RSDSA Supports Access to Health Care and Disability Benefits for Persons
With RSD/CRPS

RSDSA works in many ways to help patients with workers compensation and
other disability issues receive fair treatment and appropriate benefits. We are
assembling data and information on how to best work within widely varying
public and private systems, much as we did to influence the Social Security
Administration’s (SSA) policies and procedures for RSD/CRPS related claims in
2003. The extensive guidelines for people with RSD/CRPS who apply for SSA
benefits, published in the Federal register
(http://www.rsds.org/pdf/ssruling.pdf),
are fair and generous.

We are working to help people with RSD/CRPS who should qualify for workers
compensation benefits receive them. Our ongoing efforts stem from discussions
with members who have been denied benefits or who are anticipating conflict
because they do not meet unfair diagnostic criteria for RSD/CRPS.

RSDSA Challenges the Unfairness of the AMA Diagnostic Criteria for RSD/CRPS

Unlike the SSA diagnostic criteria for RSD/CRPS, the AMA’s Guides to the
Evaluation of Permanent Impairment, 5th Edition (The Guides) contain some
incorrect and overly restrictive diagnostic criteria for RSD/CRPS, which have
resulted in people being denied disability status and benefits. As part of our
ongoing effort on behalf of persons with RSD/CRPS we have approached the
editors of The Guides with a proposal to have its diagnostic criteria conform
to
those developed by the best current scientific opinion.

In October, 2004, two physician and experts on RSD/CRPS, representing RSDSA,
met with one of the two senior editors of The Guides. They discussed the
incorrect information and fundamental unfairness of The Guides’ diagnostic
criteria, noting that the RSD/CRPS research and treatment community does not
recognize the author of those diagnostic criteria as an expert. They discussed
with the editor the differences between the diagnostic criteria contained in
the current edition of The Guides and those that were developed and revised by
the International Association for the Study of Pain (IASP). The IASP
diagnostic criteria are widely accepted by experts in the field as the “gold
standard.” Our representatives also offered to work with the AMA's editors
as they
prepare the upcoming 6th edition of The Guides. The editor stated that he
would present the offered material to the editorial board of The Guides at its
next meeting.

RSDSA Works with the Insurance Industry to Promote Fairness in Processing
Claims

Concurrently, RSDSA is working with the insurance industry to make sure
their policies and procedures conform to the clinical guidelines promoted by
responsible representatives of the RSD/CRPS community. Since workers
compensation
is regulated by each state, there is no national or prevailing standard for
determining benefits and disability. As a result of RSDSA’s long-term
dialogue with some of the largest workers compensation insurers, we have
determined
that there is no exclusive, or even predominant, reliance on The Guides.
Although 80% of states mandate the use of The Guides, not all use the current
edition - some stipulating the 4th Edition and others the 3d Edition.
Applicants should be aware that companies may use other guidelines. They may
modify
The Guides diagnostic criteria with internal data. They may determine a
diagnosis of RSD/CRPS with as few as 4 out of 11 criteria, as opposed to the 8
out
of 11 required by the AMA’s diagnosis guidelines from the 5th Edit
ion.

RSDSA finds it unacceptable that people might be denied benefits for a
legitimate disability. We continue to develop strategies to help persons with
RSD/CRPS and their advocates present strong arguments to support their
applications for benefits against unfair diagnostic criteria. We remain
steadfast in
our commitment to represent the interests of our members, and help all persons
with RSD/CRPS obtain the disability determinations and benefits they
deserve.



[Non-text portions of this message have been removed]