December 21, 2014

Why does Social Security Want You to See a Psychiatrist if You Have a Physical Injury?

psychiatric testingAt some point in your Social Security disability case – usually during the initial application evaluation, but possibly later – Social Security will send you out for a “consultative examination” with one or more doctors.   In my experience, the physical medicine consultative evaluations are fairly useless – Social Security tends to contract with “industrial clinics” who handle worker’s compensation claims and those reports often minimize symptoms.

Mental health evaluations, by contrast, often help your case – perhaps because psychologists and psychiatrists are generally not biased from being part of an adversarial workers’ compensation system and because mental health professionals often see a need for on-going therapy for many that they see.   To put this another way, physical medicine doctors face insurance company pressure and financial incentive to fix a problem as fast as possible, whereas mental health professionals are not looking for a “cure” as much as they are looking for gradual improvement over time, and thus on-going visits.

I have read literally thousands of physical and mental health consultative examination reports and as a rule the mental health evaluation reports usually offer some help, while the physical medicine reports either hurt my client’s case or offer no conclusions at all.

You may be wondering why you are being scheduled for either a physical, a mental evaluation or both?   The Social Security law requires the Commissioner of Social Security (and by extension, the employees of the agency) to help “develop” your medical record.   Consultative evaluations, therefore, would satisfy SSA’s statutory requirement even when considering the claims of applicants who have little or no medical treatment (due to lack of money or other causes).

Appeals courts considering the nature of SSA’s obligations have held that that consultative evaluations do satisfy SSA’s statutory duties to develop a claimant’s record.   SSA, presumably hoping to avoid further court challenges, orders consultative examinations in almost every case, even those where there are extensive medical records.

Why, then, would SSA schedule you for a mental health evaluation when your injuries are physical, or vice versa?  This question was posed to me in an email from one of my blog readers:

I was severely injured (multiple spinous fractures, spinal compression fractures, hip fracture) in a catastrophic train accident in London, England while on a business there in November 2010. I underwent spinal surgery in February 2011. I’ve undergone physical therapy since surgery, but have not recovered from my injuries and I continue to suffer debilitating pain in my back, neck and etremeties. I was seeing a psychiatrist leading up to my surgery because I was suffering mental trauma from the accident. I stopped seeing the psychiatrist after the surgery, principally because it was too difficult for me to get around. I’ve filed for disability from the SSA. My case is presently under review. I’ve hired a company to represent me in my claim. I just received a call from my SSA case worker asking me if I would see their pshyciatrist. I said I had no objection to this. My question: I don’t know why I need to see a psychiatrist if my claim is based on my physical disability, not any mental disability. Also, how should I approach my interview with the SSA psychiatrist?

Here are my thoughts:  first, I don’t necessarily presume that anything done by Social Security is inherently grounded in reason or logic.   It is possible that the adjudicator evaluating your case refers every claimant to both a physical and a mental health evaluation.

It is also possible that the adjudicator saw the psychiatric records in your file and that your treatment had stopped, and wanted more development.

Realize that a disability adjudicator (and ultimately a judge) has to justify his decision to approve (or disapprove) a case in writing.  In your case, I suspect that the adjudicator is looking for additional reasons to approve your case in addition to the obvious physical issues present.

Although not applicable to you, I have seen cases where an individual is referred to a psychiatrist or psychologist if there are suggestions of malingering or drug seeking behavior, or if the physical impairments claimed are out of proportion to physical injuries suffered.

My guess is that in your case the adjudicator is attempting to fully develop your record and to tie up loose ends.

As far as what to expect, most psychiatric evaluations involve a series of tests for depression and anxiety – there is no way to prepare for these evaluations – just tell the truth and do your best at completing the tests.

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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. I went today. She asked closed ended questions. She reconfirmed facts. At the end I asked her why she did not want any explanation for any answer. She found that funny. She said that most people will rattle off tons of information. I am a law enforcement person. I deal with yes and no. I feel she did not do her job. She is a child therapist. I see her as the enemy. She is there to stop my claim.

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