What Happens at a Social Security Consultative Exam?

A consultative exam (CE) is a physical or mental exam, or a test, that Social Security orders and pays for when your own doctors’ records don’t give it enough evidence to decide your disability claim. The state agency handling your claim, Disability Determination Services (DDS), arranges it, and it can happen at the first decision, at reconsideration or before a hearing. If you skip it without a good reason, Social Security can decide your claim on the evidence it already has and find you not disabled.

The examiner doesn’t decide your claim. Their report goes to the DDS team, a disability examiner and a medical or psychological consultant, who weigh it with everything else in your file. Being sent for an exam isn’t a sign either way; it means something was missing or unclear in the records.

Why Social Security orders an exam

Before ordering an exam, the agency looks at your existing records and the disability report you filled out. It buys an exam to settle a conflict in the evidence or when the evidence as a whole isn’t enough, for example when:

• the information it needs isn’t in your doctors’ records, such as a specific test, a diagnosis or a description of your limits,
• your records can’t be obtained, because a doctor has died or won’t respond,
• it needs specialized evidence your doctors don’t have, or
• your condition seems to have changed and its current severity isn’t documented.

It won’t order one when the answer can’t change the outcome, for instance when your insured status ran out before any possible onset date, or when it hasn’t yet resolved whether your work counts as substantial gainful activity.

If only one test is missing, such as an X-ray, a breathing test or an EKG, Social Security’s consultative exam guidelines tell the agency to order just that test instead of a full exam.

Who does the exam

Your own doctor is the first choice, if they’re qualified, have the right equipment, accept the state’s fee and usually send complete reports on time. If yours can’t or won’t, the agency chooses an independent provider based on appointment availability, distance from your home and the tests needed.

The provider must be currently licensed in your state, have the training to do that type of exam, and not be barred from Social Security work. That can be a physician, a psychologist, or another qualified source such as a speech-language pathologist. Fees are set by each state.

You can object to the examiner if you have a good reason, and the agency will schedule someone else. Reasons Social Security recognizes include:

• the examiner has worked against you before, for example for your employer in a workers’ compensation case or in an insurance claim,
• the examiner saw you for an earlier disability decision that went against you,
• a language barrier,
• the office is hard to reach, such as a second floor with no elevator, or you have travel restrictions.

If your own doctor tells you not to take a particular exam or test, tell the agency right away. It may be able to get the information another way.

The appointment notice

The notice must tell you why the exam is needed, the examiner’s name, address and phone number, the date, time and type of exam, and that Social Security pays for it and may cover travel. It also tells you to:

• bring a current government-issued ID, preferably with a photo,
• bring all your medications in their original containers, plus glasses, contact lenses, hearing aids and any cane, walker or other device you use,
• confirm that you’ll attend, and call right away if you can’t make it,
• ask for an interpreter if you need one. Interpreters are free.

Confirming matters more than most people realize. If you haven’t confirmed within 10 days of the notice, the agency makes one attempt to reach you by phone, and if it can’t, it sends a letter asking you to call within 10 days. If nobody responds, the appointment is canceled and your claim can be decided without it. You, your legal guardian or your representative can confirm, cancel or ask to reschedule.

What to bring, and what not to

Bring your ID, your medications and your medical devices. You don’t need to carry your whole medical file. The agency gives the examiner the background they need, and records belong with Social Security, not the examiner. If you’re worried that records are missing, send them to the agency or upload them, and ask your DDS examiner which providers have responded. The agency makes one request and one follow-up to each provider, but it can’t force a provider to answer.

How long the exam takes

Social Security sets minimum appointment times so exams aren’t rushed. They’re the time set aside for you, not a promise of how long the exam lasts:

What happens at a physical exam

The examiner starts by checking your identity, then takes your history: your main complaints in your own words, when they started, your symptoms, treatment and its effects, what makes things better or worse, your daily activities, and your medications with their side effects. The examiner also lists the medical records they reviewed.

The physical part focuses on your complaints. For back, joint or other musculoskeletal problems, Social Security’s guidelines for exam reports ask the examiner to describe things like your ability to:

• walk, with and without any device you use, and walk heel-to-toe, on your heels and on your toes,
• bend, squat and get up from a squat,
• get up from a chair, get on and off the exam table, and dress and undress,
• grip, pinch, make a fist and handle small objects, with strength graded on a 0 to 5 scale or measured with a device.

