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Chronic Fatigue Syndrome F024

Last amended 
Thursday, November 4, 2021
Current RMA Instruments

Reasonable Hypothesis SOP [1]

105 of 2021

Balance of Probabilities SOP [2]

106 of 2021

Changes from previous Instruments

SOP Bulletin 226 [3]

 

ICD Coding

  • ICD-9-CM Codes: 780.7, 799.3
  • ICD-10-AM Codes: R53, G93.3
Brief description

This is an unexplained symptom disorder, the main feature of which is severe chronic fatigue, which cannot be improved by bed rest and which is interfering with the person’s work and daily activities.

Confirming the diagnosis

Specific diagnostic criteria (as per the SOP definition) must be met.  This diagnosis should be accepted with caution and only after other chronic conditions, including pre-existing psychiatric diseases, have been satisfactorily excluded.  To confirm this diagnosis you will therefore need a detailed medical report indicating that other potential causes for the patient’s condition have been appropriately investigated and ruled out (see the list below for examples).  An assessment by a psychiatrist will allow psychiatric conditions to be excluded.

Additional diagnoses covered by SOP
  • systemic exertion intolerance disease
Related conditions that may be covered by SOP (further information required)
  • myalgic encephalomyelitis
  • post viral fatigue (syndrome)
Examples of conditions which if present preclude the diagnosis of chronic fatigue syndrome

(this list is not exhaustive, seek medical advice if in doubt)

  • alcohol or other substance use disorder
  • anaemia
  • bipolar disorder
  • chronic obstructive pulmonary disease; asthma.
  • delusional disorder
  • dementia of any type
  • eating disorders - anorexia nervosa or bulimia nervosa
  • hypothyroidism (inadequately treated)
  • ischaemic heart disease
  • major depressive disorder
  • schizophrenia
  • severe obesity
  • sleep apnoea (inadequately treated)
  • unresolved hepatitis B or C infection
Related, unexplained symptom conditions covered by separate SOPs
  • Chronic multisymptom illness
  • Fibromyalgia
  • Somatic symptom disorder
Clinical onset

Clinical onset will be based on the time of new or definitive onset of severe fatigue.

Clinical worsening

The only SOP worsening factor is for inability to obtain appropriate clinical management.  There is limited evidence that treatment interventions (cognitive behavior therapy, exercise therapy, diet, medications) can alter the course of the condition.  The prognosis for functional recovery is generally poor, although a proportion of patients will improve over time.

 

Rulebase for chronic fatigue syndrome

Place holder node for Rulebase for chronic fatigue syndrome

Coxiella burnetii (Q fever) infection

Chronic fatigue syndrome - Coxiella burnetii (Q fever) infection Factor

Last reviewed for CCPS 17 December 2003.

Investigative Documents

Medical Report - Infections - Chronic Fatigue Syndrome [MR9304]

Preliminary questions [33176]

[5]33177

the veteran has suffered from Coxiella burnetii (Q fever) infection at some time.

[6]33178

the veteran suffered from Coxiella burnetii (Q fever) infection at the time of the clinical onset of chronic fatigue syndrome.

33179 — the veteran has established the causal connection between Coxiella burnetii (Q fever) infection and VEA service for the clinical onset of chronic fatigue syndrome.

33180 — the veteran has established the causal connection between Coxiella burnetii (Q fever) infection and operational service for the clinical onset of chronic fatigue syndrome.

or

33181 — the veteran has established the causal connection between Coxiella burnetii (Q fever) infection and eligible service for the clinical onset of chronic fatigue syndrome.

Clinical onset and operational service [33180]

[7]33182

the Coxiella burnetii (Q fever) infection was caused by operational service.

Clinical onset and eligible service [33181]

[8]33183

the Coxiella burnetii (Q fever) infection was caused by eligible service. [9]

Inability to obtain appropriate clinical management for chronic fatigue syndrome

Chronic fatigue syndrome - Inability to obtain appropriate clinical management for chronic fatigue syndrome Factor

Last reviewed for CCPS 17 December 2003.

