Complex Regional Pain Syndrome and Qualifying for Disability Benefits
Can I get disability benefits if I am suffering from the effects of Complex Regional Pain Syndrome?
Author: Attorney Lonnie Roach
Complex regional pain syndrome, or CRPS, affects approximately 200,000 people in the U.S. each year. Though the disorder is relatively uncommon, CRPS can be challenging for those people impacted because of pain, discomfort and lack of information about the disorder. CRPS is a form of chronic pain that develops after a major or minor trauma, usually to an arm or leg. CRPS can also appear after a stroke, heart attack, surgery, fracture, infection, burns or cuts, but the pain is always out of proportion to the initial injury. If you are suffering from the effects of Complex regional pain syndrome you may qualify for disability benefits.
Symptoms of CRPS vary from person to person and include:
- Continuous burning or throbbing pain
- Sensitivity to touch or temperature
- Changes in skin temperature alternating between sweaty and cold
- Changes in skin texture or color
- Joint stiffness
- Changes in hair and nail growth
- Muscle spasms, tremors, or weakness
Symptoms may persist for months to years or go away on their own, but if the condition is not treated early, it can lead to more disabling symptoms such as tissue wasting, muscle contractures and weak bones. There are two types of CRPS, having similar symptoms but different causes.
- Type 1, also known as reflex sympathetic dystrophy (RSD), occurs after an injury or illness that didn’t directly damage nerves in the affected limb. 90% of people have this type of CRPS.
- Type 2, called causalgia, has similar symptoms but occurs after a distinct nerve injury.
Causes of CRPS are not completely understood, but experts believe CRPS results from dysfunction in the central or peripheral nervous systems.
Some researchers suggest that peripheral nerve fibers become hyperactive after an injury and continue to send pain signals to the brain, prompting the central nervous system to initiate inflammation, creating pain and discomfort.
If you are suffering from Complex regional pain syndrome and have been denied disability don’t give up, almost 70% are denied initially!
Just call 512-454-4000 for a free, no obligation consultation to learn what your options are. Have some questions? just give us a call, we love to help folks just like you!
There is no single test for CRPS so diagnosis is based on a patient’s medical history and a medical exam.
However, some procedures and tests such as bone scans, x-rays and MRIs can show changes in tissue and bones, giving important clues. Treatments include pain relievers and bone loss medications, heat therapy, physical therapy, and topical analgesics, but is most effective if it’s begun early in a patient’s condition.
What do I need to qualify for Social Security Disability Income?
Sometimes CRPS improves and goes away.
However, in other cases, the pain becomes chronic and disabling. Social Security recognizes that CRPS is potentially disabling, but there is no listing for CRPS in Social Security’s Blue Book. You will need more than a diagnosis of CRPS to be approved for disability benefits, but if you can prove that your functional limitations prevent you from working, and you have good medical records, it’s possible that Social Security will grant your claim. Social Security grants benefits based on medical evidence and may request an independent medical exam with a Social Security doctor. You will need to submit the following information as part of your claim:
- Medical records covering months to years indicating ongoing medical evaluation and treatment;
- Doctors’ clinical notes detailing your medical condition and limitations;
- Medications taken and your response;
- Treatments followed and your response; and
- Whether your symptoms have remained stable, improved, or worsened
Your medical records must include complaints of persistent, intense pain that causes impaired mobility of the affected body part and must be related to swelling, changes in skin color or texture, increased or decreased sweating, changes in skin temperature, osteoporosis, or involuntary movements in the area of the initial injury.
At least one of these symptoms needs to be present since the date of initial injury.
Your treatment history and doctors’ opinions in this case are very important in getting approved for disability benefits.
Social Security uses your medical records and doctor’s opinion to conduct a residual functional capacity (RFC) assessment to determine if you can perform your last job or any job, taking into account whether or not you are able to drive, your age, and level of education. You should ask your doctor for a statement detailing your limitations and restrictions. For example, you might have the following restrictions caused by CRPS:
- Walking or standing only 4 hours a day
- Stooping, crouching, crawling, kneeling or bending only occasionally
- Lifting and carrying no more than 20 lbs. occasionally (1/3 of a work day) or 10 lbs. frequently (2/3 of a work day)
- Limited ability to concentrate and work at an adequate pace
Age or another medical condition may help you get approval.
Social Security may find that your old job is too strenuous and depending on your age and job experience, Social Security might not expect you to learn a new job.
Social Security follows a set of medical-vocational grid rules to determine when the agency expects an applicant to learn a new job. Disability applicants who are older than 50 or 55 will often fall under a grid rule, which means they don’t have to learn a new job. If you can’t go back to your old job and you don’t have to learn a new one, Social Security will likely grant you disability benefits.
Additionally, you may be eligible for Social Security Disability benefits if you have another impairment, such as high blood pressure or osteoporosis.
