SSR 03-2p, no Blue Book listing
Complex Regional Pain Syndrome (CRPS) and SSDI
Pain out of proportion to the triggering injury, plus at least one clinically documented sign in the affected region such as swelling or skin changes, is how SSA establishes complex regional pain syndrome under SSR 03-2p. With no listing of its own, CRPS is then compared to other listings.
Complex regional pain syndrome, which SSA also calls reflex sympathetic dystrophy syndrome, has a ruling of its own. SSR 03-2p, Evaluating Cases Involving Reflex Sympathetic Dystrophy Syndrome/Complex Regional Pain Syndrome, tells SSA which physical signs prove the condition and how to handle findings that come and go.
We represent adults with CRPS in Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) claims. This page covers the signs the ruling accepts, how CRPS is compared to the listings, the residual functional capacity (RFC) route, the records that carry the claim, and the patterns behind denials.
No Blue Book listing
SSR 03-2p
Spine, joints and pain
SSA evaluates it under the ruling and listings explained below.
How does SSR 03-2p establish CRPS for a disability claim?
For every sign, SSA needs medical evidence of signs, laboratory findings and symptoms, and not only your own statement of symptoms.
The ruling starts with the pain. SSR 03-2p describes CRPS pain as persistent, burning, aching or searing, and says the degree of pain reported is out of proportion to the severity of the injury sustained. The ruling lists surgical procedures among the events that can set it off.
Pain alone does not establish the condition. Once the record shows persistent pain complaints out of proportion to the precipitant, CRPS can be established by one or more of these clinically documented signs in the affected region:
- Swelling
- Autonomic instability, seen as changes in skin color or texture, changes in sweating (decreased or excessive), changes in skin temperature, and abnormal pilomotor erection (gooseflesh)
- Abnormal hair or nail growth, either too slow or too fast
- Osteoporosis
- Involuntary movements of the affected region of the initial injury
For osteoporosis, the ruling notes that it may be shown through medically acceptable imaging. For every sign, SSA needs medical evidence of signs, laboratory findings and symptoms, and not only your own statement of symptoms. A treating note that says the hand is cold, mottled and swollen compared with the other side is the kind of finding the ruling has in mind.
Is there a Blue Book listing for complex regional pain syndrome?
There is not. SSR 03-2p states that CRPS is not a listed impairment, so it cannot meet a listing on its own. SSA instead compares the specific findings in your file to the pertinent listings to decide whether medical equivalence exists. The ruling names no single listing for that comparison, which means the comparison follows wherever your findings point.
The comparison is only as strong as the documented findings. The diagnosis does not substitute for them, which is why the signs described above need to appear in the record in specific terms, limb by limb and visit by visit.
Psychological effects take a separate path. The ruling says psychological manifestations of CRPS should be evaluated under the mental disorders listings. Depression or anxiety that develops alongside chronic pain is a distinct impairment with its own criteria, and our depression disability page explains how SSA measures it.
The RFC route for CRPS disability claims
It says the effects of chronic pain and the use of pain medications must be carefully considered when evaluating duration, severity and RFC.
A CRPS claim that does not equal a listing is decided on residual functional capacity, the assessment SSA uses at the fourth and fifth steps to decide whether you can do past work or other work. The limits depend on the affected limb. CRPS in a hand or arm limits handling, fingering, gripping and reaching, and SSR 96-9p notes that most unskilled sedentary jobs require good use of the hands and fingers for repetitive hand-finger actions. CRPS in a foot or leg limits standing, walking and the use of foot controls, and may bring a medically required cane.
The ruling directs SSA to look past the limb. It says the effects of chronic pain and the use of pain medications must be carefully considered when evaluating duration, severity and RFC. Chronic pain and its medications can affect attention, concentration, cognition and mood. The ruling notes that analgesics, including narcotics, may be part of treatment, and that the behavioral and cognitive effects of those medications need to be thoroughly considered.
For the RFC, that means the file should record more than reduced use of a limb. It should record side effects such as drowsiness or slowed thinking, how often pain breaks your concentration, and how those effects change across the day.
Evidence that decides a CRPS disability claim
SSR 03-2p calls longitudinal clinical records reflecting ongoing medical evaluation and treatment extremely helpful in documenting the signs and findings. One examination rarely captures CRPS, because the signs shift.
The records that carry these claims are:
- Examination notes that describe each sign in specific terms: which limb, what color, what temperature difference, what swelling, compared with the unaffected side
- Imaging that documents osteoporosis in the affected region, when present
- Pain management records showing nerve blocks, medications and other treatments tried, with their results
- Medication lists with documented side effects
- Mental health records when mood or anxiety symptoms are present
The ruling also treats information from people who see you outside the clinic as important, because it helps SSA evaluate statements about symptoms that the objective evidence does not fully support. That evidence carries particular weight for a condition defined by pain that outruns the visible injury.
Why are CRPS disability claims denied?
A consultative or treating exam finds no swelling or color change, and the file is read as showing no objective findings.
A common pattern in denied CRPS files is an examination on a quiet day. A consultative or treating exam finds no swelling or color change, and the file is read as showing no objective findings. SSR 03-2p answers this directly: it says transient findings are characteristic of CRPS and that the signs may not be present at every examination.
A related pattern is conflict between sources. One clinician records a cold, discolored hand and another records a normal limb. The ruling says conflicting evidence in the medical record is not unusual in these cases, and that clarification should first be sought from treating or other medical sources. A file that leaves the conflict unexplained invites the less favorable reading.
The third pattern is pain described without signs. A record full of pain scores and no clinical description of the limb does not satisfy the ruling. When pain is widespread rather than tied to one region, our fibromyalgia disability page sets out how that separate ruling works.
Complex Regional Pain Syndrome (CRPS) Disability Claim Questions
Can I get disability for CRPS if my original injury was minor?
The size of the injury is not the test. SSR 03-2p says the precipitating injury may be so minor that the person does not even recall sustaining it. What the ruling looks for is pain out of proportion to that event, plus at least one documented sign in the affected region, recorded by a medical source.
Will SSA think my CRPS pain is psychological?
SSR 03-2p says a mental evaluation may be used to check for an undiagnosed psychiatric condition that could affect pain tolerance, and that such an evaluation does not assume the physical findings are imaginary. If a mental condition is found, it is evaluated as its own impairment alongside the CRPS rather than in place of it.
Does a diary of my CRPS symptoms count as evidence?
The ruling lists your own diary or notes among the sources SSA may use, along with statements from family, friends, former employers and other practitioners. A diary is most useful when it records dates, which limb flared, visible changes such as swelling or color, medication taken and side effects, and what you could not do that day.
Sources: SSR 03-2p, Evaluating Cases Involving RSDS/CRPS; SSR 96-9p, Implications of an RFC for Less Than a Full Range of Sedentary Work.
Free case review
A condition that keeps you from working deserves a complete file
Tell us where your claim stands and what your records show. We respond within 3 business hours, and there is no fee unless you win.