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the increase of sphingomyelins pathway products in GWS, and decrease in ME/CFS (Naviaux et al., 2016, 2019), may therefore contribute to the muscle fatigue experienced by patients with these conditions

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Uchida Y, Yagi Y, Takao M, Tano M, Umetsu M, Hirano S, et al

With Convention Automatic Presumptive Linkage Coding Clinic has clarified that the with convention in ICD-10-CM Guideline I.A.15 establishes a presumptive causal relationship based on the Alphabetic Index structure alone no explicit documentation of causation is required from the provider