infections, insomnia, irritable bowel syndrome, headaches, sore throat, cognitive dysfunction, and tender points (fibromyalgia).
She had also been diagnosed with Lyme disease. NW Mutual Life denied her claim, saying there was no medical support for a disabling condition that did not fall under the Mental Disorder provision contained in the group policy. The medical, as opposed to psychological, nature of the client’s condition was well supported by her treating physicians, and she had been awarded SSDI benefits.

Author: Attorney Greg Reed has been practicing law for 29 years. He is Superlawyers rated by Thomson Reuters and is Top AV Preeminent® and Client Champion Gold rated by Martindale Hubbell. Through his extensive litigation Mr. Reed obtained board certification from the Texas Board of Legal Specialization. Greg is admitted to practice in the United States District Court - all Texas Districts and the United States Court of Appeals-Fifth Circuit. Mr. Reed is a member of the Travis County Bar Association, Texas Trial Lawyers Association, past Director of the Capital Area Trial Lawyers Association, and an Associate member of the American Board of Trial Advocates. Mr. Reed and all the members of Bemis, Roach & Reed have been active participants in the Travis County Lawyer referral service.