Find Out What Type of Medical Consultant Reviewed Your Social Security Disability Claim

Only certain types of doctors are allowed to make disability decisions on certain types of claims.

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If you’re denied disability benefits by Social Security, check your disability file to see if the medical consultant who reviewed your disability application was the appropriate type of doctor. For instance, an orthopedic surgeon is the best one to evaluate a complex musculoskeletal disorder, and a cardiologist can best assess a serious heart condition.

Medical Consultants

Medical consultants work for Disability Determination Services (DDS), the state agency that makes the initial disability decisions, usually as part-time contractors. All medical consultants must be M.D.s, D.O.s, or for certain medical conditions, psychologists, optometrists, podiatrists, or speech-language pathologists.

Unfortunately, many DDS offices do not have a full range of specialists among their in-house medical consultants. Most medical consultants work in the fields of family medicine, internal medicine, or psychiatry/psychology. While these generalists are often able to properly evaluate the less complicated cases, more complicated cases require specialists or subspecialists. Unfortunately, some DDS offices do not have cardiologists, orthopedic specialists, neurologists, or ophthalmologists on their staff.

Rules on Medical Consultant Expertise

The evaluation of mental disorders and limitations must be done by a psychiatrist or psychologist (for adults and children), not a neurologist or internist. For instance, if you applied for disability for a traumatic brain injury, a neurologist can evaluate your diagnosis, but a psychiatrist or psychologist needs to weigh in on your resulting mental and cognitive impairments and limitations. Another Social Security rule is that children’s claims for physical disabilities should always be evaluated by a medical consultant who’s a pediatrician.

In other cases, there are no strict rules about which type of doctor should review your claim, but if your case is complex and a specialist or subspecialist didn’t evaluate your claim, you can raise this issue on appeal. Under Social Security ruling SSR 96-6p, the administrative law judge hearing an appeal or the Appeals Council must take into account the specialization of the medical consultant.

How to Find the Medical Consultant’s Field of Expertise

You can find specialty code for the medical consultant who evaluated your claim on Form SSA-831, Disability Determination and Transmittal. This form is the official disability determination document used by. Your file will have a copy of Form 831, but you won’t receive one. To see it, you need to request your file.

Most of the information on the front of the form will be of little use to you because of the number of codes used by the SSA. But the form should contain the name and signature of both the disability examiner and the DDS medical consultant who worked on your claim. The number of the medical consultant’s specialty code should be near his or her name or signature. The specialty code information can demonstrate that the wrong kind of doctor reviewed your claim.

Medical Consultant Codes

Here is a list of the codes for medical consultants and what type of doctor they refer to.

DDS Medical Consultant Codes

1 Anesthesiology

26 Occupational Medicine

2 Ambulatory Medicine

27 Oncology

3 Audiology

28 Ophthalmology

4 Cardiology

29 Orthopedics

5 Cardiopulmonary

30 Osteopathy

6 Dermatology

31 Pathology

7 E.E.N.T. (Eyes, Ears, Nose, & Throat)

32 Pediatrics

8 E.N.T. (Ear, Nose, & Throat)

33 Physiatry

9 E.T. (Ear & Throat)

34 Physical Medicine

10 Emergency Room Medicine

35 Plastic Surgery

11 Endocrinology

36 Preventive Medicine

12 Family or General Practice

37 Psychiatry

13 Gastroenterology

38 Psychology

14 Geriatrics

39 Public Health

15 Gynecology

40 Pulmonary

16 Hematology

41 Radiology

17 Industrial Medicine

42 Rehabilitative Medicine

18 Infectious Diseases

43 Rheumatology

19 Internal Medicine

44 Special Senses

20 Neurology

45 Surgery

21 Neuroophthalmology

46 Urology

22 Neuropsychiatry

47 Other

23 Neonatology

48 Speech – Language Pathology

24 Nephrology

49 Child and Adolescent Psychiatry

25 Obstetrics

 

 

This article was based on an excerpt from Nolo’s Guide to Social Security Disability, by David Morton, M.D., a former Chief Medical Consultant for Social Security.

by: , J.D.

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