Writing in Guernica, Dr. Heather Kovich discusses  her experiences as a (former) Social Security disability examiner:

There is also a stereotype of the doctors who do this work: lazy and disinterested. I found the job fascinating. The more I learned about the disability system, the more I pondered its complexities: it provides a safety net but keeps people mired in poverty. Helpful services, including job retraining, are available, but aren’t advertised. And the system rests on a deeply flawed premise—that there is a way to objectively determine who is able to work and who is not.

…

This was my job, “independent medical examiner.” On the basis of a forty-minute interview and examination, I was supposed to determine how disabled an applicant or “claimant” was. 

…

I did hundreds of disability exams over the next year, and while I did meet two people who were obviously faking, for the most part the stories I heard were heartbreaking: car accidents, massive strokes, lost jobs, dead spouses. Many people who apply for disability have lived through a tragedy. But the stories also told of the inefficiencies of the disability system. That first day in Spokane I met a man who had worked in manual labor his whole life, but for years had been getting crushing chest pain after walking a few blocks. His blood pressure was dangerously high. His condition was obviously treatable, but he did not have insurance so he had not been to a doctor in years. He knew that if he qualified for permanent disability he would eventually get Medicare or Medicaid and get proper treatment. He had no idea he could go to a community health center, a federally financed clinic where he could pay on a sliding-scale basis. With the right treatment and a less strenuous job, he would probably have not needed disability. Emphasis added.

This is the catch 22 of the Social Security system: with the health insurance Social Security provides, you might not be disabled. However, without Social Security disability, you can’t get the medical care you need.

This isn’t strictly a Social Security problem, it is US health system problem.

As of this year, Social Security is reportedly paying out more in benefits than it collects in revenue, putting pressure on the system to become more financially sustainable. Many economists propose stricter requirements for disability, letting far fewer people onto the rolls.

This is what happened in the Netherlands eight years ago: the Dutch tightened their criteria for disability and required employers to contribute to some of the disability payments. They were able to decrease the number of people on disability rolls by 15 percent (the U.S. has never seen any drop in disability recipients) and were able to show that those people had not simply transferred their needs to other government security programs, but were actually back at work. However, the Netherlands has a compulsory health insurance program, so the disabled, who have higher health care needs, were able to continue receiving health care no matter what type of employment they could find. Emphasis added.

This is just one topic covered in the article. Go and give it a read.

Social Security has physicians review disability cases as medical consultant’s to make opinions on individual’s abilities and limitations. However, what good is the medical consultant’s opinion if they don’t have expertise in with the disability in question.

Per Nate Craig:

… you may also want to look at the Medical Consultant’s Code attached to the State Agency’s opinion. I am finding more and more reviewing physician’s making opinions outside their professional field. Recently an ALJ relied on the State Agency’s opinion where the initial decision was made by a SDM and then affirmed by a “dermatologist” MCC of 6. The AC kicked it back with the directive for another physical CE. At the remand hearing, the same ALJ entered a decision of disability back to original onset date.

Wondering if the medical consultant on your case had the necessary expertise to make an opinion? Check the consultant’s code (next to the signature on the last page) with the list the at Social Security.

Note: the consultant’s codes appear on forms from doctors who review cases, not the doctors who exam claimants at consultative examinations.

MC/PC Specialty Codes
01 Anesthesiology
02 Ambulatory Medicine
03 Audiology
04 Cardiology
05 Cardiopulmonary
06 Dermatology
07 E.E.N.T.
08 E.N.T.
09 E.T.
10 Emergency Room Medicine
11 Endocrinology
12 Family or General Practice
13 Gastroenterology
14 Geriatrics
15 Gynecology
16 Hematology
17 Industrial Medicine
18 Infectious Diseases
19 Internal Medicine
20 Neurology
21 Neuro-Ophthalmology
22 Neuro-Psychiatry
23 Neonatology
24 Nephrology
25 Obstetrics
26 Occupational Medicine
27 Oncology
28 Ophthalmology
29 Orthopedics
30 Osteopathy
31 Pathology
32 Pediatrics
33 Physiatry
34 Physical Medicine
35 Plastic Surgery
36 Preventative Medicine
37 Psychiatry
38 Psychology
39 Public Health
40 Pulmonary
41 Radiology
42 Rehabilitative Medicine
43 Rheumatology
44 Special Senses
45 Surgery
46 Urology
47 Other
48 Speech-Language Pathology
49 Child and Adolescent Psychiatry

How do you begin to review your Social Security exhibit file? Here is a quick guide to finding the really important parts.

Start with the “F” section to review the medical records.

If you do not review anything else in the file, you need to know what medical records are there (and what records are missing).