By itself one disorder may not meet the requirements of an impairment as stated in Social Security’s Blue Book, but if you have more than one medical condition, Social Security must consider how those combined health issues limit your ability to hold a job and perform necessary daily tasks.
What are the basic financial requirements for SSDI?
If you don’t meet the basic financial requirements, you won’t be approved for SSDI.
You must: 1) have a disability that has lasted, or is expected to last 12 months; 2) you must have worked in a job where you paid Social Security taxes long enough and recently enough; and 3) you must not earn more than Substantial Gainful Activity (SGA), which is $1,470 per month in 2023 for nonblind applicants and $2,460 per month for blind applicants.
What if I don’t qualify for SSDI?
If you don’t have enough work credits or earn too much income, you may be eligible for disability benefits through another Social Security program, like Supplemental Security Income (SSI,) or from long-term disability insurance through your employer or a privately purchased policy.
SSI is a program that pays monthly benefits to people with limited income and resources who are disabled, blind, or age 65 or older. It is based on income, not work credits, and is financed by general funds of the U.S. Treasury.
I have long-term disability insurance – should I file a claim?
Long-term disability insurance (LTD) is coverage to protect your income if you are unable to work due to illness or injury and is purchased as part of a group employment plan or privately through an insurance company.
Policies pay between 50-60% of your salary and benefits continue until you return to work or for the number of years stated in the policy. If you have an LTD policy, remember your coverage is good only as long as you are employed, so it is important not to quit your job before you file a claim. Be sure to check the policy’s definition of “disabled” as each policy will state the definition of “disabled” which is in use. Note that long-term disability insurance companies can require a claimant to also apply for SSDI.
How do I file for Social Security Disability benefits?
You can apply for Social Security Disability benefits online, over the phone, or in person at your local Social Security Administration office.
Do not be discouraged if your application is denied – most initial applications are. You will have the opportunity to appeal. There are four steps to the appeal process:
- File a Request for Reconsideration with the Social Security Administration to completely review the case.
- If you don’t agree with SSA’s response to your Request for Reconsideration, you can request a hearing before an Administrative Law Judge (ALJ). ALJs are attorneys who work for the Social Security Administration; they review SSDI and SSI cases and either uphold or overturn decisions to deny SSDI or SSI benefits. If you are not represented by an attorney, you should obtain legal counsel at this critical point to raise your chance for success.
- If an ALJ does not grant your claim, you can request that the Appeals Council review your case.
- Federal Court review. The final step in the appeal process is filing suit in U.S. District Court.
Do I need a disability attorney?
If you have complex regional pain syndrome, and it has prevented you from working for at least 12 months, you may be eligible for Social Security Disability benefits.
You should know, however, that success is not guaranteed, particularly for a chronic pain disorder, and applying for Social Security Disability benefits is a long process that can take months to years. If you receive a denial, your chances of approval are increased significantly if you have legal representation. At the request for reconsideration and hearing levels, an attorney can collect and submit relevant medical evidence, obtain doctors’ opinions, draft a brief to the ALJ, and prepare you for questioning by the judge. An attorney can also elicit helpful testimony from you and cross-examine vocational and medical experts, demonstrating your inability to work. At the Appeals Council and federal court level, a lawyer can present legal arguments to show your case was wrongfully denied. Fees charged by disability attorneys are regulated by federal law and are usually 25% of disability backpay you are owed. There are no out-of-pocket costs, and if you don’t win your case, you won’t be charged anything.
The attorneys at Bemis, Roach & Reed have wide experience in representing clients at all levels of the Social Security Disability process and in long-term disability insurance cases.
At The Texas Disability law firm Bemis Roach & Reed, our attorneys are committed to helping injured or disabled clients receive the benefits they deserve. Mr. Roach is AV Preeminent and SuperLawyers rated and has become a recognized leader in the field of Long Term Disability law. Mr Bemis focuses his practice on Social Security disability while Mr Reed handles both LTD and SSDI claims. Both are AV Preeminent and SuperLawyers rated and all our attorneys have been successfully helping people fight for their rights against big insurance companies and the government since 1993. If you have applied for benefits and been denied call 512-454-4000 for a free consultation and get help NOW.
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Author: Attorney Lonnie Roach has been practicing law for over 29 years. He is Superlawyers rated by Thomson Reuters and is Top AV Preeminent® and Client Champion rated by Martindale Hubbell. Through his extensive litigation Mr. Roach obtained board certifications from the Texas Board of Legal Specialization. Lonnie is admitted to practice in the United States District Court - all Texas Districts and the U.S. Court of Appeals, Fifth Circuit. Highly experienced in Long Term Disability denials and appeals governed by the “ERISA” Mr. Roach is a member of the Texas Trial Lawyers Association, Austin Bar Association, and is a past the director of the Capital Area Trial Lawyers Association (Director 1999-2005) Mr. Roach and all the members of Bemis, Roach & Reed have been active participants in the Travis County Lawyer referral service.
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