Should You Trust the Social Security Disability Doctor?

After you apply for Social Security benefits (SSDI or SSI), the Social Security Administration (SSA) may arrange for you to attend a consultative examination to help determine whether you're medically eligible to receive disability payments. Consultative examinations are one-time visits with a doctor who is paid by the SSA to conduct an independent assessment of your physical and mental impairments and provide their opinion on your functional limitations.

While consultative examiners are sometimes referred to as "disability doctors," they're not technically employees of the SSA. Rather, they're independent contractors who conduct consultative exams for the SSA in addition to their regular medical practice. But because "disability doctors" only see you once and might not have access to your entire medical records, they can only provide a limited snapshot of your current health issues.

Additionally, some doctors may wish to remain in the agency's good graces in order to continue receiving consulting work, which can make them disinclined to provide favorable assessments. It's important to come prepared for the consultative examination so that you can maximize your chances of a helpful opinion (and know how to argue against an unhelpful opinion on appeal).

What Do Disability Doctors Look For?

Social Security can request information from a consultative doctor when the claims examiner or administrative law judge reviewing your case doesn't have enough medical information to decide whether you meet the agency's definition of disability. During the examination, the doctor will look for medical signs—such as a diminished knee reflex—of any limitations that could point to a finding of disability. In some cases, the exam may include an X-ray or other diagnostic testing.

The SSA might request a mental consultative exam if you have significant mental health impairments or your record suggests cognitive limitations. The consultative doctor will likely perform a mental status exam to find any abnormalities in mood, memory, and abstract thinking. These tests usually involve simple tasks such as counting backward in threes or recalling a set of pictures after five minutes.

For both physical and mental exams, the doctor will ask you questions about your condition and how it affects your activities of daily living. After the appointment is over, the doctor will review the results of your examination along with your self-reported symptoms and provide an opinion for Social Security about your residual functional capacity (RFC). Your RFC is a description of the most you're capable of doing, physically and mentally, on a sustained basis.

What Not to Tell a Disability Doctor

It's important to be open and honest with the consultative examiner. Don't think that you can inflate your symptoms and expect the doctor to nod and agree. Remember that the doctor will report back to the SSA what they find on examination and what you tell them during the appointment, so make sure that you give them useful and truthful information.

Keep in mind, however, that the consulting doctor isn't going to advocate for you the way your regular doctor might, nor are they personally invested in the outcome of your examination. Some doctors may downplay your limitations in their reports to Social Security, whether unintentionally (because they don't have the full picture of your medical treatment) or because they have certain biases against awarding disability benefits. Choosing your words carefully when describing your symptoms can help push back against any impartiality from the doctor.

Don't Minimize Your Symptoms

Many consulting doctors are inclined towards writing an RFC assessment stating that you aren't limited enough to be disabled. Avoid doing the doctor's work for them by acting like your symptoms aren't a big deal. If, during the examination, the doctor asks "How does it feel when I do this?", you should explain exactly where the pain occurs and how intense it is. Even if the doctor doesn't specifically ask you when performing a maneuver that causes pain, don't grin and bear it. Say that it hurts and describe the pain so that the doctor can include it in their notes.

A lot of people are uncomfortable when discussing their health with a doctor they've just met, particularly when talking about mental health symptoms (which often still carry an unwarranted stigma) or physical conditions that impact hygiene or sexual activity. Try not to let any feelings of embarrassment interfere with a candid description of your symptoms. You should be as thorough as possible about all your symptoms to give the doctor the clearest picture of your limitations.

Don't Exaggerate Your Symptoms

Some disability applicants, perhaps (not unreasonably) worried that the consulting doctor won't have enough time or interest to fully understand their limitations, may end up overstating their symptoms in order to make sure the doctor gets how serious they are. For example, if the doctor asks you to rate the level of pain you experience on a daily basis on a scale from 1 to 10, don't say "10" because you want the doctor to know how bad the pain is. That's likely to raise a skeptical eyebrow, since that level of daily pain would likely require ongoing hospitalization.

It's better to be realistic and precise about your symptoms and limitations. Don't just say "Everything hurts," or "I can't do anything." Such generalizations are unhelpful at best and damaging to your case at worst. Instead, use specifics where possible. "My right knee begins to throb after standing for 15 minutes and I need to sit down and elevate my leg to relieve the pain," is a much more powerful statement than "My knee always hurts and I can't stand."

