Justin S. Raines
What is a consultative examination, and why should I attend?
When you’re applying for Social Security Disability Insurance benefits (SSD, SSDI, or DIB) or Supplemental Security Income (SSI), the Social Security Administration (SSA) will order your treating medical and psychological records.
But these treating medical records may not give a complete picture of your severe physical or mental impairments. Your medical records may not provide a clear diagnosis or diagnoses. Or your medical records may not include any opinions about your physical or mental limitations or residual functional capacity (RFC).
Frequently, a claimant cannot obtain medical treatment or has not obtained treatment in a long time because of a lack of money or health insurance. Sometimes, the claimant has received treatment but has been unable to obtain the specific test needed to determine the severity of a physical or mental illness or injury. Medical and psychological tests are especially important to determining if a claimant meets or equals a listing.
For these and other reasons, the SSA will frequently send disability claimants to a one-time consultative examination (CE) with a doctor, psychiatrist, psychologist, or other acceptable medical source.
What is a CE?
A CE is a one-time physical or mental examination, test, or tests. The CE providers are not employees of the SSA. They are providers from your area who accept a specific amount of money to perform the examination or test. The examinations may be physical or mental. Tests include blood tests, x-rays, hearing tests, vision tests, and spirometry.
The type of examination and test needed will depend on the claimant’s specific disabilities. Fortunately, the CE does not cost the claimant any money.
What will happen at the CE?
The CE provider will obtain permission to examine or test the claimant. The CE provider will not give the claimant any medications or prescribe any treatment.
The CE provider will usually speak with the disability claimant to discuss the history of the claimant’s illness or injury and the reasons why the claimant cannot work.
A physical CE will include a complete physical examination and may include different medical tests. A mental CE will include a mental status examination and may include different psychological tests like a PHQ-9, BDI, BAI, or an IQ test.
Once the examination and tests are performed, the CE provider will provide an opinion about the claimant’s limitations and RFC. The CE provider will usually not give these opinions directly to the claimant but will include them in a written report, which is given to the SSA.
Why would the SSA or the administrative law judge (ALJ) order a CE?
The SSA or ALJ will order a CE when there is not enough information in a claimant’s records to decide the case.
Why should I attend my CE?
You should attend your CE because the SSA or ALJ needs additional evidence to decide your case. Your CE could result in a fully favorable decision, but the only way to know is to attend. On the other hand, failing to attend a CE without a good reason could result in a complete denial of benefits.
What should I do before my CE?
You should prepare for a CE the way you would prepare for any other doctor’s appointment. You should arrive early, be prepared to complete some paperwork, and wear comfortable clothing. If you need help completing paperwork, bring someone with you who can help.
If you are worried that you may forget to mention one of the physical or mental illnesses or injuries that keeps you from working, you can bring a list of them with you to give to the CE provider. If you have already obtained an x-ray, CT scan, or MRI, you should bring a copy of the examination report with you so that the CE examiner may review it.
If you have a severe physical or mental illness or injury, you should consult with an attorney experienced in Social Security disability for help and advice proving your case.