Social Security disability denial after ALJ hearing - now being sent for consultative exam - what to expect?

This is actually pretty unusual at the Appeals Council level. Typically, the AC just reviews the evidence that was already in the record during the ALJ hearing. A consultative exam (CE) at this stage likely means one of two things: 1) The AC is considering remanding the case back to the ALJ but wants updated medical evidence, or 2) They found some technical issue with the ALJ's decision and need more information before making their decision.As for what to expect, it depends on what type of CE they ordered. It could be a physical exam, mental exam, or both. The exam is usually brief (15-30 minutes) and focused on specific issues related to your brother's claimed disabilities. Make sure he brings a list of all medications and can clearly explain how his conditions limit him on a daily basis.

Thank you so much for this information! His letter mentions a \

When I went for mine last year it took like 20 mins tops. Dr barely looked at me. Asked me to bend over (couldnt) and touch my toes and stuff. Be honest abt the pain dont try to push through it. Doc will write down everything

That's good to know. Did they ask a lot of questions about daily activities? My brother struggles with basic things like putting on socks, but has good and bad days.

The fact that they're sending him for a CE at the Appeals Council level might actually be a positive sign. It suggests they're giving his case serious consideration rather than just rubber-stamping the ALJ's denial. When I was going through the process (took me 3 years to get approved), I had two CEs - one after initial denial and one during reconsideration.For the physical exam, they'll likely test range of motion, strength, reflexes, and observe things like how he sits, stands, walks, and transitions between positions. They'll ask about daily activities, pain levels, medication effectiveness, and side effects. The doctor will complete a form indicating what they believe your brother can do (lift, carry, stand, walk, sit, etc.).My advice:1. Be completely honest about limitations - don't exaggerate, but don't minimize2. If something hurts during the exam, say so immediately3. Explain how symptoms vary day to day if that's the case4. Mention any side effects from medications that impact functioning5. Briefly describe a typical day including any assistance neededThe CE doctor doesn't make the disability decision - they just provide medical findings that become part of the file. Good luck to your brother!

This is incredibly helpful, thank you! He's so worn down from this process. It's been almost 2 years of fighting while barely being able to function. I'll make sure he knows all these points before the exam.

tell him be careful!!!! these doctors work FOR SSA not for him. they are looking for reasons to deny him. my cousin pretended she could do more than she could cause she was embarrassed and they used it against her. tell him DON'T DO ANYTHING that hurts!!!!

While it's true the consultative exam doctors are paid by SSA, they're actually independent physicians who are supposed to provide objective medical findings. They don't

I've helped many clients through this process, and a CE at the Appeals Council level could indicate they're considering a remand (sending the case back to the ALJ for a new hearing). This is generally better than an outright denial.One thing your brother should do: keep a journal for the next week documenting his daily limitations in detail. How long can he sit before needing to change positions? How much can he lift without pain? Does he need to lie down during the day? How do his medications affect him? This will help him accurately describe his limitations during the exam.Regarding getting through to SSA if you have questions about the appointment: many people waste hours on hold or getting disconnected. I've had clients use Claimyr (claimyr.com) to get through to SSA quickly. They have a video showing how it works: https://youtu.be/Z-BRbJw3puU - might save some frustration if you need to call about appointment details or requirements.

I'll tell him to start keeping that journal right away. Great idea! And thanks for the tip about Claimyr - we've been hung up on multiple times trying to get clarification about this exam. I'll check out that video.

Just to add some context: The consultative exam is designed to provide an independent medical assessment. The doctor will complete a form called an RFC (Residual Functional Capacity) that rates your brother's ability to perform various work-related activities. This becomes part of his file but isn't the sole determining factor.The Appeals Council is more concerned with whether the ALJ made a legal or procedural error or if the decision was supported by substantial evidence. The CE suggests they may have found an issue with how the ALJ handled the medical evidence.One recommendation: After the exam, have your brother write down everything that happened while it's fresh in his mind - what tests were done, what questions were asked, what he told the doctor, etc. This can be helpful information for his attorney.

YA BUT those drs spend like 15min with you and think they know everything!!! my dr whose been treating me for YEARS says im disabled but SSA ignored him and listened to their dr who saw me once. the whole system is rigged!!!

i had 2 go to 3 of these exams b4 i got approved. just b honest. if u cant bend dont bend. if it hurts say it hurts. dont let them push u. and dont try 2 be tough/brave. took me 31 months 2 get my ssdi approved. hang in there.

31 months, wow. Did you have a lawyer? My brother's attorney hasn't been very communicative about what this exam means.

ya i had lawyer. they take 25% of backpay up to $7500. most lawyers dont talk much till theres actual news. they handle 100s of cases. def keep the lawyer cuz appeals council is complicated. btw my CE dr was actually nice but exam was really basic

I went through a similar situation with my disability case about 18 months ago. The CE at the Appeals Council level is definitely unusual, but in my experience it turned out to be a good thing - they ended up remanding my case back to a different ALJ and I was approved at the new hearing. A few practical tips for your brother's exam: Wear shoes that are easy to take off since they'll likely want to check reflexes and look at his feet/legs. Bring a complete list of medications with dosages - they always ask about this. If he uses any assistive devices (cane, back brace, etc.) make sure he brings and uses them during the exam. The key thing is consistency - whatever limitations he describes to the CE doctor should match what's in his medical records and what he told the ALJ. The doctor will be looking for objective signs that support his reported symptoms. For back issues like your brother has, they'll test things like straight leg raises, range of motion, and watch how he moves around the room. One thing that helped me was arriving a few minutes early so the doctor could observe me sitting in the waiting room - it showed I couldn't sit comfortably for long periods without shifting positions. Hope this helps and good luck to your brother!

