Often times when Disability Determining Services (the people responsible for making the determination as to whether you are disabled under Social Security’s rules on the first stages of a claim) or when an Administrative Law Judge feels that the medical records don’t say enough about a person’s conditions, they order a consultative examination. This is an examination, either physical or mental, with a doctor who often times has his/her own practice, and is paid by Social Security for his/her time evaluating you and generating a report. While many claimants get sent to a CE, and the CE’s report indicates the condition to be severe enough to be disabling, many claimants receive CE reports that say that while their condition is limiting, it is not enough to be disabling.
Too many times claimants have read these reports and believe that all is lost with the claim. This simply is NOT TRUE. Most claimants are also treating for the conditions they saw the consultative examiner for. This will generate medical records that further clarify the issue of how these conditions affect the claimant. If you are being represented by an attorney’s office for your claim, you need to notify your attorney’s office of this treating source, so they can notify Social Security to request the records. If you are not being represented by an attorney’s office, you need to notify Disability Determination Services as soon as possible to request the records from your treating source. When a consultative examiner produces evidence countering someone’s claim for Social Security, it becomes especially important that Disability Determining Services retrieves records from your treating sources, so they can get full clarification on your conditions.
Furthermore, a claimant’s treating sources carries more weight than a Consultative Examiner if the treating sources is an acceptable medical source under Social Security Administration’s policies and procedures. This is especially true when the claimant is seeing an MD for the conditions in question, if not an MD, than a PhD, PsyD or MSW. A claimant can ask this treating source to write a letter explaining how their conditions affect the claimant’s ability to do work. In this case, the claimant should request the doctor be as detailed as possible, and to have the treating source send the letter directly to Social Security, rather than going through the claimant. If a claimant is being represented by an attorney’s office, the claimant should notify the attorney’s office of the treating source, as the office may have specific questionnaires ready to send to acceptable medical sources regarding a claimant’s physical or mental conditions.
It is important, that if a claimant is in a position to request a letter or a questionnaire from an acceptable medical source as to his/her conditions, that only one treating source answers the same set of questions. Any inconsistency, no matter how inconsequential it seems, between the two questionnaires is subject to attack by Social Security. An exception in this case can be made if between the two letters or questionnaires, a serious medical event has occurred (i.e. major surgery, stroke, severe traumatizing event or suicide attempt). At these points, it is important to note the changes in the claimant’s conditions that have occurred because of the event.
If the treating source cannot fill out the questionnaire for whatever reason, see if you can obtain a physical or psychological assessment of your own by the treating source. This will allow a similar examination to the consultative examination, by a source with more weight than the CE.
Finally, while a vast majority of Consultative Examiners are very competent doctors just trying to do the best they can with the short time they have with the claimant, it has occurred, on a rare occasion, where the Consultative Examiner will make a claim that a test or portion of the evaluation has occurred that has not. If this occurs, notify Disability Determining Services immediately of where the inconsistency is, and then notify the board of medicine. This problem does not arise in the great majority of Consultative Examinations, but if it occurs to you, it’s important to notify the correct people immediately.
An unsupportive CE can be frustrating in the already too long battle for a claimant’s Social Security. A claimant treating and being proactive about gathering evidence from acceptable treating sources can create evidence that counters the CE report, and forward the claim.
