August, 2017: Josselyn’s Maine Social Security Disability Favorable Decision Involving Chronic Fatigue and Lyme Disease

Josselyn’s Social Security disability claim involving issues of Lyme disease and Chronic Fatigue syndrome was not an easy case to say the least. She came to our office having filed her initial claim without the benefit of a Maine Social Security lawyer involving the Waterville, Maine local office. Moreover, at the time she was relying on practitioners that are not considered by the Social Security Administration (SSA) to be acceptable medical sources, including naturopath and family nurse practitioners, among others.

It is important to understand that as part of Social Security’s five-step sequential evaluation process that SSA will first look to see, as part of step 2 of that process, that an individual is suffering from a medically determinable impairment that is “severe” before they will assign a set of functional limitations to those condition(s). With that in mind, one cannot simply assert on one’s application that they are suffering from fatigue or pain and expect to be awarded benefits.

Social Security Ruling 14-1P provides a very detailed analysis as to what is required in order to show that one is suffering from Chronic Fatigue Syndrome (CFS), and does track the CDC definition in finding that the “hallmark of CFS is the presence of clinically evaluated, persistent or relapsing chronic fatigue that:”

1. Is of new or definite onset (that is, has not been lifelong);
2. Cannot be explained by another physical or mental disorder;
3. Is not the result of ongoing exertion;
4. Is not substantially alleviated by rest; and
5. Results in substantial reduction in previous levels of occupational, educational, social, or personal activities.

The Social Security Ruling likewise requires a showing of 4 or more symptoms (from a wide range of symptoms listed in the ruling) that are concurrently and persistently present during at least 6 months of illness and which do not predate the fatigue. It is important to understand this complex ruling as there is included within the listing an enumeration of medical signs that can also “help establish the existence of an MDI of CFS”: this includes such things as palpably swollen or tender lymph nodes on physical examination, persistent reproducible muscle tenderness on repeated examinations, including the presence of positive tender points, frequent viral infections with prolonged recovery, sinusitis, ataxia, extreme pallor and pronounced weight change.

As with all medical conditions, history taking, repeat examination and documentation of objective findings are terribly important from the treating physician: a patient’s failure to follow-up and/or a physician’s failure to document findings during examination can prove terribly harmful to one’s disability claim.

Understanding the criteria set forth in the listing allowed our office to reference both in our brief and in oral argument that the history in the treatment records bears out a diagnosis of CFS. This was terribly important as the continued laboratory findings were not confirming a diagnosis of Lyme disease.

Josselyn made a compelling witness at hearing. Her consistent past work history made evident to the presiding Administrative Law Judge out of the Lawrence, MA hearing office just how devastating this new onset of fatigue (not to mention pain) had become for the claimant.

It was heartwarming to see that while Josselyn remained unable to find any sort of answers or relief to her medical concerns, that she was finally heard at hearing and able to find financial relief for both her family and her.

If you or someone you know is struggling as Josselyn was to find some answers both medically and from SSA, suggest they contact the Law Offices of Russell J. Goldsmith at (800) 773-8622 for what should be some welcome advice and potentially assistance.