I recently reviewed a disability insurance denial to try to help a patient develop a strategy for how to proceed to try to get her disability. Under her disability insurance policy, she was disabled if she was unable to perform the functions of the job she was in at the time she became disabled (called “own occupation”). The patient was a researcher, a high level engineer who worked on federal contracts for military and defense. Although her job was sedentary, it required great cognitive skill, alertness, intellectual ability.
The denial letter correctly recited her physical symptoms, which were moderate in severity. She could manage sedentary work, then, according to the insurer. Thus, she was not disabled.
What the insurer missed – and what most people who have not had a chronic illness don’t really understand – is the fatigue that comes along with chronic illness. It is not sleepiness, although we may also be sleepy. But this is bone tired.
In my book, I called it Friday Tired because it’s a fatigue that feels like every day is Friday. I could sleep for weeks and still be fatigued. We only call it “tired” because we don’t have another word. So I made up a phrase: Chronic Illness Fatigue.
It doesn’t get better with a nap. Or a vacation. Or even necessarily a reduction in other symptoms. It’s a symptom in and of itself. I’ve read articles that refer to fatigue as a comorbidity – a second illness of its own, secondary to the primary chronic illness. I’m not talking about chronic fatigue syndrome, which is itself a primary illness. I’m talking about fatigue that comes with Crohn’s disease or multiple sclerosis or rheumatoid arthritis - Chronic Illness Fatigue.
Chronic Illness Fatigue certainly affected this patient’s ability to do her job. She is so exhausted that tasks take her far longer than she used to. She may be in mid-sentence and lose her words or her train of thought. She makes mistakes. No way would she be able to perform the intensely intellectually demanding job she had when she became disabled.
But how do we prove that we have Chronic Illness Fatigue? It’s totally subjective.