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Can I Get Disability Benefits For Complex Regional Pain Syndrome RSD?

CaveyLaw.com > Practice Areas  > Long Term Disability & ERISA Lawyer  > Long Term Disability Disabling Conditions > Can I Get Disability Benefits For Complex Regional Pain Syndrome RSD?

Disability insurance companies don’t always make it easy for policyholders who have complex regional pain syndrome (RSD) to get the disability benefits they deserve. In fact, be prepared for a fight because disability carriers hate RSD claims. Pain is subjective. There is no way to prove your claim of pain.

What Is RSD And What Causes RSD?

RSD is poorly understood. Thought to result from a dysfunction of the central or peripheral nervous system, it can affect one or more extremity.

It is characterized by a group of symptoms, including a burning type of pain, tenderness, and swelling of the affected extremity. There are varying degrees of sweating, warmth and/or coolness, flushing, discoloration and shiny skin.

RSD is also known as complex regional pain syndrome, the shoulder-hand syndrome, causalgia, or Sudeck’s atrophy.

RSD can be triggered by:

  • Injury,
  • Surgery,
  • Heart disease,
  • Degenerative arthritis of the neck,
  • Stroke,
  • Nerve irritation or entrapment,
  • Shingles,
  • Shoulder problems, and
  • Breast cancer.

In 1 in 3 RSD cases there is no known cause.

Unfortunately, there is no gold standard test to diagnose RSD. Your physician has to document your subjective complaints and the objective findings on examination. You also may undergo a thermogram, EMG/NCV testing and a nuclear bone scan.

Reasons Why Disability Carriers Deny RSD Claims

Many RSD and chronic pain syndrome claims are denied because the disability insurance company says:

(1) There is no objective basis of the RSD or chronic pain syndrome,

(2) There is no objective basis for the restrictions and limitations assigned by your physician,

(3) There is no causal relationship between your RSD or pain syndrome and/or your restrictions and limitations, and your inability to do your own or any occupation.

(4) There is no reason you can’t work in a sedentary capacity.

Nancy Cavey, who has 35 years experience handling disability cases, has successfully represented many policyholders with RSD syndrome. She overcomes the claims denial by working closely with you and your physician.

If you are ready to file a disability application and want to improve your chances of getting disability benefits, or if your claim for RSD disability benefits has been denied, it is time to call Nancy Cavey. She offers a free initial consultation and welcomes the opportunity to speak with you about your disability claim.

What Are The Stages and Symptoms of RSD?

There is no pattern to the onset of RSD; you may not have all the symptoms. However, half of those with RSD have symptoms on both sides of the body. The stages and symptoms include:

  1. Acute

The acute stage lasts three to six months. Treatment during this period is crucial to relieve and prevent the spread of symptoms, which can include burning, blanching of the skin, sweating, swelling, pain and tenderness. X-rays may show some bone thinning.

  1. Dystrophic

The second stage lasts three to six months. There is shiny, thickened skin, contracture and pain.

  1. Atrophic

The last stage involves loss of motion and function of the involved extremity with contracture.

The prognosis and response to treatment are unpredictable.

How Disability Carriers Evaluate RSD Claims

Many disability carriers have position papers that dispute the existence of RSD and pain syndromes, discount pain as being in your head and reject any notion of disability.

Pain is subjective. Disability carriers want overwhelming proof of the underlying medical condition that causes your pain, and overwhelming proof of disability. It is important that your medical records document all symptoms and response to treatment.

It is not uncommon for those with RSD to have depression; some carriers will evaluate the claim from a psychiatric standpoint, not from the RSD.

That is why it is crucial that you have an attorney who understands RSD and knows how to gather the necessary medical and vocational evidence required to approve a claim.

Many carriers ultimately will acknowledge your pain but contend it is not disabling. A Functional Capacity Evaluation may provide objective evidence of how pain affects your ability to work, from both a physical and cognitive basis.

How Do I Get The Disability Insurance Benefits I Deserve?

RSD and chronic pain syndromes can make it difficult, if not impossible, to do things around your home and work.

If you no longer can work or your doctor has told you to apply for disability benefits, you should take steps before you apply:

  1. Obtain a copy of your disability policy. See how it defines “disability,” “occupation” and “self-reported conditions.” You’ll need to understand what you have to prove to get your benefits because of RSD and chronic pain syndromes.

Your policy can include a self-reported limitation. It limits how long you can get benefits that result from self-reported symptoms, including pain, loss of memory or fatigue. You’ll want to know what’s in your policy before you apply for benefits.

  1. Obtain a copy of your disability policy and see how it defines a mental/nervous condition; it is not uncommon for carriers to characterize your RSD as a mental condition. The carrier will attempt to limit your benefits to just two years.
  1. Obtain a copy of your medical records. Review them to see if there is an objective basis for your diagnosis, what your records say about your report of symptoms and your restrictions and limitations. It is crucial you have testing to document the basis of the diagnosis, even if the results are negative.
  1. Get treatment from a pain specialist who will follow established criteria for diagnosing your chronic pain. The treatment can include physical therapy, sympathetic nerve blocks, spinal cord stimulation and intrathecal drug pumps.
  2. Obtain a copy of your personnel file to see if your chronic pain or pain syndrome has affected your work performance.
  1. Obtain a copy of your job description. Create your own description of your physical duties with an explanation of how your symptoms impact your ability to do your occupation.
  1. Provide your doctor with the occupational description. Ask your doctor to prepare a report that explains the objective basis for your diagnosis, the objective basis of your restrictions and limitations, and the objective reasons you can’t perform some or all of the material and substantial duties of your occupation.
  1. Prepare a diary that explains and gives examples of how your symptoms interfere with your ability to do things on a daily basis and the side effects of your medication.
  1. Take pictures of the affected extremity or extremities.
  1. Prepare your statement and explain how your pain has affected your life. Make sure any statement is consistent with your medical records and your Functional Capacity Evaluation.
  1. Prepare the statement of your family members, friends and co-workers that supports your complaints of pain and how the pain has impacted your ability to function at home and at work.
  1. Hire Nancy Cavey to help you file your initial application. The application process is confusing and designed so you and your physician make mistakes that can result in a delay or even a denial of your benefits. Ms. Cavey knows how to prepare and file a winning shock and awe disability application that leaves the carrier little reason to question your claim.
  1. Hire Nancy Cavey to help you appeal a wrongful denial or termination of your disability benefits. Disability carriers are in the business of collecting premiums and not paying disability benefits for RSD or chronic pain syndromes. They’ll use any reason to deny your claim. The odds of getting your benefits on appeal are greater when you are represented by an experienced ERISA/private ID policy disability attorney.

Contact Disability Attorney Nancy L. Cavey, Who Can Help You Regardless of Where You Live

RSD can make it difficult, if not impossible, to work. You owe it to yourself and your family to get help today! Nancy Cavey can review your policy and your medical records, and explain to you what your policy says and how to get your disability benefits.  Call today for a free consultation at 727-894-3188.