Facts about Complex Regional Pain Syndrome and Filing for Disability
These selected pages answer some of the most basic, but also some of the most important, questions for individuals who are considering filing a claim for disability benefits.
Facts about the condition
1. Complex regional pain syndrome is a rare and chronic condition that primarily affects the limbs.
2. Type 1 (reflex sympathetic dystrophy) occurs after an injury or illness that does not cause nerve damage, while Type 2 (causalgia) follows an injury that clearly caused damage to the nerves.
3. Symptoms of the condition include burning or shooting pain, skin sensitivity, swelling, joint pain and stiffness, muscle spasms, bone and muscle atrophy, skin changes (temperature, texture and color), abnormal sweating, hair loss and nail changes.
4. Symptoms may change over time, as regional pain syndrome is a progressive condition. However, severity of symptoms varies among individuals.
5. Initial symptoms usually include localized pain, swelling, redness, temperature changes in only the affected area, and over sensitivity to touch and cold temperature. At these early stages, treatment can help stop progression of the condition. When the entire limb becomes affected and has full skin and nail abnormalities with tightened and atrophied muscle, then the condition has progressed to the point where it is not likely that any treatment will reverse the damage and amputation may be necessary.
6. Complex regional pain syndrome can occur after major or minor injuries and traumas, including gunshot wounds, surgery, infections, and sprains. It is unknown why these factors sometimes lead to complex regional pain syndrome.
7. As with many other conditions, women are at a greater risk ' three times as likely ' than men to develop the condition.
8. Diagnosis most often occurs in middle age, around 40, but the numbers of young adults and children diagnosed with complex regional pain syndrome are increasing.
9. The popular television show House showed a controversial treatment for complex regional pain syndrome in Season 3.
10. In real life, doctors in Germany have conducted this rare and experimental treatment, which involves inducing a coma in order to use very high doses of ketamine, a powerful anesthetic, on their patients. In some cases it has completely relieved the symptoms of complex regional pain syndrome, curing the condition or at least putting it into remission.
Qualifying for disability benefits with this condition
Whether or not you qualify for disability and, as a result, are approved for disability benefits will depend entirely on the information obtained from your medical records.
This includes whatever statements and treatment notes that may have been obtained from your treating physician (a doctor who has a history of treating your condition and is, therefore, qualified to comment as to your condition and prognosis). It also includes discharge summaries from hospital stays, reports of imaging studies (such as xrays, MRIs, and CT scans) and lab panels (i.e. bloodwork) as well as reports from physical therapy.
In many disability claims, it may also include the results of a report issued by an independent physician who examines you at the request of the Social Security Administration.
Qualifying for SSD or SSI benefits will also depend on the information obtained from your vocational, or work, history if you are an adult, or academic records if you are a minor-age child. In the case of adults, your work history information will allow a disability examiner (examiners make decisions at the initial claim and reconsideration appeal levels, but not at the hearing level where a judges decides the outcome of the case) to A) classify your past work, B) determine the physical and mental demands of your past work, C) decide if you can go back to a past job, and D) whether or not you have the ability to switch to some type of other work.
The important thing to keep in mind is that the social security administration does not award benefits based on simply having a condition, but, instead, will base an approval or denial on the extent to which a condition causes functional limitations. Functional limitations can be great enough to make work activity not possible (or, for a child, make it impossible to engage in age-appropriate activities).
Why are so many disability cases lost at the disability application and reconsideration appeal levels?
There are several reasons but here are just two:
1) Social Security makes no attempt to obtain a statement from a claimant's treating physician. By contrast, at the hearing level, a claimant's disability attorney or disability representative will generally obtain and present this type of statement to a judge.
Note: it is not enough for a doctor to simply state that their patient is disabled. To satisy Social Security's requirements, the physician must list in what ways and to what extent the individual is functionally limited. For this reason, many representatives and attorneys request that the physician fill out and sign a specialized medical source statement that captures the correct information. Solid Supporting statements from physicians easily make the difference between winning or losing a disability case at the hearing level.
2) Prior to the hearing level, a claimant will not have the opportunity to explain how their condition limits them, nor will their attorney or representative have the opportunity to make a presentation based on the evidence of the case. This is because at the initial levels of the disability system, a disability examiner decides the case without meeting the claimant. The examiner may contact the claimant to gather information on activities of daily living and with regard to medical treatment or past jobs, but usually nothing more. At the hearing level, however, presenting an argument for approval based on medical evidence that has been obtained and submitted is exactly what happens.
About the Author: Tim Moore is a former Social Security Disability Examiner in North Carolina, has been interviewed by the NY Times and the LA Times on the disability system, and is an Accredited Disability Representative (ADR) in North Carolina. For assistance on a disability application or Appeal in NC, click here.
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