How Difficult is it to Prove Chronic Fatigue in a Disability Claim?

In 2015, more than 500,000 Canadians — about 1.4% of all Canadians — reported suffering from chronic fatigue syndrome (CFS). CFS, also known as myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), is a debilitating illness involving overwhelming fatigue that can prevent a person from working or even confine him or her to bed.

Unable to work, many of those who suffer from CFS look to benefits under any applicable disability insurance policy or government program to help them make ends meet. Unfortunately, proving CFS to a disability insurer is often an uphill battle. The causes of CFS are not yet well-understood, and there are competing diagnostic criteria for the condition.

Consequently, it is critical for those suffering from CFS to obtain appropriate medical treatment, maintain thorough medical and other records of their condition, and work with an Ontario disability lawyer to hold disability insurance companies to their promises.

What causes chronic fatigue syndrome?

As we mentioned above, the exact causes of CFS are not fully known. Its onset is abrupt, and different studies have proposed different causes. Possibly, CFS has more than one cause or is the result of interaction among multiple different causes. Some of the potential causes suggested by experts include:

• Genetics;
• Viral or bacterial infections;
• Some types of medical care, such as immunization, anesthetization, blood transfusions, or physical trauma from undergoing surgery;
• Exposure to chemicals, heavy metals, or other pollutants; or
• Physical injuries caused in a traumatic event, such as a car crash.

This scientific uncertainty as to the cause of CFS can contribute to an insurance company’s decision to challenge or deny a disability claim based on CFS. But the existence of competing diagnostic criteria may also pose a difficulty in proving entitlement to disability benefits.

Symptoms and Diagnosis of Chronic Fatigue Syndrome

The first proposed set of diagnostic criteria were published by the U.S. Centers for Disease Control and Prevention (CDC) in 1988. In 1994, those criteria were revised, leading to one of the most widely-used diagnostics for the last two decades. (The CDC’s current list of symptoms for ME/CFS is available here.)

One of several competing definitions was proposed in a study by Canadian researchers in 2003. That study proposed a four-part definition: To be diagnosed with CFS, a person must:

Meet each of the following four criteria:

• Fatigue: A significant degree of new onset, unexplained, persistent, or recurrent fatigue that substantially reduces activity;
• Post-exertional malaise and/or fatigue: Generally, the person’s symptoms worsen for a day or more after mental or physical exertion;
• Sleep dysfunction: Sleep does not refresh the person or has a disturbed rhythm or quality; and
• Pain: A significant degree of muscle pain (i.e., myalgia).

Exhibit two or more of the following conditions:

• Confusion;
• Impairment of concentration and short-term memory consolidation;
• Disorientation;
• Difficulty with processing information, categorizing it, and word retrieval;
• Perceptual and sensory disturbances (e.g., an inability to focus the eyes); and
• Certain other symptoms that may qualify.

Have at least one symptom from at least two of the following categories:

• Autonomic Manifestations: e.g., light-headedness, nausea, and irritable bowel syndrome; bladder dysfunction; or palpitations.
• Neuroendocrine Manifestations: e.g., loss of temperature stability, recurrent feelings of feverishness and cold extremities, or anorexia or abnormal appetite.
• Immune Manifestations: e.g., tender lymph nodes; recurrent sore throat or flu-like symptoms; or new sensitivities to food, medicine, or chemicals.

Finally, the illness must have persisted for at least six months.

Unfortunately, there is no one test to diagnose CFS. In part, that’s because of the variety of definitions for the condition that exist. But in addition, the symptoms of CFS are similar to symptoms caused by other conditions. To diagnose someone with CFS, a doctor must first rule out those other causes, such as hypothyroidism, diabetes, or cancer.

How an Ontario Disability Lawyer Can Help

Like chronic depression, the symptoms of CFS tend to be “invisible.” Although the person suffering from the condition knows what his or her symptoms are, those symptoms are not readily observable to others, and when they are observed, their cause can be misidentified — is a person suffering from CFS or just not applying him- or herself?

That’s the sort of question insurance companies ask when they receive a claim for disability benefits on account of CFS. They ask that question even when the illness has been diagnosed by a medical professional. Here, as with chronic depression, it is critical that patients develop a strong medical record by visiting their doctor, explaining their symptoms, and undergoing treatment for CFS.

An Ontario long term disability lawyer from Preszler Injury Lawyers can help organize those records, obtain other evidence from the person suffering with CFS and his or her loved ones, and elicit expert testimony to support a claim for benefits. A lawyer can also help by interpreting the insurance policy or law on which benefits are based and ensure that the insurers are not playing games with small print or vague phrases.

If you or a loved one is suffering from CFS and needs to apply for disability benefits, or has had an application for benefits denied, contact the disability lawyers of Preszler Injury Lawyers today for a free consultation.