Complex Regional Pain Syndrome (CRPS) and Social Security Disability

Complex regional pain syndrome (CRPS) is a medical condition involving chronic pain and inflammation, usually following an injury to bone, soft tissue, or nerves. But you can also develop CRPS without a known injury. In these rare cases, doctors suspect the cause might be related to an internal nerve injury and an inappropriate immune response.

CRPS generally causes pain that's out of proportion to the prior injury. For example, someone with CRPS might experience significant pain after a light touch to the affected area.

CRPS is most common in young adults (between 20 and 35) and it's more common in women than in men. There's no cure for CRPS, and the symptoms can be complex and severe enough to affect your daily activities, including your ability to work.

Is Complex Regional Pain Syndrome a Disability?

CRPS (sometimes called reflex sympathetic dystrophy, or RSD), usually improves over time and often goes away eventually. But in rare instances, severe cases can be disabling.

A diagnosis of CRPS alone isn't enough for the Social Security Administration (SSA) to consider you disabled. But your CRPS can meet Social Security's definition of a disability if:

• you're experiencing moderate to severe limitations that prevent you from working
• your condition has lasted a year or more, and
• you have ample medical records detailing your impairments.

What Are the Symptoms of Complex Regional Pain Syndrome?

CRPS usually presents as spontaneous pain in the wrist/hand, arm, foot/ankle, or leg, but it can occur anywhere in the body. With CRPS, the damaged nerves trigger inflammation and are unable to regulate blood flow properly, which can cause you to develop problems with blood vessels, joints, muscles, and even your skin. CRPS symptoms vary from person to person and change over time. Common symptoms include:

• continuous burning or throbbing sensations, usually in your arm, leg, hand, or foot
• sensitivity to touch or cold
• swelling in the painful area
• changes in skin temperature, color, and texture
• changes in hair and nail growth (either too fast or slow)
• joint inflammation and stiffness due to reduced movement
• muscle spasms, tremors, weakness, and
• decreased ability to move the affected body part.

If untreated, severe, chronic CRPS can be crippling. The symptoms can worsen, causing long-term and sometimes permanent physical and psychological problems.

What Causes Complex Regional Pain Syndrome?

Most CRPS is caused by nerve damage or dysfunction of the nervous system that sends signals from the brain and spinal cord to other parts of the body (called the peripheral nervous system).

The exact cause of CRPS is unknown, but in most cases, CRPS happens after an injury to a limb that damages the thinnest sensory nerve fibers. These nerves transmit pain, itch, and temperature sensations and control the small blood vessels of the surrounding areas. Common injuries leading to nerve damage and CRPS include:

• fractures
• surgery or scarring
• joint sprains/strains
• burns or cuts, and
• wearing a cast.

CRPS Type 1 vs. Type 2

There are two types of CRPS. Type 1 used to be known as reflex sympathetic dystrophy (RSD) syndrome, and type 2 used to be known as causalgia. Both types of CRPS can cause lingering and severe symptoms. The difference between type 1 and type 2 is whether there's nerve damage.

Type 1 CRPS

Type 1 is the most common form of CRPS and happens after an illness or injury that didn't directly damage the nerves in the affected area. With CRPS type 1, doctors can't pinpoint which nerve specifically was damaged. CRPS1 is generally the result of trauma or surgery.

With CRPS1, your pain might radiate throughout your body. For example, CRPS pain from your finger can radiate throughout your arm or even to your opposite arm or internal organs rather than staying just in your finger.

Type 2 CRPS

CRPS type 2 has the same symptoms as CRPS1 but occurs after a specific, distinct nerve injury. CRPS2 is generally caused by:

• burns
• an amputation, or
• a crushing injury.

With CRPS2, pain generally stays in the affected area, meaning that if you have a nerve injury in your leg, only your leg hurts, and the pain doesn't radiate to other areas of your body.

How Can I Prove Complex Regional Pain Syndrome Is Disabling?

Social Security will evaluate your disability claim based on medical evidence. Your doctor's diagnosis and clinical notes (post-appointment notes) can be very helpful in proving your CRPS is a disabling medical condition according to Social Security's definition of disabled.

Is CRPS a Medically Determinable Impairment?

First, to even consider you for disability, Social Security must find that your CRPS is a "medically determinable impairment," or MDI. (20 C.F.R § 404.1529(b).) That means you must have some kind of objective evidence that you suffer from CRPS.

Your doctor must have documented your subjective complaints of persistent, intense pain and specific physical findings. A 2003 Social Security ruling lists some examples of objective medical evidence of CRPS, including the following:

• swelling
• changes in skin color or texture
• increased or decreased sweating
• skin temperature changes or gooseflesh
• abnormal hair or nail growth
• documented osteoporosis, or
• involuntary movements of the affected region of the initial injury.

Because CRPS symptoms tend to come and go, Social Security recognizes that these symptoms don't need to be present at every medical examination. But at least one of the above symptoms needs to be present at some point since the date of the initial injury.

Do You Have Enough Medical Evidence to Prove Disability?

Your medical records should cover the months or years since you were first diagnosed with CRPS and show ongoing evaluation and treatment for your CRPS symptoms. If you have insufficient records, Social Security might ask your doctor to complete a questionnaire about your limitations or send you for an independent exam by one of their doctors (called a consultative exam, or CE).

