Residual Functional Capacity Assessment for Chronic Fatigue Syndrome
What Is RFC?
If your chronic fatigue is not severe enough for you to be considered disabled at Step 3 of the Sequential Evaluation Process, the Social Security Administration will need to determine your residual functional capacity (RFC) to decide whether you are disabled at Step 4 and Step 5 of the Sequential Evaluation Process.
RFC is a claimant’s ability to perform work-related activities. In other words, it is what you can still do despite your limitations. An RFC for physical impairments is expressed in terms of whether the Social Security Administration believes you can do heavy, medium, light, or sedentary work in spite of your impairments. An RFC for mental impairments is expressed in terms of whether Social Security Administration believes the claimant can do skilled, semi-skilled, or unskilled work in spite of impairments, or whether the claimant cannot even do unskilled work. The lower your RFC, the less the Social Security Administration believes you can do.
RFC and Chronic Fatigue Syndrome
If you have chronic fatigue syndrome, you may have significant residual limitations that could potentially result in allowance of your claim.
In determining your RFC, the Social Security Administration adjudicator should consider all of your symptoms in deciding how they may affect your ability to function. Symptoms of chronic fatigue that the adjudicator should consider include those mentioned in the Center for Disease Control’s definition of CFS:
- Self-reported impairment in short-term memory or concentration severe enough to cause substantial reduction in previous levels of occupational, educational, social, or personal activities.
- Sore throat.
- Tender cervical or axillary lymph nodes.
- Muscle pain.
- Multi-joint pain without joint swelling or redness.
- Headaches of a new type, pattern, or severity.
- Unrefreshing sleep.
- Postexertional malaise lasting more than 24 hours.
Other typical symptoms that may cause functional limitations include:
- Muscle weakness.
- Visual difficulties (trouble focusing or severe photosensitivity).
- Orthostatic intolerance (e.g. lightheadedness or increased fatigue with prolonged standing).
- Other neurocognitive problems (e.g., difficulty comprehending and processing information).
- Mental problems (e.g., depression, irritability, anxiety).
The Social Security Administration has issued a ruling on CFS that provides guidance to Social Security Administration adjudicators about what to consider in assessing a claimant’s RFC. In evaluating the credibility of the symptoms you report, the adjudicator should ask your treating doctor or other medical sources to provide information about the extent and duration of your impairments, including observations and opinions about how well you are able to function, the effects of any treatment, including side effects, and how long the impairments are expected to limit your ability to function.
Opinions from your medical sources, especially treating doctors, concerning the effects of CFS on your ability to function in a sustained manner in performing work activities or in performing activities of daily living are important in enabling adjudicators to draw conclusions about the severity of your impairments. Any information a medical source is able to provide contrasting your impairments and functional capacities since the onset of your CFS with your status before its onset will be helpful in evaluating your impairments and their functional consequences. See Getting Your Doctor's Medical Opinion About What You Can Still Do.
Information from third-parties may be very useful in deciding your credibility. Information other than your allegations and reports from your treating doctors helps to assess your ability to function on a day-to-day basis and to depict your capacities over a period of time. Such evidence includes, but is not limited to:
- Information from neighbors, friends, relatives, or clergy.
- Statements from past employers, rehabilitation counselors, or teachers about your impairments and their effects on how your function in the work place, rehabilitation facility, or educational institution.
- Statements from health care professionals who have treated you, other than doctors, such as nurse-practitioners, physicians' assistants, naturopaths, therapists, social workers, and chiropractors.
- Your own record (such as a diary, journal, or notes) of your impairments and their impact on function over time.
Continue to Getting Your Doctor's Medical Opinion About What You Can Still Do or Chronic Fatigue Medical Source Statement.
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