Background: Objective measurements of function often form the basis for legal decisions about whether a patient is fit for return to work, or conversely, entitled to disability compensation. The functional capacity evaluation (FCE) is regarded as the gold standard for measuring work capacity in plaintiffs seeking disability benefits. Yet the FCE often fails to link the unremitting fatigue of chronic fatigue syndrome (CFS) to the ability to work.
Purpose: To review the legal rationale and scientific evidence related to functional capacity measurements used to establish disability in individuals with CFS.
Methods: Narrative review.
Results: Several legal cases demonstrate problems with the FCE as determinative of the ability to work in people with CFS. In addition, scientific studies are lacking to support the reliability and validity of the FCE in this population. The putative metabolic pathology of CFS suggests that maximal cardiopulmonary exercise testing, which combines direct measurements of functioning and metabolic status, may be more appropriate to establish ability and disability than the FCE in this population.
Conclusion: Utilization of the FCE in legal cases to establish disability in individuals with CFS may yield erroneous findings that can be addressed with the use of alternative validated measurements.
Scientific and legal challenges to the functional capacity evaluation in chronic fatigue syndrome, by E. Ciccolella & Todd E. Davenport in Fatigue: Biomedicine, Health & Behavior, Vol 1, Issue 4, 2013