The purpose of the Social Security disability claim process is to determine whether a person who applies for Social Security disability benefits is unable to work for a year or more due to physical or mental impairments or a combination thereof. To that end, in the event that the Social Security Administration (SSA) is unable to make a judgment based on the information provided by the claimant, it may require the claimant to undergo what the SSA calls a "Consultative Examination" (CE).
A person who files a disability claim with the SSA is responsible for providing medical evidence showing that he or she has an impairment(s) and how severe the impairment(s) is. As the SSA explains, the most important evidence is that from the claimant's treating source:
Currently, many disability claims are decided on the basis of medical evidence from "treating sources." "Treating source" means the claimant's own "acceptable medical source" who provides, or has provided, the claimant with medical treatment or evaluation and who has, or has had, an ongoing treatment relationship with the claimant. SSA regulations place special emphasis on evidence from treating sources because they are likely to be the medical professionals most able to provide a detailed longitudinal picture of the claimant's impairments and they may bring a unique perspective to the medical evidence that cannot be obtained from the medical findings alone or from reports of individual examinations or brief hospitalizations.
Accordingly, the "treating physician rule," requires that treating physicians' opinions be given controlling weight where they are well-supported by medically acceptable clinical and laboratory diagnostic techniques and not inconsistent with the other substantial evidence. In certain cases, however, evidence from a treating physician may be incomplete or inadequate. According to the SSA "[i]f the evidence provided by the claimant's own medical sources is inadequate to determine if he or she is disabled, additional medical information may be sought by recontacting the treating source for additional information or clarification, or by arranging for a CE."
The CE is simply a physical or mental health examination conducted by a professional. The person conducting the CE may be the claimant's own physician or psychologist or another source. Professionals are generally selected based on appointment availability, distance from a claimant's home and ability to perform specific examinations and tests.
Following the CE, the examining professional must submit a report to the SSA. The report should be complete enough to enable an independent reviewer to determine the nature, severity and duration of the impairment as well as the claimant's ability to perform basic work-related functions. Conclusions in the report must be consistent with the objective clinical findings found during the examination along with the claimant's symptoms, laboratory studies and demonstrated response to treatment. Finally, the report includes a description, based on the medical source's own findings, of the individual's ability to do basic work-related activities.
The doctors who perform CEs typically have not previously examined the Social Security claimant and, as a result, are not necessarily in the best position to make a complete opinion about the claimant's ability to work. An experienced Social Security lawyer can assist in making sure that the claimant's medical records are clear and complete so as to avoid the necessity of a CE.
Related blog posts: