Complex Regional Pain Syndrome (CRPS) is a chronic, severe pain condition that usually affects a limb, often following an injury, surgery, stroke, or heart attack. The pain experienced is often disproportionate to the severity of the initial trauma. Symptoms, which include intense burning pain, swelling, and extreme sensitivity to touch, significantly impact a person’s ability to perform daily activities and work. The direct answer is yes; the Social Security Administration (SSA) officially recognizes CRPS as a medically determinable impairment acknowledged as severe enough to prevent Substantial Gainful Activity (SGA) for at least 12 months, which is the core definition of disability used by the SSA.
Recognition of Complex Regional Pain Syndrome as an Impairment
The Social Security Administration formally recognizes CRPS as a condition that can result in disability, though it lacks a dedicated listing in the SSA’s Listing of Impairments. The SSA evaluates CRPS claims under its previous name, Reflex Sympathetic Dystrophy (RSD), and has specific internal rulings on how to assess the impairment. These rulings outline that CRPS is a medically determinable impairment requiring documented evidence of chronic pain and at least one clinically observed sign in the affected region.
The signs that help establish CRPS include swelling, changes in skin color or temperature, or involuntary movements in the affected area. The SSA acknowledges that these abnormal signs may not be present continuously, which is characteristic of CRPS, but documentation at any point after the injury is necessary. This allows the condition to be the basis of a disability claim, even if it does not meet the strict criteria of a Blue Book listing. Claimants must also meet the SSA’s durational requirement, meaning the condition has lasted or is expected to last for 12 months or more.
Functional Criteria for Disability Qualification
A diagnosis of CRPS alone is not sufficient to qualify for disability benefits; the focus shifts to the functional limitations imposed by the condition. The SSA evaluates how the physical and mental symptoms prevent an individual from engaging in Substantial Gainful Activity (SGA). Applicants must provide objective medical evidence that documents the severity of their symptoms and the resulting restrictions on movement and daily tasks.
Objective documentation may include:
- Restricted range of motion
- Muscle atrophy
- Joint stiffness
- Changes in skin texture
- Sensory abnormalities like allodynia or hyperalgesia
The treating physician plays a central role by documenting these findings and detailing how the pain and physical changes limit the patient’s ability to sit, stand, walk, lift, and perform fine motor tasks. This analysis of a person’s remaining capabilities is formalized in a Residual Functional Capacity (RFC) assessment.
The RFC assessment states what the claimant can still do despite the impairment and is a factor when a condition does not meet a Blue Book listing. The SSA uses this assessment to determine if the individual can return to their past work or adjust to any other type of work available in the national economy.
The psychological manifestations that often accompany CRPS, such as depression, anxiety, and cognitive issues, must also be documented and are evaluated under the mental disorders listings. Comprehensive medical records, including imaging results and treatment history, must clearly connect the physical and mental limitations to the inability to work.
The Social Security Disability Application Process
The process of applying for benefits begins with the initial application for either Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI). SSDI benefits are for those with a sufficient work history who have paid Social Security taxes, while SSI is a needs-based program for individuals with limited income and resources. Applicants must submit extensive documentation, including detailed work history, contact information for all treating medical providers, and a complete set of medical records dating back to the onset of the condition.
The SSA uses a five-step sequential evaluation process to determine eligibility, and the initial application is often denied for the majority of claimants. If the initial claim is denied, the applicant must file an appeal, which involves reconsideration followed by a hearing before an Administrative Law Judge (ALJ). Successfully navigating this process requires providing consistent, long-term medical evidence that clearly demonstrates the severity of the CRPS and its functional impact. Applicants can choose to apply online, by phone, or in person at a local SSA office, and a well-prepared application that highlights the specific limitations is essential for a favorable outcome.
Continuing Disability Reviews and Benefit Maintenance
Once disability benefits are approved, the Social Security Administration conducts Continuing Disability Reviews (CDRs) to confirm that the recipient still meets the definition of disability. The frequency of these reviews depends on the likelihood of medical improvement; for CRPS, which can sometimes improve or go into remission, the review schedule can vary. Recipients must comply with all requests for updated medical evidence during a CDR to maintain their benefits.
It is mandatory to report any significant changes in the medical condition or any attempt to return to work. Returning to work, even on a trial basis, can impact benefit eligibility, as the SSA has rules regarding earned income and a trial work period. Failure to cooperate with a CDR or to report changes in income or medical status can lead to the termination of benefits. Maintaining continuous medical treatment and documentation is necessary even after the initial approval of the claim.