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== Evaluation of Disability == [[United States]] BOX C-1<ref name="Beyond"/>{{Rp|258-259}} [[Social Security Administration]] Evaluation of Disability ===Medical evidence=== For the purposes of Social Security Disability evaluation, in addition to a diagnosis of ME/CFS that meets the [[Fukuda criteria|Fukuda]] case definition, one or more of the following medical signs clinically documented over a period of at least 6 consecutive months is required to establish the existence of a medically determinable impairment (MDI) of [[Chronic fatigue syndrome|CFS]]:<ref name="Beyond" />{{Rp|260-261}} * palpably [[Swollen lymph nodes|swollen or tender lymph nodes]] on physical examination; * nonexudative [[pharyngitis]]; * persistent, reproducible muscle tenderness on repeated examinations, including the presence of positive tender points; or * any other medical signs that are consistent with medically accepted clinical practice and are consistent with the other evidence in the case record. For example, the [[Canadian Consensus Criteria]] (CCC) and [[International Consensus Criteria]] for [[Myalgic encephalomyelitis|ME]] (ME-ICC) explain that an acute [[Infection|infectious]] inflammatory event may precede the onset of CFS, and that other medical signs may be present, including ** frequent [[Viral infection|viral infections]] with prolonged recovery, ** [[sinusitis]], ** [[ataxia]], ** extreme [[pallor]], and ** pronounced weight change: [[Weight gain|gain]] or [[Weight loss|loss]].<ref name="Beyond"/>{{Rp|260-261}} ===Laboratory test results=== Specific laboratory findings are not well established for ME/CFS. However, certain laboratory findings may support the finding of an MDI in people with ME/CFS even in the absence of the medical evidence listed above. It is not unusual to find standard laboratory tests in the normal range for many patients with ME/CFS, and SSA advises that such tests should not be relied upon to the exclusion of all other clinical evidence in decisions regarding the presence and severity of an MDI. The following laboratory findings establish the existence of an MDI in people with ME/CFS:<ref name="Beyond" />{{Rp|260-261}} * an elevated antibody titer to [[Epstein-Barr virus]] (EBV) [[capsid antigen]] equal to or greater than 1:5,120, or early antigen equal to or greater than 1:640; * an abnormal [[magnetic resonance imaging]] (MRI) [[Neuroimaging|brain scan]]; * [[neurally mediated hypotension]] as shown by tilt table testing or another clinically accepted form of testing; or * any other laboratory findings that are consistent with medically accepted clinical practice and are consistent with the other evidence in the case record (for example, an abnormal [[Two-day cardiopulmonary exercise test|exercise stress test]] or abnormal [[Sleep study|sleep studies]], appropriately evaluated and consistent with the other evidence in the case record).<ref name="Beyond" /> New laboratory and clinical evidence may emerge with continued research in ME/CFS. According to [[Social Security Administration|SSA]], these findings may be considered, in conjunction with laboratory findings discussed above, in the assessment of an MDI. Depending on the type of assessment, ongoing [[mental health|mental limitations]]<ref name="JamesDLMental">{{Cite web | url = http://www.jamesdisabilitylaw.com/your-testimony/disability-benefits-mental-symptoms-limitations.htm | title = Eiligibility for Disability Benefits and Mental Symptoms & Limitations|website=James Disability Law|language=en-US|access-date=2019-02-22}}</ref> or [[Cognitive dysfunction|neurocognitive manifestations]]<ref name="neurocognitive">{{Cite web | url = https://www.merriam-webster.com/medical/neurocognitive | title = Medical Definition of NEUROCOGNITIVE|website=Merrian-Webster Dictionary|language=en|access-date=2019-02-22}}</ref> documented by a [[Mental health|mental status examination]] or psychological testing may be considered medical signs or laboratory findings. SOURCE: Social Security Ruling, 2014.<ref name="Beyond" />
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