Can I receive disability benefits for CRPS? Is it recognized as a disability under Social Security Disability, veterans’ compensation, or private or group disability insurance?
Yes, complex regional pain syndrome, or CRPS, can qualify as a disability for all three types of benefits. While the process may be challenging, it is essential to remember that it is definitely achievable.
Your eligibility for disability benefits for CRPS will largely depend on the severity of your functional limitations, as well as the strength of your medical evidence, which should include objective signs beyond pain, such as swelling or involuntary movements.
This article explores how disability claims based on complex regional pain syndrome are reviewed and approved within the frameworks of:
- Social Security disability benefits
- Veterans’ disability compensation, and
- Individual and group disability insurance
In all cases, the thoroughness with which your initial CRPS disability claim or appeal is documented, organized, and presented becomes crucial to how an insurance resource interprets and ultimately approves or denies potential benefits.
Be aware that these “unconnected” disability benefits often interact with each other.
You can simultaneously receive disability benefits from the Social Security Administration (SSA), long-term disability insurance companies, and the Department of Veterans Affairs (VA).
When this happens, the claims you filed with each source often interconnect. This can be highly favorable, or sometimes it can work against you. Understanding each entity’s distinct requirements and rules for offsets, as well as how payments are coordinated, becomes a significant factor. Certain situations can create a complex web of interactions that require careful navigation.
You need a strategy to coordinate claims and avoid mistakes that could lead to denials or benefit reductions, and ensure you obtain the maximum disability benefits for CRPS to which you’re entitled.
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The Confounding Nature of Complex Regional Pain Syndrome
CRPS is a type of chronic pain that typically affects one limb, such as an arm, leg, hand, or foot. It often arises following trauma, such as an injury, stroke, heart attack, or surgery.
The current understanding of CRPS suggests a complex disorder characterized by neurological, inflammatory, and sympathetic nervous system dysfunction.
CRPS is marked by intense pain, swelling, variations in skin temperature and color, and heightened sensitivity to touch. Without appropriate treatment, the pain and associated atrophy or weakening of skin and bone may spread to involve an entire limb. For those suffering from complex regional pain syndrome, the ongoing and frequently crippling symptoms can significantly disrupt everyday living and prevent one from keeping a job.
Every person living with complex regional pain syndrome is different in their individual symptoms. The most common symptoms of CRPS include:
- Severe and unrelenting pain that is extreme given the initial injury. Pain can be aching, burning, throbbing, deep, and/or searing. Pain may last far longer than an injury’s normal healing time.
- Tremors and muscle spasms
- Extreme skin sensitivity, to the point where simply touching a cloth or water causes pain
- Swelling of the affected area; joint swelling and stiffness
- Difficulty moving; limited range of motion
- Skin changes in texture and color
- Abnormal skin temperature, where the limb involved is warmer or colder than the opposite limb
- Rapid hair and nail growth or no hair and nail growth in the impacted limb
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How Is Complex Regional Pain Syndrome Diagnosed?
There is no specific diagnostic test for CRPS. A clinical diagnosis mainly relies on what is called the “Budapest Criteria,” which is a set of clinical guidelines that evaluate symptoms such as:
- Disproportionate pain, meaning pain beyond what’s expected for the inciting event,
- Sensory changes, like allodynia (pain from non-painful stimuli) and hyperalgesia (increased sensitivity),
- Autonomic problems (for example, swelling, changes in sweating, and temperature differences)
- Motor/trophic disturbances (such as limited range of motion and tremors).
To aid the diagnosis, objective tests are used to rule out other conditions with similar symptoms. These include:
- Triple-phase bone scans to detect changes in bone
- MRI scans to detect bone and tissue abnormalities and rule out other causes of pain
- Sweat production tests called the Quantitative Sudomotor Axon Reflex Test (QSART)
- Blood tests to rule out infection or conditions like rheumatoid arthritis.
- Vascular/electrodiagnostic studies to rule out other conditions with similar symptoms.
How do the SSA, VA, and Insurance Carriers decide if CRPS disables me?