I'm new to this community but wanted to share what I learned from my own SSDI journey. The consultative exam at the Appeals Council stage is definitely uncommon, but it could actually work in your brother's favor. When I had my CE (though mine was earlier in the process), the doctor was much more thorough than I expected and actually documented limitations that helped my case. One thing I wish someone had told me: make sure your brother doesn't stop or skip any regular treatments/therapy appointments between now and the CE. Consistent medical care shows he's actively managing his conditions and isn't just claiming disability without trying to treat his issues. Also, if he has any medical devices or aids he uses regularly (heating pads, TENS unit, ergonomic supports, etc.), he should mention these during the exam as they demonstrate ongoing efforts to manage his pain and limitations. The waiting is absolutely brutal - I remember feeling like my life was on hold for years. But the fact that they're ordering additional medical evidence suggests they're taking his case seriously rather than just rubber-stamping the ALJ's decision. Hang in there!

As someone who just went through the Appeals Council process last year, I wanted to add that the timing of when you receive the CE results can also be telling. In my case, I got scheduled for the exam pretty quickly after the AC received my case, and then got a remand decision about 4 months later. One thing that really helped during my CE was being specific about functional limitations rather than just talking about pain levels. Instead of saying "my back hurts a lot," I explained things like "I can only stand for about 10 minutes before I need to sit down" or "I have to use both hands to lift a gallon of milk." The doctors seem to respond better to concrete examples of what you can't do rather than subjective pain descriptions. Also, don't be surprised if the CE doctor seems rushed or doesn't appear very sympathetic - that's pretty normal. They're just there to document objective findings, not provide treatment or emotional support. The important thing is that your brother accurately demonstrates his limitations during those brief tests. Really hoping this works out for your brother. The fact that his own specialists filled out RFC forms should carry significant weight, especially if the CE findings are consistent with what they documented.

As someone who works in disability advocacy, I want to emphasize that a CE at the Appeals Council level often indicates they're doing a thorough review of the case rather than just going through the motions. This could actually be encouraging news for your brother. One important detail many people overlook: make sure your brother arrives at the exam exactly as he normally functions on a typical day. If he usually needs extra time to get dressed or walk slowly due to pain, don't rush these things for the appointment. The doctor will note how he presents from the moment he enters the office. Also, if your brother experiences symptoms that fluctuate (like many people with chronic pain do), he should explain this pattern clearly. For example, "My pain is usually worst in the mornings and after I've been sitting or standing for more than 15 minutes." This helps the doctor understand that a brief exam might not capture the full scope of his limitations. The Appeals Council ordering additional medical evidence suggests they found something in the ALJ's decision that needs clarification. While the process is exhausting, this development could be the key to getting his case properly evaluated. Stay strong - you're advocating well for your brother during an incredibly difficult time.

I'm new to this community but wanted to share my recent experience with a CE at the Appeals Council level. I received one last fall after my ALJ denial, and while it was nerve-wracking, it actually led to a favorable outcome - the AC remanded my case and I was approved at the subsequent hearing. A few things that helped me prepare: I made sure to document all my symptoms and limitations for the week leading up to the exam, just like others have mentioned. I also brought a friend who could observe how I moved getting in and out of the car, walking to the office, etc. - sometimes we don't realize how much we compensate for our limitations until someone else points it out. During the exam itself, the doctor was actually quite professional and thorough. They spent about 25 minutes with me, which was longer than I expected. The key was being completely honest about what I could and couldn't do without trying to "power through" any painful movements. One thing I learned afterward is that the CE doctor's report becomes part of your permanent file, so even if the Appeals Council doesn't rule in your favor initially, that documentation could be helpful if you need to file a new application later. Wishing your brother the best of luck - the fact that they're taking this extra step suggests they're giving his case serious consideration.

I'm fairly new to this community but wanted to share what I learned during my own SSDI process. The CE at the Appeals Council stage is definitely unusual, but from what I've read and experienced, it often means they're seriously reviewing the case rather than just issuing a quick denial. One thing that really helped me was preparing a simple one-page summary before my CE that listed my conditions, medications, and specific daily limitations. I didn't bring it to show the doctor, but having organized my thoughts beforehand helped me give clearer, more consistent answers during the brief exam. Also, if your brother uses any adaptive techniques to get through daily tasks (like sitting on a stool while cooking, using a reacher to pick things up, taking frequent breaks), he should definitely mention these during the exam. These work-arounds actually demonstrate the extent of his limitations rather than showing he's "fine." The waiting and uncertainty is absolutely exhausting, but the fact that multiple specialists have provided detailed RFC forms supporting his claim should carry significant weight. Hoping this CE leads to the breakthrough your brother needs after fighting for so long. This community has been such a valuable resource for navigating this complicated process!

I'm new to this community but wanted to reach out with some encouragement. I went through a very similar situation with my SSDI case about 6 months ago - ALJ denial followed by an unusual CE order from the Appeals Council. I was terrified it meant they were just looking for more reasons to deny me, but it actually turned out to be the turning point in my case. The CE itself was pretty straightforward - about 20 minutes with basic physical tests and questions about daily functioning. What really mattered was being completely honest about my limitations without trying to minimize them out of embarrassment or pride. The doctor documented everything objectively, and that report ended up supporting my case when the AC remanded it back to a different ALJ. One thing I wish I'd known beforehand: take someone with you who can help observe your functioning that day. Sometimes we don't realize how much pain or difficulty we're showing because we've gotten so used to compensating. Having my spouse point out afterward how I was moving helped me understand what the doctor likely observed. The whole process took about 8 months from CE to final approval, but getting that remand was actually a relief - it meant they were taking my case seriously instead of just rubber-stamping the original denial. Your brother's case sounds very strong with all those specialist reports and RFC forms. Hang in there - this could be the breakthrough you've been waiting for after such a long fight.