When you file a mental disability claim (or appeal) with the Social Security Administration (SSA), the agency must gather medical evidence before deciding on your case. Specifically, your reviewer (claims examiner) will contact your treating doctor (or psychologist) and try to obtain the medical records related to your disability claim.
If you haven't been treated by a physician, psychiatrist, or psychologist lately, or you don't have medical records that provide a clear overview of your disability, Social Security can order that you go to a consultative examination (CE).
A Social Security exam, or CE, could include medical and/or mental examinations, depending on the kinds of impairments you're asking the SSA to consider in your disability claim. If Social Security requests that you have a CE done to assess your impairments, the agency must pay for the examination.
This article will cover what to expect from a psychological consultative exam and how Social Security uses the CE report in deciding your disability claim.
Generally, Social Security prefers that your own psychologist or psychiatrist complete the mental examination. There are situations, however, in which an independent doctor might be used, including the following:
Once the Social Security claims examiner decides that you should have a mental examination performed, the SSA will coordinate with a doctor or psychologist to set up an appointment time and place. The agency will try to get an appointment close to where you live.
Social Security can also help with your travel expenses (like if you need to pay someone to drive you because you can't drive yourself). Let the claims examiner know right away if you need help arranging or paying for transportation to your exam.
Social Security will order the tests and evaluations that the claims examiner thinks are necessary to make a fair assessment of your disability. Which ones you'll face will depend on the following:
That said, at the mental examination, Social Security requires the doctor (or psychologist) to cover several specific elements. These elements are laid out below.
Your identity. The doctor must establish your identity through proof of identification, your claim number, and a physical description of you.
Your medical history related to your ability to work. The examiner will review all your available medical records. The doctor or psychologist will ask you to provide the following information:
Any past hospitalizations, operations, and procedures, including the dates and whether they were successful.
Your other medical history—all significant past medical events (even if they're unrelated to your disability) and when they happened, including:
Your current medication and its effects on you.
Your social and family history—including asking about your past and present relationships with:
Your educational background, including the highest grade you achieved and any recent training.
Your involvement in social activities or hobbies, including a description of your typical daily activities.
Any attempts to return to work and the results.
Any history of substance abuse and the effects your use of drugs or alcohol has on your ability to function.
Past and current participation in rehabilitation, supported living, or other treatment, and your success or failure in those programs.
Physical observations. The doctor or psychologist must report on:
Mental status evaluation. The doctor or psychologist will make these determinations by observation throughout the mental examination. Areas that the doctor will assess include:
Interpretation of testing. The doctor or psychologist will provide clinical assessments of your performance on any psychological tests or other examinations performed.
Diagnosis. The psychiatrist or psychologist must diagnose you based on the American Psychiatric Association standards.
Prognosis and recommended treatment—including whether you need further evaluations.
After completing the examination, the doctor or psychologist must provide their clinical opinion on the following:
For an individual with intellectual impairments, the doctor will also need to provide the following information:
(Learn more about how Social Security determines disabilities for mental conditions.)
After receiving the report from your consultative examination, the Social Security claims examiner will generally do one of two things:
The claims examiner will consider the mental examination report along with the rest of your record when deciding if you're disabled and unable to work. Although all your medical records will have an impact on your claim, Social Security tends to put a lot of weight on the results of a mental consultative examination.
If Social Security denies your claim for disability benefits because of a consultative examination report (or other reason), you have the right to appeal. (Learn more about the Social Security disability appeals process.)