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SSDI: when is a consultative exam necessary?

Pennsylvania residents may find that there are times when the Social Security Administration will determine that the evidence provided by the applicant proving his or her physical impairment, illness or injury is not sufficient. When this happens, one step they may take is to schedule a consultative examination (CE). Usually, the medical professional that is preferred for a CE is the treating source, as long as the professional is able, agreeable and has the necessary qualifications to undertake the exam for a charge. This is true even if the only exam necessary is a supplemental test.

That being said, it may be possible for an applicant to use an independent source for the CE. This can happen for a number of reasons. For example, the treating source may not have the required equipment to obtain the necessary data from the exam. In addition, in some situations, the treating source simply may not agree to perform a CE. In other cases, the applicant's file contains facts that are either inconsistent or in conflict with one another, that cannot be settled by a CE undertaken by the treating source. Also, the SSA may have knowledge from previous CEs that a particular treating source is not a productive one. Finally, the applicant may have a valid reason to use an alternate source.

After the CE is completed, a report will be generated. The report needs to contain specific information, including the applicant's primary complaint. In addition, it must describe in detail the applicant's history with the primary complaint. It also should include a description of its findings in detail regarding the applicant's exam, history and any lab tests performed. These findings may be either negative or positive or may reveal abnormalities, if there are any. It should also include all lab test results. Finally, the CE report should both diagnose the applicant's impairment and offer a prognosis for it.

A CE can be a crucial part of a person's application for Social Security disability benefits. Those with further questions about CE's or other parts of the benefits application process should seek the help they need to understand the process.

Source: ssa.gov, "Disability Evaluation Under Social Security, Part II - Evidentiary Requirements," accessed Feb. 1, 2015

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