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  1. #1
    Join Date
    May 2008
    Posts
    3

    Default RSD/CRPS and Told I am MMI

    I was sufferred a hand injury (broken bone) in Dec. 05. Went through PT for 4 wks, pain and swelling was not getting better. In May, 06, I underwent Arthroplasty (bone had deteriorated) and carpal tunnel release and the median nerve was neurolysed. The injury was to my dominate hand.

    The pain ramped up 100x the next day after surgery. Had cast changes weekly due to extreme swelling and pain. When cast came off I underwent another 6 wks of PT. Pain still getting worse. Dr. just ignored my pain complaints. Ordered FCE Aug. 06. When the FCE results came back with accompanying letter, Dr. finally realized how severe my pain was. FCE result: 10% WP "based on this evaluation, incapable of sustaining the Light level of work for an 8 hr day".

    Dr. ordered testing for RSD. Underwent stellate ganglion blocks x3. Minimal improvement in burning and pain. I had an adverse reaction after the 3rd block so they were discontinued. Ortho Dr. said the only thing now is Pain Mgt. Said I was at MMI. WC sent a VCE to my home for evaluation.

    WC sent me to PM dr. He confirmed RSD dx. but would not rx any pain meds because I would not agree to undergo another ganglion block. Wc sent me to another PM...he concurred with dx, but would not rx meds either. Resorted to going to ER for rx. ER dr. referred me back to the Ortho for PM or a good referral to another PM.

    Ortho referred me to yet another PM. He concurred with the dx and ordered a 1 month day treatment ie..Hydrotherapy, PT, counseling etc. This really made the pain level dramatically increase along with worsening depression and anxiety. After the month of treatment, Dr. said he would recommend to WC to settle this case. This was June 07.

    Continued dr. visits every 3 months for pain meds until July 08. Burning and pain has spread up my arm, shoulder, sometimes going along my neck and past the ear. Hand feels like it is exploding. Dr. orders another FCE.

    This FCE was not like the first one. I was hooked to a computer for the tasks.. Of course, anyone with RSD knows that use of the extremity causes pain levels to increase. On 7 occassions during the testing, the computer shut down the testing sequence because my HR (highest recorded was 203)was exceeding parameters set (of course this was happenning when my hand was exploding and electrical shocks were going up my arm.) FCE results: Total Upper Extermity 25% WP 15% However, evulating dr. (who is also the PM) listed on the FCE, Validity of examination: Self-limited. Right Upper Extermity Limitations: occassional fine manual, occassional gross manual, no overhead reaching. Depression: moderate elevation Anxiety: extreme elevation Distress: Moderate elevation Somatization: extreme elevation.

    I have been experiencing electrical shocks, burning, and exploding sensations in the other hand and arm also for about 3 months. Dr. just nods his head when I tell him about it. He did try me on Cymbalta and Pristiq for depression and the burning. I could not tolerate either.

    WC called my atty and said they had determined that I had reached MMI and therefore they would be stopping my WC benefits. Sept. 08.

    Now, to my question...In January I was reading a thread about IW who had RSD and had been put at MMI. PrincessLA answered back and said " If you have RSD/CRPS you can never be at MMI". She did not elaborate. I have since seen someone else try to inquire of her about this statement, but I guess she is no longer on the board.

    Do any of you wise responders have any clue as to what she meant by that statement? Please respond ASAP as I will be meeting with my atty this coming week.

  2. #2
    Join Date
    Oct 2006
    Posts
    9,108

    Default Re: Rsd/crps told i am mmi

    she was referring to the different meanings of the term "Maximum Medical Improvement.
    legaly for workers comp it can be relative - meaning your disability is not expected to improve significantly e.g. it waxes and wanes with no overall gain or improvement.
    personally and maybe medically RSD can be a gradual but consistent decline with no one point being considered the point of maximum medical improvement. Thus personally she felt RSD could not ever be MMI.
    that was her opinion and, of course, is not supported by caselaw or the work comp courts.
    Last edited by .SH; 09-07-2008 at 07:44 AM.

  3. #3
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,017

    Default Re: Rsd/crps told i am mmi

    You could be MMI to your orginial injury, as your condition would not be expected to become better/wrose with or without treatment in the next 12 months.

