How to discredit the consultative social security exam before, during and after the exam. Discredit the exam when it is: inaccurate; allows for bias of the examiner; where the claimant has difficulty getting to the exam; it costs the government money; it hurts the claimant; it scares the claimant.

1. Discrediting the
Consultative
Exam before
during, and
after the exam
By Neil H. Good
1 Nosscr October 2014

2. Why Discredit The Exam
 They are inaccurate
 The allow for the bias of the Examiner
 Our clients have difficulty getting there
 They cost the government money
 They hurt the clients
 They scare the clients
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3. When Is SSA Supposed To Order
Consultative Evaluation
 20 CFR 404.1519a
 They will purchase a CE when:
 If SSA doesn’t get information from a
Medical Source
 To resolve inconsistencies in the medical
evidence
When the evidence is insufficient to decide
 Highly technical evidence is not available
 Current severity is not established
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4. Who Should Perform The CE
 20 CFR 404.1519(H)
 When in our judgment your treating source is
qualified, equipped, and willing to perform
the additional examination or tests for the fee
schedule payment, and generally furnishes
complete and timely reports, your treating
source will be the preferred source to do the
purchased examination. Even if only a
supplemental test is required, your treating
source is ordinarily the preferred source.
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5. Objecting To A CE
 § 404.1519j. Objections to the medical source designated to perform the
consultative examination.
 If there is a good reason for the objection, we will schedule the
examination with another medical source.
 A good reason may be that the medical source we designated had
previously represented an interest adverse to you
 The presence of a language barrier, the medical source's office location
(e.g., 2nd floor, no elevator), travel restrictions,
 whether the medical source had examined you in connection with a
previous disability determination or decision that was unfavorable to
you.
 If your objection is that a medical source allegedly “lacks objectivity” in
general, but not in relation to you personally, we will review the
allegations.
 To avoid a delay in processing your claim, the consultative examination
in your case will be changed to another medical source while a review
is being conducted.
 We will handle any objection to use of the substitute medical source in
the same manner.
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6. How Do They Read The Report
 (a) We will review the report of the consultative examination to determine
whether the specific information requested has been furnished. We will
consider the following factors in reviewing the report:
 (1) Whether the report provides evidence which serves as an adequate basis
for decision making in terms of the impairment it assesses;
 (2) Whether the report is internally consistent; Whether all the diseases,
impairments and complaints described in the history are adequately assessed
and reported in the clinical findings; Whether the conclusions correlate the
findings from your medical history, clinical examination and laboratory tests
and explain all abnormalities;
 (3) Whether the report is consistent with the other information available to us
within the specialty of the examination requested; Whether the report fails to
mention an important or relevant complaint within that specialty that is noted
in other evidence in the file (e.g., your blindness in one eye, amputations,
pain, alcoholism, depression);
 (4) Whether this is an adequate report of examination as compared to
standards set out in the course of a medical education; and
 (5) Whether the report is properly signed..(20 CRF 404.1519p)
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7. What If SSA Can’t Read The
Report
 (b) If the report is inadequate or incomplete, we will contact the
medical source who performed the consultative examination, give
an explanation of our evidentiary needs, and ask that the medical
source furnish the missing information or prepare a revised report.
 (c)With your permission, or when the examination discloses new
diagnostic information or test results that reveal a potentially life-threatening
situation, we will refer the consultative examination
report to your treating source. When we refer the consultative
examination report to your treating source without your permission,
we will notify you that we have done so.
 (d)We will perform ongoing special management studies on the
quality of consultative examinations purchased from major medical
sources and the appropriateness of the examinations authorized.
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8. The Studies say 26% of CE’s are
deficient.
 An Assessment of Consultative Examination (CE) Processes,
Content, and Quality: Findings from the CE Review Data
 Final DATED November 12 2012 Report(http://www.
