What is a consultative exam and why does Social Security want one?

Occasionally, Social Security may determine the evidence provided by a claimant’s medial sources is inadequate to rule whether a disability claim is valid or not. In these situations, additional medical information may be sought by reaching out to the treating source for additional information or clarification, or by ordering a “consultative exam.”

What is a Consultative Exam?

A consultative exam is a onetime doctor’s examination for which Social Security pays. While the treating source is the preferred source for any additional examinations or tests that are ordered, the SSA allows for the use of an independent source for a Consultative Exam or diagnostic study if:

• The treating source prefers not to perform the examination
• There are conflicts or inconsistencies in the file that cannot be resolved by going back to the treating source
• The claimant prefers another source and has a good reason for doing so
• Prior experience indicates that the treating source may not be a productive source

If an exam is scheduled, it’s important to attend since Social Security can deny a claimant for failing to cooperate.

The type of exam scheduled depends on the reason a claimant applied for disability. If a claimant applied due to vision loss, then the exam will likely be with an ophthalmologist. If a claimant applied due to bipolar disorder, then the exam will likely be with a psychologist. Be prepared to discuss the history of the condition and any symptoms that might manifest as a result of the condition.

What makes the Consultative Exam valid?

The Consultative Exam report must contain the following information in order to be considered valid:

• Provide evidence that serves as an adequate basis for disability decision making in terms of the impairment it assesses.
• Be internally consistent. Are all the diseases, impairments and complaints described in the history adequately assessed and reported in the clinical findings?
• Do the conclusions correlate the medical history, the clinical examination and laboratory tests, and explain all abnormalities?
• Be consistent with the other information available within the specialty of the examination requested.
• Did the report fail to mention an important or relevant complaint within that specialty that is noted in other evidence in the file (e.g., blindness in one eye, amputations, pain, alcoholism, depression)?
• Be adequate as compared to the standards set out in the course of a medical education.
• Be properly signed.

If the report is inadequate or incomplete, the DDS will contact the medical source and ask the medical source to furnish the missing information or prepare a revised report.

Balin brings benefits. Have an upcoming Consultative Exam to prepare for? Contact Balin Law at 1-866-492-2546 or fill out our free consultation form here.