Pain is primarily a subjective experience. This is fundamentally why many claimants face delays and denials due to incomplete applications or a lack of substantial proof of disability. These agencies require extensive evidence and documentation to support your CRPS claim. Most claimants aren’t prepared to provide this level of detail.
When evidence is missing, you must not assume the SSA, VA, or insurance company will connect the dots for you. If your claim is denied, it means that the insurance carrier or government entity has determined you are not disabled in light of the claim you submitted — even if you truly qualify.
To increase your chances of winning disability benefits based on CRPS, you must focus on medical evidence, thorough documentation, persistence, and getting experienced legal help.
- Medical evidence − you need to provide comprehensive medical proof of your complex regional pain syndrome diagnosis with medical records and history showing a clear link to your work limitations.
- Accurate paperwork – whether you’re preparing to file an initial disability application or you were denied disability benefits for CRPS and now need to appeal, the documentation and records you submit are crucial. Timelines must be met. Not only must your claim show the full extent of your limitations, but it must also make your case by being free of mistakes, clear of missing evidence, or any other improper or disputable issue. In the case of LTD insurance claims, your CRPS claim or appeal must be prepared in a way that it can withstand an insurer’s scrutiny and potential denial tactics.
- Our disability attorneys can help. – Winning maximum disability benefits for CRPS is best done under the guidance of a qualified disability attorney. Some insurance companies may find ways to deny claims for complex regional pain syndrome, even if they are valid. Social Security and veterans’ benefits claims are often unreasonably denied as well.
We have extensive experience helping people through these and other legal obstacles. We are familiar with each agency’s eligibility requirements, documentation criteria, and evaluation process. We’ll help you gather all the necessary evidence, present it in the best possible way, and keep you from making critical mistakes. If you’re appealing a claim denial, navigating the appeals process is a specialized area that requires an attorney with experience dealing with the SSA, the VA, or major disability insurance companies.
Tips for Winning Social Security Disability Benefits for CRPS
Complex regional pain syndrome is not mentioned in the SSA’s listing of impairments. However, the SSA does have internal rulings for evaluating cases involving CRPS. These rulings allow for unlisted conditions to be identified as “medically determinable impairments.”
In other words, CRPS may be the basis for a finding of disability. However, disability may not be established solely based on an individual’s statement of symptoms.
Under Social Security’s internal policy for complex regional pain syndrome, CRPS can be confirmed if you have
- Persistent, intense pain that results in impaired mobility of the affected region. The pain is usually out of proportion (greater) than what would be expected based on any recorded trigger, along with
- one or more of the following clinically observed signs in the affected limb at any time after the recorded trigger:
- Swelling;
- Your autonomic nervous system fails to regulate bodily functions properly – including changes in skin color or texture, difficulties with temperature regulation, fluctuating skin temperature, and abnormal pilomotor erection (goosebumps);
- Abnormal hair or nail growth (growth can be either too slow or too fast);
- Osteoporosis;
- Involuntary movements of the affected region of the initial injury.
- Additionally, your CRPS must stop you from doing any substantial gainful activity (SGA) for at least a year.
Social Security will expect thorough medical documentation from you to show how your pain affects your physical and/or mental ability to work. The date of your triggering injury is essential in establishing the presence of a medically determinable impairment.
Supporting evidence should include your complete patient record from relevant healthcare sources, which should show ongoing doctors’ notes, medical evaluations, and treatments. Your personal diary of pain and symptoms will be of great importance. A Residual Functional Capacity (RFC) assessment will be crucial. A mental evaluation may be requested.
What if Social Security Denies Your Claim for Disability Benefits for CRPS?
Did the SSA deny your claim? You can and should fight (appeal) the decision. The appeals process allows you to present a stronger, more comprehensive case supporting the severity of your complex regional pain syndrome and justifying approval.
The first step is to file a Request for Reconsideration, and if denied again, you can request a hearing before an Administrative Law Judge (ALJ). If the ALJ also denies your claim, you can pursue further appeals, potentially to the Appeals Council or U.S. District Court.
