Complexities with CRPS as a new/omitted condition, and positioning to win the battle in Oregon Workers’ Compensation
The cause of complex regional pain syndrome (CRPS) is not well understood. It is a form of chronic pain, usually affecting an arm or leg, and typically develops after an injury, surgery, stroke, or heart attack. A diagnosis of CRPS should include disproportionate pain symptoms compared the severity of the initial injury, which are present in several categories of sensory/appearance/motor function categories, and no other diagnosis that can better explain the signs and symptoms.
When a claim presents a complex medical question, it must be resolved by expert medical opinion. When medical experts disagree, the fact finders usually give more weight to opinions that are well reasoned and based on complete information.
In an Oregon Workers’ Compensation Board recent opinion on Karen Petrie, 74 Van Natta 687 (2022), the battle of the experts was won out on the last requirement for a diagnosis of CRPS: that no other diagnosis could better explain claimant’s signs and symptoms. The insurer denied claimant’s new/omitted claim for right arm CRPS, the ALJ affirmed, and on review, the Board upheld the denial.
The insurer requested examinations by Drs. Bell and Radecki. Dr. Bell opined that claimant’s utilization of “treatments” such as compressive gloves, nocturnal braces, and hand splints, contributed to the progression of objective findings of right-hand stasis edema and right finger joint contractures. Claimant’s electrodiagnostics were normal and other diagnostics found no right-hand injury. Thus, Dr. Bell explained claimant’s symptoms were due to disuse and her subjective complaints explained by a somatic symptoms disorder. Dr. Radecki opined that claimant did not meet any of the AMA criteria for CRPS and agreed entirely with Dr. Bell’s opinion. The Board noted that Dr. Bell’s explanation was thorough and provided alternative causes for claimant’s symptoms. Thus, not only did the Board agree with Dr. Radecki that the claimed condition did not exist, but Dr. Bell’s opinion also provided alternative explanations.
By comparison, claimant relied on the opinions of Drs. Kim and Chang. Dr. Kim examined claimant via video call and opined claimant met most of the criteria for CRPS and ordered a diagnostic MRI. Later and again by video call, Dr. Kim opined claimant met all the criteria for CRPS without addressing her previous opinion, but instead, opined that the cumulation of facts and medical evidence supported the diagnosis. Dr. Chang, interpreting claimant’s bone scan results, was merely “suspicious” of a CRPS diagnosis. Dr. Kim did not explain how the records supported her diagnosis and did not address the inconclusive interpretations of Dr. Chang and others. Like dominoes falling, the Board found Dr. Chang’s opinion was unpersuasive, other opinions agreeing with Dr. Kim’s were also unpersuasive, because Dr. Kim’s opinion was not well-reasoned and failed to consider all available information.
The Board upheld the insurer’s denial and further noted that even though claimant had not persuasively established the existence of CRPS, even if she had, the expert opinions supporting compensability were unpersuasive in the face of Drs. Bell and Radecki.
As many of you know, in the battle of the experts, IMEs and concurrence opinions are a necessity for a solid defense. Careful formulation of inquiries that are more likely to elicit persuasive opinions from experts are essential when compensability hinges on a complex issue, as in the existence of CRPS. If you would like assistance planning and obtaining strong opinions for the battle of the experts, please contact me at or 971-867-2723.
Posted by Erling Hanna.
