Circulation, Vein, and Artery Problems, Plebitis

Chronic fatigue syndrome (“CFS”) is a debilitating condition with a complex constellation of symptoms and a dozen names.  The cause of the condition remains controversial.  It is similar to fibromyalgia in that it is a diagnosis of exclusion, which means that other causes for the severe fatigue experienced by its sufferers must be ruled out before it is diagnosed.  Its victims suffer from extreme exhaustion, malaise and muscle aches in addition to a host of other problems including sleep disturbance and mental fogginess.  It is often diagnosed together with fibromyalgia and irritable bowel syndrome, and the symptoms overlap with these conditions.

Because we cannot hook you up to a machine and get a read out of how tired you are, it can be very difficult to prove disability on the basis of CFS.  It is helpful if you have seen a specialist, such as a rheumatologist, in addition to your primary care physician.  This is true because a specialist such as rheumatologist will usually conduct more in depth testing to eliminate potential other causes for your fatigue and other symptoms.  Also, it is just typically the case that a person who truly has this condition has gone from doctor to doctor trying to track down some answers so that is the pattern the judges are looking for in your records.

So how do we prove it?  Often it comes down to getting statements from the doctors who have treated you and the people who you interact with regularly.  It is the very fact that everywhere you go, there you are looking exhausted, that helps us prove your case.  For this reason, it is very important to maintain your credibility with your health care providers by always pursuing the treatments and options that have been recommended to you.  I know that is difficult to do when your very problem is that you are exhausted, but it’s the only way to show that you really do have a serious problem and you are doing everything in your power to help yourself.

People who are diagnosed with CFS are usually also diagnosed with depression, probably because being exhausted all the time is depressing.  For this reason, it is most helpful for proving your case that you are regularly treated by a mental health care provider.  In addition to providing you the emotional support you need to get through this, a mental health care provider is in a unique position to be able to comment on how your fatigue and depression is affecting your ability to concentrate and focus, which is critical in determining your ability to work.

Vascular problems sometimes cause swelling and pain that could limit your ability to work or engage in normal activities of daily living. Deep vein thrombosis, peripheral artery disease and phlebitis can cause physical limitations but also mental limitations associated with chronic pain. In a typical case, the vascular problem causes lower extremity pain and edema that would limit you to no more than sit down work, but even at a sit down job you would need to keep your legs elevated too often during the work day to be able to maintain a regular schedule at a full time job.

You need to be in regular treatment for your vascular issues, and you need to be compliant with treatment. For instance, if the doctor has recommended and prescribed compression hose then you need to wear those hose as recommended. It is your doctor’s opinion that you would have the kinds of limitations I describe that will win your case for you, so let your doctor know that you have done everything you can do to help yourself. For instance, weight loss is often another problem that goes together with vascular issues. If you doctor has recommended that you lose weight then make sure your doctor understands everything you are doing in that regard including going on a named diet plan, keeping a food log, and participating in water aerobics.

The regulations regarding these problems are covered insections 4.11 (Chronic venous insufficiency) and 4.12 (Peripheral arterial disease) of the Social Security Listing of Impairments. These rules govern whether or not you might be able to get disability based on your vascular issues alone. Again, it is not usually the case that a person gets approved for disability on the basis of vascular issues alone, but it is possible. These regulations are copied below:

4.11 Chronic venous insufficiency of a lower extremity with incompetency or obstruction of the deep venous system and one of the following:

A. Extensive brawny edema (see 4.00G3) involving at least two-thirds of the leg between the ankle and knee or the distal one-third of the lower extremity between the ankle and hip.

OR

B. Superficial varicosities, stasis dermatitis, and either recurrent ulceration or persistent ulceration that has not healed following at least 3 months of prescribed treatment.

4.12 Peripheral arterial disease, as determined by appropriate medically acceptable imaging (see 4.00A3d, 4.00G2, 4.00G5, and 4.00G6), causing intermittent claudication (see 4.00G1) and one of the following:

A. Resting ankle/brachial systolic blood pressure ratio of less than 0.50.

OR

B. Decrease in systolic blood pressure at the ankle on exercise (see 4.00G7a and 4.00C16-4.00C17) of 50 percent or more of pre-exercise level and requiring 10 minutes or more to return to pre-exercise level.

OR

C. Resting toe systolic pressure of less than 30 mm Hg (see 4.00G7c and 4.00G8).

OR

D. Resting toe/brachial systolic blood pressure ratio of less than 0.40 (see 4.00G7c).