The Social Security Consultative Exam: What You Need to Know

If you are filing an initial application for Social Security disability benefits, or an appeal after being denied disability benefits, you may be notified that Social Security wants you to undergo a consultative exam. If so, don’t be alarmed. It is not uncommon for Social Security to request a consultative exam. Unlike medical exams you have likely received in the past, a consultative exam is not designed to provide medical advice or treatment. The purpose of a consultative exam—which can be physical or psychological in nature—is to evaluate your current medical condition and your limitations.

Nash Disability Law Attorneys Dan Rosen and Lawrence Mabes point out that “at its core a disability determination is not a medical issue but a legal issue.” The goal of the Social Security Administration (SSA) is to evaluate your residual functional capacity, or RFC, to determine if there’s any type of work you’re able to perform given the limitations caused by your condition. You may be approved for benefits if the SSA determines that you’re unable to do any work based upon your age, education, and work experience. Social Security will make this determination based on whether you can sustain competitive employment on a consistent, full-time basis, or an equivalent schedule.

When you apply for disability benefits, your medical situation will be evaluated by the Disability Determination Service (DDS).The DDS office is the agency in Illinois (or the state where you reside) that completes the disability decision for the SSA. They will use medical evidence from your healthcare providers and from a consultative exam, if one is ordered. They will seek answers to these questions from the medical professionals:

• What is your medical condition?
• When did your medical condition begin?
• How has your medical condition limited your activities of daily life?
• What do your medical tests show?
• What treatment you have received?

Also, they will collect information about your ability to do work-related activities, such as walking, sitting, lifting, carrying, and remembering instructions. It is important to keep in mind, Rosen and Mabes say, that SSA’s doctors are not asked to make the final decision on whether you are disabled. Only SSA can make that decision.

Consultative exams are contracted and paid for by Social Security. They are performed by independent medical consultants who must be licensed physicians in private practice, or under the supervision of a licensed doctor (for example your hearing could be tested by an audiologist in conjunction with an examination by a physician.)

Attorneys Rosen and Mabes offer these tips to help you navigate a consultative exam:

• If you want to qualify for Social Security disability benefits, showing up for your consultative exam is not optional. Should you miss a scheduled appointment without a very compelling reason, your disability application may be denied. Show up and be on time.
• Come to the exam with a list of all your medical conditions, your treatments, and your prescribed medications.
• Give the examiner as much background as you can about your impairments. Be truthful and accurate. Don’t exaggerate or minimize your condition. Don’t be defensive.
• Bring a family member to provide background information about how your impairment affects your life. Not all medical examiners will allow a family member into the examination room, but you should explain why this is important when you arrive to the exam.
• Treat the day like any other in terms of treating your conditions. If you normally use a cane, bring it, but if you don’t, you shouldn’t bring it just for the sake of the exam. If you take medications, take them as you would on the day of the exam.

And of particular importance, keep in mind that the examiner will be watching you and making notes on your condition throughout the whole appointment—maybe even from the time you arrive in the waiting room and until you walk out the door.

After your consultative exam, you should write down the details of your exam—what was discussed, what questions the examiner asked of you, how you answered his or her questions, how long the examination lasted, and anything else that may be relevant.

Before filing a claim for Social Security disability benefits, or if you have been turned down for benefits, you should consider consulting a Chicago-area attorney who regularly handles Social Security benefits claims. A lawyer can increase your chances of receiving much-needed benefits. Contact Nash Disability Law for a free consultation about whether you qualify for Social Security Disability benefits.