Don't Overshare

The consultative examination is fairly limited in scope. The doctor's role is solely to provide an opinion about your medical limitations for your RFC. But there's more to your disability determination than just your RFC. Factors such as your employment history and substance abuse can affect the decision-making process. These factors are better addressed by communicating directly with Social Security rather than having the information filtered through the consultative exam, where it can be misconstrued.

It's natural to feel nervous at a doctor's office, and many people get chatty when they're anxious. But sometimes a casual, tossed-off comment about babysitting for a relative gets noted down and makes its way into the record, where the SSA can then use it to say that you can babysit as a full-time job (and deny your application). You can avoid this by keeping your focus on answering just the doctor's questions.

What Should I Bring to the Social Security Disability Doctor's Evaluation?

Once you're scheduled for a consultative exam, Social Security will send you a notice with the time, date, and location of the doctor's appointment. Bring the notice with you, along with your ID and any medications you're currently taking in their original containers. If you have any other medical assistive devices, such as a cane, hearing aid, or reading glasses, bring those as well. The doctor should make a note about how you're using these devices in the exam report.

If you're worried that you'll forget to mention something important to the consulting doctor, make a list before the appointment. Include all the things you struggle with on a daily basis, from shopping and preparing meals to lifting, standing, sitting, and walking. You can bring the list with you to help you remember what to discuss, but don't just read off of it. Interact with the doctor so they can see how you react to basic questions and tests.

Will the Consultative Exam Be Good or Bad?

One of the worst-kept secrets in Social Security disability law is the limited effectiveness of consultative exams. It's difficult for a doctor to get a solid sense of whether an SSDI or SSI applicant ("claimant") is disabled based on a single short examination. Almost every disability attorney has heard complaints from their clients about the consulting doctor rushing through the exam, missing crucial information, or not paying enough attention to their symptoms.

For example, a claimant might mention that they have severe lower back pain several times a day, especially after sitting for more than 30 minutes or lifting grocery bags. The doctor could record this as follows: "Patient can sit with occasional breaks for up to eight hours without pain. Patient can do moderate lifting without pain." And consulting doctors aren't particularly great at communicating when a claimant has symptoms that result in "good days" and "bad days," so if you frequently experience fatigue due to fibromyalgia and your exam falls on a "good day," the doctor might write, "Patient seemed bright and alert. No apparent issue with fatigue."

Such reports aren't particularly insightful, which is why many judges are less willing to rely on them when making a disability decision—provided the medical record as a whole shows greater limitations than the doctor's opinion does. But you'll have to appeal two denials before you have a chance to tell a judge why the consulting doctor was wrong, which can take years. If you can get a helpful doctor's report early on in the disability determination process, you have a higher chance of getting benefits sooner, especially if you haven't received much medical treatment.

What to Do When the Doctor's Report Is Unhelpful

It's much more common to have an unhelpful doctor's report following a consultative exam than it is to have a helpful one. Typically, only the strongest disability claims will result in getting a favorable opinion from a consulting doctor. But the SSA doesn't just look at the consulting doctor's report when determining disability. The agency must consider the report within the context of your file as a whole. That means you can take steps to make an unfavorable doctor's opinion look like an outlier. Here are a few examples:

• Seek regular medical treatment. Your medical records are the foundation of your disability claim. The fewer treatment records you have, the more Social Security is forced to rely on the doctor's opinion to decide whether you're disabled.
• Improve the quality of your records. Even if you've had regular medical treatment, you might be missing some crucial documents that can strengthen your claim. An MRI showing severe spondylolisthesis can help establish disabling back pain, for example.
• Get a doctor's note from your regular provider. Broadly, the SSA values the opinions of doctors who've seen you on an ongoing basis over those who've seen you once. Having a helpful "treating source statement" can be very persuasive to Social Security.

Consider getting a disability lawyer to help you strengthen your case. At your appeal hearing, your attorney can poke holes in the consulting doctor's report and present reasons to the judge why the report should be given little "weight" (legal force).

Hiring a Social Security Disability Attorney

Not many disability claimants have the experience and knowledge to defang an unhelpful doctor's opinion on their own. That's why it's smart to get legal advice from a disability attorney, especially if you've been scheduled for a hearing. Your lawyer will be able to argue on your behalf and present the evidence in a light most favorable to you. Disability lawyers work on contingency—meaning they don't get paid unless (and until) you win—so there's little downside to hiring one. Most offer free consultations, so you can ask around until you find a representative who's a good match.