See my comments below:

"Hey" to you Nanc,

So, first thing I would do is gather all the records from your doctors and also request copies of all documentation provided to your STD/LTD claims department from your physicians. I would also make a written request either through eMail or certified letter for specific reasoning for your denial. I would also look over what you sent to SSD and compare that with what was submitted to LTD to see if there are any obvious discrepancies.

I have all records and they were all submitted to the STD/LTD carrier with my appeal. The reason for denial is listed in the denial letter, they said the records did not support the fact that I could not do the sedentary job. I provided SSD the same records that STD received, also the same letters from my drs.

Regarding the return to work letter - this is usually given to the employee and then asking the employee to have the treating physician to fill out whether or not you are ready to return to work or not, it usually asks for specific limitations or restriction and then also includes an area for those that aren't able to return yet (which you would fall under).

there was no return to work letter, there probably would have been had I been approved.

Was your initial disability claim filed after your pain increased enough to seek care and treatment that resulted in the SCS? Or did you wait until after this to file your claim? I totally get not being able to tolerate the pain and it affecting performance etc., what I was trying to get at is if anything specifically that you recall caused this increase or was it just a gradual thing. See sometimes work habits (repetitive tasks and such) can cause a "work related injury" even though you had underlying RSD if something you were doing at work provoked the new injury or spread then this would fall under a work comp claim and thus be denied by STD/LTD. If it was just a gradual progression then the timing of filing could still play a roll in the approval or denial but, since I am still not clear on what if anything physically caused the increase in RSD spread/pain/symptoms I cannot comment much more than that right now.

My disability claim was filed 12/6/12 stating that I was going out on STD on 12/31/12 (last day to work 12/28/12). The SCS's were implanted in 2011, but the effectiveness wore off. I gradually got worse and worse. The constant use of my hands made me worse. I injured my hand in 2009 outside of work, this is how I developed RSD in my hand. It spread to my other hand. I got to the point where i could barely use my hands so i got the SCS's. It wasn't a work related injury, but work definitely didn't help it.

Who initiated the FCE? It is not necessary to be required to have an FCE in order to receive STD or the first 24 months of LTD unless the records are unclear (which is my suspicion). I know you have a PM doctor but, do you also have either a PCP or Internal Medicine doctor, Chiropractor, Physical Therapist etc., treating you regularly? Did your PM place the SCS or was this another doctor, and were those records also included in your claim process?

my stupid PM sent me for the FCE, said he couldn't fill out the disability paperwork without it...it was HIS requirement. I do have a PCP as I mentioned in my previous post. She is an internist and manages all of my medications. My PM is a physical pain & rehabilitation dr. He implanted the SCS's. Those records were included in the claim appeal.

Do your records reflect all the above limitations that you describe? Not just in that you state you 'can't walk to from the copier' or 'sit for very long' but, also your physician noting this as his/her "impression" also? Usually insurance carriers heavily weigh the "objective findings" and "impression" when looking over doctors chart notes or opinions and overlook much of what the patient verbally states unless those things are "classic hallmark symptoms" etc... sad but true. There should be notes from your doctor regarding medications & cognitive side effects, difficulty with driving etc., these are important in situations such as yours.

I think this is where my problem lies. There is some "she says" in my records and the different areas that they review or note are bs. Neurological - memory intact, or range of motion good, or gait/balance fine, or no edema....none is correct. If they didn't examine these areas, then it was notated as ok. I would be sitting when they'd come in the room and didn't see me walk - I walked slow, shuffled my feet and limped. Medications - I was allergic to everything, which was noted in my charts. Never knew how to treat because I could not tolerate anything.

You most certainly need to find another PM who is well versed in RSD/CRPS as well as an internal medicine doctor for sure. I personally would also seek out a Physiatrist as they look at the whole body and consider all factors that contribute to physical limitations and often work very well with PM's and PT's for your care. Personally in your shoes I would treat my Physiatrist like a PCP and make sure all records from each physician are copied strait away to the other doctors in your care - including Chiro's, PT and massage therapist. Heck even my Chiro gets copies of every single medical chart note and lab result done in my care. Getting all your records and finding out what your diagnosis codes are is KEY and should be done ASAP before your appeal time runs out.

i am having difficulty finding a new PM, mine is well versed in RSD/CRPS, but he has completely changed since he went to his new practice. He was the 6th one I went to. All others in this area have terrible ratings. What do the diagnosis codes mean to me and how would they help my appeal?

I would also print out the pertinent highly regarded medical journals regarding CRPS/RSD and it's long term effects and be sure your claims manager gets it and then be sure to include it with your appeal.

Did you ever have written work release notes from your physician that you provided to your employer? I was actually required to keep my employer informed every 2 weeks as part of my duty and requirements during STD/LTD status. I had every treating doctor write one every two weeks for over 2 years :/ a pain yes.. but necessary.

there were no work release notes as I was never released to return to work. He wrote "unknown" as the date expected to return to work. My boss visited me twice and we talked about things. I told him I wouldn't be able to return.

Your employment status does not affect your disability benefits unless you were injured/illness struck after your termination which obviously isn't the case for you. That is why I keep wondering about when and exactly what the original claim form stated as to why you needed the benefits and the timing of it.

You know how horrible I feel for your situation and others who have gone through this but, please don't give up yet.. I think there are enough red flags to consider yet another appeal.

Be strong,
Tessa