You have been diagnosed with Complex Regional Pain Syndrome (CRPS.) You have missed a lot of work and your doctor tells you that your symptoms will get worse. At this point, you are concerned that you may not be able to go back to work. Do you qualify for Social Security disability?
Before we answer that question, let’s look at how the Social Security Administration decides whether or not someone is disabled. You may have heard someone talk about the “blue book” that contains a list of the various medical conditions that the SSA considers serious enough to be disabling. It is a common belief that if your illness or condition is on the list, you will automatically be considered disabled and entitled to benefits and if it is not on the list, then you will not qualify for disability. This belief is not totally accurate.
How Does the SSA Determine Disability?
It is true that there is a list of serious impairments or conditions that is referred to by the SSA disability decision makers. The list is an important tool that the adjudicators have available but their decision is not based on whether or not your condition or impairment is on the list. A determination that you are disabled can be made only after an adjudicator has conducted an evaluation of your condition and determined that you meet the SSA’s definition of disabled.
When you file an application for Social Security Disability, or SSDI, your file is assigned to a representative or adjudicator. This person examines the information included with your application. If necessary, additional information will be requested such as medical or employment records. Social Security disability adjudicators use a 5-step evaluation process to determine if you are disabled.
The first step of the process is to learn whether or not you are currently engaged in “substantial gainful activity”. If you have a job and are working, then you are not currently disabled. If you are not currently able to work, your application can proceed to the second step.
The second step in the evaluation process is to learn why you are not able to work. In order to qualify for benefits, you must be unable to participate in substantial gainful activity because of a medically determinable, physical or mental impairment (or a combination of impairments.) The impairment must be severe which means that your condition interferes with basic work related activities and has lasted or is expected to last for 12 months, or is expected to result in death. If you are not working because your employer went out of business and you can’t find a new job, then you will not get past step 2. If you are off work because of a serious medical condition, then your file will progress to the next step.
It is during the third step of the evaluation process that the adjudicator refers to the list of impairments that the SSA considers severe enough to indicate disability. If you have made it through steps 1 and 2 and your condition or illness is on “the list” there is no need for additional proof. You are disabled.
The fourth step of the process requires that the adjudicator decide whether or not you are (1) capable of performing the tasks required for a job that you have had in the past and (2) are you able to perform those tasks at the same performance level that is expected now from others doing that work. If the decision is that you are able to do that past work at the required performance level, then you are not disabled. If you are not able to do so, then your application can move on to the next step.
This second part of the third step requires the adjudicator to do an assessment of your residual functional capacity or RFC. The assessment amounts to a decision by the representative or adjudicator as to whether or not, despite your limitations, you should be able to work full time. Full time means 8 hours a day, 5 days a week. If you are capable of working full-time, then you are not disabled. However, if the adjudicator decides that you are not able to work full time, your application will progress to the fourth step.
If you have made it to the fifth step, then you have established that you are disabled. You will be entitled to benefits unless the SSA is able to prove that there are jobs available that you could do or could learn to do despite your current condition of Complex Regional Pain Syndrome (CRPS). At this stage, your age, education and previous work experience are all considered.
To Learn More About Complex Regional Pain Syndrome (CRPS) and Social Security Disability
The Social Security disability attorneys at Herman Law Group, PLLC have successfully argued many cases involving impairments that are not on the “list.” They will be able to tell if you should apply for disability now or if you should wait until you see how your condition progresses. Proper handling of a claim involving Complex Regional Pain Syndrome (CRPS) will have an impact on your ability to take care of yourself and your family. Be sure that you make the right decisions.