Investigative Documents

Medical Report - Inability to Obtain Appropriate Clinical Management - [GQACM]

Preliminary questions [15391]

11109 — the condition under consideration has been accepted on the basis of inability to obtain appropriate clinical management for the condition under consideration.

[10]7066

there is some evidence that an inability to obtain appropriate clinical management for the condition under consideration may be a factor in the worsening of the condition under consideration.

7334 [11] the clinical onset of the condition under consideration occurred after the end of the veteran's last period of VEA service.

[12]7335

the condition under consideration permanently worsened.

[13]7378

the veteran was unable to obtain appropriate clinical management for the condition under consideration at some time.

7379 [14] the inability to obtain appropriate clinical management for the condition under consideration contributed to the clinical worsening of the condition under consideration.

11234 — the veteran has established the causal connection between the inability to obtain appropriate clinical management for the condition under consideration and VEA service for the clinical worsening of the condition under consideration.

11235 — the veteran has established the causal connection between the inability to obtain appropriate clinical management for the condition under consideration and operational service for the clinical worsening of the condition under consideration.

or

11236 — the veteran has established the causal connection between the inability to obtain appropriate clinical management for the condition under consideration and eligible service for the clinical worsening of the condition under consideration.

Clinical worsening and operational service [11235]

[15]7384

the veteran was unable to obtain appropriate clinical management for the condition under consideration, which contributed to the clinical worsening of the condition under consideration, during operational service.

[16]21084

the veteran was unable to obtain appropriate clinical management for the condition under consideration, which contributed to the clinical worsening of the condition under consideration, during operational service, as a causal result of operational service.

[17]7387

the veteran's inability to obtain appropriate clinical management for the condition under consideration during operational service was due to the veteran's serious default, wilful act or serious breach of discipline.

or

[18]7389

the veteran was unable to obtain appropriate clinical management for the condition under consideration, which contributed to the clinical worsening of the condition under consideration, because of an illness or injury which is identifiable.

7390 — the identified illness or injury which prevented the veteran from obtaining appropriate clinical management for the condition under consideration is causally related to operational service. [19] [20]

[21]7392

the clinical onset of the condition under consideration occurred prior to that part of operational service to which the identified illness or injury that prevented the veteran from obtaining appropriate clinical management for the condition under consideration is causally related.

Clinical worsening and eligible service [11236]

[22]7385

the veteran was unable to obtain appropriate clinical management for the condition under consideration, which contributed to the clinical worsening of the condition under consideration, during eligible service.

[23]7386

the veteran was unable to obtain appropriate clinical management for the condition under consideration, which contributed to the clinical worsening of the condition under consideration, during eligible service, as a causal result of eligible service.

[24]7388

the veteran's inability to obtain appropriate clinical management for the condition under consideration during eligible service was due to the veteran's serious default, wilful act or serious breach of discipline.

or

[18]7389

the veteran was unable to obtain appropriate clinical management for the condition under consideration, which contributed to the clinical worsening of the condition under consideration, because of an illness or injury which is identifiable.

7391 — the identified illness or injury which prevented the veteran from obtaining appropriate clinical management for the condition under consideration is causally related to eligible service. [19] [20]

[25]7393

the clinical onset of the condition under consideration occurred prior to that part of eligible service to which the identified illness or injury that prevented the veteran from obtaining appropriate clinical management for the condition under consideration is causally related. [26]

Ross River virus infection

Chronic fatigue syndrome - Ross River virus infection Factor

Last reviewed for CCPS 17 December 2003.

Investigative Documents

Medical Report - Infections - Chronic Fatigue Syndrome [MR9304]

Preliminary questions [24894]

[5]24895

the veteran suffered from Ross River virus infection at some time.

[27]24896

the veteran suffered from Ross River virus infection at the time of the clinical onset of chronic fatigue syndrome.

24897 — the veteran has established the causal connection between the Ross River virus infection and VEA service for the clinical onset of chronic fatigue syndrome.

24898 — the veteran has established the causal connection between the Ross River virus infection and operational service for the clinical onset of chronic fatigue syndrome.

or

24899 — the veteran has established the causal connection between the Ross River virus infection and eligible service for the clinical onset of chronic fatigue syndrome.

