Medical Examinations For Social Security Disability Claims

You may be here because either your Administrative Law Judge or the Department of Disability Services (DDS) arm of the Social Security Administration (SSA) has scheduled an appointment for you to see one of their doctors, either a medical doctor or psychologist. These are commonly called Medical Examinations (ME) or Consultative Examinations (CE). Refer to the letter scheduling the appointment for the date and time of your appointment.

Is having a medical exam a good thing? Is it going to hurt your case? Help your case? Are there things you can do to improve your chances that the report you get from the consultative doctor will help your case? This article addresses the most asked questions from claimants when an examination is scheduled.

Is a Consultative Exam Good or Bad?

In almost every Social Security disability claim, the judge or the Social Security claims handler will order a medical examination.

The reason they do this is to help develop the medical record. One of the things that Social Security law requires is that the Social Security Administration help develop the medical evidence in the administrative record.

These medical examinations are supposed to help the decision-maker – the adjudicator or the judge – to determine your work capacity. Now, the consultative can be ordered by either (a) the adjudicator – at the initial or the Recon stage, or (b) the judge – typically at the hearing – if the judge feels there’s insufficient information to make a decision.

So, medical examinations are not bad or good. Generally speaking, if it’s ordered at the hearing, it means that the judge feels like there’s enough there but that they need to see a little bit more and will, therefore, order the consultative evaluation.

Who Conducts The Medical Exam?

The doctors or psychologists who perform the medical examinations are on a panel and are paid a flat fee for performing the evaluation. And they will specifically say in these reports, in most cases, that they are not performing an evaluation for treatment purposes. It’s purely for diagnostic purposes to issue an opinion.

In some cases – and this is the ideal – the judge will order a treating physician, somebody who knows you already, to perform the evaluation. That’s somewhat uncommon, unfortunately. But that’s the best type of medical examination because that’s from a doctor who treats and knows you.

However, some new evidence rules went into effect in 2010 and 2017. These rules say that the reports from the doctor can be given controlling weight by a judge. Until February 2017, a treating physician’s report had to be given controlling weight over a consultative examination. But that’s changed. So, a judge can ignore a doctor who has treated you for the last seven years and take the opinion of someone who saw you one time for an hour as being controlling evidence.

As you can imagine, I think that’s absurd. It’s ridiculous. But that’s the rule. So, a medical evaluation is becoming more relevant and important as time passes. It’s essential to prepare for them properly.

Mental vs. Physical Examinations

I will also tell you that medical examinations for physical problems are typically – in my review at least – less reliable and less likely to help your claim than a mental health evaluation.

The reason is that the doctors who will appear on those panels (and again, who get paid a flat fee that is not a lot of money) are typically industrial clinic doctors. These are normally the same doctors who do independent medical examinations for insurance companies in car accident cases or workers’ compensation claims. Industrial clinic doctors frequently are not the “cream of the crop” when it comes to doctors.

Secondly, their bias generally is to find that there’s not much wrong with you. So, more often than not, a consultative examination from an industrial clinic doctor will not help us very much.

By contrast, the doctors in the panel who are psychologists are typically independent doctors who do this to make a little bit of extra money. They seem to have less of a built-in bias. They usually will be a little more fair regarding their evaluation. Although, again, some of them are less fair than others.

But, typically, you’ll get a better result from the psychological exam than a physical exam.

All of that is very much a generalization about what happens.

Do I Have to Attend the Exam?

The first question we are typically asked is whether you must attend this exam. Can you say, “No, I don’t really want to go.”

You must go to this appointment. If you miss this appointment without a valid excuse like you were very ill or hospitalized, you may be denied for non-compliance, and you do not want that!

Sometimes, a claimant may decide that they do not want to go to the examination. The case will then be denied, and a Request for Hearing will be filed. However, the Administrative Law Judge (ALJ) may see that a claimant failed to cooperate and deny the claim. So, it’s super important that you go to this medical exam.

What Happens During the Examination?

In most cases, the physician who will examine you is a competent doctor, and you should approach the examination as if they were your physician. The doctor will perform an examination much like you have already had from your physicians, and you should fully cooperate with them – within reason.

What Do You Mean “Within Reason?”

Sometimes, the examining physician may be biased, have a poor bedside manner, or both. You should still do your best to remain polite and keep your cool.

If a physician asks you to perform an act that will cause you excruciating pain or something that you cannot do (like bend at the waist due to several L-spine level fusions), you can politely decline. However, you should always give your best effort.

What Should I Do During the Examination?

