April 17, 2014

What to Expect When Social Security Schedules You for a Medical Exam?

social security consultative examinationEarlier this month I received an email asking about initial application procedures from a gentleman who had visited my Georgia disability web site.   This person had not yet applied and he wrote to ask me what he should expect when he did apply.

After discussing with him the ways he could apply – either by phone, in person at his local Social Security office, or online at ssa.gov, he asked me what was going to happen after he started his application.  I explained that once his claim was opened, his file would be sent to a disability adjudicator and that he should expect to hear from the adjudicator to set up an in-person or telephone interview.

Today, I heard back from this gentleman asking another very good question about the initial application process.  I believe that he has been through his initial interview and that his claim is now being processed.   Since his question is relevant to just about everyone who files for benefits, I thought I would answer it in my blog rather than by an email.

The applicant told me that he had applied in person and that his adjudicator had scheduled him to meet with a private doctor for a medical exam.  Is this a good sign or not?  What should he expect at this meeting?  Here are my thoughts:

The exam that has been scheduled is called a “consultative examination.”   These examinations are conducted by doctors who have contracted with the Social Security Administration to do this kind of work for a designated fee.

The most common kinds of consultative evaluations are general physical exams, as well as mental health evaluations by psychologists.   Depending on where you live, there could be specialists (such as cardiologists, neuropsychologists, etc.) on the consultative examination panel.  Further, if your regular treating physician will handle a consultative evaluation for the payment offered, your doctor can also serve as the provider for this evaluation.

In my experience, physical consultative evaluations are usually a waste of time.  Often the doctors on the panel for physical exams are “industrial clinic” doctors who also perform independent medical examinations for insurance companies in workers’ compensation cases.  More often than not, these clinic doctors will find nothing wrong with you.

By contrast, the psychologists who perform consultative psychological examinations will often identify one or more mental health issues.  These issues may not be “disabling” but they can pay dividends later by eliminating categories of jobs and thus narrowing the judge’s questions to a vocational witness at your hearing.

My experience has been that most Social Security judges recognize the limitations of a one time consultative examination and they weigh the importance of the exam report accordingly.  I also find that some of the medical or mental health vendors do a poor job when completing their reports – as I have discussed at length on this blog, the main issue in any Social Security case relates to your capacity to work, and I read far too many consultative reports that do not discuss this threshold issue at all.

As far as preparing for a consultative examination, there is not much  you can do.  If you have x-rays, MRI reports or CT scan reports, bring them.  If you have supporting records from a treating doctor I would bring those as well.  If you don’t have any of this documentation, that is fine as well.

At this initial and reconsideration appeal level, you are not going to win, generally, unless your condition meets a listing.  The consultative evaluations make up part of the puzzle for a judge’s determination about your capacity to work but your treating doctor’s records, reports and statements of opinion carry far more weight.

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Jonathan Ginsberg represents Social Security disability claimants in Georgia. In practice for over 23 years, Jonathan publishes a widely known disability blog, a podcast and several disability web sites. In 2004, Jonathan published a "how to" book about Social Security disability called the Disability Answer Guide. Jonathan lives with his wife and 2 children in Atlanta.

Comments

  1. This is a really informative post! It’s important that the medical evidence in an applicant’s record is detailed. Consistent opinions, even from non-medical sources, can help as well. But we completely concur that a treating doctor’s evidence will be given much more weight in the judge’s consideration of a file.

  2. I went through the consultative exam with a psychologist on appeal and the woman was so nasty to me that I shut down completely (I have severe Social Anxiety and ADHD). She made annoyed sounds and gestures, threw a box of tissues at me when the tears started, and sneered, “What the Hell is the matter with you now?!” It was horrible, and damaging, and when the time was up, she told me she hadn’t even finished, yet, I was never given another appointment, and SS rejected me. I don’t understand how they can reject someone who hasn’t finished the required evaluation.

    This was several years ago, and my anxiety is even worse now. I have to reapply, but I’m more terrified than ever because of that experience. Is this the sort of treatment I should expect again? Were they really permitted to make a decision even though their own psychologist never completed the evaluation?

    Keeping in mind that I have ADHD and Social Anxiety so there is very little I can make myself do as far as speaking up for myself, focusing, following through, etc, is there anything to prevent another damaging experience like that last one? Can my own counselor go with me for support and to get me through it, keep my mind from wandering, etc? If I find a psychiatrist or psychologist of my own, will SS skip this one-time evaluation and take my psychiatrist or psychologist’s recommendation instead?

  3. @Kwie:

    Could you take a friend or family member with you? Maybe someone who could speak for you and give moral support.

  4. @Cheryl – Often times consultative examining physicians will interview a “collateral” – a friend or family member. However, I would not be surprised if the doctor insisted on seeing you (the claimant) alone for most of the examination.

