When applying for social security disability insurance benefits (SSDI) or Supplemental Security Income (SSI), your social security administration disability claims examiner may order you to undergo a mandatory consultative exam (CE).
What is a consultative exam?
From the Social Security Administration (SSA):
“If the evidence provided by the claimant’s own medical sources is inadequate to determine if he or she is disabled, additional medical information may be sought by recontacting the treating source for additional information or clarification, or by arranging for a CE.”
There are two types of CEs, physical and mental. Physical CE exams usually take around 5-20 minutes and include a few physical tests and a few questions about your health history. Mental CE exams usually run 15-45 minutes, primarily consists of questioning, and may include a mental status exam.
What Does it Mean When Social Security Sends You To a Doctor?
If social security sends you a letter asking you to see a doctor at their expense, it means that the disability examiner thinks there is not enough medical evidence on the disabilities that you are alleging. Most of the time, this is because you are not getting medical treatment on your own. Failing to get your own medical treatment is a major obstacle to winning your disability case.
Yet few disability applicants see that consultative exam notice letter as a sign they are not doing what they need to do to win their disability case. Rather, most SSDI and SSI applicants with an upcoming consultative examination focus on the nature of the consultative exam, many wrongly assuming the CE will be all the evidence they need to win. A pending consultative examination is not a sign that the social security administration is assuming responsibility for securing the necessary medical evidence in your claim.
So am I saying the CE is worthless? Should you simply not go? Absolutely not. CEs can be very helpful in a disability case, and failure to attend a CE will ensure a disability denial. But you need to keep what CE can and cannot do for you in perspective.
SSI doctors appointment: Who Will Perform the Consultative Examination (CE)?
The consultative examination will be performed by a licensed physician or psychologist pursuant to a contract with the Disability Determination Service in your state, the agency that makes disability decisions for the social security administration.
Disability applicants often refer to consultative doctors as “government” or “social security” doctors, but they are not employees of the government. These disability doctor evaluations are paid for by social security.
The fee social security pays for consultative examinations is much lower than what doctors can earn in a routine and successful private practice. This low remuneration to the consultative doctor may account for many of the typical complaints from social security disability applicants I have heard in my 25 years of social security disability representation.
Many disability applicants have heard that social security will arrange for their own treating doctor to be the “consultative examiner” if requested. As a reality, this almost never happens and is not worth trying to arrange.
As noted above, most consultative examinations are ordered by social security in response to inadequate or non-existent medical treatment. So there is not likely to be a treating physician to perform the consultative exam.
Getting social security to approve the use of your treating doctor for the consultative examination is difficult and will needlessly slow the disability process down. Your treating doctor will not be enthusiastic about performing a specific exam for a paltry government fee.
You should secure the opinion of your own treating doctor in the form of a medical source statement (a qualified social security disability attorney will know exactly what this is) not bound by the narrow confines of the government-ordered consultative examination.
What Does the Consultative Examiner Do?
The consultative examiner’s job is simple: (i) perform the examination of you that social security ordered him to perform and (ii) prepare a report for social security documenting his findings.
Many disability applicants are under the false impression that the consultative examiner will determine whether they are entitled to social security disability. The consultative doctor does not “put you on” disability.
Rather, the social security administrative determines whether a person’s medical condition meets the requirements of the Social Security Act for disability benefits.
The social security administration will, however, consider and analyze the medical findings and opinions in the record – including the results of the consultative examination.
What Can I Expect at the Social Security Disability Consultative Examination?
Uneven Quality Social Security Disability Consultative Doctors
Complaints from disability applicants about the quality of consultative doctors are widespread. While it is unfair to label doctors who do consultative examinations for social security across the board as “low quality”, it is true that these doctors would likely not be doing consultative examinations for the social security administration if they had a thriving private practice.
The fee paid to consultative doctors for disability examinations is well below what doctors can expect to earn as a physician. Younger physicians still building their practice are less problematic, but many older consultative disability doctors have simply failed to thrive in private practice. There could be many reasons for this, including that they may simply not be very good doctors.
No Doctor-Patient Relationship with Your Consultative Examiner
The consultative doctor is not “treating” you; you are not his or her patient. The fact that the CEs are really “working for the government” perhaps leads some of the examining doctors not to extend the same courtesy to CE patients as they would have if they were regular patients with whom they hope to maintain an on-going cordial relationship. Many social security disability claimants have complained that the doctor that performed their CE was grumpy, angry, or rude.
The Consultative Exam is Limited to What Social Security Has Ordered
There you are: sitting in front of the consultative doctor in her white coat and stethoscope – just as if you were seeing your own doctor. It is very hard not to “default” to normal doctor-patient behavior. We all expect that our doctor wants to hear every detail about our health, right?
Not the consultative doctor. Her job is to perform the examination that the social security administration has ordered: no more, no less. Her role is not to delve into every physical or mental problem you have that impacts your ability to work. If she has been asked to perform an x-ray of your knee, she is not interested in hearing about your problems with anxiety.
The Consultative Exam Will Be Brief
Besides having a dour demeanor, consultative physicians often give extremely quick exams leaving patients feeling as though the physician didn’t really try to understand their problems.
