bee33, I'm so sorry to hear you've had CFS for 25 years, and are not progressing as you'd like. I can't imagine. I'm just at the beginning of my journey. I guess the consolation prize to all of this is that we have each other, this community to lean on. I want to make sure I haven't misrepresented Dr. Lerner in my postings. I can understand your frustration at the situation. However the last thing he is intending to do is offend anyone. He suffered from CFS 25 years ago and since he made it through his approx 5 year battle he went to bat for all of us who can't. He's the most compassionate man I've ever met. He never rests. For example, he spent all of Easter weekend (Friday, Saturday and Sunday checking on me after I had an unexpected side effect from a new medication). After unsuccessful visits with about 15 different "specialists" I started making the trip from CA to MI every 6 weeks and haven't looked back. The only reason he created this chart was to help follow progress in his office. After many people asked him to, he shared it. Right now I sit in the 3 range (Out of bed sitting, standing, walking 2 - 4 hours per day). That means on my bad days I can only sit out of bed for up to 2 hours total. Not necessarily in a row, but total. And on my best of best days, when I add up all the times I've been up and down - whether to the bathroom, to a doc appt, grocery shopping, dinner, whatever - it adds up to at most 4 hours. As you can see this is quite a range. You don't move quickly from one level to the next. Also, as a sidenote, when creating a tool like this, it must be verified by a peer-reviewed journal. It was published in "in vivo" - basically it talks through the creation of the EIPS. It was based off the FSS (a fatigue scale used for MS among other things) that takes into consideration the amount of calories burned per level. There were specific caloric ranges that need to be met in each level. He chose to use the descriptors that CFS patients can relate to (sitting, standing) that meet each range instead of caloric burn. Whomever told you that you were a 4, they were wrong. I'm very comfortable stating that. One other thing that's important is that this is something to use with a physician, not on your own. You/they need to take into consideration the exhaustion that mental expendability can have on you in addition to walking, etc... when you start bringing in the idea of work. I tried returning to work once, before I was in a responsible doctors hands. I did it way too quickly and it backfired on me. This was before I understood the seriousness of pacing and recovery. I hope this helps. And if there's anything I can ever do, please feel free to drop me a personal email. We're all in this together! I hope this hasn't aggrevated the situation. I just wanted to be sure that I didn't say anything to misrepresent my doctor. He has committed his life to helping others. He is one of the few good guys out there.