CRPS and Spinal Cord Stimulators: Virginia Workers’ Comp

Nothing in this article should be taken as legal advice. Every case is different.

Complex regional pain syndrome (CRPS) that develops from a work injury is covered by Virginia workers’ comp, the same as the injury that started it. The insurance company is required to pay for treatment that is reasonable, necessary, and causally related to the accident, and for CRPS that can include nerve blocks, pain management, and a spinal cord stimulator (Va. Code § 65.2-603). That doesn’t mean it will. CRPS claims are some of the most heavily disputed in comp, because the pain is out of proportion to the original injury and there is no single test that proves it.

What Is CRPS?

CRPS is a long-lasting pain condition that usually affects an arm or a leg after an injury, such as a broken bone, a sprain, a burn or cut, or surgery (National Institute of Neurological Disorders and Stroke). The pain is much stronger and lasts longer than the original injury would explain. It can come with swelling, changes in skin color and temperature, changes in sweating, stiffness, and changes in hair and nail growth. You may also see it called reflex sympathetic dystrophy (RSD) (MedlinePlus).

For a comp claim, two facts about CRPS matter most. It usually shows up weeks after the accident, not the same day (Cleveland Clinic). And it often starts from an injury that looked minor at first, such as a sprained wrist or ankle, or a small cut or burn.

Is CRPS From a Work Injury Covered?

Yes, when the CRPS is caused by a compensable work injury or by the treatment for it. Virginia covers the injury from the accident and the conditions that flow from it, including a condition caused by surgery or other treatment for the original injury. The injury itself has to meet the usual test: an accident that happened in the course of your job and arose out of it (Va. Code § 65.2-101).

Because CRPS shows up later, the insurance company may have accepted your hand or ankle injury months before anyone said “CRPS.” Accepting the original injury doesn’t mean the insurer accepts the CRPS. If it won’t treat the CRPS as part of the claim, the question goes to the Commission, and the answer turns on medical evidence that ties the CRPS to the work injury. Virginia doesn’t cover a new injury that connects to the work injury only through a second injury that came after it, but if a doctor says the CRPS is a direct result of the work injury itself, rather than of a separate condition that came after it, the CRPS can still be covered (a Supreme Court of Virginia decision involving Amoco Foam Products Co., 257 Va. 29 (1999)). Here’s more on injuries that come from the first injury.

What Virginia Workers’ Comp Pays for CRPS

Workers’ comp does not pay for pain and suffering. For CRPS, that is the hardest part to accept: the pain itself isn’t paid for. What is paid for is the treatment, the time you can’t work, and the permanent loss of use of the limb.

Spinal Cord Stimulators and Workers’ Comp

A spinal cord stimulator is a medical treatment like any other under Virginia comp: the insurance company is required to pay for it when it is reasonable, necessary, and causally related to the accident (Va. Code § 65.2-603). A stimulator is a small implanted device that sends electrical pulses to the spinal cord to change how pain signals reach the brain. It usually starts with a trial of a few weeks, with temporary leads, and moves to a permanent implant only if the trial helps.

The stimulator is where many CRPS claims get fought, because it is expensive and starts a long run of follow-up care: programming, battery replacements, and sometimes revision surgery. Common ways the insurer pushes back:

• It sends you to its own doctor for an examination, who says the stimulator isn’t needed or that the CRPS diagnosis is wrong (Va. Code § 65.2-607).
• It asks for a psychological evaluation first, which many doctors require before an implant, and then argues about the result.
• It says the trial didn’t help enough to justify the permanent implant.
• It says the CRPS isn’t from the work injury at all.

Any of these is a few of many. If the insurance company won’t authorize the stimulator, you can ask the Commission for a hearing, and the decision will turn on what your treating doctor puts in writing about why it is necessary. Here’s how choosing your doctor works in a Virginia comp claim.

Does a Stimulator Change My Restrictions?

Often, yes. Doctors commonly limit bending, twisting, and lifting for weeks after the leads are placed (MedlinePlus), and some people keep permanent restrictions. Those restrictions affect whether you can do your old job or a light-duty job, and so they affect your wage checks.