Denials happen too often because claimants are unaware of the level of medical and functional evidence and history required to meet SSA’s evidentiary standards. The SSA decision makers also make mistakes, from failing to consider all your impairments and symptoms, to thinking that you do have the ability to work (when in fact you do not), and underestimating the severity of pain and how it affects your daily life.
These are primary reasons why an accomplished Social Security Disability lawyer can be crucial when applying initially for disability benefits for CRPS or when you need to appeal an SSDI claim denial.
Please contact us today for a complimentary and informative consultation regarding your claim.
Veterans’ Disability Benefits for CRPS
Complex regional pain syndrome is a common disability among veterans because it is linked to injuries during service, like trauma to limbs or surgery.
The VA does not have a separate CRPS disability rating.
Complex Regional Pain Syndrome does not have a specific diagnostic code in the VA rating schedule. In these cases, the VA will rate your condition analogously under other diagnostic codes based on the specific symptoms and resulting limitations.
The VA will assess disability ratings for impairments resulting from CRPS on a case-by-case basis. The examiner may involve the following conditions:
- Limited range of motion in the knees, arms, wrists, elbows, or ankles
- Muscular atrophy
- Neuralgia
- Partial paralysis
- Peripheral nerve damage
The ratings for these conditions are determined by their diagnostic code, the affected body part, and the level of impairment.
A Recent Win for Veterans with Disabling Pain Issues such as CRPS.
Historically, the VA would not award disability benefits for pain by itself—there needed to be a diagnosed condition behind it. However, in 2018, a Federal Circuit Court’s groundbreaking decision changed this. The ruling Saunders v. Wilkie has made it possible for veterans to get service connection for pain even without a diagnosed condition.
The court held that, under 38 U.S.C. 1110,
- The term “disability” refers to the functional impairment of earning capacity, not the underlying cause of such disability. To establish the presence of a disability, a veteran will need to show that their pain reaches the level of a functional impairment of earning capacity
- The court further stated that pain alone, without an accompanying diagnosis of a present disease, can qualify as a disability.
A well-placed statement in your CRPS disability claim should refer the VA examiner to the case law, stating your case aligns with 38 U.S.C. 1110, which clearly says, pain alone can qualify as a disability if it causes functional impairment.
Veterans with CRPS can receive VA disability ratings ranging from 10% to 100%, depending on the severity of their condition and its impact on daily life.
Proving Service Connection for Complex Regional Pain Syndrome
One of the main difficulties veterans with CRPS face is demonstrating that their condition is connected to their military service. The VA claims examiner needs to see the following evidence:
- Lay or medical evidence of an in-service precipitating event (injury, disease, or stressor) that could have caused your condition or aggravated an existing condition;
- A current diagnosis of your CRPS;
- A medical opinion provided by an expert analyzing the evidence and linking the CRPS to the precipitating incident or disease.
If the initial injury occurred during your service, you can easily access records of that injury and the treatment you received.
However, if the source of the pain is uncertain, or if your military service aggravated a preexisting injury that resulted in your CRPS, your case may be more challenging.
Obtaining a written medical opinion from a CRPS specialist can significantly strengthen your case. You’ll also need to present reliable evidence showing how the condition leads to specific impairments.
As part of the application process, you will likely have to take an exam at a VA Medical Center. This exam, known as a C&P exam, is performed by a military doctor who may not fully grasp the complexities of a condition like CRPS.
As veterans’ attorneys, we have reviewed many adverse decisions resulting from insufficient VA exams. These exams can fall short for several reasons, with the most common being:
- The examiner lacked the qualifications to assess the condition
- Findings are not based on sound clinical judgment
- Examiner inadequately portrayed or ignored the condition’s symptoms and characteristics
The C&P exam can be an integral part of your claim file, and you must arrive prepared. Our veterans’ attorneys can help you navigate your C&P exam in the best light.
