Will an SSI or Social Security Exam help with the Decision?

How to prove you are disabled
and win disability benefits

A disability exam may help with the decision a case. Or it may not. However, it really depends on what a person means by "help". To answer that, we should discuss why it is that social security sends claimants to examinations in the first place.

The social security medical exam is actually something called a CE, or consultative examination. These exams are sometimes ordered by administrative law judges who hold disability hearings. But probably 95 percent of the time they are scheduled by disability examiners who are trying to make decisions on disability applications and reconsideration appeals.

A CE is ordered by a disability examiner in just a couple of scenarios:

1) When the person filing for disability benefits has alleged on their application for disability that they have a certain physical or mental condition, but there is no evidence of them ever having received treatment for the condition. Depression is a condition that often fits this category. An individual will list depression when they file for disability; yet they have never received counseling, been prescribed medication, or even mentioned to a psychiatrist, or even their family doctor, that they are experiencing, or have experienced, depression. In some cases, claimants will allege that they have carpal tunnel syndrome or a back condition but have not been officially diagnosed or treated by a doctor.

2. When the person applying for disability has received a diagnosis for their condition and has received medical treatment in the past, but has not received recent medical treatment. For SSA, recent medical treatment means treatment received in the last 90 days. How important is recent medical treatment and having documentation of this? The social security administration takes the position that a person cannot be considered disabled as of the here and now (and, thus, cannot qualify for disability), if they do not have medical proof that is recent.

Now that we've gone over why a social security exam is usually scheduled, we can state that consultative examinations definitely help in the sense that they allow a disability examiner to make a decision on a social security disability or SSI case.

However, this does not mean that it, in any way, shape or form, pushes the case toward an approval. Speaking as a former disability examiner, I can state that in most instances the results of a consultative medical examination has little positive effect on a case. As was said, it usually just allows a decision to be made since it provides a small amount of recent evidence when it is lacking.

Having said this, however, there are many cases that are already in the position of being approved for disability benefits based on the cumulative record but which are lacking recent records. In these cases, getting the results of a CE, i.e. a social security medical exam, will facilitate a case being approved. In other words, when a claimant is in the position of qualifying for disability, getting the report from a CE can simply tie up the loose lends and make the approval happen.

Finally, there are cases in which the results of a CE do substantially provide evidence that results in the awarding of benefits. For example, when claimants are sent to a mental consultative exam, this is often to have memory or IQ testing done. And in cases for which memory impairment or low IQ are alleged, the results of this testing can provide a basis for approval. Also, in some cases, a physical CE will be a neurological exam or an appointment to have an XRAY done (at the government's expense, of course) and the medical information provided can also provide a needed basis for approval.