A visit to a doctor scheduled by the DDS or the SSA is not an uncommon event. Does the claimant have to make the appointment? What is the reason or the purpose of the exam? How much weight is given to the exam results? Will the findings help or hurt the SSD claim?
First and foremost: yes, the claimant must attend the visit to the SSA doctor. Failure to attend the scheduled appointment without a valid excuse can result in a case being dismissed. Thus, attendance is mandatory. If for some reason an appointment cannot be kept, the doctor and the SSA should be notified immediately.
The purpose of the visit to a doctor utilized by the SSA can be for several reasons. Often times the consultative exam (CE) by the doctor is scheduled due to a lack of records or because the claimant has not received treatments in quite some time. Thus, the DDS examiner determining disability at the application level needs or the judge (ALJ) that will be hearing the case need more medical information to make a determination.
Not all consultative exams are negative; however, several unfavorable issues can occur when a claimant is examined by a doctor in a CE. Typically, the examining physician is not familiar with the claimant’s medical history. The doctor has only minimal records or often times no records of the claimant. Even if medical records are provided to the doctor, there is no assurance the doctor has reviewed the records. The CE is typically brief, lasting between 5-15 minutes. The doctor often makes notes, findings, and conclusions of the limitations or most often times, the lack of limitations, through observations of the claimant. A typical scenario is where a doctor makes an evaluation and assessment of the claimant based on a (very brief) exam as well as observations of the claimant getting out of a vehicle, movements of the claimant in the waiting room, the way a claimant sits in the waiting room, the way a claimant gets out of a chair in the waiting room, how a claimant walks into the examination room, how the claimant gets on and off the examination table, etc.
The claimant needs to be mindful that the medical examiner is not the claimant’s physician so the claimant should not expect to be treated like a patient of that particular doctor. The claimant should be aware that she/he might be under observation from the time the claimant exits a vehicle until the time the claimant enters a vehicle after the exam. The claimant should also document when the exam begins and concludes.
An unfavorable CE can be detrimental to a claimant’s case when there are minimal treatments or no recent treatments. A DDS examiner or Administrative Law Judge (ALJ) might give records from a CE weight when there are no other records to be considered. Such findings can hurt the chances of a claimant being found disabled.
It is important for a claimant to get evaluated by a doctor that is the claimant’s doctor. The evaluation might not result in a different finding, but the claimant’s doctor will have the benefit of reviewing the claimant’s past medical records and will have familiarity with the claimant’s medical history. Thus, the claimant has a better chance of receiving a more accurate assessment of the claimant’s diagnosis, prognosis, and limitations.