Consultative Examination

What is a Consultative Examination and Why is it Important for My Social Security Disability Case?

Has Social Security scheduled you for a Consultative Examination? If not, don’t worry! If so, here are a few things to keep in mind.

Consultative exams are scheduled because Social Security needs some clarification on one of your impairments, or an aspect of one of your impairments. This means that the medical records from your treatment are inadequate to explain an important issue. Here are a few examples:

  • You claim disability based solely or in part on depression. The evidence indicates that you do indeed have significant depression. However, you treat with medications from your primary care provider, who is a Nurse Practitioner. Even though you have seen this provider on a monthly basis for several years, Social Security rules require a diagnosis from a doctor, or “acceptable medical source.” Social Security will likely schedule a consultative exam with a psychologist who will conduct a mental status exam and clarify your diagnoses.
  • You claim to have an intellectual disability that prevents you from working. The evidence indicates that may be true but you have had no formal IQ testing. Social Security will likely schedule a consultative exam so that you can see a psychologist and have IQ testing.
  • You claim to be disabled based on severe arthritis, but you don’t have insurance and cannot afford an x-ray. Social Security will likely schedule a consultative exam with a physician who will perform an x-ray on the part of your body where you have the most pain.

Social Security will pay for the consultative exam. It is extremely important that you go since the subject of the exam has been deemed necessary in deciding whether you qualify. If you cannot go, notify Social Security or your attorney and tell them why. The exam will be rescheduled. If you do not go and do not provide a good excuse, Social Security will almost certainly deny your claim.

At your consultative exam, BE HONEST and DO NOT EXAGGERATE. The doctor will likely see through this and report on it. The Social Security claims examiner will also notice and be much less likely to approve your claim. One such discrepancy in your file impairs your credibility on all other statements you make. Those reviewing your claim are smart and review several hundred claims per year. They are also people; You are probably claiming disability for good reason, so stick to the facts and they will understand.

Due to the COVID-19 pandemic, Social Security has not been scheduling in-person consultative exams. However, a rule issued on April 17, 2020, allows for some psychological CEs to be conducted by video, although the claimant must consent (See POMS: DI 22510.012).