Monday, December 22, 2008

DDS Doctors and the Social Security Disability SSI System

A lot of people get confused on what a "social security doctor" is. The point of this post is not to define this term, but let me do so anyway before I proceed. There are basically three types of doctors as they relate to the processing of a social security disability or SSI claim.

The first type is your own doctor, otherwise known as a treating physician. This doctor, obviously, can be very important to your claim because he or she will supply medical records to the social security administration and may possibly supply, at the time of a hearing, a medical source statement, a.k.a. an RFC (residual functional capacity) form on your behalf (usually your disability representative or disability attorney will attempt to obtain one of these statements for your case).

The second type is a private practice physician who conducts consultative medical exams for the social security administration. This doctor is often referred to as a "social security doctor", but he or she does not work for SSA. This doctor has simply agreed to take CE, or consultative exam, appointments.

A consultative exam, by the way, is usually scheduled when A) a claimant has alleged an impairment on their disability application that they have not been treated for (depression is an excellent example of this), or when B) a claimant has not received treatment for a condition for a certain length of time (usually 90 days, but I've scheduled exams when a claimant's last doctor visit was 60 days back).

Now, the third type of doctor, as it relates to the social security disability and SSI claim system, is the DDS unit medical consultant. I say "unit" because this doctor is actually attached to a processing unit full of disability examiners, a case consultant/assistant unit manager, and a unit manager. This doctor is the only one of the three who could correctly be categorized as the "social security doctor".

What does this doctor do? Pretty much what a disability examiner does. He or she sits in an office all day long reading medical records and deciding what a claimant's residual functional capacity should be, based on the functional indications presented by the medical records. The unit medical consultant does not actually make the decision on an SSD or SSI case...but he does have final say on what the claimant's RFC rating is. So, in a sense, he does make the decision. If you're confused at this point, let me elaborate:

1. The disability examiner gets all the medical records together, reads them, makes notes, and then, at some point, does a writeup. This is sort of "the pre-RFC".

2. Then the examiner takes the writeup and a completed RFC form in to his unit medical consultant. Depending on how busy the doctor is, he either sits there with the doctor and discusses the case, or he leaves the writeup with the doctor.

3. Next, the unit medical consultant will do his own writeup, this time on an actual RFC form. Most of the time, the doctor will agree completely with the examiner's assessment. Sometimes, the doctor won't. Either way, the outcome of the case depends on the doctor's assessment of the claimant's residual functional capacity. And that's reasonable. After all, the doctor is a doctor, and the examiner is not a doctor.

Now that we've gotten that terminology out of the way, we're finally on the actual point of this post. In this post, I simply wanted to make some comments regarding DDS medical consultants (social security doctors) since this subject was lately on my mind. However, due to the amount of material in this post, that will now be part 2, soon to follow.

Return to the Social Security Disability SSI Benefits Blog

Other Posts

Getting seen by a Social Security Doctor
A Letter from Your Doctor for Social Security Disability or SSI
Doctor appointment for Social Security Disability
Social Security Disability - Does it take the right doctor to win?
Should your Doctor determine if you get Social Security Disability or SSI?
Doctor Records and the Social Security Disability Hearing
Is it mandatory to go to a Social Security disability doctor appointment?

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