Like fibromyalgia and peripheral neuropathy,complex regional pain syndrome (formerly called reflex sympathetic dystrophy or RSD), afflicts patients with a chronic pain condition. According to the National Institute of Neurological Disorders and Stroke, the key symptom of CRPS is continuous, intense pain out of proportion to the severity of the injury, which gets worse rather than better over time.
CRPS most often affects one of the arms, legs, hands, or feet. Often the pain spreads to include the entire arm or leg. Typical symptoms include dramatic changes in the color and temperature of the skin over the affected limb or body part, accompanied by intense burning pain, skin sensitivity, sweating, and swelling. Temperature changes need not be heat only. Often patients complain of extreme cold in limbs.
Doctors aren’t sure what causes CRPS. In some cases the sympathetic nervous system plays an important role in sustaining the pain. Another theory is that CRPS is caused by a triggering of the immune response, which leads to the characteristic inflammatory symptoms of redness, warmth, and swelling in the affected area.
Social Security judges recognize CRPS as a legitimate basis for awarding benefits, but it has been my experience that the medical evidence needed to prevail must be comprehensive and consistent over an extended period of time.
Disability Arguments Used in CRPS Cases
There is no “listing” for CRPS with in Neurological Impairment listing number 11. In addition, since the functional issues in an CRPS case arise from pain, the grid rules are inapplicable as well (there must be a physical impairment for a claimant to fall within the grid rules). Therefore, when I present an CRPS case to a judge, I use a functional capacity argument.
A CRPS patient loses work capacity because of pain and limitation of use of one or more extremities. In a work limitation context, extreme pain will interfere with:
- attention and concentration
- persistence and pace
- ability to withstand everyday work stress
- memory and the capacity to remember even simple instructions
- interaction with co-workers and supervisors
- interaction with the general public
- reliability during the course of a workday
- missed time from work
If my client has a treating physician who has followed my client over months and years and that physician agrees to complete a functional capacity evaluation form that I provide, our chances at success increase dramatically.
Social Security has published a “ruling” about how judges and adjudicators should consider evidence in a CRPS case. The link to Ruling SSR 03-02 is here. As you read the ruling you will note SSA’s focus on “longitudinal treatment records 1 SSA also expects to see complaints of pain along with:
- Autonomic instability—seen as changes in skin color or texture, changes in sweating (decreased or excessive sweating), skin temperature changes, or abnormal pilomotor erection (gooseflesh);
- Abnormal hair or nail growth (growth can be either too slow or too fast);
- Osteoporosis; or
- Involuntary movements of the affected region of the initial injury
Since CRPS/RSD is inherently a subjective medical condition, it is essential that your medical file track the requirements of the ruling, where Social Security has told us what it needs to approve a CRPS/RSD case.
Problems that Arise in CRPS Cases
As you might imagine, Social Security administrative law judges may question the sincerity and truthfulness of an individual who asserts severe pain that cannot be traced to a specific source. This is especially true if treatment involves narcotic pain prescriptions.
In my experience Social Security judges want clear affirmations from a treating doctor that the CRPS patient is not a “malingerer” nor is the claimant exhibiting “drug seeking behavior.” If either of these terms finds its way into your medical record, you will have an uphill battle. Similarly, if a doctor has discharged you for violating the terms of a narcotic medicine contract (for example if the doctor discovers that his patient has been receiving narcotics from a different physician without the first physician’s knowledge) you will most likely not win.
I have also found that CRPS cases with minimal medical evidence will be difficult to win. You need regular, on-going treatment (known as a “longitudinal treatment record) in a CRPS case.
A Solid Work History Can Shift the Balance in Your Favor
In the CRPS cases that I have tried recently, I note that the judges considering these claims took a lot of interest in my client’s work history. A long, solid work history, especially if you work involved rewarding, good paying jobs, will help you case. Hardworking, solidly employed people do not leave good, high paying jobs to sit at home and wait for a Social Security check. Judges recognize this, and it is important that your express any frustration you have about not working, and that you present testimony of experiences where you tried to work through the pain but you had to stop after just a few minutes to rest or to take pain medication.
- This means that your doctor has evaluated you over a long period of time. ↩