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March 10, 1997

A Doctor's Dilemma: Is a Diagnosis Disabling or Enabling?

Arch Intern Med. 1997;157(5):491-492. doi:10.1001/archinte.1997.00440260021005

INCREASING administrative and legal responsibilities have been added to the traditional roles of physicians. This became even clearer to me as a medical adviser to administrative law judges considering appeals of applicants who have been initially denied disability claims under the Social Security system. Guidelines are published listing specific medical requirements for disability under Social Security regulations. The physician's role is to interpret the medical guidelines and advise the judge if the objective medical data meet the requirements.

However, what does one do when no objective medical data exist? I recently served as medical adviser in 3 cases of chronic fatigue syndrome (CFS) that created a dilemma. Chronic fatigue syndrome is characterized by a principal complaint of severe fatigue of at least 6 months' duration associated with appreciable disability and unexplained by recognized organic disease.1,2 A recent study3 has concluded that adding cognitive behavior therapy to the medical