What Is the Consultative Exam (CE) In Your Disability Case?

At some point in the course of processing your claim for disability benefits, Social Security may require you to attend a consultative examination, or "CE." CEs are one-time medical evaluations performed by a doctor or psychiatrist to assess your physical or mental limitations. The agency often requests CEs in cases where the claims examiner assigned to a case doesn't think there's enough medical evidence to make a disability determination and needs an additional opinion.

Getting notice that a CE was scheduled is a routine part of applying for benefits. The examination is conducted on Social Security's dime at no cost to you, and if the exam "goes well," you may have a stronger case that you're disabled than you had before the CE—especially if you arrive at the examination knowing what to expect and prepared to answer questions.

What Is a Consultative Exam?

Consultative exams are much like visits to your regular physician or psychiatrist, only the doctor is paid by the Social Security Administration (SSA) for the specific purpose of helping the agency determine whether you're disabled. Although examining doctors are reimbursed by the SSA, they're required to state that they'll be impartial evaluators.

Consultative examinations typically last around 30-45 minutes, although some may be shorter. During the exam, the doctor will ask about your condition and go over your medical history. The doctor will try to assess your current situation and offer the SSA some insight into how your condition might prevent you from doing everyday tasks. Depending on whether you're scheduled for a physical CE or a mental CE, you may be asked to undergo an X-ray or take a mental status exam. Exams can also include vision tests or, rarely, blood work.

Who Performs a CE Exam?

Typically, the doctors who perform CEs are independent physicians or psychologists who have contracted with the SSA to conduct these exams. But sometimes the agency will contact your own doctor for a CE, provided they're qualified with adequate experience, have access to the required examination equipment, and are willing to submit a CE report within the time frame set by Social Security. You can even request that your own doctor perform the exam—the agency could approve your request if your doctor has the right medical background for the exam.

No matter whether you're sent to your doctor or an independent examiner, the person conducting the CE exam must have experience in the area of medicine that broadly covers your health impairment. That means for physical conditions, you'll be seen by a general practitioner (rather than a specialist like a neurologist). For cognitive, behavioral, or mental health conditions, you'll be seen by a psychologist or psychiatrist.

What to Expect at a Disability Medical Exam?

The purpose of a disability medical exam is to provide a recent snapshot of your conditions and various limitations—not for the purpose of delivering medical treatment. The doctor should have reviewed the medical records provided to them by the SSA so that they are broadly familiar with your health issues. The doctor will ask you several questions about your current medical complaints and then conduct the examination.

Consultative physical exams usually involve all of the elements of a routine physical examination, but may be much shorter. For instance, a medical assistant will usually check your blood pressure, heart rate, weight, and other routine measurements. Then, the physician will evaluate the part of your body that's impaired or will perform additional diagnostics, such as an exercise stress test.

Mental consultative exams typically involve the doctor asking you questions about how you feel in order to assess your GAF (Global Assessment of Functioning) score, which measures the extent to which your mental health symptoms affect your activities of daily living. Some mental CEs may involve memory or cognitive testing, such as asking you to name the states which border your own or recall a set of objects after several minutes have passed.

What Does It Mean if a CE Has Been Scheduled?

While most disability examiners will first contact your doctor for clarification on an issue or additional information, there are cases in which this may be impossible. Some claimants haven't been able to see a doctor for ongoing medical treatment or their medical information is considered outdated for the purposes of the disability determination. At the very least, getting an appointment letter for a CE means that your claim is actively being worked on. In some cases, it may mean that the examiner handling your claim is leaning towards approving your application but needs to obtain additional evidence.

But a CE appointment can also mean that you have little in the way of medical records or you haven't gone to a doctor in a long time, which isn't a good sign for your claim. In such cases, the scheduling of a CE may simply be a technical necessity before a disability examiner denies the claim (examiners are required to obtain recent medical evidence before making a decision.)

Since you won't know the reason for the exam, don't be overly concerned about having to go to one. You'll know soon enough—decisions often come out a month or two after the consultative exam, but how long it takes for a decision after an exam depends on various factors, including how quickly the CE doctor sends in the report.

Are There Problems With Consultative Exams?

