When an appellant has a disability condition such as chronic pain, chronic fatigue, or depression, it is difficult to describe the subjective symptoms that one may experience. I am reposting this blog entry as I recently has a client - let's call her Julie, who I was diagnosed with Chronic Fatigue Syndrome after she had surgery for thyroid cancer ( I also would keep this in mind for people who have "chemo brain" after chemotherapy, or if you want to describe any type of chronic fatigue from say Fibromyalgia).
As I said, I recently had a case with a client who has Chronic Fatigue Syndrome. This client, Julie, was in her late forties and had been unable to work due to her condition for approximately four years. She had gone through a process of elimination with her physicians and specialists to see if there was an alternative illness causing her chronic fatigue which all came up negative. She had also been through numerous type of treatment both traditional and non - and had spent a large amount of money trying to regain her health. Unfortunately this has not happened and she is not able to work at all. Julie was a very accomplished woman - she was a single mother who raised two children, who was also well-educated with a good job and resume to her name.
When I was preparing for Julie's appeal I remembered a client I had in 2010 who had experienced similar symptoms. He was referred to a Psychiatrist who specialized in Chronic Fatigue Syndrome and Fibromyalgia.
Saying one is simply fatigued does not really describe the condition - and this doctor quoted five variants of fatigue as identified in a recent scholarly article by Jason et al. I did a google search and found a link to this article http://www.ncbi.nlm.nih.gov/pubmed/20185398?dopt=Abstract
When presenting a chronic fatigue case to an appeal's body I think it is helpful to discuss each of these five variants of fatigue. These are some of the examples we used in Julie's case -
Post-exertional Fatigue - the more that Julie did, the longer it takes for her to recover, she has to pace himself with her activities, if she does an activity she has to rest after this activity. I often hear clients say if they do something they will "pay" for it later. I think it is probably better to give examples - like how does one "pay" - increased fatigue, increased pain, would be a more appropriate way to describe this.
Brain Fog Fatigue - Julile described this type of fatigue as being in the "twilight zone" - she was unable to take in information or react to outside stimulus -she talked about how hard it was to her to follow a story line in a book, and how it was difficult to arrange her thoughts. When she was experiencing this type of fatigue she was unable to focus on anything.
Flu-like Fatigue - Julie described this type of fatigue as that she "just feels ill"
Energy Fatigue - this was described by Julie as her feeling okay and then something happens to "pull the plug" and she feels his energy draining away. If this happens, her need to rest is immediate.
Wired Fatigue - Julie described this aspect of fatigue as not really making sense to her in that when she seems to get really really tired, she gets "wired" by which she meant she was hyper - and that this was the hardest aspect of her fatigue to manage.
Julie was successful with her appeal and the Review Tribunal Panel considered the following factors - she was credible, she had a strong work history and attachment to the work force, that Julie's evidence at Review Tribunal gave them a clear idea as to the severity of her condition, that the Panel was impressed with Julie's diligence to find the appropriate diagnosis and treatment (efforts at mitigation) and that she had pursued treatment options that were recommmended by all the physicians to whom she was referred to, that it was not reasonable for her to try alternative employment (Inclima - if evidence of work capacity) and that her symptoms are unpredictable, which would make regular attendance at a place of employment either difficult or impossible - there was no evidence of functional overlay (ie: malingering, secondary gain).
I hope this helps clients who have any subjective symptoms to understand the importance of trying to quantify these symptoms to help the Panel gain a clear idea of the severity of your condition. With the changeover to the CPP Social Security Tribunal coming in a few short weeks, it is going to be more important that you are able to describe your functional limitations and use examples to explain how these functional limitations prevent you from working.