Do You Have A Case?

Chronic Fatigue Syndrome (CFS) is a debilitating condition, which is often misunderstood. It is generally characterized by persistent fatigue that is not easy to recover from. In the event that someone with CFS has to exert a lot of energy, such as through physical labor, it may take much longer to recuperate compared to an average individual. CFS may sometimes be referred to as Myalgic Encephalomyelitis (ME) or Systemic Exertion Intolerance Disease (SEID).  Those living with Chronic Fatigue Syndrome often deal with weakness, low energy, cognitive issues, and more. There is currently no cure for this condition.

Below, we will discuss how this condition can qualify for long-term disability insurance. We will also cover important aspects of your filing process when dealing with CFS.

Young woman with Chronic Fatigue Syndrome (CFS) struggling to focus on her laptop - young woman rubbing her eyes with fatigueIs Chronic Fatigue Syndrome (CFS) a Disability?

Chronic Fatigue syndrome can cause a wide assortment of physical and cognitive symptoms which could be considered a long-term disability. The symptoms of CFS can be especially challenging to deal with, as rest generally does not help with recovery. After days of significant exertion, an individual may be bedridden for days recovering. In order for your insurance company to recognize your condition as a disability, however, you will need to provide evidence in your claim.

Disabling Physical Symptoms of CFS

There are many physical symptoms of CFS. They can vary in persistence and intensity. Unfortunately, it can be hard to recover from symptoms of this condition because rest rarely helps. For many people living with Myalgic Encephalomyelitis, there are good days and bad days. Common physical symptoms include:

  • Fatigue
  • Extreme exhaustion
  • Malaise
  • Muscle and/or joint pain
  • Headaches
  • Restless sleep
  • Depression
  • Anxiety
  • Flu-like symptoms
  • Lightheadedness
  • Light sensitivity
  • Noise sensitivity
  • Gastrointestinal problems (like IBS)
  • Enlarged lymph nodes

Debilitating Cognitive Symptoms of CFS

In addition to physical symptoms, there are also cognitive deficits from Chronic Fatigue Syndrome.  Common cognitive symptoms of Chronic Fatigue Syndrome include:

  • Short-term memory impairment
  • Long-term memory issues
  • Concentration deficits
  • Lack of focus
  • Poor attention span
  • Brain fog
  • Confusion
  • Decreased processing speed
  • Problems with executive functions.

These cognitive symptoms can develop alongside physical symptoms and can be just as debilitating. However, it is more common for people to overlook their cognitive symptoms. Because of this, it is vital that you report any and all CFS symptoms that you are experiencing. Having a complete report of your symptoms in your doctor’s records is important for building your case.

How Do I Prove My Disability for Chronic Fatigue Syndrome?

When looking to file a claim for your Chronic Fatigue Syndrome, it is important to have objective proof of your symptoms and how they affect your ability to work.

Diagnosing Your Chronic Fatigue Syndrome

In order to build your disability insurance claim, you will first need documentation of your diagnosis. The insurance company will need to see proof of diagnosis before accepting any claim. Unfortunately, there is no test for Chronic Fatigue Syndrome. However, there are some factors that can point to this condition. Unfortunately, because the symptoms of this condition are often subjective and hard to quantify, this can sometimes prove difficult. According to the Institute of Medicine of the National Academies, a diagnosis of CFS/ME generally requires these three symptoms:

  • Substantial reduction or impairment of pre-illness activity levels, accompanied by fatigue that isn’t the result of exertion. This fatigue also doesn’t resolve with substantial rest.
  • Worsening symptoms after any form of exertion, be it physical, cognitive, or emotional stress. This is also known as post-exertional malaise.
  • Unrefreshing sleep.

Additionally, most doctors will look for at least one of the following as part of the diagnosis:

  • Cognitive impairment
  • Orthostatic intolerance

These symptoms, persisting for at least 6 months, indicate CFS rather than other conditions. During that period of at least 6 months, you would need to have symptoms for at least half the time, which may fluctuate between moderate, substantial, or severe intensity. Your doctor may also work with you to screen for other possible conditions. This may include looking at family history, other potential co-morbidities, and testing for other possible conditions. Other potential conditions that lab tests can rule out include Human Herpesvirus-6, Epstein Barr, or bacterial infections.