Complex Regional Pain Syndrome as a Secondary Disability
CRPS can also occur as a secondary issue following an injury. In addition, CRPS can lead to other mental and physical conditions that have their own VA disability ratings. These conditions may include:
- Depression or anxiety
- Post-traumatic stress disorder
- Sleep disorders
- Gastrointestinal problems
- Mobility deficiencies causing joint disease in other areas
By filing for secondary conditions along with your CRPS claim, you can increase your total disability rating and receive an increased monthly payment.
Note, secondary conditions must stem from a service-connected disability, which is why it is crucial to demonstrate that your CRPS is a result of your military service.
The veterans claim attorneys at Marc Whitehead & Associates can assist you throughout the entire process—helping you collect documents, prepare your claim, and build a solid case for the benefits you are entitled to.
How Can I Win Disability Benefits for CRPS from My Insurance Company?
Disability insurance is designed to help cover the income loss associated with a long-term disability. The truth is, some insurers will set out to pay you the least amount possible, or deny your claim altogether.
Claims for CRPS disability are prime targets for denial. CRPS raises doubts among insurance providers, who are keenly aware that the condition is challenging to diagnose and medically confirm.
They will find ways to exploit your credibility or state that your claim exaggerates your pain. Many insurers will look for gaps in your treatment or resort to video surveillance to help them build their argument that you are not disabled under your group disability plan or private insurance policy.
These claims require experienced disability insurance attorneys who are skilled litigators and ready to use their skills and deep resources to prove your case.
Other ways that insurance companies dig for loopholes and weaknesses in pain-based disability claims that you may not expect include:
Unreasonable Requests
One denial tactic is to overwhelm you with unreasonable demands for documentation to prove the severity of your condition. You need a disability insurance claims attorney in your corner to handle all communications and demands from your insurance carrier. Otherwise, these requests only add to a claimant’s frustration, leading to abandoned claims or significant delays.
Lack of Objective Medical Evidence
Insurers may be quick to deny benefits for CRPS based on a lack of objective evidence. Whether through a group plan or a private policy, winning benefits requires providing medical evidence that shows your pain prevents you from working. This includes current, detailed medical records with diagnostic test results that identify the underlying causes of your complex regional pain syndrome.
Without sufficient medical documentation, treatment history, and confirmation from your doctors, you won’t be able to back up your claim against an insurer’s unfair or unreasonable decision.
Ineffective Physician’s Statement
An insurer usually sends forms for attending physician statements to your doctors. Don’t depend on the forms from your insurance provider. These forms are often intentionally designed to request the minimum threshold of information required under insurance laws and can be misleading or confusing. This holds even more so in cases involving disability benefits for CRPS and other “subjective” claims.
Your doctor’s responsiveness in completing the Physician’s Statement is crucial to the success of your claim. We work with your physicians to get these claim forms completed accurately. The importance of a competent physician’s statement explaining how your complex regional pain syndrome symptoms affect your ability to work cannot be overstated.
Ineffective (or lack of a) Vocational Report
Equal importance should be given to a detailed vocational report that explains the physical and mental demands of your previous job, why you can no longer perform that role, and whether you are capable or unable to do any job that meets the insurance policy’s definition of gainful employment. Especially for claims like CRPS, which insurers may view skeptically from the start, you must not overlook the value of non-medical evidence.
A denial from the insurance company does not mean you can’t fight back and win.
Our legal team will help you directly reach out to and work with your physicians, healthcare providers, and vocational experts, ensuring that compelling and legally relevant facts and arguments are provided that an insurer cannot discredit.
We help you keep a detailed symptom journal, collect statements from family, friends, and co-workers, and get expert opinions to back up your claim. If necessary, we arrange for additional tests, such as a Functional Capacity Evaluation, to provide objective medical proof to support your claim.
Send a Strong CRPS Claim or Appeal to the SSA, the VA, or Your Insurer
If your application for disability benefits for CRPS has been denied or if you are starting the process, skilled and resourceful legal representation can greatly enhance your outcome. At Marc Whitehead & Associates, disability benefits law is what we do. We know what is needed for your initial claim or appeal for CRPS disability benefits to be successful.
To learn how we can help, please contact us or call us at 800-562-9830. There’s no fee unless we win.
