Why Will You be Sent to a Social Security Doctor for your disability case?

Sometimes in the course of evaluating a claim, a disability examiner (examiners work for the state disability determination services agencies in charge of deciding all initial applications and first appeals for Social Security) will schedule the claimant for a consultative exam (CE).

CEs are not performed by physicians who are employed by DDS; rather Social Security contracts with independent physicians, psychologists or psychiatrists to perform these exams as needed.

In general, those who have recently been seen by their physician (within the past 60 days) will not have to attend a CE, but this is not always the case. You could be sent for a CE even if you have seen your doctor recently, particularly if the disability examiner feels more information is needed before he can close a case.

For instance, a CE could be needed to obtain testing that is not in the claimant's medical records, such as spirometry testing for asthma or COPD, X-rays for fractures or degenerative disc disease, or hearing tests if you are filing on the basis of hearing loss.

CEs can also be used to gather information about the claimant's mental condition through IQ tests, memory exams, or a full psychiatric workup.

In some cases the disability examiner will schedule a CE if a medical condition is indicated in your medical records, but you have not mentioned it on your initial application.

For instance, if your family doctor has prescribed antidepressants, you could be sent for a mental CE to provide the examiner with a clear picture of your level of depression and the limitations this could impose on your ability to work.

The most common reason a disability examiner schedules a CE is so that the examiner can receive a written opinion from the consultative examiner about your current state of physical or mental health. Without recent (within the past 60 days) medical documentation, the examiner cannot close a case.

In fact, it is rare that a CE will have any great impact on the approval or denial of a claim. Medical records from a treating physician that establish a date of onset (when your symptoms began), specific limitations imposed by your impairment (activities you can or cannot do), and a prognosis (how your impairment is expected to progress over time) carry more weight in the examiner's decision-making process than the opinion of a physician hired to perform a CE.

This is why it is so important for those whose impairments compromise their ability to work to immediately seek medical attention from a physician with whom they have enough rapport to establish a long-term doctor-patient relationship.

In the end, all disability decisions are based on information contained in medical records'-if you have not sought regular medical treatment for your impairment, it is unlikely that a consultative exam will supply a disability examiner with enough proof to approve your claim for disability.

About the Author: Tim Moore is a former Social Security Disability Examiner in North Carolina, has been interviewed by the NY Times and the LA Times on the disability system, and is an Accredited Disability Representative (ADR) in North Carolina. For assistance on a disability application or Appeal in NC, click here.

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