What is Fatigue and "Chronic" Fatigue?
Fatigue is the common perception of “extreme tiredness, typically resulting from mental or physical exertion or illness.” It is an experience that is familiar to all of us. However, in certain medical illnesses, fatigue may be much more severe and persistent than typical fatigue and can be completely out of proportion to the level of exercise or activity that preceded it
What causes ChronicFatigue?
Examples of conditions causing chronic fatigue can be seen in anemia, thyroid disorders, cardiac and pulmonary disorders, in rheumatoid arthritis and lupus, in multiple sclerosis, fibromyalgia, and in very many other medical conditions.
In Chronic Fatigue Syndrome (“CFS”), fatigue can itself become the illness.
Fatigue Can be Disabling
Fatigue can be disabling when it is persistent, chronic, and severe. It may make it impossible for a person to perform even a desk job. For example, if you must lie down to rest more than 2 hours a day, then it's likely you would be unable to sit for 6 hours out of an 8-hour workday, which is a requirement for even a “sedentary” job.
How to “Prove” You Have Fatigue
Because fatigue is a perception, and you are the only person who can experience your fatigue, there are no “objective” ways to prove you have fatigue, and yet disability insurers may ask for that. Here is what we recommend you do to prove you have fatigue, and that the intensity of the fatigue is disabling.
1.) Get Your Doctor to Document Your Fatigue (with detail) in your Medical Records
When you see your doctor at the office, tell your doctor about the fatigue you are having.
How bad is it? How often do you have it? How long does it last? How does it affect your activity and what you can and cannot do? How long can you sit, stand or walk before you must lie down to rest? How long do you have to rest? What can/can't you lift and carry frequently/occasionally without difficulty (example - a gallon of water)?
If you were previously working, what specific job duties does your fatigue keep you from being able to do? Don't forget that if you don't tell your doctor, how is he to know and how is he to document that in your medical records?
2.) Check to See That the Documentation is Getting into the Records
The HIPAA Privacy Rule, under the Code of Federal Regulations§ 164.526, provides a patient with the right to copy, inspect and to request an amendment to his or her health records. As a patient, take advantage of this right that the law provides, to periodically look at your medical records and, if needed, to request that your doctor amend your medical record to reflect the extent of your fatigue and how it disables you from performing certain activities.
3.) Keep a Diary of Your Fatigue
It will be easier for you to inform your doctor of the level of your fatigue and how it affects your daily activities, if you keep a diary of the fatigue at home. The diary does not have to be elaborate. A few lines every day will suffice. You can use a numerical scale from 1-10 to indicate how severe the fatigue is on any given day. Or you can describe it as mild, moderate, or severe. If you have a consistent method of documenting your fatigue, its severity, how long it lasts, and what activities it impairs or makes impossible to do, then that should be all you need.Furthermore, the diary that you keep will itself serve as contemporaneous “proof” of your fatigue.
4.) Physical Therapy Documentation
If your doctor prescribes physical therapy, that may be a good opportunity for you to have the physical therapist that you are seeing document the nature and extent of your fatigue. Remember to tell the physical therapist, much as you would tell your doctor, how your fatigue impairs your functionality.
5.) Aim for Consistency
You may be seeing more than one doctor for your medical condition. It is important, therefore, to get all your doctors to document the extent and nature of your fatigue in a consistent manner. For example, if you see your rheumatologist, who is treating you for fibromyalgia, and he documents your fatigue, but not the neurologist, who is seeing you for your headaches, then your medical records will appear to be inconsistent and therefore unreliable.
6.) Fatigue Assessment Questionnaires
There are several different questionnaires that may be used to document and describe fatigue. These questionnaires are not “objective' to the extent that they measure self-reported symptoms. However, they are useful, and your doctor should be encouraged to incorporate them in the evaluation and treatment of your fatigue.
SSA utilizes the term "Impairments" (and resulting "limitations" - why you cannot work) are the essential bits of information that must be clearly and consistently documented throughout your medical history by the treating sources (medical doctors, psychologists, psychiatrists).
SSA additionally utilizes the term "Residual Functional Capacity" (RFC); this is a key concept related to the resulting physical and/or mental impairments from conditions for which the disability claim is based upon and the impact upon ability to work.
SSA has its own forms that are used for Physical RFC here. These forms can be filled out by the treating source who has the opportunity to examine the patient and understand the limitations which result from his/her condition and thereby document with specificity in the language of SSA disability.
Your disablity lawyer must work closely with your treating physician to get the proper documentation of your specific findings and impairments into the medical records. At Law Med that's what we do.