When you apply for Social Security disability, the disability claims examiner might require you to have a "consultative examination" (CE) performed by a Social Security doctor before your case is decided. After a consultative exam, it shouldn't be long before you know whether your application for disability benefits is approved or denied. But the time it takes to get a decision can vary depending on how long it takes the CE doctor to file a report, the contents of the report, and other factors.
It's common to get a disability decision about a month after a consultative exam. Generally, you're not sent to a consultative examination until the DDS (Disability Determination Services) medical consultant and disability claims examiner have received and evaluated all of your medical records from the doctors and hospitals you listed on your application. That process can take several months, depending on how long it takes for DDS to receive all your medical records.
Once you've had a consultative examination, the CE physician or psychologist who examined you sends an examination report to the DDS claims examiner. In most cases, the CE report is the last piece of medical evidence the disability examiner needs to make a decision. So, once the CE report comes in, it shouldn't take long to get a decision on your disability claim.
The CE report will cover details about you, your medical history, and the consultative exam itself. It won't include a disability determination, as the responsibility for deciding whether you're disabled lies with the DDS claims examiner.
The Social Security Administration (SSA) requires the CE report to clearly identify you by including your name, birthdate, and Social Security number or non-SSN claim number. And, unless the examining doctor or psychologist is one of the medical sources (that you cited in your application) with whom you have a long-standing relationship, the CE report must verify that you provided appropriate proof of identity on the day of your consultative exam (like a state-issued photo ID or driver's license). Or it must give a physical description to verify that you were the person examined.
The consultative exam report should list the primary impairments that you say keep you from working. The CE report should cover:
The discussion of your current impairment must be in narrative form (checklists aren't allowed). And any information about your condition that's based on statements made by you must be reported in your own words.
Your CE report will also cover your complete medical history (or as much as the CE examiner has received from DDS), including:
The report will contain details of the consultative examination itself, including test results and the examiner's findings. The examining doctor or psychologist might share an opinion regarding your ability to perform certain work tasks (like how long you can stand and how much you can lift). But the report won't say whether you are legally disabled or not.
It's difficult to give a concrete answer on how long it takes to get a disability decision after a physical or mental consultative exam because there are a number of variables that differ from case to case. Each can delay your disability determination. While you could get an answer within a month of your exam if the report is submitted quickly (and most people do), any of the following issues could cause delays.
The first variable is how long the results of the physical or mental consultative exam take to get to DDS. The SSA makes it clear to the consulting doctors who conduct the exams that the consultative examination report should be sent to DDS within 10 business days from the date of the exam. This means basically two weeks. But not every doctor gets their CE report in on time.
The disability examiner could discover, late in the process, that a particular condition wasn't investigated because it hadn't been discovered in the previously gathered medical evidence. This can cause delays, as the examiner may then have to schedule another consultative exam to learn more about the new condition. If the examiner sets you up with another exam, try not to cancel and reschedule, as this will cause further delays.
Sometimes the examining physician or psychologist will question the results they found during the physical or mental exam. The doctor or psychologist might indicate that they suspect the results aren't accurate (and why). If this happens, another exam might need to be scheduled—sometimes more than once.
For example, an individual might need to take multiple IQ tests if their scores come out suspiciously low and the examiner thinks the person is trying to steer the outcome of the testing to get disability benefits when they don't qualify.
Your case could be slowed by a "technical review" before exiting the DDS agency. In a technical review, a DDS supervisor checks that all forms, rationales, and notices in a claim have been properly completed. It's a check that all the DDS paperwork for your claim is in order.
Your case might be intercepted by external quality control at the Disability Quality Branch (DQB), where the decisions of disability examiners are reviewed for their accuracy. When a case is sent to DQB, it can be delayed for several weeks.
You won't get a copy of the consultative examination report if your claim is approved after the CE exam, but you can get one if your disability claim is denied (as the majority of claims initially are).
Once DDS has denied your claim, you can request a copy of your CE report. You (and your lawyer) will want to see it because, if the DDS claims examiner required you to get a consultative exam, you can be sure it played a role in your disability determination.
It's common for the disability claims examiner to request a consultative exam when they're close to making a determination, but feel they need more evidence to confirm their decision. Often, claims examiners set up a consultative exam when they expect to deny a claim, but need medical evidence for your file to back up their decision.
And unfortunately, the doctors who perform consultative exams for the SSA can be skeptical of disability claims, so many CE reports aren't favorable, meaning the findings may not support your claim of not being able to work. So don't be surprised if your claim is denied following a CE—even if you feel you have overwhelming evidence that you can't work because of your impairment.
If DDS denies your disability claim because of something in the CE report (or any other reason), you have the right to appeal.
Updated July 14, 2022