Your medical records should also document the following:

• a description of the ongoing medical care you're receiving
• documentation of medications you've tried and your response to them
• whether your symptoms have remained stable, improved, or worsened over time, and
• a detailed description of how the impairment limits your ability to function.

Does Your CRPS Prevent You From Working?

If you suffer from CRPS, you probably won't meet the requirements of any impairments listed in the "Blue Book," a list of impairments that Social Security has found to be severe enough to automatically qualify as disabilities. For example, the Blue Book includes a listing for peripheral neuropathy, which shares some of the symptoms of CRPS.

But you can qualify for disability benefits without meeting a listing—if both of the following are true:

• your limitations make you unable to perform your previous jobs, and
• you're unable to transition into another type of work that's less demanding.

To decide whether or not you can work, Social Security will look at how your medical condition limits your ability to do many work-related activities. A claims examiner will assess your residual functional capacity (RFC)—the most intensive work you can still do (medium, light, or sedentary) despite the limitations your CRPS causes.

How Does the SSA Create Your RFC?

An RFC is based on the medical evidence in your file, including your doctor's opinion on your functional limitations and the consultative exam report (if you're sent for a CE). Social Security might also ask your friends, neighbors, and co-workers their opinions on how your pain affects your ability to do certain activities.

Ask your doctor to fill out an RFC form to provide details about how your CRPS affects your ability to work (in particular, to stand, walk, and lift). Your doctor should compare your capabilities before and after the onset of CRPS and explain your current restrictions.

For example, in an RFC form, your doctor might limit how many hours you can stand or walk daily or how much weight you can lift and carry due to your pain, stiffness, and weakness. Your doctor could even limit you to performing simple work tasks, due to difficulty concentrating that stems from persistent pain and medication side effects.

In determining your RFC, Social Security must also consider your statements about how pain prevents you from working, including the following:

• how intense your pain is
• how long the pain lasts, and
• how limiting your pain is.

Social Security will decide if your statements are consistent with your entire case record, and therefore are credible. (Learn more about how Social Security evaluates chronic pain.)

What's In Your RFC Assessment?

An RFC for a person with CRPS will include limitations imposed by diminished muscle strength or flexibility of the affected limbs. If you've lost significant use of one arm, you likely have difficulty with tasks like:

• pushing
• pulling
• lifting, and
• carrying even lightweight objects.

If you can't fully perform these activities, you probably can't do most secretarial, janitorial, or factory jobs.

Someone with advanced CRPS can develop soft bones, a complication called "osteomalacia." Osteomalacia increases the risk of a bone fracture from even the slightest injury. If you have osteomalacia, your RFC might state that you can't work anywhere there's the possibility of injury, such as jobs involving:

• carpentry
• welding
• automotive
• farming, or
• construction.

Social Security will also consider mental impairments that stem from your condition. For example, the chronic pain of CRPS frequently leads to anxiety or depression that can interfere with your ability to work.

If you receive treatment from a psychologist or psychiatrist, you should report this to Social Security. The SSA will then prepare a mental RFC that details your psychological limitations. And Social Security must consider the combined effects of your physical and mental limitations on your ability to work.

Let's say, for instance, that your chronic pain interferes with your ability to concentrate and makes it hard to complete tasks on time, and your depression or anxiety causes you to miss work frequently. These limitations, combined with the physical restrictions caused by your CRPS, could prevent you from doing any kind of full-time work.

What Does an RFC for CRPS Look Like?

An RFC for someone suffering from severe CRPS might be quite limiting. The physical RFC could include work restrictions like:

• walk and stand for no more than four hours of an eight-hour workday
• lift and carry no more than twenty pounds "occasionally" (defined as one-third of an eight-hour workday) and ten pounds "frequently" (defined as occurring from one-third to two-thirds of an eight-hour workday)
• only occasional movements like:
• stooping
• crouching
• crawling
• kneeling, or
• bending over.

The mental RFC might include a statement that you can "understand, remember, and apply simple instructions and tasks with adequate pace and persistence for one to two hours at a time for an eight-hour workday."

These limitations would likely prevent you from performing most jobs because you couldn't perform most of the requirements of even sit-down work.

Standard Requirements for Social Security Disability

There are a couple of requirements everyone must meet to be eligible for disability benefits for any impairment:

• You can't earn enough from work for Social Security to consider it "substantial gainful activity" (SGA). The SGA earnings limit changes each year, but for 2024, the limit is $1,550 per month.
• Your medical condition must keep you from working (or be expected to keep you from working) for at least 12 months.

In addition, to receive Social Security disability insurance (SSDI) benefits, you must have worked and paid Social Security taxes (FICA taxes) for long enough and recently enough to meet the SSA's work requirements. Learn more about the SSDI work requirements.

Supplemental Security Income (SSI) disability benefits are for people without a qualifying work history who meet Social Security's income and asset limits. Learn more about SSI eligibility.

How Do You Apply for Social Security Disability Benefits?

An easy way to apply for Social Security disability benefits is to file your claim online. You can also apply for benefits over the phone by contacting Social Security at 800-772-1213, but be prepared for long wait times. Or make an appointment to apply in person at your local Social Security office.

Learn more about applying for Social Security disability benefits.

_{Updated November 28, 2023}