What if I have no recent medical treatment for arthritis when I apply for disability?

"What will happen if I have no recent medical treatment for my arthritis when I apply for disability?"

Many disability applicants have no current medical treatment to substantiate their disability claim for arthritis. This is sometimes due to not having health insurance, or not being being able to afford co-pays.

With regard to medical record documentation, Social Security likes to have a twelve-month medical history, at the very least, to make a decision on a disability claim. This is so it can be determined how far back a disability may exist. And it is not out of the ordinary for a disability examiner to request records from five years prior.

However, to make a decision at all, Social Security must have access to recent records; examiners must have 'current' medical information to make their decision. Social Security defines "current" as any medical treatment records that are ninety days or less old. I.E., to make the decision, there must be some medical evidence that is not older than three months.

If the disability examiner needs current medical information because it is not available from the medical records obtained from treatment sources, they will schedule you for a consultative medical examination. A CE, or consultative examination (What is a Social Security Consultative exam?), may be for a physical or a mental impairment. Very often, claimants are scheduled for both types of exams.

Such exams, if they are for a physical issue, tend to be short and are typically performed by an M.D. who has no past experience treating the claimant. Often, they last less than ten minutes. If the exam is for a mental issue, it may comprise psychological testing, a psychiatric evaluation, a mental status exam, or memory scale testing.

Most examinations are generally short status examinations geared toward providing just enough information for the disability examiner to make their medical disability determination.

However, some disability applicants will receive additional testing if the disability examiner feels that more information is needed. This may involve multiple consultative exams or perhaps an appointment to obtain xrays. In certain cases, a person may be sent to spirometry to assess their pulmonary lung function, or to audiometry for their hearing function, or to an eye exam.

In general, these examinations rarely lead to an approval for disability benefits. Despite that, these examinations are better than having no way to evaluate the severity of your arthritis. And, there is the chance that an approval for disability will result from your consultative examination simply by providing enough recent documenation so that an examiner will then be able to review the rest of the case file and the records that have been gathered.


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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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