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Reflex Sympathetic Dystrophy/Complex Regional Pain Syndrome And SSA Disability Claims
What if you were in terrible pain and no one would believe you? That was the situation that some people suffering from an unusual chronic pain syndrome found themselves in when applying for disability insurance benefits with the Social Security Administration. This column is going to examine a terrible chronic pain syndrome that causes a patient to suffer severe pain which seems totally out of proportion to the actual trauma the patient has undergone. This syndrome is called Reflex Dystrophy Syndrome (RSDS) or Complex Regional Pain Syndrome (Type 1) (CRPS). Both of these terms mean the same thing, RSDS was used in the past and CRPS is a newer name for the same chronic pain problem. Unfortunately for the claimant suffering from this syndrome, his complaints of pain frequently seemed out of proportion to the extent to of his injury. In every disability case, the Social Security Administration (SSA) has to judge the credibility of the claimant in describing his/her pain. If the pain complaints seemed out of proportion to the injury, the SSA might determine that the person was exaggerating the pain and deny an otherwise meritorious Disability Insurance Benefits claim.
Fortunately for patients with chronic pain syndrome, the SSA recently issued a Ruling to evaluate cases where the claimant is suffering from severe chronic pain which results from a traumatic injury. This new Ruling specifically provides guidelines to evaluate claims with a diagnosis of RSDS/CRPS. After a traumatic injury such as a bone fracture in an motor vehicle accident or a gun shot wound, the patient can develop intense pain which gets worse over time instead of better.
The SSA uses formal findings called Rulings to evaluate disability claims. This new Ruling on chronic pain syndrome became effective 20 October 2003. The new Ruling defines RSDS/ CRPS as “a unique clinical syndrome that may develop following trauma. This syndrome is characterized by complaints of intense pain and typically includes signs of autonomic dysfunction.” The Ruling describes RSDS/CRPS as a “constellation of symptoms and signs that may occur following an injury to bone or soft tissue.” The Ruling notes that the original injury may be so minor that the individual does not even remember the original injury. The Ruling also notes that the syndrome can be caused by “surgical procedures, drug exposure, stroke with hemiplegia, and cervical spondylosis.”
The Ruling states the RSDS/CRPS is a “chronic pain syndrome that most often results from trauma to a single extremity.” The syndrome typically has the claimant reporting intense pain and findings of autonomic dysfunction at the site of the injury. It is not uncommon for the complaints of pain to seem far out of proportion to the injury suffered by the claimant. The Ruling notes that the symptoms of RSDS/CRPS if not appropriately treated may worsen over time.
The Ruling notes that the cause of the RSDS/CRPS has not been medically determined. Medical literature indicates strongly that the sympathetic nervous system is involved with the chronic pain syndrome. The Ruling states: “The sympathetic nervous system regulates the body’s involuntary physiological changes that prepare the body to respond to stressful stimulus by ‘flight or fight.’” If the sympathetic nervous system reacts abnormally to the trauma it can produce “inappropriate or exaggerated neural signals which may be misinterpreted as pain.” The Ruling notes that early diagnosis and treatment of the syndrome within the first 3 months offers the best chance of recovering from RSDS/CRPS.
Patients with this pain syndrome “typically report persistent, burning, aching or searing pain that is initially localized to the site of the injury. The involved area usually has increased sensitivity to touch. The degree of reported pain is often out of proportion to the severity of the precipitating injury. Without appropriate treatment, the pain and associated atrophic skin and bone changes may spread to involve an entire limb.” The Ruling notes that with delayed treatment the symptoms may spread and result in “long term and even permanent physical and psychological problems.”
The SSA has now defined RSDS/CRPS as a Medically Determinable Impairment which can be used a basis of finding of disabled for SSA disability benefits. The diagnosis for RSDS/CRPS is established by patient complaints of intense pain which are typically out of proportion to the severity of any documented cause with one or more of the following signs: swelling, changes in skin color, texture, sweating, abnormal hair or nail growth, osteoporosis or involuntary movements of the affected region of the injury.
In general, these symptoms have to appear over a period of at least 12 months and be documented by the patient’s medical records. The Ruling notes that there is typically conflicting evidence in the patient’s medical records because the syndrome tends to flare and subside over time. Once the RSDS/CRPS has been diagnosed the SSA then has to evaluate the intensity, persistence and limiting effects of the person’s symptoms to perform work activities. This information can be documented by such persons as the patient’s medical care providers, statements from neighbors, friends, clergy, past employers, coworkers, rehabilitation counselors, chiropractors, and social workers.
The recognition of the SSA of this pain syndrome as a medically determinable impairment is a positive step for people who are suffering from the unremitting pain of RSDS/CRPS. The SSA recognizes persons with this condition have real pain. The impact of this ruling should result in more people with RSDS/CRPS receiving Social Security Disability insurance benefits without the added indignity of having their pain testimony disbelieved.