I-3-2-30.Disqualification and Referrals of Medical Experts, Vocational Experts, or Consultative Examiners

Last Update: 3/3/25 (Transmittal I-3-201)

A. Notification of a Disqualification From Disability Determination Services

When the Disability Determination Services (DDS) identifies a medical provider who is disqualified from performing consultative examinations on behalf of the Social Security Administration, DDS may provide formal notice to the Office of Appellate Operations (OAO) through the regional consultative examination coordinator (CEC). In most circumstances, DDS will identify cases pending in OAO that require further action because the record contains a consultative examination report performed by the disqualified consultative examiner.

When OAO receives notification of a disqualified consultative examiner, the Executive Director's Office (EDO) will identify the affected cases pending with the Appeals Council (AC) and issue instructions on how to adjudicate the cases.

B. Claimant Alleges Disqualification in Request for Review

A claimant or appointed representative may allege in the request for review that the consultative examiner is not licensed or has otherwise been medically disqualified. In this circumstance, the AC will consider whether a referral to DDS is appropriate, following the instructions in subsection C.1.. In addition, the AC will process the allegation following the instructions in Hearings, Appeals, and Litigation Law (HALLEX) manual I-3-2-31 B.

C. AC Referrals of Medical Experts (ME), Vocational Experts (VE), or Consultative Examiners

1. Referral to EDO

Occasionally, the AC may discover potential issues regarding the conduct, qualifications, or performance of an ME, VE, or consultative examiner during case adjudication.

When a referral for further consideration may be warranted, the analyst will discuss the situation with an administrative appeals judge (AAJ). If the AAJ agrees a referral is appropriate, the analyst will send an email to EDO at ^DCARO OAO with the subject line “Expert conduct referral.” The content of the email will include the following information:

  • The claimant's name and Social Security Number;

  • The name of the ME, VE, or consultative examiner;

  • A brief description of the conduct or qualification issue;

  • The exhibit number or location of the relevant information in the file; and

  • The name of the AAJ agreeing that referral is appropriate.

NOTE 1:

If the case is paper, staff will also forward copies of any relevant documents to EDO via a scanned attachment or, when more appropriate, forward hard copies of the documents.

After sending the email, the analyst will add the expert conduct case characteristic “EXCN” in the applicable case processing system(s).

NOTE 2:

If the analyst suspects fraudulent behavior, the analyst need not consult with an adjudicator before referring the matter to the Office of the Inspector General (OIG), as explained in HALLEX I-1-3-9.

2. EDO Actions

EDO will review and evaluate each referral. If EDO determines a referral of a consultative examiner is warranted, it will send an email to the regional DDS CEC with the subject line “Possible Consultative Examiner Misconduct Referral.” If EDO determines that further investigation of an ME or VE is warranted, it will refer the information to the Division of Field Procedures (DFP) in the Office of the Chief Administrative Law Judge (OCALJ) at |||OHO OCALJ DFP. EDO may also make referrals to the Executive Review Board for potential considerations of focused reviews.