Chronic Fatigue Syndrome

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Narrative: Chronic fatigue syndrome (CFS) is an illness characterized by debilitating fatigue and several flu-like symptoms. It may have both physical and psychiatric manifestations and closely resembles neurasthenia, neurocirculatory asthenia, fibrositis, or fibromyalgia.

For VA purposes, a diagnosis of CFS must meet both of the following criteria:

1. New onset of debilitating fatigue that is severe enough to reduce or impair average daily activity below 50 percent of the patient's pre-illness activity level for a period of 6 months, and
2. Other clinical conditions that may produce similar symptoms must be excluded by thorough evaluation, based on history, physical examination, and appropriate laboratory tests.

It must also meet six or more of the following ten criteria:

1. Describe in detail:

1. Acute onset of the condition.
2. Low grade fever.
3. Nonexudative pharyngitis.
4. Palpable or tender cervical or axillary lymph nodes.
5. Generalized muscle aches or weakness.
6. Fatigue lasting 24 hours or longer after exercise.
7. Headaches (of a type, severity or pattern that is different from headaches in the premorbid state.)
8. Migratory joint pains.
9. Neuropsychologic symptoms.
10. Sleep disturbance.

A. Review of Medical Records:

Comment on:

1. Date diagnosis established.
2. Does it meet the requirements outlined above?
3. History of hospitalizations, dates and location, if known, reason.

B. Medical History (Subjective Complaints):

Comment on:

1. Estimate the amount of routine daily activities, including employment if applicable, that are restricted due to CFS. Give specific examples.
2. Is there debilitating fatigue? Constant or nearly so; wax and wane.
3. Are there incapacitating episodes (defined as requiring bed rest and treatment by a physician), what are there frequency and duration?
4. Cognitive impairment - constant or nearly so; wax and wane.
5. Any other current symptoms - constant or nearly so; wax and wane.
6. Does the patient require continuous medication for CFS?

C. Physical Examination (Objective Findings):

1. General appearance.
2. Throat.
3. Cervical/axillary lymphadenopathy.

D. Diagnostic and Clinical Tests:

1. Include results of all diagnostic and clinical tests conducted in the examination report.

E. Diagnosis:

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