Social Security Disability and Reflex Sympathetic Dystrophy

Is RSD a Disability?

We presently have a client who has been diagnosed with Reflex Sympathetic Dystrophy (RSD) also known as Complex Regional Pain Syndrome (CRPS).  RSD is a unique clinical syndrome that may develop following trauma, severe or minor. Claimants with RSD typically report burning, aching, or searing pain that starts out at the site of the trauma and can then spread to other limbs or parts of the body. In our case, our claimant is a 30-year-old woman who fractured her finger playing football. She had surgery on the finger but it never healed properly. She can’t bend it or make a fist. After the surgery, her hand started to swell and tingle. She also had a burning, searing pain first in the injured hand and then in her other, non-injured hand. Thereafter she developed symptoms all over her body including both her lower extremities. The pain and spasms are so bad that both her feet contract inward during an episode making it extremely difficult for her to walk. She certainly can no longer do her job as a certified nurse’s assistant.

The Disability Lawyers with the  San Diego Disability Law Group analyze each case according to the sequential evaluation process applied to all initial Social Security insurance claims and all adult SSI claims i.e. 1) Is the claimant presently engaged in substantial gainful activity; 2) Does the claimant have a severe impairment; 3) Does the impairment meet or equal a listed impairment; 4) Does the impairment prevent the claimant from performing past relevant work and 5) Does the impairment prevent the performance of other work considering the claimant’s age, education and prior work experience.

The Social Security  Administration publishes a Listing of Impairments with medical evidence requirements which, if met, are conclusive of social security disability. Sometimes, however, a severe condition like RSD is not listed in the Listing of Impairments but is addressed in a Social Security Policy Interpretation Ruling.  In preparing this case,  the Disability Lawyers at the San Diego Disability  Law Group referenced SSR 03-02P ” EVALUATING REFLEX SYMPATHETIC DYSTROPHY SYNDROME/COMPLEX REGIONAL PAIN SYNDROME”.

SSR 03-02P acknowledges that RSD/CRPS is a chronic pain syndrome most often resulting from trauma to a single extremity and that patients typically report persistent, burning, aching or searing pain that is initially localized to the site of the injury. The degree of pain is often out of proportion to the severity of the precipitating injury and cases have been reported to progress and spread to other limbs, or to remote parts of the body (Like in our case).

The Social Security Act defines “disability” as the inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months. The act also requires that the impairment result from anatomical, physiological, or psychological abnormalities that can be shown by medically acceptable clinical and laboratory diagnostic techniques.

SSR 03-02P states that, for purposes of Social Security disability evaluation, RSD/CRPS can be established in the presence of persistent complaints of pain that are typically out of proportion to the severity of any documented precipitant and one or more of the following clinically documented signs in the affected region at any time following the documented precipitant: 1) Swelling; 2) Autonomic instability i.e. changes in skin color or texture, changes in sweating(decreased or excessive sweating); 3) changes is skin temperature; 4)Abnormal hair or nail growth;  5) Osteoporosis; or 6) involuntary movements of the affected region of the initial injury.

The Disability Attorneys with the San Diego Disability  Law Group know that it is important in RSD/CRPS cases to present longitudinal treatment records that document the above-referenced criteria in order to make the strongest case possible for RSD/CRPS claimants.

As a claimant with  RSD/CRPS it is extremely important for you to continually tell you treating doctors about your symptoms and the effect that your symptoms have on your activities of daily living and your ability to function. Develop a longitudinal medical record that clearly documents your RSD/CRPS symptoms. Documenting your symptoms will enable your Disability Lawyer to present the best claim possible.

If you or any friend or family member has a Social Security Disability claim or question, contact the Disability Attorneys at the San Diego Disability Law Group for a free consultation, or call us at 619-338-9000.

All is not necessarily lost if you don’t get your Social Security Disability appeal filed on time. The Social Security Administration (SSA) regulations recognize several excuses as “good cause” for missing the appeal deadline. An experienced San Diego Social Security attorney can help you establish good cause, or, even better, help you meet the time requirement in the first place.

Procedure for Raising Excuse

The first thing you need to do with a late disability appeal is getting it filed. If it has clearly missed the deadline, you’ll need to include a detailed letter telling the SSA exactly why you are filing late.

If the SSA finds that your explanation amounts to “good cause,” it extends the deadline, magically making your late disability appeal a timely appeal.

Who Determines “Good Cause”

The SSA’s lengthy Program Operations Manual System gives the authority to decide if there is “good cause” to the “individual from the component that has the authority to adjudicate the appeal being filed.” In practical terms, this means that the official who determines good cause depends on which filing is late:

• If the Request for Hearing is late an administrative law judge (ALJ) determines good cause
• If the Request for Review of Hearing Decision is late, the Appeals Council determines good cause
• If the deadline to file in federal court was missed, the Appeals Council again determines good cause

What Excuses Amount to “Good Cause”

There are SSA regulations describing, at general level, what amount to “good cause”:

• The specific circumstances which led to the untimely filing
• Whether the claimant was misled by any action of the SSA
• Whether the claimant understood the time requirement

A more specific regulation provides that SSA will consider whether the claimant had any physical, mental, educational, or linguistic limitations—including any lack of facility with the English language–which prevented a timely filing, or which prevented the claimant from understanding or knowing about the need to file a timely request for review.

SSA has issued a Ruling on the lack of mental capacity, which states that tardiness will be excused when claimants lack the capacity to understand the procedures for requesting review, and had no one legally responsible for prosecuting the claim, such as “a parent of a claimant who is a minor, legal guardian, attorney, or other legal representative.” In applying this standard of mental incapacity, it doesn’t matter how much time has passed since the decision the claimant wants to appeal.

Reasonable doubt about the claimant’s capacity is resolved in favor of the claimant.

Get Social Security Disability Help

Establishing good cause is something best left to an experienced disability attorney in San Diego. Get the help you need to protect your right to benefits; if you need a lawyer for ssi appeals, call George Heppner and Aline Gaba at (619) 338-9000.

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