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Physical examination and Social Security Disability

Every day on our forum we get a variety of questions about Social Security Disability exams. For instance, many claimants want to know if the Social Security Administration will send them to a physical examination to determine whether or not they are disabled or if they can get a physical examination if they do not have medical care.

Other claimants want to know if they should agree to go see a consultative examiner. These are all good questions. This blog will describe the type of physical examination that the SSA may expect a claimant to attend and what this physical examination will mean for you, the claimant.

Why would the SSA send me to a consultative examination?

First, it is important to know that not everyone is sent to a consultative examination. Most claimants will be approved for SSDI or SSI based exclusively on their own medical records. If you have been scheduled to see a consultative examiner this is because 1) the Social Security Administration does not have enough recent medical information to evaluate your SSI or SSDI case (recent is generally defined as the last 3 months); 2) your doctor has not sent your medical records to the SSA; 3) you have not seen the proper specialist for your condition.

Who are the consultative examiners?

Consultative examiners are not government employees. They do not work for the SSA; however, they are contracted to provide information to the SSA about your mental or physical health condition. Specifically, the consultative examiner will evaluate either your mental or physical health condition symptoms and determine how severe they are and whether you have the residual capacity to work.

Is the consultative examination as good as seeing my own doctor?

No, the consultative examination is a very cursory review of you mental or physical limitations. It cannot compare to having a treating physician and a strong, on-going relationship with your doctor who understands your daily limitations.

Consultative examiners may request your medical records and review them prior to your consultative examination but even with this effort it is difficult for them to truly understand your condition. Claimants with severe mental health conditions may have the most difficult time because often their disability is not visible, especially if they have a “good” day when they are visiting the C.E.

Many consultative examiners are contracted to perform tests for specific conditions. For example, if you have COPD or asthma the C.E. may only be required to perform a breathing test. They do not determine whether or not you are disabled; they are simply providing more information to the SSA.

Does anyone win benefits after a consultative examination?

If you have not been able to get any type of medical care because you do not have medical insurance or money to pay for a doctor a consultative examination may be your best chance to accumulate evidence that you are disabled and unable to work.

If your disabilities are readily apparent a consultative examination may be just what you need to provide good medical evidence to the SSA. Additionally, if you have been scheduled for a C.E. examination at least you know that someone has reviewed your case and it is moving forward.

Can I choose not to attend a consultative examination?

No, if the SSA has requested that you go to a consultative examination you must attend the exam or potentially have your claim denied due to a failure to cooperate. Under some conditions you may request that your current treating physical perform the consultative examination; however, many physicians will not agree to perform the exams due to the amount of paperwork which must be completed and sent to the SSA.
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