  5. Lee Laughlin says:

    SSDI sent me for a CE and the doctor confirmed my diagnosis which is a listed disability. Can I expect approval and if not, how could they deny me when the doctor THEY sent me to has confirmed my disability ?

  6. Lee, the CE (consultative examination) is one piece of evidence that the judge will consider, although it is usually given a lot of weight. On the other hand, disability adjudicators and judges will look at the records and conclusions of long time treating doctors and give those reports more weight than they will to a one time consultative doctor.

  7. Went to the hearing and judge is sending me to a neurologist how long does it take to get the app?

  8. Linda Huyler says:

    I have been on SSD for 5 years but received back pay from 2001 when I 1st applied ,until 2006 when I had a fully favorable decision. I finally came up for review in August 2010 and I thought it would be ok. I’ve read that once you are approved then Social Security’ has to prove that you are no longer disabled. When I got my denial in April 2011 for continuing benefits I was so sad, My condition of Lyme disease and major depression is worse and I thought I proved it .I also have seizures hallucinations and severe hearing abnormalities and complete social withdraw, and many other things but I was initially approved based on Depression. I have been consistently seeing a Dr for 10 years.
    I was sent to a Psychologist for a CE in February and my anxiety and panic attack are much worse. I brought a friend with me and the Psychologist asked if I wanted to hook up with him as she pointed to my friend. I couldn’t believe what I was hearing. This woman also made me change many of my answers as she did not want to hear my real feelings. I cried through the entire exam. I called the determination person working on my file and she said that I should report her. I was so distraught I did not get her name or a business card. I called my local SS office as the appointment was set up through them and they would not give me her name. I sent in a certified letter to SS requesting my file and I just received it.
    90% of what this woman wrote was a lie and I believe that she is the main reason that I was denied. She asked why I was depressed I said chronic Lyme disease and she said NO, you can’t say that. My friend that went with me is a government employee for the Surface warfare dept .If he did not witness this abuse himself, he would not have believed it. My hearing with the DO is October 26th and I am terrified. After this if I have to go before the ALJ judge and am denied, my benefits will end. What do I do?

  9. Linda, if you can possibly afford to do so, I would suggest that you hire a lawyer to appear with you at your hearing. What you are describing is both disturbing and highly irregular and you would be well served to have representation.

  10. I recently applied for SSDI. I had my second heart attack in May of this year. My first heart attack was a silent one, and I did not receive any treatment for it. Thus most of the damage to my heart was due to the first heart attack. I also had triple bypass surgery in May, and since then my heart function is only EF 25%, well below the normal range. My cardiologist wants to do another echocardiogram in February. He is expecting the results to be the same, and wants to put in a defibrillator.
    This is where I fell like I’m talking to a brick wall with the local Medicard office in Ohio. I was told it could take up to a year on my case. I really don’t know what to do now. I don’t have the means to pay for another echocardiogram, muchless to pay for the implant of the defibrillator.
    My heart condition is listed on the SSDI as a disability. Do you think I will have any problems with my SSDI case? Also any comments on what to do about my Medicaid case?

  11. james mcfarlin says:

    I had my hearing the last part of sept 2011 i have degenarative disk disease,bipoler,anxiety,depression,COPD,Diabetes among several other health issues im on oxygen therepy,morphine for pain, insulin injections,at the hearing the judge asked the other people there the hypothetical questions all agreed that i couldnt work including both medical examiners they had he then asked me why the social security office hadnt signed me up for ssi when i filed for my hearing because i was elgible for it also the judge told me to sign up for ssi also as I was elgible for it that if I didn’t I wouldn’t get enough social security to live on! then asked me if I had objections to seeing a couple more doctors one was a md and the other was a phycyatrist I went and seen them both and then got a letter telling me the judge had the reports from the ce’s to enter into my evedence and my lawyer had 10 days to ask for a continuance hearing I called my attorney today its been a month since I got the letter and his secutary tells me were waiting on a decision and that he didn’t ask for a continuance hearing! so I hope he knows what hes doing hes been a social security lawyer 30 years so I’m assuming he feels we don’t need it! what’s your thoughts on it would be!

  12. James, based on what you say, I would agree with your lawyer’s hunch that you will likely get a favorable decision. Assuming the consultative reports were favorable, there is no reason for a supplemental hearing. A good lawyer knows when to keep his mouth shut, especially if he is going to win!