Clinical onset and operational service [24898]

[28]24900

the Ross River virus infection was caused by operational service.

Clinical onset and eligible service [24899]

[29]24901

the Ross River virus infection was caused by eligible service. [30]

Symptomatic Epstein-Barr virus infection

Chronic fatigue syndrome - Symptomatic Epstein-Barr virus infection Factor

Last reviewed for CCPS 17 December 2003.

Investigative Documents

Medical Report - Infections - Chronic Fatigue Syndrome [MR9304]

Preliminary questions [24884]

[5]24906

the veteran has suffered from symptomatic Epstein-Barr virus infection at some time.

[31]24886

the veteran suffered from symptomatic Epstein-Barr virus infection at the time of the clinical onset of chronic fatigue syndrome.

24885 — the veteran has established the causal connection between symptomatic Epstein-Barr virus infection and VEA service for the clinical onset of chronic fatigue syndrome.

24887 — the veteran has established the causal connection between symptomatic Epstein-Barr virus infection and operational service for the clinical onset of chronic fatigue syndrome.

or

24888 — the veteran has established the causal connection between symptomatic Epstein-Barr virus infection and eligible service for the clinical onset of chronic fatigue syndrome.

Clinical onset and operational service [24887]

[32]24891

the symptomatic Epstein-Barr virus infection was caused by operational service.

Clinical onset and eligible service [24888]

[33]24892

the symptomatic Epstein-Barr virus infection was caused by eligible service. [34]

Source URL (modified on 15/11/2021 - 1:19pm): https://clik.dva.gov.au/ccps-medical-research-library/statements-principles/c-d/chronic-fatigue-syndrome-f024-r53g933

Links
[1] http://www.rma.gov.au/assets/SOP/2021/668271b196/105.pdf
[2] http://www.rma.gov.au/assets/SOP/2021/1655ce60af/106.pdf
[3] https://clik.dva.gov.au/system/files/media/SOP%20Bulletin%20226.pdf
[4] https://clik.dva.gov.au/user/login?destination=comment/reply/63378%23comment-form
[5] https://clik.dva.gov.au/ccpsmedical-261
[6] clikpopup://CCPS/reject33177No
[7] clikpopup://CCPS/reject33178No
[8] clikpopup://CCPS/reject33182No
[9] clikpopup://CCPS/reject33183No
[10] https://clik.dva.gov.au/ccpsother-31
[11] https://clik.dva.gov.au/node/69352
[12] clikpopup://CCPS/Reject/OnsetAfterService
[13] clikpopup://CCPS/Reject/NoPermanentWorsening
[14] clikpopup://CCPS/Chronic fatigue syndrome/ACM %C2%96 Contributed to worsening
[15] clikpopup://CCPS/ACM/NoContribution
[16] clikpopup://CCPS/ACM/NotOpService
[17] clikpopup://CCPS/ACM/NotOperDuties
[18] clikpopup://CCPS/rejectwilful
[19] clikpopup://CCPS/ACM/NoIllness
[20] clikpopup://CCPS/reject7390,7391No
[21] clikpopup://CCPS/Chronic fatigue syndrome/ACM %C2%96 onset prior to operational service
[22] clikpopup://CCPS/ACM/OnsetFailOper
[23] clikpopup://CCPS/ACM/NotEligService
[24] clikpopup://CCPS/ACM/NotEligDuties
[25] clikpopup://CCPS/Chronic fatigue syndrome/ACM %C2%96 onset prior to eligible service
[26] clikpopup://CCPS/ACM/OnsetFailElig
[27] clikpopup://CCPS/reject24895No
[28] clikpopup://CCPS/reject24896No
[29] clikpopup://CCPS/reject24900No
[30] clikpopup://CCPS/reject24901No
[31] clikpopup://CCPS/reject24906No
[32] clikpopup://CCPS/reject24886No
[33] clikpopup://CCPS/reject24891No
[34] clikpopup://CCPS/reject24892No