Realize, however, that the scope of what the consultative doctor has been asked to do (i.e., the specific examination that social security is paying for) is limited, and may not take much time to perform. The low fee paid by social security, unfortunately, encourages consultative doctors to move quickly through their disability patient examinations.
What Should I Bring to the Consultative Examination?
Review your notice of the consultative examination carefully. You will need to bring proper identification. You may bring medical treatment records in your possession that you think are relevant, but there is no guarantee that the consultative doctor will agree to review them.
Advice for Your Social Security Disability Consultative Examination
Lower your Expectations and Adjust Your Attitude
Social security disability applicants typically have unrealistic expectations of the consultative exam. Many see the CE as an indication that social security is finally taking their complaint seriously and wrongly assume the CE will be thorough and will cover all their disabling impairments – both physical and mental.
As noted above, the CE will be very limited in scope and duration, perhaps in a crowded and unattractive office setting. The CE is apt to feel more like a “cattle call” than a professional medical treatment office.
Presenting to your CE with unrealistic expectations will likely lead to disappointment and frustration. Many disability claimants allow that frustration to show, creating tension between the claimant and the examiner. A claimant that communicates disappointment and anger with the examiner is less likely to find the examiner receptive to their cause.
Many consultative examiners are unwilling to review medical records that claimants bring to the examination. This can be frustrating to claimants, but realize that consultative doctors often see claimants who try to unload stacks of unorganized medical treatment notes on the doctor, or even bring actual radiographic images.
If there are specific objective medical tests such as x-rays or MRI results reports (not the actual films) that document the problem for which the consultative doctor is examining you, be prepared with those most recent results at hand.
If you present no more than 5 or 6 pages of diagnostic test results to the consultative examiner, it is likely he will be willing to review them. If the consultative examiner refuses to review any medical evidence you have brought, refrain from arguing the matter.
What not to tell a disability doctor: Don’t downplay, brag, exaggerate or “sell”
Many consultative doctors seem to be on the lookout for malingerers or people exaggerating an injury in an attempt to get disability so they don’t have to work. Since consultative doctors typically perform a lot of CEs because of the low reimbursement rate from social security, they may see a lot of “fakers” in their exams. Exaggeration and “over-endorsement” of symptoms is a hallmark for those trying to work the system.
But you don’t have to be a faker to exaggerate and “over-endorse” in a social security disability consultative exam. Disability claimants who are in fact entitled to disability can also fall victim to this practice because they fear being denied disability benefits if the doctor fails to notice problems or if they admit that they have no problems in certain areas.
For example, a person who is qualified for disability and who walks with a slight limp may act as if it is suddenly worse or constantly moan in the examination. Or a middle-aged man with limited education and past work as a construction worker may wrongly assume that his ability to sit will keep him from getting disability. If he tells the consultative doctor that he has significant problems with sitting because he fears admitting this ability may hurt his case- even though he has no medical evidence to support sitting problems – he may appear to be malingering in the eyes of the consultative doctor.
What not to say to a consultative doctor in a consultative exam is important; but so is what you need to say. Do not fail to admit to limitations that you actually have. Men are more prone to this unwillingness to admit to problems, but false pride can lead men and women alike to brag about abilities they do not possess and undermine their own disability claim.
For example, when you first see the doctor and they ask “how are you today?” don’t just play nice and reply “fine, how are you?” That may end up in your report. Instead, just tell the doctor how you are really feeling and explain what is wrong.
You should also be aware that the consultative doctor and her staff are not just paying attention to your words; they may also be carefully observing how you walk and move. Many have been known to watch patients walking in the parking lot or to drop things on purpose to see if the disability claimant quickly picks it up.
The watchword in a consultative exam is to be authentic: don’t try to draw attention to yourself, exaggerate, or try to sell the doctor on your claim. But don’t “put your best face forward” or worry about what the doctor might think of you either.
Can a doctor put you on disability? Do CE exams usually end in denials for disability?
Ultimately, the results of consultative exams are just one consideration in social security disability cases. The consultative doctor’s opinion is not the final word on whether you qualify for disability or not. That may be a good thing for disability claimants.
Sadly, most consultative examination reports are not helpful to disability claimants. Typically the findings support the denial of benefits or are so limited in scope that they provide little evidence to support claim approval.
But when consultative examination results support a finding of disability, they are worth their weight in gold. Because Administrative Law Judges widely regard consultative examiners as unfriendly to disability applicants, they find consultative opinions that do support disability to be particularly credible.
ALJs often would prefer to support a favorable disability decision with consultative report findings than with those of a treating doctor. The social security administration worries about bias in results from a treating doctor due to that doctor’s personal relationship with the claimant, an issue not present with consultative examiners.
As a social security disability lawyer for over 25 years, I can tell you that favorable consultative exam reports have often provided critical support for favorable disability findings. In fact, my routine practice in case hearing preparation is to start with the review of consultative examiner reports.
Even consultative examinations that as a whole do not support a disability case may include particular findings that, when combined with other medical findings in the record, support a winning claim.
A hallmark of skilled social security disability representation is the ability to carefully mine the “gold nuggets” that may be found in an otherwise hostile consultative exam report.
Fort Worth and Dallas Disability Attorney
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