March, 2015: Social Security’s Consultative Examinations and how they may actually Help One’s Case
Mary’s case serves as an example as to how the Social Security Administration not only ignores the opinions of one’s treating physicians, but also ignores many times the opinions of its own consultative examiners. As part of the disability process, the state agency in charge of making the disability determination for the Social Security Administration will many times send individuals to doctors that are paid to meet with you and undertake a one-time examination so as to provide what is supposed to be an independent opinion as to the severity of one’s medical condition. These examinations are many times considered in the circumstance where a claimant may not have much in the way of treatment or examination from their own physician for a medical condition that they are claiming is severe and disabling. For example, if one is claiming depression and/or anxiety (that is, mental health concerns) but is only treating with their primary care physician for these conditions, the state agency may arrange for the individual to be seen by a psychologist or a psychiatrist. One would then expect that the Social Security Administration would provide significant weight to the opinion provided. In my experience, this is many times not the case.
Mary is a perfect example. Mary is a woman in her 40’s who had been working many years undertaking administrative type work, struggling through her chronic problems with Multiple Sclerosis, a nerve disorder that caused her to experience severe headaches. fatigue, cognitive problems, depression and anxiety. Given Mary was not treating with a mental health specialist, she was referred by the Social Security Administration for a consultative examination with a psychologist, who confirmed diagnoses of major depressive disorder, severe with psychotic features along with cognitive disorder and panic disorder. He additionally provided Mary with what is called a Global Assessment of Functioning (GAF) of 45. The GAF scale was established by the American Psychiatric Association as part of its DSM IV Manual of Psychiatric Disorders as a manner of labeling a patient’s ability to function: the scale runs from a 0 to 100. A GAF score of 45 corresponds with any serious impairment in social, educational and/or occupational functioning, which is supportive of the notion that Mary has remained totally disabled from working. The psychological examiner described Mary as suffering from a cognitive disorder that might restrict her ability to take in information she could otherwise understand, provided his opinion that she may indeed have difficulty adapting to change in light of her cognitive disorder and depression, and commented that a demand on Mary to learn additional information may cause an increase in her anxiety. He concluded that she was suffering for serious psychological limitation in terms of her ability to do work related activity given her depression and anxiety. These findings were ultimately ignored by the state agency (and this was pointed out to the presiding judge in anticipation of hearing). Likewise, given the problems Mary was having, I provided Mary with the suggestion that she should return to see the neuropsychologist she had seen in the past for additional testing. Indeed, this additional testing, along with a Mental Impairment Questionnaire kindly filled out by the neuropsychologist, served to convince the judge that the Consultative Examination findings were worthy of a great deal of weight given they were corroborative of the findings of her own doctors. Consequently, the presiding ALJ (Administrative Law Judge) saw fit to provide a fully favorable on the record decision (that is, without the need to proceed to hearing).