How Long Does It Take for a Decision After a Social Security Consultative Exam?

After you apply for Social Security disability benefits, the agency may require you to attend a consultative examination (CE) before making a decision on your case. Once you've gone to an exam, you can typically expect to know within four to eight weeks whether your application is approved or denied. But the exact time it will take you to get a decision following your CE depends on several factors outside your control, including how promptly the examining doctor files the report.

As with most steps in the Social Security disability determination timeline, patience is a virtue. Knowing what's going on "behind the scenes" as your CE is processed can be helpful while you play the waiting game—and can provide useful information if you need to appeal a denial based on information contained in your examination report.

How Long After the SSDI CE Exam Will I Get a Decision?

It's common to get a disability decision about six weeks after a CE. Generally, you're not sent to a CE until a claims examiner and medical consultant at Disability Determination Services (DDS), the state agency that helps Social Security review applications for benefits, have evaluated all of your records from the medical providers 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.

What Happens After a CE Exam for Disability?

Once you've had a CE, the physician or psychologist who examined you sends a report back to the DDS claims examiner. Your CE report will cover several key topics: basic identifying information, a brief description of your medical history, your current symptoms, and the results of the examination itself. (It will not include a statement that you're disabled, however, as the responsibility of deciding whether you're disabled lies with the claims examiner.)

Identifying Information

DDS needs to know that the CE doctor examined the right person, so the report must clearly identify you by including your name, date of birth, and Social Security number (or claim number, if you don't have one). The report must also state that you provided appropriate proof of identity on the day of your CE, 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.

Your Past Medical History and Current Condition

Your CE report will also describe your medical history (to the extent that the examining doctor has received records from DDS), including:

• the onset of your condition and how it has progressed since it started
• relevant hospitalizations and surgical procedures
• medical diagnostic imaging such as MRIs, X-rays, and CT scans
• results from any other examinations or laboratory tests, and
• therapeutic methods you use to treat your condition, such as medications you take and any side effects you experience as a result.

Then, the consultative exam report should list the primary impairments that you say keep you from working. The CE report should cover:

• your current symptoms
• your typical daily activities, and
• your description of how your condition limits your ability to function.

The discussion of your current impairment must be in narrative form (checklists aren't allowed). Any information about your condition that's based on statements made by you must be reported in your own words.

Physical or Mental Examination

Finally, the report will contain details of the examination itself, including test results and the examiner's findings. The examining physician or psychologist may state their opinion regarding your ability to perform certain work duties, like how much weight you can lift or how long you can focus on basic tasks.

Once completed, the CE report is then signed, dated, and sent back to the DDS office that requested the examination. The CE report is often the last piece of medical evidence the claims examiner needs to make a disability determination, so once the report comes in, it shouldn't take long to get a decision on your claim.

What Can Delay Your Disability Decision After a CE?

Social Security's procedural rules state that the doctor who conducts the exam should submit their report within 10 business days—basically, two weeks—of the examination, but not all doctors send them back on time. Other variables can also affect the amount of time between when your CE report is submitted and when you receive your decision. While you could get an answer within a month of your exam if the report is submitted quickly, any of the following issues could cause delays.

A New Medical Condition or Impairment Is Brought to Light

The disability examiner could realize 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 be more common in cases involving mental health because Social Security is required to develop the record further if there's evidence suggesting the possibility of a mental impairment (20 C.F.R. § 404.1529), which can be as simple as reporting symptoms of depression to your doctor during your most recent visit.

Evidence of a new medical condition 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.

The Results of the Exam Are In Question

Sometimes the examining doctor will question the results they found during the physical or mental exam. They might indicate that they suspect the results aren't accurate (and describe why). For example, a claimant 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 fraudulently obtain disability benefits. If this happens, another exam might need to be scheduled—perhaps more than once.

Your Claim Is Under a Technical or Quality Review

Your case could be slowed by a "technical review" before exiting the DDS agency. In a technical review, a supervisor checks that all forms, rationales, and notices in a claim have been properly completed—it's essentially a safeguard to make sure that the paperwork for your claim is in order. Or, your case might be intercepted by the external Disability Quality Branch (DQB), where the decisions of DDS examiners are reviewed for accuracy. When a case is sent to DQB, it can be delayed for several weeks.

How Do I Know If My CE Went Well?

It's really hard to tell if your CE went "well" right after the examination. CEs are typically short snapshots of how you're feeling at that moment. Many disability claimants have "bad days" and "good days," so if the CE happens to fall on a "good day" where you're feeling a bit better, the CE report might not be an accurate reflection of how you're doing overall.

It's more likely that your CE went well if you were specific when answering the doctor's questions or describing your symptoms. Keep in mind that disability examiners look at the CE because they need a doctor's opinion about any functional limitations you have that could meet a listing or rule out all work, two methods by which the agency can find you medically disabled. So answering a question such as "How long can you sit?" with a number or quantity (for example, "I can sit for 15 minutes before I need to lie down to relieve pain") is much more useful to both the doctor and the examiner than a vague response such as "Not long."

Do CE Exams Usually End in a Denial?

CE exams are often ordered during the initial level of disability determinations when most claims are denied, so unless your medical records are very strong (and, after reviewing them, the examining doctor agrees that you have significant limitations) it's unlikely that you'll be approved at this stage. Doctors who perform Social Security exams 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 you receive a denial letter following a CE, even if you feel you have overwhelming evidence that you can't work because of your condition.

Will I Get to See the Results Of My CE Exam?

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. Once DDS has denied your claim, you can (and should) request a copy of your CE report. You'll want to review 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.

What If You Disagree With the Consultative Exam Report?

Fortunately, you have the right to appeal if DDS denies your disability application because of something in the CE report (or any other reason). Most claimants who are ultimately awarded benefits don't get approved until after they've had a hearing with an administrative law judge, which requires appealing an initial denial as well as a second denial at the reconsideration level.

While it can be understandably frustrating to keep appealing denials—a process that can take over a year on average—it does have the benefit of giving you time to strengthen any weaknesses in your claim. For example, disability judges often don't give much legal weight to an unfavorable CE report if you have one or more persuasive medical source statements from your regular doctors. That means it's not unusual for a judge to disregard a CE that DDS had earlier used to deny you benefits and issue you a favorable decision in light of new medical evidence and opinions.

You may want to contact an experienced disability lawyer as you proceed with appealing your claim. An attorney can help contextualize an unhelpful CE report within your medical record as a whole, draft a pre-hearing brief that outlines why you're disabled, and represent you in front of a hearing judge. Disability lawyers work on contingency (meaning they don't get paid unless you win) and many offer free consultations, so you can ask around to find one who's a good match.