Many people have never heard of Reflex Sympathetic Dystrophy (RSD), which is also known as Complex Regional Pain Syndrome (CRPS). However, those who suffer from it know how frustrating and debilitating it can be. In fact, the National Institute of Neurological Disorders and Stroke (NINDS) notes that “severe or prolonged cases are profoundly disabling.”
As a Social Security attorney, I sometimes take cases in front of judges which involve rare and mysterious impairments like RSD/CRPS. Sometimes judges don’t understand these impairments and can be reluctant to approve this kind of claim. Nonetheless, I have been pleasantly surprised to see that the judges who handle Social Security disability cases have been receptive to cases involving RSD/CRPS and seem to understand how its symptoms can make someone unable to sustain competitive employment.
This likely has to do with a 2003 Social Security Ruling, SSR 03-2p, “Evaluating Cases Involving Reflex Sympathetic Dystrophy / Complex Regional Pain Syndrome,” which provides guidance to judges about this disease.
RSD/CRPS Can Be Debilitating, and Can Affect Your Ability to Work
The SSR explains that RSD/CRPS involves a “constellation of symptoms” which can arise following an injury or surgery. Pain is the primary symptom, often arising in a joint of the upper or lower extremities. I have had several cases in which the RSD/CRPS presented in the ankle following an injury. (This seems the most common to me but that is very anecdotal.) The pain can be excruciating, often seeming out of proportion to the original injury. However, the pain is very real.
Doctors believe RSD/CRPS involves an abnormal reaction in the body’s sympathetic nervous system that creates changes in blood vessels, skin, musculature and bone. In a clinical setting, doctors observe symptoms like swelling, color changes, temperature changes, involuntary movements, or abnormal hair growth. But each case is unique and may not involve all of these symptoms.
Pain is the common denominator and can be associated with muscle atrophy and instability. Someone may have so much pain that medical professionals even suggest amputation of the affected extremity. The associated dysfunction can be so extreme that it leaves someone unable to “ambulate effectively,” meaning the person cannot get around well enough to carry out activities of daily living and may require a walker or crutches.
An Experienced Attorney and Sound Medical Evidence Can Make All the Difference
While a case of RSD/CRPS may be very different than a straightforward case of osteoarthritis, Social Security will evaluate it in much the same way as it evaluates standard musculoskeletal impairments like degenerative joint or degenerative disc disease. If you are seeking Social Security Disability for RSD/CRPS, a judge will consider your statements about the pain and limitations associated with the disorder, then compare your statements with your medical records to make a finding about the consistency of these two evidentiary sources. (Essentially, the judge will decide whether or not they believe you.)
Of course, you want the judge to believe you. A skilled Social Security attorney can present your case in a way that emphasizes its strengths so the judge knows you are telling the truth. Any time we present a disability case, we want to prove that our client is unable to work on a regular basis. Judges are always more likely to believe this if someone has a consistent, steady work history. A Social Security hearing always involves a discussion of a claimant’s past work, so an attorney can emphasize how hard you worked and how you would be working if you could.
Judges are also much more likely to believe you if your doctor does. However, a doctor’s medical records won’t necessarily say that they believe you; their job is to listen to what you have to say about your symptoms and treat you. A Social Security attorney can seek a statement from your doctor and ask them to confirm that they believe your RSD/CRPS would create significant limitations. A medical opinion like this can be some of the most important evidence in a case.
RSD/CRPS Affects Older Women the Most, but Can Affect Anyone
The NINDS also notes that “CRPS is more common in women but can occur in anyone at any age, with a peak around age 40.” This indicates that the “average” CRPS sufferer is a 40 year-old woman, and a case like this may present various challenges. We already talked about how judges are more likely to believe someone with a strong work history, but what about a 40 year-old woman whose work history is limited because she has focused on raising children? In this situation, a skilled attorney can help emphasize the strengths of your case to offset any bias a judge may have due to relatively low lifetime earnings. Additionally, as you may have heard, people under 50 years old have the most difficulty getting their Social Security disability benefits. This is because, to prevail on such a claim, such a person has to show that they are incapable of doing any job whatsoever. This can be problematic, even for someone whose RSD/CRPS makes them unable to perform minimal standing and walking, making them unable to perform the kind of work they did in the past.
Social Security pays vocational experts who testify that there are jobs that hardly require any standing, walking, or lifting, and can be done by someone without any meaningful skills or a basic education. This kind of testimony reflects a disingenuous neglect of the extent of the skills required of modern office work and our Social Security attorneys fight this kind of unfair testimony in our country’s federal courts. However, at the administrative hearing (which comes before any federal court appeal), judges are inclined to uncritically accept this kind of testimony from vocational experts. For this reason, we want to be prepared to show a judge that you couldn’t even do a job that doesn’t require hardly any standing, walking, or lifting, and know the kinds of limitations we need to present to make this kind of showing. RSD/CRPS can involve arm leg problems which prevent even work involving minimal exertion.
Our Social Security Attorneys Can Help with Your Disability Claim
If you doctor has suggested that you may have RSD/CRPS, you should continue to follow up with this doctor or others to whom you may be referred. Do this as soon as possible. Early, consistent treatment gives you your best chance of getting better. If you can’t improve to the point at which you can return to work, you are welcome to contact Keller & Keller to talk about Social Security disability benefits.