After you apply for Social Security Disability (SSD), the Social Security Administration (SSA) may request that you participate in a consultative examination. This medical exam is essential to evaluating a claimant’s eligibility in cases in which the SSA believes they have insufficient evidence to make a decision. Understanding what to expect during a consultative examination is important to help you prepare for what is sometimes a confusing process.
Disability Law Group is thoroughly experienced with all aspects of disability benefits, including consultative exams. We will walk you through your consultative examination, answer any questions you have, and advocate on your behalf.
What Is The Consultative Examination?
The consultative examination, or CE, is a necessary step for many applicants who seek Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI). Generally, the CE is required where Social Security does not have enough evidence to make an accurate determination as to disability. An applicant may be requested to participate in a CE in the following situations:
- There is not enough evidence in the applicant’s medical records
- An applicant has not seen a doctor in a significant amount of time
- The evidence in the applicant’s records is not up to date
Working with the Disability Determination Services (DDS), a state agency that helps the SSA evaluate disability claims, you may be asked to undergo the CE or take additional tests as needed. SSA pays for the CE.
Who Will Perform The Consultative Exam?
The doctors who administer the CE are independent physicians. In other words, they do not technically work for the SSA but have instead contracted with the agency to provide the examination.
An experienced disability lawyer and firm that specializes only in disability benefits can assist you further by drafting medical source statements that will detail the types of limitations that the CE will consider which can hopefully avoid a CE altogether. If you do not have a supportive medical source statement, or if the SSA examiner does not feel that statement is persuasive, DDS will likely refer you for a CE. These are some other reasons DDS may arrange for physician to take care of your CE:
- To clear up confusion in your treating physician’s report
- If for some reason DDS does not trust your treating physician
- If you request that a different physician perform the CE
What Happens During The CE?
There are different types of consultative examinations, such as physical, internal medicine, psychiatric, and psychological, for example. What exactly happens during the CE is generally at the discretion of the physician. But the exam could involve x-rays, taking blood, and other common medical procedures.
The doctor will ask you about your recent medical complaints and about your medical history. In performing the examination, the doctor will also conduct any tests specifically requested by DDS. It’s important to understand that the CE is merely for the purposes of assessing your medical condition and specific limitations you may have. The doctor does not have the power to decide whether you should receive disability benefits. However, a doctor’s opinion, whether your own and/or by a CE, could be helpful if the limitations prove you are unable to work and support your claim.
After the CE is complete, the doctor will write a report detailing his or her findings. This report may include the results of any tests you took as well as a diagnosis, limitations assessed, and prognosis (the likely course of your condition). The report could also contain details related to how much work you are able to perform, although the SSA will still need to decide if you meet the criteria for disability in consideration of all of the records and doctor reports. Unfortunately, most CE reports are not supportive, therefore, it is a good practice to have a medical source statement from your own treating physician.
What Is A Mental Status Examination?
Some disability applicants claim mental health disorders as the basis for their request for benefits. A particular type of CE that may be ordered for these applicants is a psychiatric examination or a mental status examination (MSE).
The purpose of the MSE is to test a claimant’s intelligence, concentration, judgment, memory, and ability to understand and follow instructions, for example. These are the types of MSEs that may be administered:
- Psychiatric. Typically used for individuals who have various mental disorders, such as bipolar disorder, schizophrenia, schizoaffective disorder, and/or psychosis.
- Psychological. For applicants who have suffered head injuries, who have intellectual or learning disabilities, or who have developed cognitive disorders. An IQ test is often administered.
- Memory scale. Used for victims of short-term memory loss. This test may cover claimants with Alzheimer’s Disease or who have suffered a stroke or traumatic brain injury.
- Mental status. Used for claimants with mood disorders like depression and anxiety.
What Happens If You Don’t Attend A CE?
If you fail to attend your CE or refuse to participate, Social Security will make its determination based on the evidence it has. This means your request for disability benefits will likely be denied either for failure to comply with their request and/or a lack of information needed. You can appeal this decision, but it would be a good practice to have a medical source statement to submit in consideration of your appeal and/or ask for another CE to be rescheduled on appeal. There are many reasons why a CE may be missed or canceled, but an experienced disability attorney can help you along the way and ensure you have as much supporting evidence as possible to prove you are disabled under the law.
Some Tips For Applicants In Their Consultative Examination
Here are some useful tips for applicants who have been referred to a CE:
- Understand the process. We’ve provided some general guidance here on CE’s and what to expect, but if you have specific questions about the CE, let our experienced team answer them.
- Reschedule a missed CE right away. If you missed your CE appointment through no fault of your own, reach out to your disability claims examiner immediately to reschedule, ideally well before a decision could be issued.
- Make notes about your condition. Write down information your physician will need to know like medicines you are taking, any previous treatments or hospitalizations you’ve had for your condition, and other details.
- Be organized. Bring your medical records if possible, your Social Security claim number, and your personal identification with you to the CE. An expert disability attorney can help you by ensuring your records are in your file and your information is up-to-date.
- Be prepared to answer a variety of questions. Your doctor may ask questions that are related to your disability such as work history and educational experience and what a typical day looks like for you. Ultimately, it’s important to listen to the questions, and try the best you can, remembering to highlight the problems you have and any help you may need.
We’re Here To Answer Your Questions And Stand Up For Your Rights
Consultative examinations (CEs) can take time and are not always pleasant. But for many applicants, they are a vital part of making a compelling case for disability benefits and are an opportunity for you to have additional evidence in your case about your condition. Nevertheless, it’s recommended to have a disability lawyer who can assist you from the very start, and prepare you for what to expect along the way. If you’ve been asked to take a CE or you need other assistance with your claim, schedule a consultation with Disability Law Group today.