DI 22510.006:
When Not to Purchase a Consultative Examination (CE)
Effective Dates: 10/13/2017 - Present- Effective Dates: 06/05/2018 - Present
- TN 13 (04-13)
- DI 22510.006 When Not to Purchase a Consultative Examination (CE)
- IMPORTANT: This section includes most, but not all, situations where CE purchase is inappropriate.
- Do not purchase a CE:
- A. When case evidence is sufficient and consistent enough to adjudicate the claim
- See DI 24515.001B.
- REMINDER: For continuing disability reviews (CDRs), the nature of the impairment determines whether you need recent medical evidence. Do not order a CE in CDR cases where the impairment:
- * Meets a listing and will always meet the listing.
- * Meets the requirement for certain Medical Improvement Not Expected (MINE) or MINE-equivalent cases. (See DI 28040.005.)
- B. When other sources have available evidence
- Do not request a CE for diagnostic tests or procedures already performed by a medical source. If you need a test, evaluation, or procedure that a medical source has already performed, request the results of the test or procedure from the appropriate source.
- C. When the test or procedure involves significant risk
- Do not order diagnostic tests or procedures such as myelograms, arteriograms, or cardiac catheterizations that involve significant risk to the claimant. If you are uncertain about whether a diagnostic test or procedure poses significant risk, obtain the approval of a disability determination services (DDS) medical consultant prior to ordering the CE.
- IMPORTANT: The medical source designated to do the CE is responsible for deciding whether to perform a requested test or procedure that may involve significant risk to a claimant.
- D. For issues of potential malingering
- Do not purchase symptom validity tests (SVT) to address symptom evaluation or issues of potential malingering as part of a CE. Tests cannot prove whether a claimant is malingering because there is no test that, when passed or failed, conclusively determines the claimant’s motivation. Malingering requires a deliberate attempt to deceive.
- Examples of SVT include, but are not limited to:
- * Rey 15 Item Memory Test (Rey-II),
- * Miller Forensic Assessment of Symptoms Test (M-FAST),
- * Millon Clinical Multiaxial Inventory,
- * Minnesota Multiphasic Personality Inventory (MMPI),
- * Malingering Probability Scale,
- * Structured Interview of Reported Symptoms,
- * Test of Memory Malingering, and
- * Validity Indicator Profile.
EXCEPTION: The Office of Disability Programs may approve rare exceptions to this prohibition on a case-by-case basis (for example, testing ordered pursuant to a court order). When necessary, the Office of Hearing Operations will email ^ODP Controls for preapproval and copy both ^ODP OMLI Controls and ||DCO ODD.- EXCEPTION: The Office of Disability Programs may approve rare exceptions to this prohibition on a case-by-case basis (for example, testing ordered pursuant to a court order). When necessary, the Office of Hearing Operations will email ^ODP Controls for preapproval and copy both ^ODP OMP Controls and ||DCO ODD.
- REMINDER: Consider referring a case with evidence suggestive of fraud or similar fault to the Office of Inspector General for investigation. See DI 23025.015.
- NOTE: When the results of SVT are part of the medical evidence of record, we consider them along with all of the relevant evidence in the case record.
- E. For drug or alcohol testing
- Do not purchase drug or alcohol testing to evaluate an issue of drug addiction or alcoholism (DAA). A single drug or alcohol test is not sufficient to establish DAA as a medically determinable impairment, nor does it provide pertinent information that can help us determine whether DAA is material to a finding of disability. For details on evaluating cases involving DAA, see SSR13-2p.
- F. When a substantial gainful activity (SGA) issue precludes entitlement
- Resolve any outstanding SGA issue that could preclude entitlement before ordering a CE.
- G. When a technical factor precludes entitlement
- These situations include, but are not limited to:
- 1. Disability insurance benefits claims (DIB)
- Date last insured (DLI) is in the past and there is no possibility of establishing an established onset date (EOD) prior to the DLI.
- 2. Widow's or widower's benefits based on disability (DWB)
- The prescribed period has ended and there is no possibility of establishing an EOD prior to the date the prescribed period ended.
- 3. Child's benefits based on disability (CDB)
- There is no possibility of establishing an EOD before the date the claimant attained age 22.
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