    The problem with RSD is getting the condition accepted as a ''compensable consequence'' to the org injury.
    As the doctors the CA/IC sent you to, this should have been accepted as compensable, meaning they are accepting liability for your RSD.
    A very luck situation for you.

    A determination by your doctors is the ONLY one that can make you MMI..not the CA or their attorney.

    IF you and your AA disagree with the MMI status, you should discuss with your AA filing for a hearing with the WC board/court for a judge to make the determination on your current status based on the medical reporting of your doctors...which ever doctors reports a judge finds the most convincing can determine your MMI status.

    If you/AA agree with the current findings, and WPI rating...you could probably settle out the PD/WPI indemnity of your claim...but IMO, I' would not settle out the future medical entitlements you may have available...treatment to RSD is VERY expensive...

    From your post information, the reason you are now found MMI is because the PM doctors wouldnt treat you any further because you denied the recommended treatment plan...the shots. When you deny treatment, the doctors really have no choice but to declare you MMI and issue a rating based on your current condition/impairment.

    As your Upper Ext rating is 25% and WPI is 15%, it doesn't appear your RSD was taken into consideration on the WPI rating...indicating the ER/IC is not accepting the RSD as compensable at this point. And you can expect a fight on this issue ....

  4. #4
    Join Date
    May 2008
    Posts
    3

    Default Re: Rsd/crps told i am mmi

    Thanks to all for your responses. I appreciate it.

    My PM doctor is also the doctor who did the FCE. The FCE report says MMI DATE 7/79/2008.

    The psychologist who owns the Pain clinic mentioned a spinal cord stimulator during the initial evaluation over a year ago. My PM doctor, who is with this group, has never mentioned it. In fact, about all he does is write the rx for pain meds.

    I have been controlling the pain as best as I can with pain meds, relaxation methods, redirectional thoughts, Pt at home, etc. Luckily for me, for now, this is helping. But, I do not know what the future holds.

    My AA advised after the severe reaction to the ganglion block, that I could not be required to submit to any procedure that could be detrimental to my health. (I almost died on the side of the highway on the way home from the hospital due to constriction of the trachea from the medication.) He also advised that AL mandates future medical unless I choose to waive it.

    What if the RSD is spreading to my other arm? What then?

  5. #5
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,017

    Default Re: Rsd/crps told i am mmi

    What if the RSD is spreading to my other arm? What then?
    If you look up the meaning of RSD, it is basically a condition that affects both sides of your body...Radicular Sympathic Distrophy...meaning one side affecting the other...(very simply stated)

    That is why it is important to ensure the ER/IC accepts the condition as a 'compensable consequence' to the orginial injury...
    And they will fight this to the wall...treatment to RSD is very expensive, and life long at best... there being no cure...and only treatment is pain management...

    IMO...I would NOT waive my entitlement to future medical benefits..even though the IC will use the UR to deny/delay/modify any treatment request as submitted by your PTP... and it will be a fight to get the treatment you are entitled to...but RSD is not something you can handle on your own...or with any amount of money you might receive in a lump sum settlement... and IF you were to settle this out... Medicare would become an issue at some point...guaranteed...

  6. #6
    Join Date
    Dec 2006
    Posts
    2,165

    Default Re: RSD/CRPS and Told I am MMI

    Injured Lady, your attorney is 100% CORRECT that the IC can NOT FORCE YOU to have a PROCEDURE that caused you an ADVERSE REACTION....Nor can The IC can NOT CUT YOUR BENEFITS because of are NOT ABLE to TOLERATE A RECOMMENDED FORM OF TREATMENT!!!!

    There is a HUGE DISTINCTION between not HAVING recommended treatment BECAUSE OF AN ADVERSE REATION, as opposed to REFUSING REASONABLY NECESSARY MEDICAL TREATMENT WITHOUT A LEGITIMATE BASIS, and IF THIS is what your CURRENT PM DOCTOR is telling you, and WHY he MIGHT BE DEEMING YOU P&S/MMI AT THIS TIME, then HE IS WRONG. in my very humble opinion!!!!

    Given that your THROAT SWELLED, it is QUITE POSSIBLE that you had an ALLERGIC REACTION to one of the medications USED DURING the procedure, and you are LUCKY that you did NOT GO INTO ANAPHYLACTIC SHOCK while DRIVING HOME....