  13. james mcfarlin says:

    jginsberg thank you for the quik reply yes i figured he wasnt to worried about it, the day we went to the hearing he told me the judge we had was a hard judge to win with but after all the testomony and the ve saying i couldnt return to any job with my medical problems and the judge i thought was a real nice man after he heard my side of it thats when he told me to apply for the ssi also and even told me and my attorney to tell them at the social securitry office we had a hearing for regular ssdi and when they was done taking the app for ssi to skip there process and forward the app strait to his office? its been a month since i got the letter from judge telling me he had the reports from my consulative exams and we had ten days to file for a continiance hearing i am just wandering also how long it may before i get the decision letter!!

    thanks again

  14. David D. says:

    I finally was awarded my disability in 4/2007. My disability case came up for review in December this year. Since my doctor had quit in September of 2011, and my longterm therapist had retired as well, it was a few months before I could get in to see my new doctor and it wasn’t until this last month I was able to find a therapist that was compatible and that would accept Medicare at least somewhat close to me. (I live in a small rural town in Kansas). This of course meant there wasn’t enough recent medical information in my files when my CDR came in December. So my file was flagged and after numerous pages of reports I and family and friends filled out, I was then told to report for a mental health exam and physical exam. The mental health exam was a few weeks ago and it was fine. Although I don’t know the result of that, it was more or less what I expected. This morning I had my medical exam, if you could call it that. I’m so upset I don’t know where to begin.

    I realize that these doctors are supposed to be impartial, but not rude and hateful. My mistake. This doctor came in, barely glanced at me, and perfunctorily said “I’m contracted to assess you physically for disability.”. He flipped open the file and asked a few standard questions and then said “I see you have listed ‘that you think you have CFS’. What symptoms are you having ‘that make you think that’”. Um…I have CAEBV (Chronic Active Epstein-Barr Virus) first of all, which causes extreme fatigue. I started to explain the physical issues, extreme fatigue, brain fog, memory problems, virtually no stamina, depleted immune system that causes frequent colds, flus and infections, etc. (which is all in my medical history of course). But I was cut short and didn’t get to finish.

    He then asked about what issues I have with PTSD, and I was honest as I am supposed to be with disability. I told him about the fact that I was molested by my brother all growing up and that at 19 I was raped by an acquaintance. He wrote this down but I noticed he slightly rolled his eyes.

    He then asked about family health history. When he asked about my brother I said the only thing I know is that he is an alcoholic but I didn’t feel that was a medical issue. His response was “No. Now THAT’S a disability”. Which was like a slap in the face.

    I offered that he could see the recent blood work I brought, but he said “It doesn’t amount to a hill of beans to me. Has no bearing on my report.”. After a few pushing, pulling and reflex exercises (of which he complimented me on my hyper-vigilant reflexes (what PTSD sufferer doesn’t have hyper-vigilant reflexes? that’s a good thing?) he asked if he could see my blood work ‘just out of curiosity’ but that ‘It wouldn’t make any difference either way. Means nothing.”.

    He looked at it for several minutes like a deer in headlights and said ‘This is confusing. Makes no sense to me. Oh, well. Like I said, has no bearing on my report”. He handed it back then stood up and said “I’ll write up everything ‘as you’ve dictated it to me’ and file it with DDS, but frankly you’re not disabled. Must be mental (said sarcastically). Then said ‘there’s the exit’ and walked away. This ‘exam’ took less than 10 minutes (although I waited an hour in the office and twenty minutes in the exam room, not to mention the drive there which is an hour and a half. My Mom drove thankfully since long drives are too tiring for me and I have problems staying alert.)

    This whole experience was demoralizing, stressful, and emotionally distressing. I did call DDS and speak with the person handling my paperwork (although she is not the person who makes the decision). She was very nice and supportive and encouraged me to write everything out about the experience as I explained it to her (she was also documenting it) and send it to a woman at DDS who handles these issues. As she even said ‘Our taxes pay for these people that we contract with. This isn’t what taxpayers would want to pay for.’. I agree. I also would hate for someone to experience this treatment.

    I really feel this doctor has no clue about CAEBV, or CFS, and had his own assumptions or prejudices before he even entered the room. I mean really. A physical assessment that takes less than 10 minutes? Really?! The only physical thing was having me push on him, pull him toward me, push his hands down, checked my reflexes, and that was it. And from that he can tell ‘I’m not disabled’? wow. I’m so beside myself I don’t know what to do or think. If I lose my disability I have nothing. I won’t be able to live. I am not able to work, which my medical history shows, I need therapy and my medical. I just found out I have gall stones as well and need surgery and my doctor thinks I may also have Fibromyalgia for which she is sending me to a Rheumatologist. People should not be in fear like this, especially when they are ill. I honestly don’t know what to think or do.