Here is what I look for:

• Are all the doctors and hospitals listed? If the doctor or hospital is not listed, it is a safe bet that those records are not in the file. There are some exceptions to this. Occasionally, records are commingled, with more than one doctor’s records in one exhibit, but that is usually straightened out as the Office of Disability Adjudication and Review (ODAR) gets your exhibit file ready for the hearing.
• Are all all the dates of service complete? In the image above the records cover August 19, 2003 through November 13, 2003. If you know you treated with that doctor in 2004, you know the records are not complete.
• Do the number of pages look right? If you were treating with the same doctor for years and years, but Social Security only shows 12 pages, the records are probably not complete.

Then, start to review the actual records. While a review of the exhibit list can help you quickly spot missing records or other problems, you really have to examine the records to find out what Social Security has (and what might be missing).

The F section of the file also has all the reports from any doctors Social Security sent you to. If you want to see what the consultative examiner had to say, now is your chance to find out!

You will also find the forms from the Social Security technicians describing what limitations they think you have. Social Security often uses this information in deciding your case, so you need to know what they are saying.

I previously wrote about how long it takes to receive an initial decision after you apply for Social Security disability benefits and how long it takes to get a Social Security hearing.

Unfortunately, there are no hard and fast rules for how long it will take to get a decision after the consultative examination. But, you can make a pretty good guess. 

I usually see a decision four to six months after an application for either disability insurance (SSDI) or Supplemental Security Income (SSI) benefits.  

So, if Social Security schedules a consultative examination 3 months after the application was filed, as an estimate, you can expect a decision in the next 30 to 90 days.

How long after the consultative examination did you get your decision? Let me know in the comments!

Here are some common questions I hear when Social Security schedules an evaluation or examination with one of their doctors:

Do I have to attend the consultative examination?

Since you are applying for Social Security benefits, you have a duty to assist Social Security in obtaining the information it needs to evaluate your case. This includes going to evaluations or examination that Social Security may schedule for you.

So, “yes,” you do have to go the examination.

Of course, Social Security cannot make you attend a consultative examination. But if you do not attend, your case may be denied, or even dismissed.

What if I cannot attend the consultative examination?

If you cannot attend, contact Social Security right away.

However, do not call just any Social Security office. The notice you received when Social Security scheduled the consultative examination should provide the name and telephone number of your case worker.

In Colorado, the consultative examination is usually scheduled through Disability Determination Services (so do not let that name throw you, it is the Colorado agency that performs the initial development, evaluation and determination of your Social Security case).  Even though the letter may say, “Disability Determination Services,” it is still part of the Social Security Administration.

Let the case worker know that you cannot attend the examination and the reasons why you cannot attend.

TIP: keep a log of any telephone calls between yourself and Social Security, including date, time, who you speak to, and a summary of the conversation.

WATCH OUT: I have seen several cases where an individual called Disability Determination Services and cancelled an evaluation only to receive a denial a short time later because they “did not keep the scheduled evaluation.”  Unfortunately, your only recourse is to appeal the denial.

Keep in mind that if Social Security denies you for missing an evaluation, it is a safe bet that the judge will ask you why you missed the consultative examination when your case goes to hearing. This is where your log showing your communication with Social Security can come in handy.

If you have kept a log of your communication with Social Security regarding the cancellation of your consultative examination and your attempts to reschedule, you have a better chance of convincing the judge that missing the consultation should not be held against you.

Has Social Security sent you to a doctor for an examination? Here are some things you should know when going to a consultative examination. 

The examination begins earlier than you think:

• You are observed from the moment you enter the office. 
• The observation continues in the waiting area and you may even be observed when you walk back to your car. 
• The examination may include how you walk from the waiting area to the examination room and your ability to climb on and off of the examination table.

Your behavior may then become part of the doctor’s report to Social Security.

In my experience, the chance of a Social Security consultative examination proving that you are disabled is quite low.  Normally, they mostly bolster Social Security’s denial of your claim.  However, you can take that statement with a grain of salt. Most consultative examinations take place BEFORE the initial decision and individuals usually contact an attorney AFTER they are denied. So, I do not see the case where the consultative examination was helpful, because it results in an approval.

photo credit: cesarastudillo

Your doctor’s opinion of your disability is critical evidence in your Social Security disability case. If your doctor does not believe in you, you and your lawyer are facing an uphill battle.

Chances are, Social Security either sent you to one of their doctors for a consultative examination, or had your medical records reviewed by a Social Security doctor. If Social Security denied your claim, their doctors probably did not think you were disabled.

So, here is the problem: if the Social Security doctor says you are not disabled and your doctor does not believe in your disability, you may not have the evidence you need to prove your case.

What can I do if my doctor does not support me?

Unless you can get your doctor to change his or her mind, you may need to get a new doctor as soon as possible. You may not be able to undo the damage done by your current doctor, but you can at least provide fresh evidence that supports your disability from the new doctor.

I do not advocate shopping for a more favorable medical opinion. However, if you and your lawyer think that your doctor is biased against you, or against anyone applying for disability benefits, don’t let them ruin your claim!