I got a call from Texas Disability Determination Services asking me to see a doctor before a decision is made on my Social Security disability application. Do I have to attend this appointment?

Generally, yes, if you want your application for Social Security disability benefits to be approved then you need to comply with the Disability Determination Services (DDS) request that you attend a consultative medical exam. This exam will not cost you any money, but before you see any doctor for any reason, it is important to understand the purpose of the appointment and your rights.

Who Performs a Consultative Exam?

The doctor who you usually see may be the one who performs your consultative exam. It is the Social Security Administration’s policy that the treating source (or your regular doctor) perform the consultative exam if the doctor is:

• Qualified and able to perform the exam or tests requested.
• Willing to do the exam or tests for the fee schedule payment provided by the Social Security Administration.
• One who generally furnishes complete and timely reports.

However, in some cases DDS may request that an independent medical provider conduct the consultative exam or test. This may occur if one of the following things is true:

• Your regular doctor does not want to perform the exam.
• There are conflicts or inconsistencies in your file that can’t be resolved by your regular doctor.
• You prefer to have someone else perform the exam and you have a good reason for having this preference.
• Prior experience indicates that your regular doctor may not be a productive source for getting the information sought in the consultative exam.

If a doctor other than your own is selected to perform your consultative exam, then that selection should be based on the doctor’s ability to perform the requested tests or specific exam, the doctor’s appointment availability, and the distance you must travel to get to the doctor.

What Happens at a Consultative Exam

DDS must be clear about the additional medical evidence that it needs to make a determination about your eligibility. In some cases a full exam may be needed. However, in other cases one test (such as an X-ray or EKG) may be all that is needed. You should understand the scope of the consultative exam before you attend your scheduled appointment.

Even though the scope of the consultative exam may be limited, the consultative exam report must contain specific information. Specifically, the Social Security Administration requires the report to include:

• Your claim number and a physical description of you.
• Your medical history.
• The results of your physical examination and laboratory findings.
• The examiner’s medical conclusions.

The report must be complete enough to allow a reviewer to determine what your disability is, how severe it is, how long it is expected to last, and how it impacts your ability to work. Additionally, it must be consistent. However, it should not include an opinion as to whether you are disabled as that term is defined by Social Security disability law. If the report is found to be incomplete or inconsistent then it will be sent back to the doctor and a determination about your Social Security disability claim may be delayed.

What to Know Before You Go to a Consultative Exam