What is the purpose of the Social Security Disability /SSI Medical Exam or CE?
Ask the Advocate
August 29, 2020
In a fairly large percentage of cases, a person filing for disability benefits with the Social Security Administration (in either the Social Security Disability program or the SSI program: claims in either program are evaluated in exactly the same manner) will be notified that they have to go to a scheduled appointment for a medical examination, or a psychiatric examination, or psychological testing. These exams are known as consultation examinations and are referred to by disability examiners, disability representatives and disability hearing judges as a CE.
The CE, or consultative examination, is conducted by either an M.D. (this would be for physical impairments or psychiatric impairments) or, in the case of intelligence and/or memory testing, by a psychologist who usually holds a master's degree. Contrary to myth, the CE, which is sometimes referred to as the "Social Security medical exam" is not conducted by doctors or therapists who work for the Social Security Administration in any capacity. Quite the contrary, these individuals are typically in private practice and have been contracted to A) perform evaluations and examinations on disability claimants and B) report the findings of their exams to Social Security within X number of days of performing the exam.
Who decides that a claimant will need to go to a consultative exam? The disability claim decision-maker does this. So, in most cases, an examination will be scheduled by a disability examiner (disability examiners make decisions on claims at the disability application and reconsideration appeal level).
However, administrative law judges who make decisions on claims at the disability hearing level will sometimes also require that a claimant go to a consultative exam.
What is the purpose of the consultative examination? Officially, the purpose of any CE (physical or mental) is so that a disability examiner or judge may obtain additional medical record documentation. Additional documentation will usually be needed in cases where:
A) The claimant has not been to a doctor or treating specialist for more than sixty days, or B) the claimant has listed a condition on the disability application for which they have never been treated, or been diagnosed.
Typically, what triggers the scheduling of an examination is the fact that the claimant has not been recently treated. This is because Social Security disability and SSI disability claims cannot usually be decided (either approved or denied) if the claimant's file does not contain "recent medical evidence." For the purposes of the Social Security Administration, this means having at least some medical evidence in the file that is not older than sixty days.
Because a great many consultative exams are scheduled simply so that the Social Security Administration can obtain recent medical evidence (in the form of the report from the doctor or psychologist conducting the exam), claimants who receive an appointment letter for a consultative exam should not do the following:
1. They should not assume it is a positive or negative sign regarding their case. It is simply a procedural aspect of the processing of their disability claim.
2. They should not assume that their case is close to being finished. Truthfully, in many cases, a consultative examination appointment does mean that a disability examiner is trying to get a case concluded. However, very often, it has little relation to how much longer a case will need to be worked on before a final decision will be made.
Is the final decision on a Social Security disability or SSI claim based on the information contained in the report from the consultative examination? In a percentage of cases, the CE will provide information that can aid in the determination of a case. That is, the CE can sometimes push a case toward an approval or denial.
However, in most cases the results of a CE exam are just a formality – basically just a way for a disability claim decision-maker to obtain some recent medical evidence that will allow them to close the claim. It should be said, though, that the results of consultative exams that are mental in nature (a psychiatric exam or psychological testing) are often much more useful in deciding the outcome of a disability case, whereas a physical CE is usually equivalent to a short office visit to a doctor.
This is particularly true since doctors who conduct physical consultative exams will ordinarily conduct a short review of a claimant's strength, coordination, reflexes, senses and vitals (blood pressure, breathing, etc.). In fact, most physical consultative exams are shorter than ten minutes.
An Accredited Disability Representative with more than 20 years experience, Diana Wade believes her clientele can be comfortable knowing that she is recognized by SSA and is a charter member of NADR. To contact Wade call (661) 821-0494, email [email protected] or visit http://www.CaliforniaDisability.net.