Substantiate Symptoms with Medical Evidence

You will need to provide evidence of how your symptoms of Chronic Fatigue Syndrome/ Myalgic Encephalomyelitis are debilitating. Generally, the insurance company will look at your medical history, physical examinations, diagnostic reviews, and more. The records of your symptoms need to be thorough because many of the symptoms of CFS can be subjective.

Physician’s Statements for CFS

In addition to proving your symptoms, the insurance company will likely require statements from your physician. The physician’s statements can be an important aspect of building your case.

Additional Testing to Support Your Insurance Claim

Some additional testing can help provide objective medical evidence to back up and quantify your otherwise subjective symptoms. There are three tests that can improve the overall support of your claim. Generally, your disability attorney will be able to tell you if these tests might be able to provide additional support for your claim. They are referred to as Neuropsychological Evaluation, Functional Capacity Evaluation, and Cardiopulmonary Exercise Testing.  All three of these tests also have “validity testing” features, which help prove that the individual was putting in maximum effort during the evaluations.

A Neuropsychological Evaluation is a test that helps quantify and document cognitive deficits. This can be important in proving symptoms like brain fog, concentration issues, limited processing speed, and more. a Functional Capacity Evaluation (FCE) tests the physical limitations of the individual. It can also provide evidence of limitations caused by fatigue. Lastly, Cardiopulmonary Exercise Testing (CPET) measures post-exertional malaise and physical stresses to the body. These 3 tests can be effective in proving the overall limitations that your CFS causes you in your daily life.

Appropriate Treatment for Chronic Fatigue Syndrome

Diagnosis and proving your condition aren’t enough to qualify for benefits. The disability insurance company will want you to also show that you are receiving appropriate treatment for your condition. Furthermore, you will need to show that you are continuing such treatment as recommended by your doctor(s). Otherwise, they may cancel your benefits under a non-compliance clause. They basically want you to prove that you are actively attempting to improve and maintain your condition. While there is no known cure for CFS/ME, it is important to follow your physician’s recommended treatment for managing your symptoms. There are a few avenues to treatment with CFS, and your doctor will likely advise you to pursue most if not all in some way.

Lifestyle Changes – Because fatigue and post-exertional malaise are major symptoms of the condition, it can be important to make some lifestyle changes to improve your condition. Your doctor may recommend a number of improvements to make. These may include dieting, stress management, pacing yourself at work, improving sleep habits, and more.

Medication – While there are no medications to directly combat CFS, your doctor may recommend some medications to mitigate certain symptoms. These may include sleep aids, anti-depressants, anti-anxiety medications, stimulants, and more.

Cognitive Therapy – Cognitive Behavioral Therapy (CBT) can help patients mitigate cognitive deficits and improve their symptoms. CBT can also be helpful in working through stress management.

Insurance Companies May Attempt to Classify your CFS as a Mental Condition

When filing for long-term disability insurance for CFS, it is important to make sure that the insurance company doesn’t classify your condition as a mental illness or disorder. While policies may vary, it is common for policies to include a Mental Illness Limitation (MIL). A MIL limits your benefits to 2 years. However, some policies may have an even smaller limit.

Because many of the CFS/ME symptoms are cognitive or subjective, the insurance company may try to classify your condition as a mental health issue. This allows them to stop your benefits after the MIL has been reached. Your disability attorney will be able to help you prove that your CFS is not a mental health condition.

Discuss with your disability attorney your options regarding your policy.

Can an Attorney Help Me Get Long-Term Disability for Chronic Fatigue Syndrome?

If you are looking to file a long-term disability claim for your CFS condition, you should seek out an experienced attorney. At D’Agostino & Associates, we help people living with disabling conditions such as Chronic Fatigue Syndrome file long-term disability claims. We help you through the process step by step to help you build a strong case. Our law team is here for you.

At D’Agostino & Associates, our team of lawyers can help you sort through all the details, understand what you are entitled to, and fight to get what you deserve. D’Agostino & Associates P.C. has offices in New York and New Jersey. Contact us, or call us at 1-888-245-2924 to schedule a free consultation with our attorneys.