  15. hi.
    I am applying for three conditions which are all listed as impairments, if they are severe enough. They are diabetes, lymphadema and sleep apnea. I also have depression. I see a primary doc, who has me seeing a cardiologist, a sleep doc- or neurologist i guess, a therapist, and she has sent referrals for a physical therapist and of course an eyedoctor. I gave all my doctors names and I was told by the examiner that they received all my information from my doctors. I have been going since 2007. I was not sent to a medical exam..however I am being sent to a psychologist. It doesn’t give an exam type or even a condition on the letter…it just says…type of exam…psychologist. And they sent a copy of appt to a friend of mine to bring me. So….I have no medical exam….anyone familiar with applying for medical and having a ce exam. Oh, my doc may have put that i am a bit spicy to say the least…i have had my times with her..where I get upset..then start crying…which is why she sent me to therapy. Did I mention I see a nutrionist too? My way of looking at it is why have me going through the county when I could simply have a medical card? The gov. is paying anyway.

  16. David, I hear stories like yours frequently – the “industrial clinic” type of doctors that conduct physical exams for Social Security often spend very little time with the claimant and do very little in the way of testing, but their reports can create huge problems for deserving claimants. Under Social Security law a report or records from a treating physician will be given more weight than a consultative evaluation report. This means that you need to find new doctors and create a medical record that can be used to refute the consultative doctor’s report.

  17. @jginsberg: hello jginsberg well here it is april ive had my hearing never did recieve a decision i did get sent to two CE’S for exams and just now got a letter from judge informing me that they have scheduled a another hearing for may 15 ? dont make any sense wy i got to have another hearing i figured they would award my ssdi or deny me never dreamed they would want me to go through another hearing.

    What do you think about my case now im getting fustrated and ready to just Give Up!!!!

  18. Hi I was applied for SSDI for RA and possiability of saradosis and was sent to a CE and now the adjucator is asking for xrays of my hands (which is negatve) but the CE notice my symptoms of the immune disease. Is this a sign of my approval

  19. Maybe, but not necessarily. It is a good sign that the adjudicator is asking for followup info but I would not draw any more conclusions than that.

  20. Michele deCesare says:

    I was recently denied benefits at the reconsideration phase. During the process, I was sent for a consultative exam. I just got hold of my file, and was surprised to see that while there were some minor misleading statements in the consultative examiners report, when all was said and done, he supported my claim, and the medical evidence in my file. So…the DDS medical consultant just basically threw it out saying only that he didn’t agree. I find it outrageous that they can patently reject the findings of the examination they ordered, with the doctor of their choice!

  21. Candace Camp says:

    My husband has been fighting for over four years for his disability. During this time he has submitted countless x-rays, MRIs, files, briefs, statements, medical records from expensive, educated, medical specialists and what does it all boil down to? A generic, 15 minute exam by a regular doctor who, as noted in this blog, has a contract with SS. It doesn’t get much more bias than that. He is not about to upset his income provider so he is more than likely shooting down hundreds of people who should be found disabled based on their own expert medical evidence. My husband was shot down on his first filing as the generic doctor stated he had no symptoms of heart failure because no venous distension was present. He did not know my husband had left ventricle, left sided heart failure in which venous distension is not found or does not present until much later on. This diagnose by this doctor was not supported by any detailed medical exam of my husband’s heart yet his words were clearly the defining factor by which the ALJ based his decision even with evidence at hand that my husband suffered from left sided heart failure and an enlarged heart which occurs with severe hypertension. The only advice I can give from our own experience is to have an identical exam done by your own specialist the day after you see the generic SS doctor and make sure those findings are compared side by side at the hearing. The Socail Security administration stated they could not determine that my husband was disabled without this generic exam..Really? So specialists in the field of congestive heart failure, damaged knees and ruptured discs are just wasting their time evaluating their patients and really don’t have the expertise required to determine if their patient is disabled.

  22. Three years ago I applied for disability. Fibromyalgia, depression, agoraphobia, anxiety and panic disorders, ptsd, asthma, migraines, agoraphobia, hashimotos disease which affects my immune system. I get deathly sick for months on end about twice a year… among many other health issues. I was denied of course, had the appeal, was denied again, requested appeal board reconsideration … social security office never sent the last two years of medical records… appeal board sent letter stating no further evidence, no reconsideration!!!! I could just scream. Now I have applied again, and I get a letter on Monday that they are sending me to their doctor (a general practitioner no less), I am seeing an asthma specialist, a neurologist, an endocrinologist. How can a general practitioner that has never seen me give more information than these doctors? Then Today I get a notice that they are sending me for a mental health evaluation too and I am absolutely terrified! I can barely stand going to see all of these doctors, let alone someone who I haven’t been dealing with before who has not gained my trust. Should I take all of my records up to them in advance so they can look at the 300+ pages of records I have? Can I take someone with me? I am WAYYYYYYYYYYYY freaked out after reading all of the posts I have read today. I just don’t know how much more of this I can take! My nerves are shot. I just don’t know what to do next.

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