Social Security Disability for Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) occurs when there is pressure on a nerve in the wrist caused by swelling. The nerve affected is the median nerve, which provides feeling to parts of the hand. Repetitive motions of the hands and wrist are the most common cause of carpal tunnel syndrome (a form of repetitive stress injury, or RSI), with typing being one of the most common causes. Other causes of carpal tunnel syndrome can include injuries to the wrist or diseases like arthritis or lupus.

Disabling Symptoms of Carpal Tunnel Syndrome

The symptoms of carpal tunnel syndrome include weakness in the hand, numbness, or tingling in the thumb, the next two fingers and the palms, difficulty moving your fingers, difficulty gripping or carrying items, and pain in the arm, wrist, and hand.

Treatment for carpal tunnel syndrome can include wearing a splint on the affected wrist, making changes to your work environment to alleviate symptoms, and taking medication. Surgery to cut the ligament that is pushing on the nerve can be performed if other treatments don't work. While treatment and/or surgery usually alleviates the symptoms, you may be left with permanent weakness, numbness, and tingling. In addition, surgery may not improve carpal tunnel symptoms when the CTS is caused by a disease like rheumatoid arthritis.

Getting Disability Benefits for Carpal Tunnel Syndrome

In order to receive Social Security Disability benefits, you must show that you meet the criteria in one of Social Security's impairment listings (from the agency's "blue book"), that your symptoms are substantially "equal" to the criteria in one of the impairment listings, or that you are unable to work any job due to your limitations.

Unfortunately, Social Security claims examiners do not generally find that the symptoms of carpal tunnel syndrome rise to the level of disability. However, quite a few disability applicants have been successful in winning disability benefits on appeal by one of the following methods.

Meeting or Equaling an Impairment Listing

There is no impairment listing for carpal tunnel syndrome, but if there is nerve damage, your condition might be considered peripheral neuropathy. However, the requirements of the listing for peripheral neuropathy are very difficult to meet, particularly for someone with carpal tunnel syndrome. For more information, see our article on disability for peripheral neuropathy. When the ligaments involved in carpal tunnel cause you to lose functional use of your wrists and hands, your condition might be considered under the soft tissue injury listing.

Alternatively, carpal tunnel can be a symptom of disease that has an impairment listing. Examples of possible listed impairment that could cause, or are related to, carpal tunnel include:

• diabetes
• arthritis
• lupus
• scleroderma, and
• kidney failure.

If you have any of these possibly related conditions, visit the above links to learn how you can qualify for disability benefits based on the impairment listings for these conditions.

Medical Evidence

The diagnosis of carpal tunnel syndrome can be challenging. Diagnosing CTS involves three elements: showing signs of classic symptoms, specific physical findings, and abnormal electrodiagnostic test results, such as electromyography. There are several test results that can make the diagnosis of CTS more likely. These tests include:

• Thumb weakness test measures the strength of your thumb by measuring your ability to raise your thumb towards the sky when it is flat on a table and to touch your thumb to your pinky finger.
• Phalen's test checks for symptoms when your hands are dangled off of a table with the back of your hands touching one another and your fingers pointing towards the ground.
• Tinel's sign occurs when the median nerve is tapped to check for tingling or shock upon contact.
• Pressure provocation test applies pressure over the carpal tunnel to check for tingling or shock.
• Tourniquet test applies an inflatable cuff over the carpal tunnel to check for tingling or shock.
• Nerve conduction study measures how quickly signals travel through the nerves that control movement and sensation in your wrist and hand by sending electrical pulses through your wrist and hand.
• Electromyography places an electric wire on the muscle to record electrical activity of that muscle.

Imaging, including ultrasounds and MRIs, have also been used for diagnosis of CTS. However, they are not generally accepted in the medical community for diagnosis and therefore would likely be given less importance by Social Security in determining if you have CTS.

While a diagnosis of CTS is helpful, a diagnosis alone is not enough to be determined disabled. You must prove that you are unable to work. Tests such as grip strength and dexterity tests will be useful in showing a decrease in your abilities to effectively use your hands and finger.

Inability to Work Due to Limitations

If your carpal tunnel syndrome is severe enough, you may be able to receive disability benefits by showing that you are unable to return to any work. The Residual Functional Capacity (RFC) assessment is the tool used by Social Security to assess your physical and mental abilities with regards to performing a job.

Carpal tunnel syndrome generally affects your physical abilities, although the pain involved in carpal tunnel syndrome can also affect your mental abilities, such as your ability to concentrate. (For information on self-reports of pain as medical evidence, see our article on how Social Security evaluates pain symptoms.)

Physical exertion and limitations. Social Security will look at the level of physical exertion you are able to perform (such as light work or sedentary work) and assess your ability to work based on jobs in that category. In assessing the physical ability of your arms, Social Security looks at your ability to lift, carry, and grip items and perform fine manipulation with your fingers. For those with carpal tunnel syndrome, difficulty with fine motor skills, which includes all tasks that are completed using your fingers (such as typing, using a telephone, operating a cash register or surveillance monitor, filing, or picking up and moving small objects) makes performing a job that requires these tasks nearly impossible. In addition, weakness in your hands may make gripping and carrying items difficult, which prevents you from being able to perform jobs where you are required to use handheld tools to complete a task or pick up items using your hands.

Medical-vocational allowance. Social Security acknowledges that the loss of fine motor skills can narrow significantly the work that can be done by those who can only do sedentary or light work. If your carpal tunnel syndrome is severe enough that the use of your hands become very limited, and Social Security finds your diagnosis of CTS and functional limitations credible, it is possible that the agency might agree there are no jobs you can perform because you can do "less than sedentary" work. This could result in your being granted benefits through a medical-vocational allowance.

Example of a successful disability claim for CTS. A woman who had CTS in both hands and had previously done secretarial work was determined unable to work based on her CTS. Despite having CTS surgery, the woman continued to have severe limitations. She had problems with decreased grip strength and swelling and pain in her hands, wrists, and arms. She could no longer perform activities she did before her CTS, such as typing, filing, cooking, baking, sewing, or even basic housework. Another important factor in her determination of disability was an order from her doctor that she not perform even light work if it included any type of repetitive use of her either one or both of her hands. On appeal, the judge determined that she could not do any work and was thus disabled.

Likelihood of need to appeal. Of course, it's unlikely you'll be granted benefits for CTS during the initial application process. Chances are that you'll need to get a hearing in front of an ALJ and hope the ALJ gives you an RFC that includes all of your limitations and that the vocational expert agrees there are no jobs you can do with that RFC.

If not, you may need to appeal to the Appeals Council or federal court before you can get a judge to recognize that your carpal tunnel syndrome makes it impossible for you to work any jobs. With a still-controversial diagnosis like carpal tunnel syndrome, an experienced disability attorney can greatly improve your chances of winning at a hearing.