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Complex Regional Pain Syndrome: Legal difficulties in Wisconsin

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Complex regional pain syndrome (formerly known as reflex sympathetic dystrophy) can be a catastrophic disability for an injured worker. Complex regional pain syndrome (CRPS) is a pain condition that can affect specific body parts after an injury, with some nasty symptoms: burning/throbbing pain, swelling, severe sensitivity to touch or temperature, color changes, or strange hair growth or nail growth.

A classic example is a worker with a "simple" ankle injury that heals slowly with a later developing CRPS condition affecting the entire leg and potentially the back. Many instances of CRPS occur from lack of appropriate or timely medical care for an injury. What should have been a resolved ankle injury and medical fix can morph into a debilitating chronic condition-causing severe pain and continuing off-work status.

In Wisconsin, there is an arbitrary distinction between two basic categories of injuries: scheduled injuries (limbs, eyes, ears) and non-scheduled injuries (torso, head, systemic and mental). The distinction between the two categories is important because scheduled injuries are compensated very differently from non-scheduled injuries. The difference is especially important because for scheduled injuries no additional compensation is allowed for a resultingloss of earning capacity (LOEC). Only certain employees with permanent disability resulting from a non-scheduled injury may be entitled to additional permanent disability benefits in the form of compensation for a resulting loss of earning capacity.

When evaluating CRPS, the Wisconsin Labor and Industry Review Commission generally makes the scheduled vs. unscheduled injury distinction based on the location of pain and symptoms. See Michael S. Murawski v. Contract Transport Services, WC Claim No. 2000-041229 (LIRC Nov. 26, 2003). For example, if the evidence shows pain symptoms and disability in the back, the Commission has found an unscheduled component, with resulting loss of earning capacity award. The following cases are helpful:

  • Vanremmen v. Central Processing Corp. 2013 WL 660185, WC Claim No. 2006-022071 (LIRC Jan. 22, 2013) (Left foot injury with resulting CRPS diagnosis, abnormal gait, and need for spinal cord stimulator. Evidence supported pain symptoms and complaints in spine, and Commission found ascertainable portion of disability due to unscheduled back component and awarded permanent total disability benefits.);
  • Tomasovich v. County Transit Corp., 2003 WL 21634016, WC Claim No. 1995-055411 (LIRC June 6, 2003) (Commission awarded permanent total disability based on an arm injury and resulting complex regional pain syndrome. Applicant credibly testified that pain radiated from arm into upper back, and treating physician credibly demonstrated that CRPS caused cervical spine nerves to become over sensitized and respond excessively to every day stimuli);
  • McNaughton v. Wal-Mart Associates Inc., 2012 WL 3288877, WC Claim No. 2005-014491 (LIRC July 23, 2012) (Foot trauma with alleged CRPS restricted to a scheduled injury as the Commission found no medical evidence of a disability involving the spine).

CRPS does not automatically equal an unscheduled injury (with resulting possibility for a loss of earning capacity). The injured worker, physician, and attorney must document a disability, symptoms, or condition affecting an unscheduled component-like the neck or back. If disability in an unscheduled body part is found, the worker can present a loss of earning capacity opinion.

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