The Social Security Consultative Exam: What to Expect

A notice from the Social Security Administration (SSA) asking you to appear for a consultative examination (CE) can bring a sense of relief but might cause you some concern. That's because being sent to a CE means that you've successfully transited to the next stage in the disability determination process, but your medical records didn't provide enough medical evidence for Social Security to approve your disability claim.

Don't panic. Being sent to a consultative examination doesn't mean you won't qualify for disability. It's a step in the determination process that many people must go through on their way to getting benefits. And Social Security pays for all consultative examinations, so you won't be charged for the exam or tests performed.

It might help to understand why Social Security orders consultative exams, what you can realistically expect during the CE, and how important it is to your disability claim.

Why Does Social Security Order a CE Exam?

Disability Determination Service (DDS) is an agency run by your state (but funded by the federal government) that helps Social Security make disability determinations. DDS is authorized to send you for a consultative examination when more medical information is needed to make a disability determination. (20 C.F.R. § 404.1519a and § 416.1519a) Examples of when that might happen include, but aren't limited to, the following situations:

• There isn't enough evidence in your medical records to decide if you meet Social Security's definition of disabled.
• Specific tests or specialized medical evidence isn't available from your treating doctors.
• Your medical evidence or test results aren't up to date (not recent enough).
• The evidence in your file is contradictory or ambiguous.

Sometimes, Social Security runs into issues gathering your medical records. For instance, if your treating doctor has died or refuses to share your records, you might be sent for a consultative exam. Or, your evidence might be insufficient if Social Security doesn't consider the health care provider it comes from to be an "acceptable medical source."

For example, if the medical evidence of your disabling back conditions comes from your chiropractor, you'll likely have to have a CE exam by a licensed doctor who's an MD or DO. Social Security doesn't include chiropractors on its list of acceptable medical sources.

But being sent for a consultative examination doesn't always mean there's anything wrong with the medical evidence in your file. The Social Security disability claims process is a long one. Sometimes, the claims examiner wants to see if your condition has improved or declined since the medical tests and evaluations in your file were performed.

Who Performs the SSA Consultative Examination?

Social Security will generally request that your treating doctor (if you have one) perform the CE as long as your doctor has the necessary skills and equipment to complete the exam. But your doctor can refuse (and many do).

If your doctor can't or won't perform the consultative exam, DDS will arrange a CE with another doctor. There are other times DDS will send you to a different doctor for the CE exam, such as:

• when DDS is seeking to clear up some confusion in your treating doctor's report
• if DDS doesn't trust your doctor, or
• if you prefer to go to someone new.

All consultative examiners must be licensed physicians (MDs, DOs, or psychiatrists) in private practice. Or the provider must be under the supervision of a licensed doctor—an audiologist, for instance, who tests your hearing in conjunction with an examination by a physician.

DDS will schedule the exam or medical testing with the doctor or testing facility for you.

What Happens at a Consultative Examination?

The doctor or examiner will ask you about your medical history and the symptoms and limitations you're experiencing. The doctor will also conduct a physical examination and complete any specific tests DDS requests.

The doctor performing the CE will gather only the evidence specifically requested by DDS. So, your CE exam will likely take only about 15 to 20 minutes.

The examining doctor typically takes about ten days to send the CE report to the DDS. That report will contain the following information:

• your medical history
• the results of a physical examination
• your treatment history
• any laboratory findings, and
• the examiner's estimates of your ability to perform work-related functions.

The CE is an assessment only. So, the examining doctor won't provide treatment advice or give you an opinion about whether you should receive disability benefits.

What's a Mental Status Examination?

The Social Security system calls one type of psychiatric or psychological consultative exam a "mental status examination" (MSE). DDS might send you for an MSE if you're claiming a mental impairment, such as:

• anxiety
• depression or bipolar disorder, or
• PTSD.

At an MSE, the psychiatrist will ask questions about your impairment(s) and how your condition affects your daily life. You'll be asked about your relationships with family and others—including work or school relationships.

The psychologist will want to know how far you got in school and whether you have any specialized training or degrees. You'll also have to answer questions about your work history and any trouble you've had getting and keeping a job. And the psychiatrist might have you take an IQ test or other neuropsychological tests to gage your:

• intelligence
• memory
• concentration
• judgment, and
• ability to follow directions.

(Read more about what to expect at a mental consultative exam.)

What Happens If You Miss a Social Security CE Exam?

DDS will schedule the CE appointment and then inform you of when and where it will take place. If you need to reschedule the appointment for any reason, you must contact DDS (at the number provided on the notice) as soon as possible.

If you don't show up or refuse to go to your CE, you risk having your disability claim denied. (Social Security will make a determination based on the medical evidence currently in your file, and it will likely be a denial.)

If you miss your CE appointment, you can generally only reschedule if you have a "good reason" for missing it, such as:

• you were ill or injured
• there was a death in your family
• your car broke down, or your ride fell through at the last minute, or
• other circumstances happened that were beyond your control.

Even when you have a good reason for missing the CE, you'll need to contact Social Security (or have a family member or representative do so) as soon as possible to explain your situation and reschedule the exam.

How to Handle the Consultative Examination

You don't need to stress about an impending CE or MSE. It's an increasingly common part of the disability determination process. But it's an important step, and you need to take it seriously.

The consultative examiner, especially a doctor or psychiatrist you don't know, will be looking for signs that you're exaggerating your impairments. So, be honest about your condition and how it affects your ability to function. Don't exaggerate, but don't downplay your issues either.

If you're not sure how to best handle your upcoming CE or you disagree with the examiner's report, you might benefit from talking with an experienced disability attorney about your claim.