Consultative Exams: What they are and what they mean for your disability claim

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Many of my clients receive a notice from the Social Security Administration ("SSA") requesting that they attend a Consultative Evaluation ("CE") by either a medical doctor (for physical impairments) or a psychologist ( for mental health impairments), or both when there is a disability involving a combination of illnesses. Because SSA is responsible to fully develop the medical record in your case, these CEs are often scheduled when there is insufficient medical evidence for the disability analyst to make a decision on your claim for benefits. This post is intended as an overview of the Consultative Examination process.

Consultative Examiners–who are they?

SSA maintains a rotation of doctors who serve as Consultative Examiners. They are independent physicians and psychologists, usually in private practice, who have agreed to examine disabled applicants for SSA for a reduced fee. Social Security rules provide that you are entitled to have your own treating doctor perform the Consultative Evaluation; however, this can prove difficult as SSA does not pay very much for the examination, and many doctors decline the opportunity.

What is the purpose of a Consultative Examination?

The purpose of attending a CE is not to be treated by a new medical source. The objective is to obtain a "snapshot" of your impairments and how they impact your ability to sustain full time employment. In the event that there are inconsistencies in your existing treatment records, one objective of the exam is to reconcile any contradicting medical evidence or opinions. Also, your CE may include updated blood work, X-rays, or psychological testing. The disability adjudicator that is analyzing your claim will order the particular tests that they feel are necessary to complete your file. Sometimes the Consultative Examiner's opinion will be helpful and support your Social Security claim.

What are some common problems with Consultative Evaluations?

One of the most common complaints that I hear concerning these examinations is that the doctor spent only minimal time speaking with the disability applicant–sometimes a little as 10 minutes! I suggest that you take a few moments after your appointment to make notes about the examination including, how long it lasted, the types of questions that you were asked, and any information that was given to you by the examining doctor. You should speak to your attorney or their paralegal after the examination to convey any concerns that you might have. If the Consultative Examiner's report does not support your disability claim, your attorney can bring these concerns to the attention of the Administrative Law Judge and argue that the report should be discounted.

Do I have to attend my Consultative Examination?

Social Security cannot force you to attend your CE, however, your decision to not participate will be noted and your claim may be denied on the basis of "insufficient medical evidence" or "failure to cooperate." I always advise my clients that it is in their interest to attend the examination and to then contact me afterward so that we can discuss their experience. If you are unable to attend your CE, it is vital that you contact the disability analyst, whose contact details should be listed on the appointment reminder. At minimum, you should notify your attorney as soon as possible so that they may notify DDS and request that your appointment be rescheduled.

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