PVA: ME/CFS Cases on the Rise

In 2019, the PVA recorded the main diagnosis of ME/CFS in only 16 applications for occupational disability and invalidity pensions or rehabilitation benefits, but in 2024, it was recorded in 288 cases - an increase of 1,700 percent. Not included are those cases where applicants presented with the diagnosis of ME/CFS, but it was not adopted by the PVA.

Higher Rejection Rate

The rejection rate of applications has increased significantly in recent years, as revealed in a recent response to a parliamentary inquiry by the Greens from Social Minister Korinna Schumann (SPÖ). In 2022 - the first of the years mentioned in the response with a significant number of diagnoses made by the PVA (107) - 61 of the applications, or 57 percent, were rejected. By 2024, the rejection rate had already risen to 66 percent. For comparison: In the previous years with very few ME/CFS cases diagnosed by the PVA, the rejection rate was between 27 and 50 percent.

It remains unclear how many applications from ME/CFS sufferers have been submitted to the PVA in the past five years. "There are no statistical data available on this (...)," Schumann pointed out that the PVA does not record the preliminary findings with which applicants present themselves. Only the diagnoses assigned by the assessors are documented. ME/CFS patients who are not given a main diagnosis of ME/CFS by the PVA or are certified with a completely different diagnosis are therefore not included in the above figures.

Guidelines and Training

Regarding the question of which guidelines or scientific foundations the PVA currently uses for the assessment and evaluation of ME/CFS, the health department stated that the assessors working on behalf of the PVA act "independently" - namely "within the framework of the relevant professional legal laws and regulations".

"They can refer to all guidelines recognized and scientifically validated by medical professional societies during the assessment." The PVA does not make any specific medical requirements for the assessment.

According to Schumann, there are also no special training sessions for PVA assessors in dealing with ME/CFS sufferers. The PVA is not responsible for the specific training, further education, and continuing education of the assessors. This obligation lies with the individual assessors according to legal regulations. The "professional representative bodies," such as the Medical Association, are responsible for monitoring further education, Schumann said.

Since the PVA is not responsible for further education, there would also be no statistics on the completion of training events. It is also "not possible" to provide "specially trained personnel for every conceivable medical constellation." However, the PVA ensures "that assessments are carried out by professionally qualified assessors." In another response to an inquiry by Schumann, it states: "The assessments are conducted according to high standards and are carried out by highly qualified doctors."

When asked about measures that the health and social department is taking regarding assessment standards, Schumann referred to the self-administration of the pension insurance carriers: "Neither my department nor I are authorized by law to influence the performance matters of the pension insurance carriers." The PVA and other carriers would "decide and act independently."

ME/CFS Specialist

For the Viennese neurologist and ME/CFS specialist Michael Stingl, the data reflect the problems experienced in practice - along with the frequent conversion of the ME/CFS diagnosis into psychiatric diagnoses by the PVA, as shown in research by APA, ORF, and Dossier: Namely, that it is "extremely difficult" to get "rehabilitation benefits approved" with ME/CFS.

This does not align with the "often high degree of impairment and ultimately does not correspond to the state of science, where the large extent of restriction in daily and work ability has been regularly demonstrated." The problem of the cardinal symptom of PEM (post-exertional malaise, note) is often not appreciated in the assessment of work ability, nor often in the assessment process itself. "Overexertion in these procedures regularly leads to deteriorations in condition," says Stingl. "And this is just as counterproductive for the recovery of people with PEM as an overestimation of work ability."

Criticism from the Greens

Sharp criticism was expressed by the Green health spokesperson and author of the inquiry, Ralph Schallmeiner, who was annoyed by the statements regarding assessor training: "On one hand, the law requires that the pension insurance institution makes evidence-based decisions. At the same time, the ministry cannot ensure that experts have the competence," but refers to their independence. "There is no control over whether the experts are qualified to do what they do," he told APA.

It is also problematic that the diagnoses with which applicants first approach the PVA are not recorded, criticized Schallmeiner.

The mentioned joint research by APA, ORF, and Dossier from May also pointed out problems with granting such benefits to ME/CFS or Post Covid patients. In the cases provided to and evaluated by the research collective at that time, 79 percent of the applications were rejected (or already granted benefits were withdrawn). The diagnoses of ME/CFS or Post Covid were completely negated in more than half of the assessments and changed to a psychological or psychosomatic diagnosis in about 40 percent. In a good portion, applicants were accused of "aggravation" (exaggeration) of symptoms, "emphasis," or even simulation.

Jürgen Holzinger, the chairman of the association Chronically Ill, also pointed out the problem of misdiagnoses to the APA. If an applicant is granted rehabilitation money but with an incorrect diagnosis, this becomes relevant within the framework of the legally prescribed "duty to cooperate": The implementation of this by the PVA (but also by the ÖGK) is in practice "more than questionable," especially when it comes to the mandatory intake of psychotropic drugs (in cases of psychiatric misdiagnoses, note). Due to "often poorly made" PVA assessments, those affected repeatedly receive "incorrect rehabilitation plans" that they must adhere to, according to the chairman.

Schumann also pointed out in her response that appeals can be filed against PVA decisions and that these proceedings are free of charge for the insured. However, the data also shows that appeals by ME/CFS patients diagnosed by the PVA against the decisions are almost never successful: Between 2022 and 2025, appeals were filed against PVA decisions in 411 such cases, and only in 36 (nine percent) of them were the applicants successful. Here too, the number increased significantly - from 18 in 2022 to 176 in 2024.

There is no information available on the expenses for the assessments obtained by the PVA. The PVA informed the ministry that the corresponding data is not available, it was said. The ministry also does not plan to collect this data. Furthermore, the Ministry of Social Affairs does not have any general evaluations or key figures available on how many assessments are obtained per year in proceedings for rehabilitation money, disability pension, or occupational disability, and what costs are associated with them.

Reported Statements

Schumann was reserved about the statements attributed to PVA Director General Winfried Pinggera in September, according to which he allegedly referred to ME/CFS patients and their doctors as "freeloaders" and "charlatans" during a meeting with the founder of the We&Me Foundation, Gerhard Ströck. The quoted interview is "known" to her, the minister explained. Pinggera had the claims refuted at the time - it was said to have been "constructive discussions." Ströck, however, stood by his statements when asked.

"It is not my task as a federal minister to evaluate certain statements made by others," Schumann said on the matter. "But I would like to generally state that derogatory assessments reproduced in the media are in no way shared by me." However, she considers the quoted wording "of course inappropriate." The situation of those affected by ME/CFS should be improved, and medical care further developed.

For Schallmeiner, this was too weak a reaction: Because the inquiry also reveals that Schumann or her department have not yet sought direct talks with Pinggera, he said, referring to Schumann's response that "ongoing" discussions with the social insurance carriers are taking place. Schallmeiner also criticized Schumann's reference to the self-administration of the PVA, calling it "cowardly."

(APA/Red)

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