Why CRPS Claims Are Hard to Prove

CRPS is diagnosed mostly from symptoms and an examination, so the claim depends on how well your records document it. There is no blood test or scan that confirms it on its own. That gives the insurance company room to argue.

• Late diagnosis. CRPS often goes weeks or months before anyone names it, and the insurer may say something else caused it in between.
• “Out of proportion” pain. Pain greater than the injury would explain is how CRPS works, but the insurer may describe it as exaggeration.
• Surveillance. Insurers sometimes video injured workers. A few minutes of you carrying groceries can be shown as if it were your whole day.
• A doctor’s word against a doctor’s word. The treating doctor and the insurer’s doctor often disagree about the diagnosis, the stimulator, and your restrictions.

What helps is consistency. Tell every doctor the same thing about where it hurts and what you can and can’t do, keep your appointments, and make sure the CRPS diagnosis, when it comes, is written in your records along with what caused it.

Permanent Ratings for CRPS

Virginia pays permanent partial disability for a permanent loss of use of a body part on its schedule, and for CRPS that usually means the arm, hand, leg, or foot where it settled (Va. Code § 65.2-503). A doctor gives the rating once you reach maximum medical improvement. A 30 percent loss of use of a leg works out to 30 percent of 175 weeks, or 52.5 weeks of pay at your compensation rate. Here’s how impairment ratings work in Virginia.

CRPS can spread to another limb. Virginia law treats the permanent loss of use of any two of your hands, arms, feet, or legs as permanent and total incapacity, including when the second limb is affected as a consequence of the original injury. That pays wage checks for life with no cap on the total (Va. Code § 65.2-503(C), § 65.2-500(D)). Loss of use doesn’t mean the limb can’t move at all. It means you can’t use it to any substantial degree in any kind of paying work. Whether you meet that standard is decided from the medical evidence, including the permanency ratings, and it is often the whole fight.

What Is a CRPS Claim Worth?

No one can tell you what a CRPS claim is worth without your medical records, your wages, and what your doctors expect your future care to be. What drives the value is the cost of future treatment, including a stimulator and its upkeep for the rest of your life, how long you can’t work, your average weekly wage, the permanent rating, and how strong the evidence is that the CRPS came from the work injury.

“On the first call, I won’t guess what your case is worth. I don’t know anything about it yet. Any lawyer who puts a number on it that early is making it up.” (Bryn Swartz)

Future medical care matters more in a CRPS claim than almost any other. Most Virginia cases settle with a full and final settlement that closes medical care for good, so a settlement has to cover care that may last decades. A settlement is optional; nobody can force you to take one. Here’s more on workers’ comp settlements in Virginia.

CRPS and Workers’ Comp Questions

My CRPS Started Months After the Accident. Is It Too Late?

Not necessarily. CRPS commonly shows up weeks or months later. What matters is that it is caused by the work injury or its treatment, and that your claim with the Commission was filed in time. A claim must be on file with the Commission within two years of your date of accident, although exceptions apply (Va. Code § 65.2-601). And if your doctor ties the CRPS to the original injury, it can count as a change in condition. In that case, if you have an award, a claim for more wage checks may fall under the 24-month deadline that runs from the last day you were paid under the award (Va. Code § 65.2-708(A)), instead of the two-year filing rule for a new injury (a Court of Appeals decision involving Berglund Chevrolet, Inc., 43 Va. App. 742 (2004)).

Can I Refuse a Spinal Cord Stimulator?

You can, but if the insurance company offers it and you refuse without a good reason, your wage checks can stop until you agree, and you don’t get back the checks for that time (Va. Code § 65.2-603(B)). Whether a refusal is justified is judged from your point of view, based on what you knew when you decided, such as the risks your doctors explained and how earlier procedures went. Fear alone may not be enough.

Will Workers’ Comp Pay for Battery Replacements and Repairs?

Necessary care for the injury continues as long as it is necessary, and that can include stimulator replacements and revisions, unless the case has been closed by a full and final settlement (Va. Code § 65.2-603).

Talk to Pathfinder Injury Law About CRPS

Pathfinder Injury Law handles only Virginia workers’ compensation claims. Call 804-505-0633 or use our online contact form.