Persons suffering from Reflex Sympathetic Dystrophy Syndrome (Rsds) or involved Regional Pain Syndrome ("Rsds" will be used for both in this discussion) who are seeking group security Disability benefits received assistance with the issuance of a group security Ruling on October 20, 2003. This Ruling, entitled: "Title Ii and Xvi: Evaluating Cases challenging Reflex Sympathetic Dystrophy Syndrome/Complex Regional Pain Syndrome" outlines binding criteria for both proving the disease, and determining its impact on function, in group security disability claims. This Ruling will also impact on claims evaluated by the Veterans' management and the railroad withdrawal Board.
The group security Act is defined by formal Regulations. The Regulations are supplemented by the group security Administration's Rulings. These Rulings are binding on all decision makers in the disability process and are given principal weight by federal court judges. Ruling 03-2p significantly clears up issues relating to the proof of Rsds claims.
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Background
The group security Act requires Claimants to provide healing proof of the inability to accomplish any great gainful operation because of a medically determinable impairment that has lasted at least 12 months, or is thinkable, to last 12 months, or succeed in death.
Basically this means that Claimant must:
1. Prove the existence of healing impairments;
2. Prove that those problems produce severe symptoms;
3. And, prove that, considering age, education, work history and remaining quality to function, those symptoms make it is impossible to "do" any type of work activity, for a duration of at least twelve months.
The Regulations place strong emphasis on the use of "objective healing evidence", i.e. Test results, clinical findings, data that can not be "faked". Rsds claims have always been problematic because of the mystery in proving the existence of the disease, and then in proving the severity of the symptoms. Since there is no test which is determinative for Rsds, and the pain complaints also can not be proven, these cases have been difficult to prove. Most records for Rsds patients focus on "subjective symptoms" such as "I hurt" and this type of evidence is given much less weight as it can not be scientifically proven.
Social security Ruling 003-2P
The Ruling provides guidelines for decision makers for both determining the existence of the impairment and for determining its impact on function.
A. Does a medically determinable impairment exist?
The Ruling notes that Rsds is a chronic pain syndrome usually resulting from trauma to an extremity. As in any group security claim, the diagnosis starts with the findings contained in the treating healing records. For diagnostic purposes (proving the existence of the healing impairment) the Ruling requires the presence of complaints of "persistent, intense pain that results in impaired mobility of the affected region." These complaints must be related with clinical findings of:
• swelling;
• autonomic instability (changes in skin color, changes in sweating, skin temperature change, gooseflesh);
• abnormal hair or nail growth
• osteoporosis
• involuntary movements of the affected region of the introductory injury.
These types of findings must be in the records of the treating specialist. The focus will be on the 12-month duration prior to the date of application, depending on the facts of the claim.
The Ruling does note that this is a progressive disorder, and that symptoms do wax and wane. The focus is on "longitudinal medicine records" documenting persistent limiting pain over a sustained duration of time. The other clinical findings may be transient. The Ruling also notes that there may be conflicting diagnoses.
A very key feature of the Ruling is its re-emphasis on the "treating physician rule." This plan provides that the findings and opinions of the treating master are entitled to deference, and possibly controlling weight, if they are supported and consistent with the clinical record. This again emphasizes the point of consistent healing care with the accepted specialists.
B. How is the severity of the health evaluated?
The Ruling provides guidelines for evaluating the severity of the pain in an Rsds claim. Again the focus is on the treating physician's healing records. The Ruling notes that symptoms will vary - sometimes stable, sometimes better, sometimes worse. A longitudinal view of the records is foremost given the nature of the disease.
Decision makers are instructed to look at the nature of type of medications prescribed, the impact on concentration and concentration, cognition, mood and behavior. Depression and anxiety may be present and disabling and need to be considered. There may be findings of reduced motor reaction times. Facts about the response to medicine is foremost in determining whether the health will be disabling for the required 12 month period.
The Ruling notes that other symptoms related with Rsds may impact on the quality to work such as greatest sensitivity to touch or pressure and abnormal reactions to hot and cold.
As with any case based on symptoms focused upon symptoms - such as pain or fatigue - the claim often boils down to the credibility of the Claimant. Careful making ready of the Daily Activities forms, making ready for consultative examinations and Careful spin of the issues prior to any testimony at an Alj hearing, can make a principal contrast in the outcome.
The Ruling notes that the individual's statements, the treating physician's records and opinions, and the statements of knowledgeable third parties are all to be used in determining credibility. Noted third party sources comprise neighbors, friends, relatives, clergy, past employers, teachers, nurse-practitioners, group workers, therapists, chiropractors and others with knowledge of the individual's quality to function in daily activities.
Conclusion
Social security Ruling 03-2p is a principal statement for persons suffering from Rsds. It provides concrete, and fairly liberal, guidelines for Claimants and their representatives to use when proving the existence and severity of Rsds on the quality to maintain work activity. This should lead to more approvals for people suffering from this debilitating impairment.
Ruling for Reflex Sympathetic Dystrophy Syndrome Claims
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