The Medical Exam or Consultative Exam for Social Security Disability
The who, what, and why of medical exams for Social Security disability.
Consultative examinations are medical examinations that Social Security disability and SSI claimants are sometimes sent to in the course of processing a claim for disability benefits.
In cases where a claimant's medical records are "thin" (there is not enough evidence) or where a claimant has not been seen by a doctor for a considerable amount of time, the DDS claims examiner will generally schedule a consultative exam.
Who Performs a Consultative Exam?
Consultative exams (CEs) are not conducted by doctors who work for the Social Security Administration (SSA). The doctors who perform consultative examinations for the SSA are independent physicians who have contracted to perform such services for the SSA.
What Is the Purpose of a Consultative Exam?
Medical exams conducted for Social Security objectives are not for the purpose of delivering medical treatment. Instead, their purpose is to provide a recent snapshot of a claimant's conditions and various limitations. Consultative exams can be physical, psychiatric, or psychological in nature. They can also include ophthalmological exams, blood work, and the taking of x-rays. What happens at the medical examination is at the discretion of the disability examiner ordering the exam. The examiner obtains only what is necessary for a decision to be made.
Are There Problems With Consultative Exams?
Consultative medical examinations are not necessarily the best way to get evidence to decide a disability claim. For one thing, a doctor who conducts a consultative exam has typically never seen a claimant (the disability applicant). And though DDS examiners often send a portion of a claimant's medical records to the physician who will conduct the CE (to appraise the doctor of the client's medical background), some CE doctors don't actually read the file ahead of time, and in any case, this is a poor substitute for an established doctor-patient relationship.
Additionally, Social Security medical exams tend to be fairly brief. It is a common complaint among claimants who have gone to such examinations that the duration of the exam was only 5-10 minutes. Though this may not be true for every CE, it is probably true for a large percentage of them.
What Does It Mean if a CE Has Been Scheduled?
Getting an appointment letter for a Social Security medical examination means, at the very least, that a claim is actively being worked on. In some cases, it may be that a claims examiner who is leaning toward making an approval needs to obtain additional evidence, such as an x-ray.
However, a CE appointment can also mean that a claimant has very little in the way of medical records -- that is, has not gone to a doctor in quite a long time, or has been treated by a doctor only sporadically. In such cases, the scheduling of a consultative examination may simply be a technical necessity before a claims examiner denies a claim (examiners are required to obtain "recent" medical evidence on which to base their decisions).
Since you won't know the reason for the exam, don't be overly concerned about having to go to one. But you should always attend a scheduled CE, since claims examiners are allowed to deny disability claims for "failure to cooperate," except when a claimant has a valid reason for missing a scheduled exam (in which case the claims examiner will usually allow for the examination to be rescheduled).
What's in a Report from a Consultative Exam?
The consulting doctor who performs your consultative exam will send a written report about the results of the physical examination, positive or negative findings, and the results of any tests you took. The doctor will also include a diagnosis and prognosis of your condition and a statement about what you are capable of doing, such as how many hours you can stand or walk and how many pounds you can lift.
The doctor may also include notations on his or her opinion of whether your symptoms are as serious as you say. For instance, the doctor could note that you were able to get out of your vehicle with little or no difficulty, or that the doctor did not feel that you gave your best effort during the examination. Consulting doctors do see some disability claimants who are malingering (faking the severity of their condition), so they will be on the lookout for this. Remember that Social Security doctors are evaluating you from the moment they see you, not just during their physical or mental examination.