Why are you sent to a disability mental exam?

by Tim Moore, Disability Representative in North Carolina

Why will Social Security send you to a mental exam with a Psychiatrist?

Why The quickest and simplest answer to this question is to say that if you file for disability and you are sent to a Social Security medical exam involving a psychiatrist, this is because 1. Social Security is aware that you have a mental condition that may be disabling, 2. they need additional information about that condition, and 3. you may not have recent medical records documenting this condition. Some people, when they apply for SSD or SSI, have not been treated in many months. In fact, some people list conditions on their disability application that they have never actually been treated for.

But, to answer the question, if Social Security schedules you for an exam with a psychiatrist, this is actually a good sign. It means they think your condition is severe.

Why does Social Security bother to schedule any kind of exam?

To understand why this might be the case, you have to understand why it is that most consultative examinations, be they physical or mental in nature, are actually scheduled. Speaking as a former disability examiner for the social security administration’s DDS (disability determination services, where cases are evaluated and decisions on claims are made), I can authoritatively state that most examinations are scheduled for the following reasons.

1. In some cases, an exam will be scheduled because the claimant has alleged a condition (for example, carpal tunnel syndrome, bipolar disorder, depression, or back pain) for which they have never received treatment. Believe it or not, this is not an unusual occurrence.

In such cases, where there is absolutely no way for a disability examiner to obtain medical evidence for the purpose of rendering a decision, it is almost guaranteed that the examiner will send the claimant to an examination (note: exams are paid for by social security and performed by independent physicians, i.e. they are not employed by SSA).

2. In other cases, and this is probably the majority of them, the claimant has a history of receiving treatment for a condition but has not been treated for that condition in the last 90 days, or has not seen a doctor for any reason at all in the last 90 days. In these cases, as well, it is imperative for the disability examiner to obtain recent medical evidence and so the examiner will send the claimant to an appointment for a CE.

In both scenarios, the reason for sending the claimant is not to obtain specialized evidence that would be available from the claimant’s regular doctor or doctors, or any other medical treatment source. The goal of sending a claimant to a consultative examination is simply so that the examiner can obtain recent medical documentation which will allow them to make a decision and close the case.

This is exactly why, when a person receives an appointment letter for an examination from a disability examiner, the fact that the examination has been scheduled may, or may not, be particularly important. In most cases, the exam will simply be a formality that allows the case to be finalized. As was said, social security requires “recent evidence” to be in the file before a decision can be made.

Going to your own doctors periodically can eliminate the need for a consultative exam

Note: Claimants should pay particular attention to the evidence recency requirement because, though it is very difficult for SSA to make any type of decision on a case without recent evidence, it is practically impossible to make an approval on a disability case without recent evidence.

Therefore, individuals who file for disability should make sure that they have been seen by their medical treatment sources recently. Ideally, this would mean having been seen sometime before an application for disability was filed, and, perhaps, a few weeks after the claim has been filed as well (typically, it will take about 10-12 weeks for social security to make a decision on a disability case).

Physical consultative examinations, it can be said, will tend to have little significance on a case simply it is so very rare for a physical CE to provide any meaningful evidence on a case. Most of these are basically short, thinly-detailed exams that offer little to the case file other than a snapshot of a person’s reflexes, muscle strength, balance and coordination, and vital signs.

Neurological exams, a specialized form of physical exam, may offer more valuable evidence to a case, but aside from these, most physical consultative examinations are relatively useless to a case. Why does social security require them? As was said, simply to obtain “recent evidence” that might allow for a case to be closed.

Mental consultative examinations, however, often provide more substantive and useful medical evidence on a Social Security Disability or SSI case. This is because such exams will often comprise detailed testing such as a weschler memory scale (for individuals who may have some type and degree of memory impairment, stemming from a physical or mental cause), or a weschler IQ test. These exams are considered to be psychological testing and are usually conducted by licensed psychologists.

However, SSA will also send claimants to full psychiatric evaluations conducted by psychiatrists who are physicians holding an M.D. SSA does not ordinarily schedule full psychiatric evaluations unless the claimant has a more documented history of possessing a mental impairment and having, in the past, received treatment for it. And it is for this reason that when a psychiatric evaluation has been scheduled, it may hold more significance than other types of social security examinations.

Related: What can I expect from a Social Security Mental Examination or Evaluation?