There is no way to guarantee that the examining doctor is going to write a favorable report for you, but below is a list of things you can do to make sure that you do your part:

1. Be polite. You do not need to be sugary, sweet, or overly nice. But you should be polite.
2. Do not exaggerate your symptoms. Keep in mind that reporting your pain as a 10 out of 10 is very high and is typically the type of pain that causes people to lose consciousness or be hospitalized.
3. Give your best effort when asked to perform tasks.
4. Be mindful that you may be watched or listened to by the staff while you are in the waiting room. This is a serious thing, and it is best not to speak about your case or make jokes while you are there. The staff could misinterpret your nervous jokes as you being completely fine.
5. You can bring someone with you, but remember that the physician may not let the other person into the examination room. If they do, it’s a great way to ensure that things happened as they say they did during the report.
6. Complete a post-examination questionnaire (attached below) as soon after your examination as possible, and return it to us so that we can attack the report, if necessary.

What You Can Do To Help Your Claim at a Consultative Evaluation

Assume You Are Being Watched at All Times

First of all, realize that you are being observed from the time you arrive – even walking in from the parking lot. That means the doctor or someone on his staff may be watching you walk in and watching you in the waiting room. Everything is being noted, even whether you drove or somebody’s driving you, and that does find its way into the evaluation.

For example, let’s say you walk in, have a perfectly normal gait (walking pattern), and don’t seem bent over in pain. But when you walk into the doctor’s office, you are limping and complaining that everything hurts. You can’t get on and off the examination table. The doctor is going to note that discrepancy in the report. So, don’t come in and then start really playing up for the doctor. Just be yourself and tell the truth.

Don’t Exaggerate Symptoms or Malinger

Second, physical and mental health doctors are looking for examples of symptom exaggeration or malingering. Using a variety of tests (they’re not going to tell you that they’re giving you those tests; they’re just going to be doing them), they’re going to be trying to figure out whether you are over-exaggerating your symptoms.

So, again, you want to be very truthful. You want to be very forthcoming about what you’re dealing with. But don’t exaggerate, don’t say everything hurts you 24 hours a day to the point you can’t focus and concentrate ever. It’s much better to say, “This particular issue – my hand – was hurting before, but it’s much better now. The main problem now is my neck problem…”

If something is improved, tell the doctor that. If the medicines are working, tell the doctors that. And if something is really bothering you, let them know. It’s much better to come across as credible, believable, and honest than saying, “Everything is hurting me.” That’s just not going to fly, especially with a doctor that might have a built-in bias.

Bring Your Own Objective Medical Records

If you’ve been going to your own doctor for months or years, supply the consultative doctor with your medical records and reports, including things like MRIs, CT-Scans, x-rays, ultrasound records, etc., so that the consultative doctor will have that background information when he or she sees you.

Doctors are less likely to go against the opinion of a longtime treating doctor. I’m not saying they won’t ever do it. But if you have a doctor that says, “I read this MRI and there is a significant problem with a bulging disc that has a nerve root impingement”, it’s much, much less likely the consultative doctor is going to basically say there’s nothing wrong with you.

The same goes for a psychological examination. If you go in and you have reports of a psychiatric hospitalization and significant problems noted by a treating doctor, the psychologist doing the exam is less likely to say that long-time treating providers are incorrect.

Doctors don’t like to contradict one another. If there are records in there that talk about specific and significant problems, it’s more likely that the consultative doctor will basically echo those reports and find that you have some significant problems as well.

Advice for Your SSA Medical Exam

So those are a couple of thoughts I have about the SSA’s medical examinations.

One thing I find just absurd about this whole process is a doctor who will examine you, who knows nothing about you, and sees no records at all, will basically be doing a one-hour evaluation and making conclusions that could really turn the decision in your disability case.

You definitely want to go. You want to be on time. And like I said, you want to be completely truthful. And, if you can, provide background information about you to the doctor so that he or she won’t be going in blind.

Finally, if you go to the consultative doctor and the doctor only spends five minutes with you, doesn’t touch you, asks you only a couple of questions, and has you leave – make note of that. That may be grounds to object to the weight given to the consultative examination if it was only for five minutes and really nothing much was done.

To that end, you may consider filling out the attached Post Consultative Examination Questionnaire, which may convince the judge or adjudicator to give the CE report less weight as evidence in the claim.

FREE RESOURCE: Post Consultative Examination Questionnaire

Get Help with Your Social Security Disability Claim

Do you need assistance with your Social Security Disability claim? Our team can help you navigate the process smoothly. From filling out forms to gathering necessary medical documentation, our team is here to assist you. Let us handle the legwork while you focus on your well-being. Contact us today for a free case review. Call (888) 321-8131 today.