Consultative Examination for Social Security Disability - How Important is It?

According to the blue book (this is a the book that disability examiners use to determine if an individual meets the criteria for disability) a consultative examination is an examination that embodies all of the elements of a complete examination in the medical specialty that addresses your specific disabling condition. The disability blue book goes on to state that a consultative examination report should contain the person's medical history and primary medical problems, a description and history of the person's primary complaint, and the physician's findings based upon laboratory tests and the examination.

As a former Social Security disability examiner, I would advise any individual who is thinking about filing for Social Security disability to make sure that they have a current medical treatment history, if at all possible.

Consultative examinations are a one-time examination, and contrary to what many claimants assume, most consultative physicians are not specialists in the medical specialty that addresses your impairment or impairments. For example, recently, I read an article in a local newspaper article regarding problems in the Social Security disability process. The article related a story about a gentleman with a significant back problem being sent to a gynecologist for his consultative examination. As an examiner, I actually saw this done a number of times.

In theory, disability claimants should be examined by a physician who specializes in the medical specialty of their medical impairment, i.e. being seen by an orthopedist if you have a musculoskeletal problem or by a respiratory specialist if you have COPD. However, in the “real world” this has proven to be impractical if not impossible.

Generally, disabled individuals have problems even going to examinations that are far from their homes for a variety of reasons, including their medical conditions and problems with transportation.

Social Security has a stated goal of sending disability claimants to medical professionals who are in their area. But let's be realistic, sometimes there are no specialists for them to see in their immediate area.

So now, why did I state that you should try to establish your medical treatment history prior to filing for disability?

As you can see, most individuals who attend consultative examinations do not see physicians who specialize in their specific medical problems. In fact, very often individuals have consultative examinations with physicians who have little or no experience dealing with their particular medical impairments. Consequently---if you have no medical treatment history, or a limited medical treatment history for your condition (or conditions), the disability decision you receive may be based on a hurried one-time examination, as opposed to the notes of a physician who is familiar with your medical conditions and limitations.