The Consultative Exam

Social Security Administration
Office of Disability
Pub No. 64-040
Issue 1–2000 (No. 25)

Jim filed an application for disability benefits with the local Social Security office about 30 days ago, and today he received a letter from the DDS asking him to go to a consultative examination (CE). He is concerned, and calls his caseworker at the DDS to get more information.

Jim shouldn?t be worried. Here is some important background information to help him and everyone else who is scheduled for a CE.

When a person files a claim for disability benefits, or we do a continuing disability review to see if he or she is still entitled to benefits, we need medical evidence to show whether the person is disabled or still disabled. We generally try to get medical information from the sources (like doctors and hospitals) the individual has gone to for treatment or examinations. But that isn’t always enough for us to make a decision under Social Security law and rules.

There are several reasons we may buy a CE, or even more than one CE. One of the main reasons is to supplement existing medical evidence from treatment sources when there just isn’t enough information for us to make a decision. Another major reason is to resolve a conflict or ambiguity in the person’s records. Less often, CEs are required when a person doesn’t have a treating source or when existing records are not available. In short, a CE is an effort to get additional information.

A CE can be a physical or mental examination or tests. We may request a CE from a treating physician or psychologist, another source listed in your records, or from an independent source, including a pediatrician when appropriate. We pay for the CE.

One thing that you should remember is that you will not necessarily have a lengthy or exhaustive examination for your alleged disability because we may already have enough other information from your records. We will purchase only the specific examinations and tests we need to make a determination in your claim. For example, we will not authorize a full medical examination when the only evidence we need is a special test, such as an X-ray, blood studies, or an electrocardiogram (EKG). You should also know that we allow the physician or psychologist to use support staff to help perform the CE, but the physician or psychologist is still responsible for reviewing what they did and for the report that he or she sends to us.

You are allowed to object to being examined by a particular physician or psychologist we choose to do the CE if you have a good reason. If there is a good reason for your objection, we will schedule the examination with another physician or psychologist. Good reasons include that the consultative examiner had once represented an interest adverse to you, or the consultative examiner had examined you in connection with a previous Social Security disability determination or decision that was unfavorable to you. If your objection is that you think a physician or psychologist “lacks objectivity” in general, but not in relation to you personally, we will review your allegations, but will also change your CE to another provider to avoid a delay in your claim while we conduct the review. However, if we had previously conducted such a review and found that the reports of the consultative physician or psychologist in question conformed to our guidelines, we will not change your examination. We will also consider your objections to a specific CE if there is a language barrier, physical inaccessibility of the examination site or you have travel restrictions.

We expect that a CE will be a professional and courteous experience for you. If you have a complaint about your treatment or the CE provider, you should contact the DDS and let them know your concerns. The letter from the DDS asking you to go to a CE will tell you how to do this. Finally, you need to keep your CE appointment and be there on time. Doing this will help the timely processing of your claim.