Commonwealth Worker's Compensation Scheme (Comcare) for CFS
URL Comcare: http://www.nla.gov.au/dir/portfoli/comcare.htm

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OPERATIONAL ADVICE NO 96/024

CLAIMS FOR CHRONIC FATIGUE SYNDROME


PURPOSE

1. To clarify operational policy concerning claims for Chronic Fatigue
Syndrome (CFS).

2 CFS may also be referred to as:
                 * myalgic encephalomyelitis (ME);
                 * post viral fatigue syndrome (PVPS);
                 * chronic fatigue and immune dysfunction (CFIDS);
                 * post infectious fatigue syndrome (PIFS);
                 * neurasthenia;
                 * fibrositis myalgia; and by some sectors as
                 * "Yuppie flu"

BACKGROUND

3. According to some experienced researchers, the chief characteristics of
CFS are:
        * symptoms of marked and prolonged fatigue;
        * fatigue which is of new onset,
        * Symptoms lasting more than six months;
        * Up to a 50% reduction in activity.
        The cardinal feature of CFS is unexplained chronic fatigue that may
        be constant or relapsing.

4.  Research has indicated that there is widespread agreement within the
medical profession that there is no specific diagnostic test for CFS and
that it does not represent a specific disease. The cause of the condition is
unknown and there is much disagreement about what it constitutes.

ADMINISTRATIVE APPEALS TRIBUNAL

5. However; a recent Administrative Appeals Tribunal ruling has now provided
Comcare with guidance in dealing with these claims.

6.  The case of Swanson and Comcare (No Q94/396) involved a claim that the
employee's work environment (mainly the air conditioning and formaldehyde
'off-gassing' from furniture) aggravated his CFS. His symptoms were very non
specific, being stated as fatigue, difficulty concentrating, skin rashes,
poor memory and abdominal pains.

7.  The Administrative Appeals Tribunal affirmed, in unequivocal terms,
Comcare's decision to reject liability. Its conclusions were reached after
looking at medical evidence indicating that CFS is an unknown condition for
which there are no diagnostic tests. Further, there was nothing to suggest
that Mr Swanson was suffering from any organic disease.

CRITERIA FOR DIAGNOSIS of CFS

8. Generally, there is consensus between experts within the Centres for
Disease Control (Atlanta) that the following criteria currently best
represent a diagnosis for CFS (Holmes at al 1988 Chronic Fatigue Syndrome: A
Working Case Defnition. Annals of Internal Medicine. 108:387-89):

9. For diagnosis, both the following major criteria must be present:
        * New onset fatigue lasting longer than 6 months with a 50%
          reduction in activity.
        * No other medical or psychiatric conditions that could cause
          symptoms.

10. Additionally, at least 6 of the following minor symptoms must be present
where physical signs are also apparent, or 8 minor Symptoms where no
physical signs are apparent:

Minor criteria - Symptoms

SYMPTOMS which must begin at or after the onset of fatigue

        * Low grade fever (ie 37.5C to 38.6C);
        * Sore throat;
        * Painful cervical or axillary (armpit) lymph node enlargement or
          disease;
        * Generalised muscle weakness;
        * Myalgias (muscle pains);
        * Fatigue lasting 24 hours or more after moderate exercise;
        * Headaches;
        * Migratory arthralgia (joint pain);
        * Sleep disturbance (hypersomnia or insomnia);
        * Neuropsychological complaints (one or more of photophobia,
          absent/depressed vision, such as visual scotomas, forgetfulness,
          irritability, confusion, difficulty concentrating, depression);
        * Acute onset (over a few hours to a few days).

11.  Where only 6 of the above symptoms are diagnosed, at least 2 of the
following physical signs must be present

Minor criteria - physical. signs (which must be documented by a medical
practitioner twice, at least 1 month apart)
        * Low grade fever;
        * Pharynx inflammation or pharyngitis;
        * Cervical or.axillary (armpit) lymph node Enlargement or disease.

POLICY - CONTRACTION OF CFS

12.  Specific research into CFS, which has been conducted on Comcare's
behalf by Dr Peter Grant and has involved select studies conducted
worldwide,  has suggested that any assertions that the onset of Qie
condition. was a result of an infection acquired in the workplace should be
treated as speculative unless:
        * the claimant has had serum tests to indicate recent infection with
          a viral agent and
        * there is clear evidence of a workrelated epidemic infection within
          the workplace of the type of viral agent infecting the employee.

13. Importantly, then is no evidence that heredity, genetic or developmental
factors play a part in the onset of CFS. Nor is there any consistent
evidence that the condition is associated with particular types of
occupation, lifestyle, mental or physical stress or preexisting psychiatric
illness.

14.  As these findings and recommendations are impossible to prove or
disprove, in the absence of any other evidence, it cannot be said that on
the balance of probabilities, CFS can generally be contracted in the
workplace.

15.  The Federal Court case of Comcare v Mooi (QG 75 of 1995, Drummond J)
has held that:

"there would be no need for that..... (elaborately defining 'injury' in
section 4)... if s14 (1) makes compensible any condition or Circumstance in
which an employee finds himself, so long as it arose in the course of his
employment and so long as it interferes with his capacity for work ...
before an employee can have any entitlement to compensation under s14, one
of the things he must show is that he has suffered something that can be
regarded as an injury or something that can be regarded as a disease."

POLICY - AGGRAVATlON OF CFS

16.  Given current findings on CFS, it is clear that the aggravation of this
condition will also be difficult to substantiate. This is again supported by
the decision made in the Swanson and Comcare AAT case, which involved the
aggravation of CFS.

17. Assuming that symptoms as outlined at paragraphs 9, 10 and 11 are
present (including fatigue, headaches and neuropsychological complaints),
there may be strong grounds to show that the condition itself is impacting
on the employee's work, as distinct from the employee's work causing or
contributing to any aggravation.

PROCEDURE

18.  In light of the research available to date on this condition, claims
for the contraction and aggravation of CFS need to be examined very
carefully. Despite any supporting evidence provided by treating doctors, it
is essential that specialist medical evidence be sought from a qualified
immunologist or other specialist in the field.

19.  It is most unlikely that claims for CFS, including its aggravation,
will succeed unless it can be established that the causal infection has been
contracted in the workplace and is clearly linked to an epidemic of the same
infection.

20. It should be made clear in correspondence to employees claiming CE that
Comcare is not questioning the general existence of the condition but rather
that a connection between the onset or aggravation of the condition and work
needs to be established.

ACTION

21. All Claims Management staff should note and observe the above policy.

(signed)

Robert Knapp
Deputy Chief Executive Officer
5 November 1996