Consultative medical examinations aren't necessarily the best way to get evidence to decide a disability claim. For one thing, it will usually be the first time you're seeing the doctor who conducts the consultative exam. And although the SSA should send a portion of your medical records to the doctor who will conduct the CE (to let them know about your medical history), some CE doctors don't read the file ahead of time.

Additionally, consultative exams tend to be brief. It's a common complaint among applicants who have gone to CEs that the duration of the exam was only five to ten minutes. But keep in mind that sometimes the SSA doesn't require a comprehensive consultative exam; for example, the agency might only need to see the results of an X-ray or a straight leg raise test.

What Happens if You Miss a Social Security Doctor's Appointment?

If you don't go to the consultative exam that Social Security arranged for you (and you don't reschedule), your disability claim could be decided without medical evidence from the CE. It's likely that this means you'll be denied disability for failing to attend an exam, and you'll need to appeal the denial to have your case looked at again. At that point, you would either have to pay to go to your own doctor or hope that an administrative law judge sends you to another CE.

If you had a good reason for missing an appointment that you confirmed, the claims examiner will usually allow the exam to be rescheduled. Good reasons include hospitalization, a death in the family, or unexpected transportation problems. To reschedule an appointment, call the Disability Determination Services office where the examiner who set up the appointment works. (The notice you received about the CE should include the phone number to call.) Write down the day and time you called and who you spoke to, in case Social Security later says that you didn't reschedule the appointment.

What's in a Consultative Exam Report?

After the examination, the examining doctor will complete a written report that will include a detailed synopsis of your medical impairment, results of the physical or mental testing that you underwent, and any laboratory findings that arose during the course of the exam. The doctor may also note things like your appearance, your punctuality, and how you're behaving towards other patients or administrative staff.

Typically, the report will also contain a statement with regard to what you're capable of doing in spite of your impairment—what Social Security refers to as your residual functional capacity. Your doctor may form an opinion on your ability to perform work-related activities such as lifting, carrying, standing, walking, handling things, hearing, and speaking (among others).

For example, physical CE reports should include the doctor's assessment of how many hours you can sit, stand, and walk during an eight-hour workday as well as how much weight you can lift in pounds. Mental CE reports should document your ability to carry out instructions, finish work at a reasonable pace, and interact with others appropriately. Both physical and mental CE reports may contain information about whether you'd miss too many days of work due to your impairment or would need to avoid certain work environments (like working outdoors or around hazardous machinery.)

How to Pass a Disability Physical Exam

It's not entirely correct to say that you "pass" or "fail" a disability physical exam. While Social Security will use the CE report to see whether you have functional limitations that are disabling according to the agency's definition, the doctors themselves don't make that determination. They simply report their findings for the claims examiners to review, who then decide if you should be considered disabled.

There's no magic phrase or way to act during a consultative examination that is guaranteed to result in a favorable CE report. What you will want to avoid is anything that can be construed as "malingering," meaning exaggerating the severity of your symptoms for material gain. Doctors are trained to recognize signs of malingering and will mention it in the CE report if they suspect that you are misrepresenting your condition. That said, doctors can also tell the difference between a good faith mistake (or simply nervousness) and intentional deception. As long as you're honest with the doctor about what you can and can't do and put forth your best effort during testing, you shouldn't have any problems "passing" the physical examination.

Remember that Social Security doctors are evaluating you from the moment they see you, not just during their physical or mental examination. For more information, see our article on trusting a doctor hired by Social Security.

What Happens After My CE Exam?

After your CE is finished, the consulting doctor will send the written report to the disability examiner handling your case. The examiner will review the report within the context of your medical records as a whole and then make a determination as to whether you meet Social Security's definition of disability. If the examiner concludes that you do, then you'll receive an award letter in the mail outlining your ongoing benefit payment schedule and amount of any backpay you're owed.

If, however, you receive a denial letter, it doesn't have to be the end of the road. Most applicants don't get disability benefits on their first try, and you have 60 days from when you received the letter to appeal the denial. You may want to consider contacting an experienced disability attorney to help with your appeal, especially if you're requesting a hearing. Having a lawyer by your side increases your chances of getting benefits, and because most disability attorneys work on contingency (meaning they don't get paid unless you win), there's little upfront cost to you in hiring one.