Mental Exams vs Physical Exams
The results of a consultative examination, i.e. a social security medical exam, that is mental in nature will have a much better chance of getting a claimant approved on a Social Security Disability claim or SSI disability claim than a physical consultative examination (CE).
I say this from my perspective of being a former disability examiner at DDS (disability determination services) where claims are decided for the social security administration.
Why physical consultative exams often don’t help much
Typically, the physical exams that are given are very short, and are only cursory in nature. The examining physician, who knows practically nothing about the claimant or their medical history, will generally give a brief examination that only results in him or her recording an individual’s muscle strength, reflexes, and vitals.
The doctor will also make observations about the individual’s balance and gait (they have even been known to observe claimants as they walked to and from their car to see if they were “faking” being disabled…which tells you something about how some consultative physicians actually feel about disability claimants in general).
As you would expect, based on this description of a physical CE (consultative examination), not many cases can be expected to be won based on the findings obtained after such an exam.
In cases where a person is approved for disability after a CE has been done, it is likely that the disability examiner really had enough positive medical evidence in the file to approve the case, but needed some “recent” medical documentation (recent being defined as within the last 90 days) in order to be allowed to close the case.
For those who are unaware, social security requires recent medical records before a case can be approved, which makes sense since they are essentially certifying the individual as disabled from that point forward.
In contrast to the effect that a physical exam has on a claim, a consultative exam that is mental in nature is more likely to have a beneficial effect, as long as the results are considered to be:
A) Valid (and sometimes they are not if it is determined that the individual is exaggerating their symptoms or are deliberately giving less than their best effort on testing)
B) Supported by the remainder of the medical evidence.
Types of mental exams and how they can affect a claim
Mental consultative exams fall into several categories. They may be brief mental status exams, they may be full fledged psychiatric evaluations, or they may be comprised of methodical testing, such as a memory scale exam, or an intelligence test.
Mental exams can help win a claim in particular cases where a person has never had a certain type of testing and, as a result, does not have the needed evidence in their file. For example, they may have memory issues or a drop in IQ, but without test results, this cannot be proven. Very few individuals will have this type of testing before they file a claim for disability, so a mental exam can help fill in a crucial evidence gap.
Also, it is common for a person to have anxiety or depression as a disability, but no formal treatment. A mental status exam, or a psychiatric exam, can provide needed, recent evidence to address these issues, though it goes without saying that if you are applying for disability based on one of these conditions, you should seek treatment and get it documented.
It cannot be understated that for individuals who have never been given mental testing, the results of a mental CE can add tremendously to their case because it can supply the type of objective (or subjective in the case of a psychiatric evaluation by a trained psychiatrist) evidence that their file is missing.
And if the results of a mental CE lean particularly in the direction of approving a case, it will become much more difficult for a disability examiner (or their supervisor) to take the position that the individual is not disabled and should be denied for disability.