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Social Security Disability Claims and Medical Exams

If you have ever participated in a disability medical exam (known as a consultative exam or CE), chances are you were less than impressed with the level of attention you received. You may even have had the feeling that the doctor was merely going through the motions, and not all that sympathetic toward your condition.

Unfortunately, if this was your impression, you may not have been that far off the mark. And we'll discuss why such situations occur. Before doing that, however, some background information on why these exams are done in the first place.

Why does Social Security send people to medical exams?

Before an examiner can close a case, he or she must have recent medical information regarding your disability (meaning they must have some medical evidence in the file that is no older than the last 90 days).

For this reason, if you apply for disability and the disability examiner investigating your case finds that you have not been seen by a medical professional within the last few months, or you have a condition listed on your application for disability but have not actually received treatment for it--such as depression--you will most likely be scheduled to go to an examination appointment.

Going to this appointment is not optional and if you refuse to go, or consistently miss scheduled appointments, your case can be denied. Social Security will, however, reschedule you if you miss one or more appointments but have a valid reason, such as a medical emergency, transportation issues, or even getting lost on the way to the appointment.

Social Security Medical exams--which may be simple physical exams, neurological exams, appointments to have xrays done, mental status exams, memory or IQ testing, and even full psychiatric evaluations--are paid for and scheduled by the Social Security Administration.

The actual process is that a disability examiner will a) determine that an exam needs to be done and b) then ask the PRO, or professional relations office section of the DDS, or disability determination services agency, to make the appointment.

The doctors who perform consultative exams

But..these exams are not conducted by doctors who actually work for the Social Security Administration. They are physicians who are contracted to independently perform examinations and submit a report of findings.

What types of doctors agree to do examinations? Nearly all types. Social Security only requires that the doctor be a licensed physician. That said, many of the physicians who perform CEs do not have positive feelings for individuals filing for disability.

This, not too surprisingly, is revealed through the myriad complaints that claimants have about the exams they are sent to, such as "the exam was incredibly short", or "the doctor was rude", or "the doctor was condescending".

These are age-old complaints about consultative physicians. And, unfortunately, a claimant can disadvantage their case if they attempt to appear more physically able than they really are, or, when asked by the doctor about their condition, verbally play down the severity of their condition (in one sense, it is amazing that people do this, but the truth is most individuals do not want to apply for disability and, under other ideal circumstances, would prefer to be working).

Doctors who have a bias against Social Security's disability programs, or disability claimants themselves, will sometimes even go so far as to look for signs that the claimant is malingering, such as observing the claimant walking out of the office back to their car (and then write this observation in their CE report that is submitted to Social Security).

Other valid complaints about CE doctors include the fact that claimants with conditions like degenerative disc disease are sometimes sent to doctors whose specialty is completely removed from such conditions, such as gynecologists (this does happen). Also, very often the claimant will find that the examining doctor was not sent any background information by the DDS examiner to give them insight into the claimant's medical condition.

The reality of Social Security medical exams

Most disability consultative exams are scheduled, not to determine the state of the claimantís health or even functional limitations, but as a mere formality that must be satisfied before the examiner can close the case.

So, if you havenít seen a doctor recently, or if you havenít ever been treated for one or more of your medical conditions, your disability examiner will most likely schedule a physical or psychological consultative exam (or both if applicable).

The effect of a Social Security Medical Exam on your case

A physical CE exam typically offers very little to your case, and will rarely be used to support a claimant being approved for disability. Of course, itís only logical that a CE canít be given the same weight as your entire medical history; it can only show your physical capabilities or strength at the time of the exam, and offers no real insight into your medical condition. The brief nature of the exam and the fact that the examining doctor has never met nor treated you illustrates how unlikely it is for most consultative exams to assist a person's case (nonetheless, if you are scheduled, you must go or risk being denied for failure to cooperate).

As a disability examiner, I found it exceedingly rare for a standard physical CE to have any impact on a claim, other than the fact that it provided recent medical documentation which allowed a disability decision to be made and the case to be closed.

So, is a consultative exam really nothing more than procedural formality, possibly even a sham? Well, the answer to that is, surprisingly, not necessarily.

A physical consultative exam, or CE, can, in some instances provide a disability examiner with an up-to-date snapshot of the claimant's current medical condition that simply allows the examiner to go ahead with an approval--when the remaining older evidence in the file is strong and validates the case.

In addition, a mental CE, meaning a psychological or psychiatric evaluation, can be critical to those seeking disability benefits on the basis of a mental impairment. Many individuals who are filing on the basis of one or more mental conditions have not received regular (if any) mental health care in the past, and the CE could be the only medical documentation or support available to the examiner working on their disability application or request for reconsideration.

The most important thing to remember about a consultative exam is that it is a tool used to further the purposes of the social security disability agency (i.e., closing cases, denying claims) rather than those of the claimant (receiving benefits).

The best thing to do is show up (as stated, failure to participate in the CE could be grounds for dismissal of your claim), and donít worry about the results-óin most cases, they will not carry nearly as much weight as your past medical history and the observations made by your regular treating physician or medical specialist.

Return to:  Social Security Disability Resource Center, or read answers to Questions

Related pages:

Social Security Disability Claims and Medical Exams
What is the Purpose of the Social Security Disability SSI Medical Exam, or CE?
Social Security Medical Exam - the purpose of the Consultative Examination
Social Security Consultative Medical Exams and How they affect Disability Claims
The Social Security Disability Doctor Appointment is Called a CE
If Social Security Disability sends you to an Exam, will it be done by your doctor?
Social Security Disability, SSI Medical Exams For Physical Problems
Social Security Administration Physical Consultative Exam (CE)
Social Security Disability, SSI, and Mental Testing
Do the Results of the Social Security Psychological Exam have any Bearing on Being Approved?
Will an SSI or Social Security Exam help with the Decision?
Can you qualify for disability based on narcolepsy?

Information on the following topics can be found here: Social Security Disability Questions and in these subsections:

Frequently asked questions about getting Denied for Disability Benefits | FAQ on Disability Claim Representation | Info about Social Security Disability Approvals and Being Approved | FAQ on Social Security Disability SSI decisions | The SSD SSI Decision Process and what gets taken into consideration | Disability hearings before Judges | Medical exams for disability claims | Applying for Disability in various states | Selecting and hiring Disability Lawyers | Applying for Disability in North Carolina | Recent articles and answers to questions about SSD and SSI

These pages answer some of the most basic questions for individuals who are considering filing a claim.

Filing for disability - How to file for SSD or SSI and the Information that is needed by Social Security
How to Apply for Disability - What medical conditions can you apply and qualify for?
Applying for Disability - How long does it take to get Social Security Disability or SSI benefits?
What happens if I file a disability application and it is denied by a disability examiner or Judge?
How to Prove you are disabled and qualify to win disability benefits
How do you prove your disability case if you have a mental condition or impairment?
Social Security Disability Back pay and How Long it Takes to Qualify for it and receive it
Social Security Disability SSI - Eligibility Requirements and Qualifications Criteria