    It is ABSOLUTELY IMPERATIVE that you be REFERRED TO AN ALLERGIST to determine EXACTLY WHAT DRUGS you MIGHT HAVE AN ALLERGY TO, and this IS a "compensable consequence" of the injury and treatment, for which the WC carrier is ON THE HOOK FOR.

    AND, UNTIL you have UNDERGONE ALLERGY TESTING, you MUST be EXTREMELY CAREFUL and AVOID ANY OF THE DRUGS THAT WERE USED DURING THE STELLATE NERVE BLOCK.....your NEXT REACTION to the offending Drug(s) could be even MORE SERIOUS, because your BODY HAS BECOME QUITE SENSITIVE to the OFFENDING DRUG(S), and your ANTIHISTIMINES are on "HIGH ALERT" now, which is WHY each SUBSEQUENT Exposure to the offending drug(s) will ONLY GET WORSE!!!!

    You MUST get copies of your medical records, and look at EACH AND EVERY DRUG THAT WAS ADMINISTERED DURING THE PROCEDURE, and that INCLUDES ANY meds that were administered not JUST for the STG, but any drugs used for "light sedation" or relaxation, whether through injection, IV or pills....and provide that information to the ALLERGIST.

    Once you have been THOROUGHLY TESTED for ALL THE DRUGS ADMINISTERED for ANY potential Allergies and IF you DO have ANY SENSITIVITY/ALLERGIC REACTIONS, you MUST get a Med-Alert BRACELET or NECKLACE that LISTS YOUR DRUG ALLERGIES for Emergency purposes.....


    THEN, once you KNOW what the offending drug(s) ARE, you can start to explore OTHER SHORT and LONG-TERM TREATMENT OPTIONS for the RSD....

    FURTHERMORE, and BTW, after having a Stellate Gangloin Nerve Block, WHY IN HELL did the PM Doctor even ALLOW YOU to DRIVE YOURSELF HOME??? I SINCERELY HOPE that this PM Doctor is a FORMER PM DOCTOR....

    Now, it is also important to realize that not ALL "PAIN MANAGEMENT" Doctors are the "SAME"...There are PM Docs that fall under the category of "Physical Medicine and Rehab", and THESE PM&R Doctors have a COMPLETELY different approach when managing a Chronic Pain syndrome, and might NOT be CERTIFIED to perform certain procedures or prescribe LONG-TERM USE OF PAIN MEDICATIONS....

    Pain Mangement Doctors under the discipline of Physical Medicine and Rehab are somewhat LIMITED in the PROCEDURES that they can perform; it depends on their CERTIFICATION/QUALIFICATIONS, as I just mentioned....also, MOST PM&R Doctors do NOT advocate "invasive procedures" like STGs, or the use of Pain meds..their PRIMARY focus is PHYSICAL REHAB and counseling, which is FINE for SOME "typical" Chronic Pain sufferers, but NOT NECCESARILY SO WITH RSD/CRPS...

    Although RSD/CRPS is "technically" a "Chronic Pain Syndrome", RSD is an actual NEUROLOGICAL disorder, and is NOT TREATED the SAME way that "typical" Chronic Pain is treated!

    RSD/CRPS REQUIRES that you be treated not only by a Pain Doctor with EXPERTISE in Diagnosing and TREATING RSD, the TYPE of PAIM MANAGEMENT Doctor that you SHOULD BE SEEING is a PAIN MANAGEMENT ANESTHESIOLOGIST....

    A PMA is BOTH CERTIFIED AND QUALIFIED to prescribe pain medications, INCLUDING OPIATES, PER THE TREATMENT ALGORYTHMS/EBM FOR RSD/CRPS, perform STGs and AXILLARY NERVE BLOCKS,etc., and can perform TRIAL AND PERMANENT SPINAL CHORD STIMULATOR IMPLANT PROCEDURES.

    THE PMA will ALSO refer you out to a PAIN MANAGEMENT PSYCHOLOGIST, and to Physical Therapy, as YOUR particular case requires. In SOME CASES, PT is NOT recommended, and only YOUR PMA can be the one to DETERMINE THAT.... I will provide you the EBM that SUPPORTS THIS, AND the TREATMENT ALGORYTHMS for RSD/CRPS....

