Medical/Professional Relations

Role of the Medical and Education Professional

Each year, Social Security processes over three million disability claims. Health and school professionals are involved in the disability determination process in a variety of ways:

  • As medical sources who provide medical evidence on behalf of their patients;
  • As consultative examination (CE) sources to perform, for a fee, examinations and/or tests that are needed; and
  • As full-time or part-time medical or psychological consultants reviewing claims in a disability determination services (DDS), in one of our regional offices, or in our central office;

  • As nonmedical sources who provide school records and information on behalf of their students.

Educational Personnel

Educational personnel and school records are two of the best sources of evidence about how a school-age child is functioning, and whether there have been changes in the child's functioning over the year. We may ask school professionals to provide information from school records about academic performance, psychological evaluation, attendance, behavior, testing, therapeutic interventions, use of special services, individual educational plans, and other assessments about the child's ability to perform age-appropriate activities.

Medical Sources

A claimant’s own medical source has provided the claimant with medical treatment or evaluation and usually has important medical evidence about the nature and severity of an individual’s impairment(s). The medical evidence provided by the medical source should be as complete and timely as possible so that we can give the claimant an accurate and prompt decision on his or her disability claim. In many cases, a medical source’s evidence is sufficient for us to make the disability decision.

If an additional examination or testing is needed, we usually consider a claimant’s own medical source to be the preferred source for performing the additional examination or test.

The medical source is neither asked nor expected to make a decision whether the claimant is disabled. However, a medical source will usually be asked to provide a statement about the claimant’s ability, despite his or her impairments, to do work-related physical or mental activities.

Consultative Examiners for the Disability Determination Services (DDS)

In the absence of sufficient medical evidence from a claimant's own medical sources, Social Security, through the State DDS, may request an additional examination(s). These consultative examinations (CEs) are performed by physicians, osteopaths, psychologists, or in certain circumstances, other health professionals. All CE sources must be currently licensed in the State and have the training and experience to perform the type of examination or test that Social Security requests.

Fees for CEs are set by each State and may vary from State to State. Each State agency is responsible for comprehensive oversight management of its CE program. The Professional/Medical Relations Officers for your State can provide additional information about performing consultative examinations for the DDS in your State.

Medical professionals who perform CEs must have a good understanding of Social Security disability programs and their evidentiary requirements. In addition, medical professionals are made fully aware of their responsibilities and obligations regarding confidentiality and:

  • CE scheduling intervals
  • CE report content
  • Elements of a complete CE
  • When a complete CE is not required
  • Signature requirements

Program Medical Professionals

Psychologists and physicians of virtually all specialties review claims for disability benefits at the State, regional, or national level. The review work is performed in the State DDSs or SSA's regional offices or headquarters. It is strictly a paper review in which the program physician or psychologist usually has no contact with the claimant.

Information

If you are interested in performing consultative examinations or reviewing work in your State DDS, contact one of the Professional/Medical Relations Officers listed for your area.

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