They also measure range of motion, and for back problems they test reflexes and straight-leg raising. If you use a cane or walker, they note whether it was prescribed, by whom, and the medical need for it.

The examiner records general observations too: how you got to the appointment, whether you came alone, how far you traveled and who drove, and your cooperation and effort on the tests. Answer honestly and do each test only as far as you can. Exaggerating shows up in the effort notes, and pushing through pain you’d normally avoid misstates your limits.

X-rays, blood work, breathing tests, EKGs and stress tests can be ordered, but Social Security won’t order risky procedures such as a myelogram, an arteriogram or a cardiac catheterization.

What happens at a mental exam

A psychiatric or psychological exam is mostly conversation. The examiner asks about your history, treatment, medications, hospitalizations, schooling, work and relationships, and about how you function day to day: understanding and remembering information, getting along with others, keeping up concentration and pace, and handling your own needs and changes.

Then they do a mental status exam: your appearance and behavior, how your thoughts flow, their content, any hallucinations, your mood, your orientation, memory and concentration, and your judgment and insight. Social Security’s guidelines say this must be the examiner’s own observations, not a repeat of the symptoms you report. A psychological exam may include intelligence or memory testing. The report also says whether you could manage your own benefits.

So your daily struggles do get asked about. Describe a typical day and your bad days as they really are; there’s no need to look a certain way.

Telehealth exams

Some mental exams can be done by video from home: psychiatric exams, psychological exams without standardized testing, and speech and language exams. You have to agree to it. You also need a private, quiet place, a reliable internet connection, a device with a camera and microphone, and, for adults, a valid government photo ID to show on camera. If you have significant trouble hearing, following simple instructions or concentrating, or you can’t meet those requirements, the exam is done in person. Physical exams are in person.

What the report contains

The examiner sends a signed report covering your complaints and history, the exam findings both normal and abnormal, test results, a diagnosis and prognosis, and usually an opinion about what you can still do: for a physical exam, lifting, carrying, sitting, standing, walking, bending, reaching and handling; for a mental exam, following instructions, keeping pace, dealing with people and handling work pressure. The report doesn’t say whether you’re disabled. That’s Social Security’s decision.

The agency checks every report. If it’s incomplete, inconsistent, or leaves out a complaint that’s in your records, the agency goes back to the examiner for the missing information or a revised report. The examiner’s opinion is then weighed like any other medical opinion, mainly on how well it’s supported and how consistent it is with the rest of your file, so detailed records from your own doctors still carry the case. The exam also feeds into your residual functional capacity.

With your permission, the agency can send the report to your own doctor. It sends it without asking if the exam found something potentially life-threatening, and then tells you it did so. To see the report yourself, ask Social Security for it; examiners are told to refer those requests to the agency.

If you can’t go, or you miss it

Call the agency as soon as you know you can’t make it, before the appointment if possible. If you have a good reason, it reschedules. Social Security’s examples of good reasons are:

• you’re ill on the day of the exam,
• you didn’t get the notice in time, or at all,
• you were given wrong or incomplete information about the examiner, time or place,
• a death or serious illness in your immediate family.

The agency also considers physical, mental, educational and language limitations that kept you from going. If you miss an exam after the agency tried to confirm it, it reschedules only if you or your representative call with a good reason before your claim is decided.

Watch out: If you already get disability benefits and you skip an exam ordered during a continuing disability review without a good reason, Social Security can decide your disability has ended because you didn’t go.

Getting your travel costs back

Travel to a consultative exam is reimbursable, and the agency that sets up the exam explains how when it notifies you. The basics:

• Reimbursement covers the most economical way to travel that suits your health, such as bus, train, or your own car at the federal or state mileage rate plus tolls and parking.
• Costs like a taxi, an attendant, meals, lodging or an ambulance need written approval in advance, unless they were unexpected or unavoidable.
• Keep receipts. You submit an itemized list to be paid.
• You can ask for an advance if the cost is a hardship. If you get one, you send your itemized costs within 20 days after the trip, and states can set different time limits and rates.

If the exam went badly

Short, rushed exams are a common complaint. If the examiner barely examined you, skipped a condition you reported, or wrote something that doesn’t match what happened, tell the DDS contact on your notice in writing. Every state agency must have procedures for handling complaints about examiners and for checking claimants’ experiences with its main providers. If you’re denied, the report is part of the file you can answer on reconsideration, where new records and a detailed statement from your own doctor go into the file next to it.