Social Security Disability for Carpal Tunnel Syndrome

Carpal tunnel syndrome happens when swelling in your wrist puts pressure on the median nerve, which carries signals between your brain and the muscles in your hand. Repetitive motions of the hands and wrist, such as typing, are the most common causes of carpal tunnel syndrome—a form of repetitive stress injury. Injuries to the wrist or chronic diseases like arthritis or lupus can also result in carpal tunnel syndrome.

Is Carpal Tunnel Syndrome a Disability?

Carpal tunnel syndrome can be disabling when your symptoms are severe enough to keep you from working full-time. Examples of symptoms that can interfere with your ability to work include:

• weakness in your hand
• numbness or tingling in your thumb, fingers, and palms
• stiffness in your fingers
• difficulty gripping or carrying objects, and
• pain in your arm, wrist, and hand.

Treatment for carpal tunnel syndrome can involve the following:

• wearing a splint on the affected wrist
• ergonomics (making changes to your work environment to reduce symptoms)
• anti-inflammatory medication (such as NSAIDs) and pain relievers
• steroid injections, and
• carpal tunnel release surgery.

People with mild carpal tunnel syndrome may be able to successfully control their symptoms with simple measures, such as adjusting their desks or exercising their hands. But if you haven't had success with conservative therapies, your doctor may recommend more invasive methods, like surgery. If your symptoms continue despite more intense treatment, you might qualify for Social Security disability benefits.

Getting Disability Benefits for Carpal Tunnel Syndrome

The Social Security Administration (SSA) can award disability benefits to people who have severe medical impairments that prevent them from earning income at the level of "substantial gainful activity" for at least twelve months.

In order to decide whether you're capable of working, the SSA reviews your medical evidence and your functional limitations to determine your residual functional capacity (RFC). Your RFC is a set of restrictions on the type of job tasks you're able to perform. If your medical evidence (such as doctors' notes or test results) supports severe restrictions in your RFC that rule out all types of jobs, the SSA will find you disabled.

Medical Evidence Needed to Document Carpal Tunnel Syndrome

Your medical records are the foundation of your disability application ("claim"). Ideally, your medical records will include a diagnosis of carpal tunnel syndrome based on specific physical findings, symptoms characteristic of the disorder, and abnormal test results. Social Security will be on the lookout for evidence of carpal tunnel symptoms from the following medical tests:

• Thumb weakness diagnostics measure the strength of your thumb by testing 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 numbness 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 testing applies pressure over the carpal tunnel to check for tingling or shock.
• Tourniquet testing applies an inflatable cuff over the carpal tunnel to check for tingling or shock.
• Nerve conduction studies measure 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.
• Grip strength and dexterity testing provides evidence of any weakness in your hands and fingers when picking up and holding objects.
• Electromyography involves placing an electric wire on the muscle to record the electrical activity of that muscle.

Doctors sometimes use medical imaging, such as ultrasounds and MRIs, to diagnose carpal tunnel syndrome. But these methods aren't generally accepted for a proper diagnosis in the medical community, so the SSA won't value them as highly when determining whether you have carpal tunnel.

Keep in mind that just having a diagnosis of carpal tunnel—while helpful—isn't enough on its own for Social Security to determine that you're disabled. You also have to prove that you're unable to work due to limitations from your symptoms.

Showing That You Can't Work Due to Carpal Tunnel Syndrome

Your RFC is a reflection of the most you're able to do in a work environment. Social Security doesn't expect you to do any jobs that don't fit within your RFC, so the agency will compare the limitations in your current RFC with the demands of your past work to see if you could do those jobs now. If you can't return to your old jobs, the SSA will then need to determine whether other jobs exist that you could perform.

What's In Your RFC? Disability claimants (applicants) with carpal tunnel syndrome will almost always have non-exertional (not strength-related) manipulative limitations in their RFC. Manipulative limitations place restrictions on how long you can use your fingers and hands.

In your RFC, the amount of time you can use your hands will be broken into five categories:

• Never means not even once during an 8-hour workday.
• Rarely means only 1-5% of the workday.
• Occasionally means up to one-third (33%) of the workday.
• Frequently means between one- and two-thirds (up to 66%) of the workday.
• Constantly means more than two-thirds (over 66%) of the workday.

The more severe your carpal tunnel symptoms are, the less you'll be able to manipulate objects during the day. If you're able to manage your symptoms with a quick rest break every hour, you might have an RFC that limits your activity to frequent (but not constant) manipulation. But if you aren't able to type for longer than 10 minutes without pain, your RFC might limit you to only occasional manipulation.

How Does Social Security Use Your RFC? The SSA doesn't expect you to do any jobs that cause you undue pain or stress, so the agency will compare the limitations—both non-exertional and exertional—in your current RFC with the demands of your past work to see if you could do those jobs now.

If you can't return to your old jobs, the SSA then needs to determine whether other work exists that you could perform. If you're under the age of 50, you'll need to be unable to perform the easiest sit-down jobs to be found disabled. If you're over the age of 50, you might be able to qualify for disability even if you can do easier jobs, as long as you've never done that type of work before (and can't learn).

Because very few, if any, jobs exist that don't require you to use your hands, make sure that you diligently document any trouble you have with your motor skills. Examples of common work tasks that can be difficult for somebody with carpal tunnel syndrome include:

• typing
• using a telephone
• operating a cash register
• filing
• picking up and moving small objects, and
• using handheld tools.

You can let Social Security know what tasks—such as chores and hobbies—you struggle to perform in your activities of daily living (ADL) questionnaire. Be detailed when you fill out the form. For example, saying "My hands hurt" doesn't give the agency much information about how long you can use your hands. But saying "I need help tying my shoes and buttoning my shirts" paints a clearer picture of your limitations.

What to Do If You're Denied Benefits for Carpal Tunnel Syndrome

Few disability applicants are awarded benefits after their initial application for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI). If you're denied, you'll need to submit an appeal ("reconsideration") of your application before you can request a hearing with an administrative law judge (ALJ).

Most people who are awarded disability don't get approved until after a hearing with a judge. At that stage, you may want to consider getting an experienced disability attorney who can help you prepare for the hearing and increase your chances of a favorable decision.

Information for Impairments Related to Carpal Tunnel

If you don't have a diagnosis of carpal tunnel syndrome but have trouble using your hands and fingers, you might have symptoms of another related disorder that's disabling. Examples of diseases that can cause difficulties with motor skills include:

• soft tissue injury
• diabetes
• arthritis
• lupus
• scleroderma, and
• kidney failure.

Even disability claimants who do have a diagnosis of carpal tunnel syndrome are rarely getting treated for that condition only. Social Security has to consider the combined effects of your impairments when assessing your RFC, so let the SSA know if you have additional medical impairments that you think interfere with your ability to work.

_{Updated June 23, 2023}