socialsecurity.gov/ disabilityresearch/document
/CE%20Report%202.pdf)
 COMS Medical Consultants’ Assessment of CE Quality and
Completeness
 Minority of cases (11 percent) judged deficient for making
disability determination
 Minority of cases (16 percent) judged not to include all of
the items expected (expected findings, conclusions, and
responses to specific questions); more frequent
occurrences of not including
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9. What Is The CE Report
Required To Include
 The Green Book explains : Consultative Exams: A
Guide for Health Professionals
 List A-K at a minimum
 Then Specific types of exams-Musculoskeletal,
Special Senses and Speech, Visual Impairments,
Hearing Impairments, Respiratory System,
 Cardiovascular System, Digestive System,
Genitourinary Impairments, Hematological
Disorders, Skin Disorders,
 Endocrine Disorders, Neurological Disorders,
Mental Disorders, Malignant Neoplastic Diseases,
Immune System Disorders
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10. Minimum Requirements
 A. Identity of Claimant with longitudinal
Medical History
 B. Current Medical History, onset date,
current symptoms, treatment and results,
typical daily activities, dates
 C Past medical History
 D. Current medications
 E. Review systems-other symptoms and
pertinent negatives
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11. Minimum Requirements
 F. Social History – tobacco and DA&A
 G. Family History
 H. Physical Exam
 I. Interpretation of Lab tests
 Imagining tests
 Medical Source Statement- opinion
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12. Minimum Requirements
 Lifting/carrying/pushing/pulling
 Sitting/standing/walking
 Posture (for example,
climbing/stooping/bending/balancing/cra
wling/ kneeling/crouching)
 Fine motor skills (that is,
handling/fingering/gripping/feeling)
 Overhead and forward reaching
 Vision/hearing/speech
 Environmental exposures (for example,
heat/cold/humidity/noise/vibration)
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13. How Long Should The Exam
Last
 20 CFR § 404.1519n
 (1) Comprehensive general medical
examination—at least 30 minutes;
 (2) Comprehensive musculoskeletal or
neurological examination—at least 20 minutes; (3)
Comprehensive psychiatric examination—at least
40 minutes;
 (4) Psychological examination—at least 60 minutes
(Additional time may be required depending on
types of psychological tests administered); and
 (5) All others—at least 30 minutes, or in
accordance with accepted medical practices.
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14. What Is The Effect Of Not
Going To The CE
 HALLEX I-2-5-24 Claimant Fails or Refuses to
Submit Evidence or Undergo a Consultative
Examination or Test
 It is never proper to dismiss a claimant's RH for
failure to provide requested evidence or to
undergo a requested CE. The ALJ should
schedule the case for hearing and if after
notice of hearing, the claimant fails to appear
for the hearing, then dismissal may be proper
under I-2-4-25. (20 CFR §§ 404.957
and416.1457.)
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15. Scheduling The Appointment
 POMS DI 23007.010
 Failure to attend a CE appointment means
the claimant did not state orally or in writing
that he or she would not attend the CE
appointment, but the claimant fails to attend
the CE appointment.
 However, a claimant cannot fail to attend a
CE appointment if: the claimant did not
confirm the appointment, see DI 22510.019D;
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16. What Is Good Cause Not to
Attend The CE
 1. The claimant was seriously ill and unable to comply with the
request.
 2. There was a death or serious illness in the claimant's immediate
family which prevented him or her from complying with the request.
 3. The claimant did not receive the request to submit evidence or
appear for a CE or test, or the claimant received the request
untimely.
 4. The request to submit evidence or appear for a CE or test
contained incorrect or incomplete information about when and
where to submit the evidence or appear for the CE or test.
 5. The evidence requested is not available due to destruction or
damage.
 6. The claimant did not understand the requirement to provide the
requested information.
 7. The claimant lacked the financial ability/means to obtain the
evidence requested. (20 CFR §§ 404.911)
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17. What Can Be Done Before The
Consultative Exam
 Send a letter asking why they need the
CE
 Object to the CE
 Have a doctor write a letter explaining
why the claimant cannot have the exam.
(depression example)
 Offer to pay for the difference between
what SSA is willing pay and what the Dr. is
going to charge
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18. What Can Be Done During
The Consultative Exam
 Advise the client to bring the records with
 Advise the client to have somebody go
with them(a nurse)
 Have them ask if they can record the
session blame it on the lawyer
 Advise the client to explain if it is a bad
day
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19. What Can Be Done After The
Exam.
 Have the client fill out the questionnaire
 Submit the Questionnaire
 Have the client’s doctor fill out the range
of motion questionnaire
 Submit the Range of Motion for to DDS
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20. What do you do at the
hearing
 In court Compare the ROM Form to that
of the Treating physician or PT
 Have the client testify about what he
disagrees in the CE
 Have the witness come to court to testify
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