Consultative Exams and Social Security Disability Claims
Dickey - Attorney
Preface: Since Social
Security Disability is directed under Federal law, the information
in this column will apply anywhere in the United States.
However each Office of Hearings and Appeals and District Office
have their own ways of doing things as does the various Federal
District and Circuit Courts. I have kept this column
primarily dealing the the mechanics of how the Social Security
District Offices and Office of Hearings and Appeals evaluates
- Pitt Dickey
This column will take a look at how the Social Security
Administration (SSA) will use outside medical professionals to
help it evaluate disability claims. The SSA will typically review
all of the medical records from the claimant’s treating
physicians. In many cases the SSA will require the claimant to
submit to further evaluation by another medical professional to
obtain additional information about the claimant.
This column will examine when such evaluations are ordered, what
the medical professional is looking for, the scope of the
evaluation, the types of tests performed and how the SSA will use
The medical professional chosen by the SSA will perform what is
called a consultative exam on the claimant. Depending upon the
type of claim involved, the SSA can refer the claimant to a
medical doctor, a psychiatrist or a psychologist.
The medical professional performing the consultative exam will not
treat the claimant. His job is to examine the patient and then
prepare a report on his findings and submit it to the SSA. This
report is called a Disability Determination Evaluation will be
considered by the SSA in determining whether to award disability
benefits. This report may be examined by the claimant prior to his
Not every case will have a consultative evaluation performed in
it. Some cases will have several such evaluations based upon the
individual facts of the case.
If a claimant has more than one type of health problem in
different speciality areas such as neurology or orthopaedics the
SSA may order reports from different specialists.
The decision to order a consultative exam is up to the SSA. The
SSA will base its decision on whether to order a consultative exam
upon such factors as whether additional information is needed
beyond the existing medical evidence such as clinical findings,
lab tests or reports with diagnosis and prognosis.
The consultative evaluation is paid for by the SSA. If one is
requested the claimant is required to participate in the
If the claimant does not show up for the evaluation without a good
reason the SSA may deny his disability claim. It is very important
to cooperate and attend such an evaluation. Some of reasons the
SSA may have for requiring the evaluation include a need for
additional evidence that is not in the claimant’s medical
records or the medical evidence needed from the treating physician
or source is not available due to reasons beyond the claimant’s
control such as death or non-cooperation of a medical
The SSA may also need highly technical information that is not
available from the treating physician. The SSA may have determined
that there is an ambiguity in the existing medical evidence that
needs to be resolved by a consultative evaluation.
Such an evaluation can also be requested if it appears to the SSA
that there has been a change in the person’s medical condition
that is likely to effect his ability to work.
If the claimant is not covered for Disability Insurance benefits
at the time he alleged his disability began and there is no chance
that the onset date could be established earlier than his onset
date, the SSA will not order an evaluation.
The SSA will pay for certain specific exams but will not authorize
a comprehensive exam if the only evidence the SSA needs is for a
specific test such as an Xray, cardiogram or blood studies.
The SSA can purchase consultative evaluations from a person’s
treating physician. However in 20 years of handling these claims I
have never seen a treating physician be hired to do a consultative
evaluation. The SSA typically hires a physician who has not
treated the claimant to do the evaluation.
The claimant can object to the SSA’s choice of physician if
there is good reason to do so. The grounds for such objection
could be that the physician had previously examined the patient
for an adverse party such as his employer in a workers’
compensation case or insurance claim case.
If the doctor or psychologist had previously examined the patient
in a prior disability claim that was denied, this is also grounds
to request another doctor perform the evaluation.
The SSA will request copies of any diagnostic tests performed by
the claimant’s treating physician in the past. The SSA will not
order any diagnostic tests that could involve significant risk to
the claimant such as myelograms, arteriograms or cardiac
The SSA has guidelines for the amount of time that the doctor
should actually spend with the patient in performing the
evaluation. A comprehensive general medical examination should
take at least 30 minutes. A comprehensive musculoskeletal or
neurological evaluation should take at least 20 minutes.
A comprehensive psychiatric evaluation should take at least 40
minutes. A comprehensive psychological examination should take at
least 60 minutes and longer depending upon the type of
psychological testing administered by the psychologist. There will
be some variance in these times but this is what the SSA
anticipates the medical provider will generally spend with the
After the evaluation is completed the doctor will provide the SSA
with a report. Typically these reports are dictated over the
telephone. The reports are typed, reviewed and signed by the
physician and become part of the permanent claim file. The reports
will include the following information:
1. The claimant’s chief complaints;
2. A detailed description within the physician’s area of
specialty of the history of the major complaints;
3. A description of the positive and negative clinical findings
based upon history, lab tests and examination;
4. The results of lab tests;
5. The diagnosis and prognosis for the claimant’s
6. A statement of what the claimant can do despite his health
problems. The physician has to express his opinion about the
claimant’s ability to perform work related tasks such as
sitting, standing, walking, lifting, carrying objects, and
7. The physician is also to evaluate and comment upon the
claimant’s major complaints and any abnormalities found on
examination or in the lab tests.
The SSA will then consider this consultative evaluation in making
its decision regarding the claimant’s disability claim. The
claimant’s treating physician’s evaluation is entitled to
greater weight with the SSA than a consultative evaluation.
Pitt Dickey has practiced law
in Fayetteville since 1978. He has handled SSA disability claims
for over twenty years. He practices with the firm of Smith,
Dickey, Smith, Hasty & Dempster, P.A. at 555 Executive Place
and can be reached at 910-485-8020 or at email@example.com
. Or at the firm web site of www.smithdickey.com
Copyright © 2002 Pitt Dickey -
Used with permission