About Chronic Fatigue Syndrome

Chronic Fatigue Syndrome (CFS) is a debilitating and complex disorder characterized by overwhelming fatigue that is not improved by bed rest and that may be worsened by physical or mental activity.  CFS may have both physical and psychiatric manifestations. For VA purposes, a diagnosis of CFS must meet both of the following criteria:

1. New onset of debilitating fatigue that is severe enough to reduce or impair average daily activity below 50% of the patient’s pre-illness activity level for a period of 6 months, and;

2. Other clinical conditions that may produce similar symptoms must be excluded by thorough evaluation, based on history, physical examination, and appropriate laboratory tests.

In addition to the above two criteria, a diagnosis of CFS must meet and describe six or more of the following ten criteria in detail:

1. Acute onset of the condition
2. Low grade fever
3. Nonexudative pharyngitis
4. Palpable or tender cervical or axillary lymph nodes
5. Generalized muscle aches or weakness
6. Fatigue lasting 24 hours or longer after exercise
7. Headaches (of a type, severity, or patter that is different from headaches in the premorbid state).
8. Migratory joint pains
9. Neuropsychologic symptoms
10. Sleep disturbance

As you can see, symptoms of CFS affect several body systems and veterans with CFS often function at a substantially lower level of activity than they were capable of before they became ill. There is no identifiable cause of CFS, and there are no tests to diagnose CFS. Additionally, CFS closely resembles neurasthenia, neurocirculatory asthenia, fibrositis, or fibromyalgia. Because of the complexity of the disease and its symptoms, veterans should make sure their doctors take the time to rule out other conditions.

Making a CFS Claim

All veterans who have served in Southwest Asia since August 2, 1990 are entitled to presumptive service connection for certain medically unexplained chronic multi-symptom illnesses such as CFS. The VA regulation on presumptive service connection for CFS can be found here. The regulation provides that if a veteran qualifies as a Persian Gulf War veteran and develops CFS (or another medically unexplained chronic illness), the veteran will be entitled to compensation benefits, so long as the condition first became manifest during the veteran’s active service in the Southwest Asia theater of operations, or became manifest to a degree of 10% or more since the veteran’s return from active duty in Southwest Asia.

The most challenging part of a CFS claim is usually proving that you have CFS. When submitting a claim for CFS, be sure to submit medical evidence stating that you have complained of your symptoms to a medical professional, sought treatment for it, and have a diagnosis of CFS. Special efforts and inquiries may be necessary when obtaining medical evidence in these types of claims because of the difficulties involved with determining whether or not a diagnosis has been established.

Lay evidence, such as buddy statements, take on great importance in claims for a medically unexplained chronic multi-symptom illness such as CFS. These statements should describe the veteran’s disability pattern and also describe the changes in the veteran’s appearance, physical abilities, and mental or emotional status. Additionally, it is important to gather evidence such as any time lost from work and any attempts to seek medical treatment for the disability pattern.

There is a relatively low threshold for requesting a VA medical exam for a CFS claim. For example, even if there is no medical evidence that the veteran has previously been treated for their disability pattern and the only significant evidence is the veteran’s own statement describing his problems, a VA examination is still warranted.

Evaluation of a CFS Claim

CFS is rated under diagnostic code 6354. The VA’s rating schedule for CFS describes the condition as “debilitating fatigue, cognitive impairments (such as inability to concentrate, forgetfulness, confusion), or a combination of other signs and symptoms which:

• Wax and wane but result in period of incapacitation of at least one but less than two weeks total duration per year, or: symptoms controlled by continuous medication. – 10% rating assigned
• Are nearly constant and restrict daily activities by less than 25% of the pre-illness level, or; which wax and wane, resulting in periods of incapacitation of at least two weeks but less than four weeks total duration per year. – 20% rating assigned
• Are nearly constant and restrict daily activities to 50-75% of the pre-illness level, or; which wax and wane, resulting in periods of incapacitation of at least four weeks but less than six weeks total duration per year. – 40% rating assigned
• Are nearly constant and restrict daily activities to less than 50% of the pre-illness level, or; which wax and wane, resulting in periods of incapacitation of at least six weeks total duration per year. – 60% rating assigned
• Are nearly constant and so severe as to restrict routine daily activities almost completely and which may occasionally preclude self-care. – 100% rating assigned

If you have established service connection for your CFS claim and received a rating for it, don’t stop there. The VA often makes mistakes when assigning a rating to a service-connected condition so it is important to carefully review your rating decisions and rating code sheets to determine if the evaluation of your CFS was done correctly.

Author Anne Thorn, Hill & Ponton, P.A. Attorney