With millions of Americans suffering from work related injuries, the tendency for employees to malinger, in an effort to increase financial benefits, are quite common. Unfortunately, for individuals suffering from RSD, also known as reflex sympathetic dystrophy, the potential for malingering must be ruled out prior to confirming an RSD diagnosis.
One such condition contributing to escalating workers’ compensation costs is known as RSD, reflex sympathetic dystrophy. RSD is a condition describe as a chronic and substantial burning sensation within the affected limb, attributed to nerve injury damage. Oftentimes, the nerve damage is of an unknown origin and presents with a varied spectrum of both subjective and objective findings. In addition to chronic burning sensations, reflex sympathetic dystrophy symptoms may also include excessive sweating of the affected limb, edema in the affected limb, sensitivity to touch and changes in bone and skin composition. For patients suffering from these symptoms, performing daily living activities often quite complicated, if not impossible.
Diagnosing RSD can be quite challenging for a medical practitioner as the condition can not be diagnosed by a simple laboratory or diagnostic study nor is the condition attributed to any one specific type of work injury. For patients visiting with a workers’ compensation physician, the first indicator of an RSD diagnosis is a chronic and persistent complaint of pain from the patient. Because some workers’ compensation cases involve malingering, the physician must take the subjective complaints and match the objective findings, to confirm RSD truly exists. Additional assessments to confirm the RSD may include temperature studies, bone density studies and a series of steroid injections to determine if relief of symptoms can be achieved. As an added criteria, the patient must exhibit some level of edema in the affected area. Sweating may or may not be presents. Failure to exhibit two or more symptoms may lead the workers’ compensation physician to classify the diagnosis as a malingering case rather than a case of RSD.
Treating RSD is even more complex than diagnosing it. Again, because of frequent malingering within the workers’ compensation programs, many physicians find they are unable to confirm successful treatment in the RSD patient. Because a confirmed RSD diagnosis involved nerve damage, of some origin, the use of neuropathic medications, anti-inflammatories and medications to improve mood and decrease anxiety are quite common. At present, there are no other treatment options available to significantly improve the RSD symptoms permanently. So, what does this mean to the workers’ compensation claim?
Under many workers’ compensation programs, controlling medical costs is a fine balance. With several states opting to provide for lifetime medical benefits, employees diagnosed with an RSD related condition translates into hundreds of thousands of dollars. For this reason, many workers’ compensation carriers, and prudent workers’ compensation physicians, are hesitant to label isolated nerve pain as a condition of RSD. For the workers’ compensation carrier, obtaining a second opinion, following an initial RSD diagnosis, is considered vital to ensuring the condition truly exists and does not involve malingering by the injured employee. To the employee’s advantage, when confirmed as having RSD, medical benefits, associated with the condition, could potentially be paid for the remainder of the employee’s life or, in some states, settlement of medical benefits will prove more significant when RSD is attached the claim.
When dealing with a work related injury, seeking appropriate health care from a well respected workers’ compensation physician is optimal to securing appropriate treatment and diagnosis. As an employer involved in the financial implication of a workers’ compensation program, discussing treatment options and second opinion reports would prove optimal in ensuring the RSD diagnosis, and related financial implications, are appropriate.
