By Ken Casanova

The following is a comprehensive review and evaluation of the April 3, 2014 Social Security Ruling for the evaluation of medical evidence and work capacity in ME/CFS disability claims. Understanding and use of this Ruling is essential for anyone pursuing a ME/CFS Social Security Disability Claim or Review—including those assisting them, such as health care practitioners and attorneys/advocates.

This review and evaluation is extensive because its importance is in the detail, and in understanding the detail and its application. We urge patients and their families needing Social Security benefits to read and digest the following review. For a short overview, see Medically Documenting Disability in ME/CFS Cases, by Barbara Comerford, Esq. and Richard Podell, MD (Frontiers in Pediatrics, 2019).

Disclaimer: This review and evaluation of the Ruling contains the opinions of the author as to how claimants, physicians, attorneys and others might utilize the policies and language in the Ruling in the effort to document CFS disability claims.

While these opinions are based on the language of the Ruling, as well as extensive experience with the Social Security disability process, there is no way to accurately know in what manner the Social Security Administration and associated agencies will, in practice, implement the Ruling. The Ruling will likely not be applied or interpreted uniformly at all administrative levels or geographic areas of evaluation. Some elements of the Ruling are likely to be given more emphasis than others; nor is the Ruling expected to remain static in its application over time.

In regard to the documentation of medical signs, symptoms, medical tests and functional evaluation, it is only possible, at this time, to make reasonable inferences from the Ruling’s language as to how CFS claims might be evaluated; however, these inferences cannot be expected to predict how the different signs, symptoms and tests will actually be evaluated.

Therefore, Kenneth Casanova, other authors/contributors to this article, and the Massachusetts ME/CFS & FM Association assume no responsibility for any use of this document by its readers, or for any results or consequences of such usage or further, for any other activity which occurs from the reading of the document or the application of its content. This document is not intended to be a substitute of the advice of a competent attorney who is well-versed on the Ruling and the disability evaluation process. For legal advice it is imperative to consult with such an attorney or qualified legal advocate of the reader’s own choosing.

The Ruling

On April 3, 2014, the Social Security Administration issued a critical new Ruling: SSR 14-1p “Titles II and XVI: Social Security Rulings: Evaluating Claims Involving Chronic Fatigue Syndrome.” This Ruling now establishes the guidance by which Social Security evaluates CFS/ME disability claims, and reviews, for both Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). (See below for a note on the relevance of disease names to this Ruling.)

The Ruling is “…binding on all components of the Social Security Administration.”

This new Ruling replaces the former CFS evaluation Ruling issued in 1999 (SSR-99-2p).

The new SSR provides guidance on how evidence is properly developed to establish that a person has a medically-determinable impairment (MDI) of Chronic Fatigue Syndrome and how the impairment is evaluated in determining whether the claimant is sufficiently disabled to qualify for benefits.

The Ruling requires that for a person to be found disabled “… he or she must be unable to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment(s) (MDI) which…has lasted or can be expected to last for a continuous period of not less than 12 months.”

The medical impairment must be established “by medical evidence that consists of signs, symptoms, and laboratory findings"…Therefore, “a claimant may not be found disabled on the basis of a person’s statement of symptoms alone.” Hence, the Ruling sets forth the medical signs and laboratory findings by which a case of CFS may be determined.

In the 1999 Ruling, the SSA used only the 1994 Centers for Disease Control (CDC) case definition as the basis for determining a case of CFS and for establishing its medically determinable signs, symptoms and laboratory findings.

The new Ruling primarily adapts the 1994 CDC definition, but also uses “to some extent” the newer 2003 Canadian ME/CFS Criteria as well as the 2011 ME International Consensus Criteria (Adult and Pediatric). As a result of recognizing the two more recent diagnostic Criteria, the Ruling includes a broader and more characteristic listing of signs, symptoms, and laboratory tests for CFS—thereby allowing claimants and their physicians to better, and with less difficulty, document and validate the illness.

(Interestingly, the Ruling states: “As mentioned we include ME as a subtype of CFS. When we refer to CFS in this SSR, we include ME.” Note: Because the Ruling primarily adopts the 1994 CFS Case Definition, claimants and their doctors would be wise to include CFS as a diagnosis, in addition to a diagnosis of ME, if applicable.)