    AS for being TTD/MMI, with RSD/CRPS, when you EVENTUALLY reach the point where your RSD/CRPS has become somewhat "stabalized", MEANING that you have undergone APPROPRIATE TREATMENT, which MAY EVENTUALLY INCLUDE a Spinal Chord Stimulator or OTHER long-term pain-management procedure, your FLARE-UPS aren't as FREQUENT or SEVERE, and that the "spreading" has either been controlled or at least minimized to the extent that the spread CAN be, given YOUR particular RSD/CRPS, THEN your PMA/PTP can REASONABLY determine that you ARE P&S/MMI....

    Even though once you have been declared P&S/MMI, due to the nature of RSD/CRPS, and depending on how severe a particular flare-up is, and/or the RSD has SPREAD MORE, there MIGHT be times where you WILL BE DEEMED TTD AGAIN....the PROBLEM here would be if Alabama WC Laws LIMITS or CAPS the AMOUNT OF TIME ONE CAN RECEIVE TTD... if there is a CAP, once that cap has been reached, you can be TTD, BUT YOU WILL NOT RECEIVE TTD BENEFITS, for they will have been EXHAUSTED. This is the problem here in Calif....TTD is CAPPED at 104 weeks, PERIOD for injuries after 2004...


    Injured Lady, I do not know HOW MUCH your attorney REALLY KNOWS about RSD/CRPS, but it is CRITICAL that he have a VERY GOOD LEVEL OF UNDERSTANDING! RSD/CRPS is a VERY COMPLEX CONDITION, and it is NOT LIKE OTHER TYPES OF CHRONIC PAIN!

    The MORE YOU and your ATTORNEY can LEARN about RSD/CRPS, the MORE EFFECTIVELY you and your attorney can help ENSURE that you receive the TREATMENT AND BENEFITS you are LEGALLY ENTITLED TO, not to mention the DIFFERENT WAYS THAT RSD CAN BE RATED TO DETERMINE THE LEVEL OF RESIDUAL PERMANENT IMPAIRMENT/PD PER THE AME 5th!!!

    Therefore, you should PRINT OUT THIS POST AND THE LINKS THAT I AM PROVIDING YOU WITH, so that you and your attorney can LEARN AS MUCH AS YOU POSSIBLY CAN AGOUT RSD/CRPS and the TREATMENT OPTIONS THAT ARE AVAILABLE. IF you DO have ALLERGIES, then you will NEED TO FIND SOME OTHER MEDICALLY FEASIBLE TYPE OF SHORT TERM TREATMENT, to HELP REDUCE THE SPREAD, and also LONG-TERM TREATMENT, and this link has a VERY EXTENSIVE TREATMENT ALGORYTHM/TREATMENTS!

    The RSD Foundation Clinical Guidelines are considered "THE BIBLE" amongst most RSD/CRPS Specialist.....

    http://www.rsdfoundation.org/test/AMA.html

    http://www.rsdfoundation.org/en/en_c...uidelines.html

    Make SURE that you access ALL the links thjat direct you to more SPECIFIC and ADDITIONAL information!

    PLEASE discuss a REFERRAL TO AN ALLERGIST with your attorney, and FIND OUT ABOUT GETTING A PAIN MANAGEMENT ANESTHESIOLOGIST AS YOUR RSD/CRPS SPECIALIST PTP, ASAP!!! ALso, be SURE TO DISCUSS YOUR P&S/MMI STATUS, as well as your TTD status...until you can change to a Pain Management ANESTHESIOLOGIST, your CURRENT PTP should have you on TTD until you either CAN have FURTHER TREATMENT for the RSD SPREAD, etc, and HOPEFULLY a CHANGE of PTPs to a PMA!!!!!

    Good Luck, and please keep us posted!

    Charlie
    Last edited by Charles Stevens; 09-08-2008 at 05:24 PM.

  7. #7
    Join Date
    Nov 2008
    Posts
    2

    Default Re: RSD/CRPS and Told I am MMI

    What does MMI stand for?

  8. #8
    Join Date
    Oct 2006
    Posts
    9,108

    Default Re: RSD/CRPS and Told I am MMI


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