The Institute of Medicine (IOM) Proposes New Diagnostic Criteria and name for Chronic Fatigue Syndrome

Between 836,000 and 2.5 million people suffer from what is now known as Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). The actual number is likely higher since many physicians misunderstand the disease and, as a result, some people suffer from the syndrome for years without being properly diagnosed.

Since only about half of medical school textbooks include information about ME/CFS, and only about one-third of medical schools include any information about the syndrome in their curriculum, doctors themselves often lack the necessary knowledge to diagnose the disease. To compound the problem, there is no objective scientific test, like blood or urine tests, x-rays, MRI or CAT scans, to use as diagnostic tools. Diagnosis is based on a subjective evaluation of the patient’s symptoms.

In response to requests by many health care organizations, the Institute of Medicine (IOM) examined the evidence for the syndrome. The IOM recently released the report of its findings in which, among other things, it recommends a set of diagnostic criteria for physicians to use that will facilitate diagnosis and treatment and foster a better understanding among providers and the public concerning this often debilitating disease. It also proposed changing the name of the syndrome to Systemic Exertion Intolerance Disease (SEID).

IOM’s Diagnostic Criteria

One goal of the IOM report is to emphasize that whether it is called ME/CFS or SEID, it “is a serious, chronic, complex, systemic disease that can profoundly affect the lives of patients.” Patients report extreme fatigue to a degree that performing daily tasks is difficult or impossible. Even so, they are often met with a “dismissive attitude” by health care professionals who misdiagnose the patient with malingering or a mental health condition.

The IOM proposes a set of diagnostic criteria that it expects will, when the criteria are applied, result in the proper diagnosis for a large population of patients who currently are suffering but left without a diagnosis or treatment. According to the IOM, three
core symptoms of the disease are:

1. Impaired day-to-day functioning in all areas that persists for six months and is accompanied by profound fatigue that is not caused by excessive exertion and not relieved by rest.

2. Post-exertional malaise which means the symptoms worsen after cognitive, emotional or physical activity.

3. Unrefreshing sleep.

Additionally, the patient will also suffer from either cognitive impairment or orthostatic intolerance (symptoms worsen upon standing and are alleviated by lying down). The IOM committee outlined a nationwide educational plan to provide the public, including health care providers and patient groups, with the new diagnostic criteria.

Expected Effect of the New Diagnostic Criteria on Claimants on Disability

No two disability cases are alike and the medical records for each claimant must be thoroughly reviewed. The success of the claim often depends on the understanding of the treating physician of the medical condition and the physician’s ability to properly document in detailed notes on how that conditions places limits and restrictions on the activity of the patient. With the dissemination of the IOM report and the acknowledgment of the seriousness of the disease, coupled with the debilitating nature of the diagnosis itself, it will be harder for disability carriers to challenge CFS, also now known as SEID, as a debilitating condition.

We have many articles about CFS disability claims on this page.

DISABILITY INSURANCE COMPANY INFORMATION
Videos, Questions, Resolved Cases, Lawsuit Summaries & Company Reviews

disability insurance companies complaints

Leave a comment or ask us a question

There is one comment so far

  • Thank for the informative article. Restorative sleep is key component. Other symptoms are a given without it. Problem is promotion of, and the cost of, safer, less effective newer sleep meds. So what is actually an old problem, now codified with new and changing nomenclature, was in the past, easily treated with very effective, inexpensive, extremely safe when not over consumed, meds known as barbiturates, Seconal, for example, previously widely used in pregnant women without indecent. All the complexity surrounding chronic fatigue, with few exceptions, boil down to this paternalistic issue of preventing self-harm from an otherwise perfect older medication for insomnia. Simply speaking this is an old problem of sleep deprivation now inadequately treated, previously easily treated, except for occasional deaths from abuse. Medical change is not always good. The unintended consequences, legion.

    R. Chris Kuhne, MD, Ob/Gyn 30yrs.Jul 22, 2015  #1

FAQ

Do you work in my state?

Yes. We are a national disability insurance law firm that is available to represent you regardless of where you live in the United States. We have partner lawyers in every state and we have filed lawsuits in most federal courts nationwide. Our disability lawyers represent disability claimants at all stages of a claim for disability insurance benefits. There is nothing that our lawyers have not seen in the disability insurance world.

What are your fees?

Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.

The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.

In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.

Do I have to come to your office to work with your law firm?

No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via telephone, e-mail, fax, GoToMeeting.com sessions, or Skype. If you prefer an initial in-person meeting please let us know. A disability company will never require you to come to their office and similarly we are set up so that we handle your entire claim without the need for you to come to our office.

How can I contact you?

When you call us during normal business hours you will immediately speak with a disability attorney. We can be reached at 800-682-8331 or by email. Lawyer and staff must return all client calls same day. Client emails are usually replied to within the same business day and seem to be the preferred and most efficient method of communication for most clients.

Reviews   *****

Pat (Florida)

My experience with Dell & Schaefer, especially attorney Cesar Gavidia and his staff was excellent. I contacted Dell & Schaefer when I needed help as my disability insurance carrier terminated my benefits at the 2 year mark of my disability. I spent about 2 months putting together what I thought may be a decent appeal of that decision. However, the further I got into the workings and gaining some understanding of how the appeals worked under ERISA, I realized there was a lot at risk and only had one shot at it. I sought advice from an immediate family member who is also an attorney and was advised “get a firm that specializes in this type of work, then get the best”. Hence my decision to chose Dell & Schaefer.

Upon acceptance of my case, I felt that I was the center of attention for Attorney Gavidia. I had already used up 1/3 of the 180 days allotted to file the appeal working on my own so we were in a bit of a time crunch. Hundreds of pages of medical records the detail of the termination of benefits, my disability policy and several other different documents were delivered to attorney Gavidia. In short order those documents were reviewed and our strategy of appeal was discussed and developed. Necessary appointments and evaluations were coordinated and our appeal was submitted before the 180 days had expired. At the 45 day mark my insurer requested a 45 day extension on the decision. I was advised by Mr Gavidia’s assistant Michal who reassured me that this happens in most appeals. At the 90 day mark we received a favorable decision on the appeal, benefits were reinstated and back pay was awarded, but the story was not over.

After the initial termination of benefits by my insurer, I was alienated and expressed my desire with attorney Gavidia to try and find an amicable separation for all parties. Attorney Gavidia tactfully used some facts and disputes of the initial claim to open conversation with the insurer’s attorneys. He developed a dialog proposing, although I remain totally disabled as defined by my plan, a lump sum buy out of my future monthly disability benefits. Attorney Gavidia was successful in reaching an agreement that was acceptable to all parties and made sure that I had the final say on acceptance or not.

Thus, working with Dell & Schaefer I had my benefits, which had been terminated, restored, received back-pay for benefits that were withheld and missed, and successfully and satisfactorily “divorced” from my insurance provider in the form of a lump sum buy-out of my future disability benefits.

Read 424 reviews

Speak With An Attorney Now

Request a free legal consultation: Call 800-682-8331 or Email Us