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Complexities of Getting Disability Benefits with CRPS

April 29, 2023

Disability Benefits for Complex Regional Pain Syndrome (CRPS), with Balin Law Social Security Disability Law Firm

Complex Regional Pain Syndrome (CRPS) is a condition that can severely impact one’s ability to work and perform daily activities. In our last article on CRPS, we answered the question “Can You Get Disability Benefits for Complex Regional Pain Syndrome?” with a “yes”. We reviewed the basics of CRPS and how CRPS can qualify for Social Security Disability (SSD) benefits.  

Today, we dive into the specific complications of filing for SSD benefits with CRPS as your primary disabling condition.

Complex Regional Pain Syndrome (CRPS) has two Types which are defined by the cause only;

  • Type 1 occurs after an illness or injury with no observable nerve damage. The most common (90% of those with CRPS), CRPS-I is sometimes referred to as Reflex Sympathetic Dystrophy (RSD).
  • Type 2, formerly called Causalgia, is when there is known nerve damage, such as a crushing injury or forceful trauma.

Getting approved for disability benefits for CRPS can be complicated. Neither CRPS-I or II, nor any of its other names, are in the Social Security Administration’s (SSA) Listing of Impairments. However, meeting an SSA Listing’s description is not the only way to be approved for benefits. You can absolutely get disability benefits for CRPS.

For this article, we interviewed disability attorney Mark Dlugopolsky at Balin Law.  Mark has successfully obtained disability benefits for many clients dealing with CRPS, RSD, and other pain disorders.  Here are Mark’s answers to our most pressing questions on CRPS and Social Security Disability benefits.

What kinds of documentation is SSA looking for to approve disability benefits for CRPS?

Since there is no definitive test to diagnose CRPS, it is usually based on medical history and exams. Therefore, it is crucial to have consistent treatment that reflects the severity of your pain. Additionally, ruling out other causes of pain or diagnosis, such as using an EMG to reveal other causes of neuropathy, may be helpful. A sweat production test can measure the amount of sweat on both limbs, and if uneven, may indicate CRPS. Additionally, an MRI/ultrasound may show tissue changes. These may help to rule out other conditions or find underlying nerve damage. SSA will be looking for documentation of attempts to treat your pain, and one main way that is done is by physical/occupational therapy. 

What kind of doctor can diagnose CRPS?

Typically, doctors that specialize in pain management, such as neurologists or rheumatologists, will be the main specialists who try to find the cause of your pain.

Can you get disability benefits with CRPS alone?

It is possible to get disability benefits for CRPS alone. The severity of pain and/or inability to use a limb can prevent someone from sustaining employment. However, it is not uncommon for individuals to be denied benefits at the initial stage.

When should I apply for disability benefits for CRPS?  Should I wait to apply?

We do not recommend waiting to apply.  CRPS is not a well-known medical condition, so it may take a long time to diagnose, and it may take several appeals to get approved for benefits. It is best to file early in order to explore all of your options throughout the disability process.  As with any medical condition, there is always the chance that you can improve with treatment so a Closed Period of disability might become appropriate.  

Waiting too long to file after you stop working could potentially disqualify you for SSDI benefits if you no longer have the necessary work credits to receive SSDI. The work requirement is generally 5 out of the last 10 years, however, there are always exceptions. There are no work requirements for SSI benefits, but there are strict limits on household income and financial resources as SSI is a needs-based program.

It should also be noted that SSA only issues payments for a maximum of 12 months before the date of application.  Because CRPS can be caused trauma, surgery, or infection, it can be possible to obtain benefits back to the original trauma if that’s when you became unable to work.

What are some common co-occurring conditions with CRPS?

CRPS typically develops after an injury, surgery, stroke, or heart attack. While there is still much research that needs to be done, some studies have indicated that autoimmunity and movement disorders may be related. Additionally, some people may experience mental health distress including severe depression, anxiety, and suicidal ideations as a result of the severity of their pain and lack of understanding, diagnosis, or treatment options.

Could CRPS be related to Long COVID?

Chronic pain issues have received more public attention as they have become a common symptom of Post-COVID-19 Syndrome (Long COVID). More research is needed as there are only a few studies indicating the possible relation of Long COVID to CRPS. However, viral infections have been long-since recognized as a possible trigger of CRPS.

If you have symptoms of both Long COVID and CRPS, we recommend following the Mayo Clinic’s suggestions when bringing this up with your physician. Be sure to document when your symptoms started, what makes them worse, the frequency, and how they affect your activities.

What are my next steps?

If you or someone you know is suffering from CRPS, it is important to seek the necessary medical care and support to manage the symptoms and explore all options for disability benefits. Be sure to keep detailed medical documentation. Even messages to your doctor on My Chart about the severity of your pain will help strengthen your case. Tracking pain symptoms in a diary or calendar can also be helpful to your case and for coping.

Consider legal representation, as these cases can be challenging to win. Balin Law works with clients across the U.S.  Most clients never pay $1 out of pocket for our services. We only get paid when we win your case and SSA pays us directly, 25% of the backpay you’re owed.

Our team knows that the journey in obtaining SSDI can be difficult. That’s why Balin Law aims to make the legal aspects as stress-free as possible.

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