and Examinations in the DDS Adjudication Process
In some disability claims, the evidence provided by a
treating doctor or other source is not sufficient to make a disability determination. In these claims, the SSA/DDS
will send the claimant for a “Consultative Examination” or a CE in order to obtain the missing
Consultative Examinations (CEs) can be
provided by your treating doctor if they have the skills to complete it, but more often than not, you will be sent
to an independent contracting medical provider who is paid by SSA to conduct the examination.
Doctors who perform these examinations are
licensed physicians, osteopaths or certified psychologists, optometrists, podiatrists or speech-language
Consultative Examiners will never be
chiropractors, naturopaths’, herbalists or other alternative healer type providers, since they are not considered
acceptable medical sources by the SSA for the purpose of disability evaluations.
The role of the Consultative Examiner is to
provide a standard examination and provide a report to the DDS office which highlights:
n Your chief complaints and a history of
n A detail of findings based on your history,
including examination and laboratory tests as related to your main complaint
n Results of lab and other test performed
according to the Listing of Impairments
n A diagnosis and prognosis for your
n A statement about what you can do despite
your impairments (i.e. functional limitations).
Nolo's Guide to Social Security Disability: Getting & Keeping Your
The opinion or statement of your treating
physician will carry more weight than that of a Consultative Examiner. This is true to the extent that your
treating physician’s statement is deemed as credible based on the objective medical findings documented in your
So you can see that Medical Consultants
employed by the DDS office are not the same as Consultative Medical Examiners who examine claimants outside the DDS
On the one hand is the MC provider who
never sees you, but who does a paper review of your claim to make disability determinations, while on the other
hand is the CE provider who does examine you, and then reports his finding to the DDS office.
Though the CE doctor issues an opinion or
statement on your medical condition, he has no authority to make the final decision on your disability claim
because he has not been trained to do so by the SSA. The CE provider is just a regular medical practitioner in the
community who has agreed to perform medical examinations on claimants in keeping with SSA/DDS disability
Hopefully now when your Claims Examiner
tells you that your claim is in the Medical Consultant’s office for review, you will know that you should receive a
decision very shortly, usually within 10 to 30 days.
And, if the examiner tells you that you
have been set up for a Consultative Examination, you will know that you will be seeing an independent medical
doctor or psychologist who is charged with filling in some missing information in your claim record. This
information allows the internal Medical Consultant to make a thorough paper review and assessment of your medical
Grid Rules – See the rules SSA / DDS uses to determine
if you are disabled or not.
SSA Listings of Impairments – Your claim will
either be decided using these rules or the Grid Rules.