Posted on Sunday, June 1st, 2025 at 9:00 am
Chronic Fatigue Syndrome (CFS), also known as Myalgic Encephalomyelitis (ME/CFS), is a complex, disabling condition. It affects millions in the U.S. and often makes working full-time impossible. Unfortunately, filing a successful chronic fatigue syndrome disability claim can be difficult.
If you’re struggling to work due to CFS, long-term disability (LTD) benefits may be key to your survival. However, proving eligibility is difficult. Here’s what you need to know.
Why CFS Is Difficult to Prove in LTD Claims
Unlike visible injuries or precise lab results, CFS doesn’t always appear on standard medical tests. This makes it harder to prove you’re unable to work. Many people with ME/CFS face skepticism from insurers and even some doctors.
Common symptoms—such as extreme fatigue, cognitive dysfunction, and chronic pain—are subjective. Insurers prefer complex data like lab tests, imaging, or surgical reports. With ME/CFS, objective evidence is limited. Instead, claimants must rely on detailed medical records and symptom tracking to show that it’s a medical condition eligible for benefits or accommodations, despite the challenges of proving invisible symptoms.
When reviewing an LTD claim, insurance companies often look for:
- Proof that you sought regular medical care
- Documentation of consistent symptoms over time
- Specific examples of how your illness limits daily tasks and job duties
Similarly, insurers may require a Functional Capacity Evaluation (FCE) to determine your ability to work. The problem is that these exams don’t always reflect how CFS affects energy over time. People with ME/CFS often experience “post-exertional malaise,” which is when symptoms get worse after an activity. FCEs usually assess performance in a single session.
That fails to capture long-term limitations, especially for those living with encephalomyelitis chronic fatigue syndrome. This condition can severely impact daily functioning, even when outward symptoms aren’t always visible.
Medical Evidence Needed for a Chronic Fatigue Syndrome LTD Claim
Long-term disability insurers expect to see a clear medical treatment history. Even if there’s no cure for CFS, regular doctor visits demonstrate you are trying to manage the illness. Symptom journals or daily logs can provide additional support. Document fatigue levels, pain, and brain fog, and how these limit your ability to perform basic tasks. Your doctor can reference these in medical notes to reinforce your condition’s severity, especially if your immune system is affected.
Please read more about the need for your disability claim here: What You Need to Know About Your Disability Claim
Medical records should generally include:
- Diagnosis by a qualified physician
- Documentation of symptoms and how they affect work
- Reports from specialists, such as rheumatologists or neurologists
Residual Functional Capacity (RFC) Forms
A Residual Functional Capacity (RFC) form for chronic fatigue syndrome can be powerful. This form outlines how your condition impacts your ability to sit, stand, focus, and perform job duties.
Your treating doctor should complete the RFC. Make sure it matches the similar symptoms described in your medical records.
Cognitive Dysfunction Documentation
Cognitive problems—often called “brain fog”—constitute a significant part of CFS. These can include:
- Trouble concentrating
- Memory lapses
- Slower mental processing
If available and possible, you can include neuropsychological testing results to document these specific impairments. Cognitive dysfunction in a CFS claim is often overlooked—but it’s critical for proving disability.
Tips to Strengthen Your LTD Claim for Chronic Fatigue Syndrome
Because CFS claims can be challenging to prove, following these tips will strengthen your claim:
- Keep medical and claim records consistent: Inconsistencies between medical notes and claim forms can result in denial. If your doctor writes that you are “doing better,” insurers may use that to question your claim, even if “better” means you can do light chores, not work full-time. Keep all communications consistent across doctors, therapists, and your LTD application.
- Request supportive statements from doctors: Ask your healthcare providers to write letters explaining your chronic fatigue work limitations. These letters should describe your diagnosis, how long you’ve been symptomatic, and why you’re unable to perform your job. Avoid vague phrases like “disabled.” Instead, ask doctors to explain how fatigue, pain, or brain fog interfere with tasks like sitting at a desk, using a computer, or attending meetings.
- Assemble additional evidence: Your claim should highlight your functional limitations because CFS doesn’t always appear in test results. Use RFC forms, symptom logs, and testimony from friends or family to paint a complete picture. This evidence helps counter the lack of traditional medical data. It can also support the idea that CFS requires long-term absence from work.
- Prepare for appeals: Don’t give up if your initial LTD claim is denied. A disability appeal for chronic fatigue is every day. In many cases, denials are based on a lack of “objective evidence,” which you can address with better documentation.
Finally, consider hiring an attorney with experience in chronic fatigue disability insurance claims. A skilled attorney can help you fight unfair denials and seek the support you deserve.
You Deserve Benefits for Your Chronic Illness
CFS is real and disabling in Philadelphia, even if insurers treat it with skepticism. A successful disability claim for a chronic illness like ME/CFS takes strong evidence and strategic documentation. Capitan Law understands how frustrating it is to fight for benefits when exhausted.
Our team is here to help you understand your rights and take the first step toward securing the necessary benefits. Contact us online or by calling [phone number] to speak with an experienced disability attorney and learn how we can help.
