Why would Social Security Send you to an Exam if You MEET a Listed Impairment?

Someone submitted this question recently and my first thought was--how do you, the claimant, actually know whether or not you meet a listed impairment?

True, anyone can visit the social security administration website, read the listings for various body systems, and note the listed criteria. However...interpreting the listings is not always the easiest thing to do, even for disability representatives and disability examiners. This is because many of the listings provide multiple tracks of disability approval criteria and often the listings are nested (layered), making the reading of them fairly tedious and, to most claimants I would assume, fairly incomprehensible.

Ok, but's lets assume that a claimant has ventured into the listings, located an impairment that they believe their condition meets or equals. That still doesn't change the fact that social security must have medical evidence that verifies this allegation.

And not only that, for a claimant to be approved for disability and receive ongoing benefits, there must be current evidence that documents and substantiates that the claimant is currently disabled. As in "at this very moment".

That, of course, is where the social security medical exam comes into play. If you file a claim for disability, a disability examiner cannot, in most instances, render a decision without having access to recent records. And "recent" typically means documentation created within the past 90 days (though it is not uncommon to order an exam for a claimant who has not been by a doctor in, say, the last 60 days).

Actually, an amazingly high percentage of claims that are filed with SSA (either for Social Security Disability or SSI disability) involve claimants being sent to a CE, or consultative examination. And this is simply because so many claimants who file for disability either have not received any treatment for a specific medical condition, or have not received recent treatment in general from a medical professional.

What if you have a condition that is disabling but does not require continuous treatment, or your doctor has released you because, in the physician's opinion, you have reached MMI, or maximum medical improvement? As far as the social security administration is concerned, that fact is somewhat irrelevant.

Their position is that they cannot render a disability determination on your claim without recent medical documentation. And that, of course, is a logical position. After all, without a "recent snapshot" how can social security really know that a claimant is currently disabled, even if past medical records indicate that the claimant's condition effectively eliminated their ability to work and earn a substantial and gainful income?

If you get scheduled for a CE, or social security medical exam, you absolutely need to go, however. Not going can form the basis for a denial. And missing an appointment for an exam can result in significant wasted time as far as the processing of your claim is concerned.

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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