Do not purchase a CE when the existing evidence is sufficient and consistent enough to adjudicate the claim. For information to evaluate the sufficiency and consistency of evidence, see DI 24501.016C.

For continuing disability review cases (CDR), a CE is necessary only when the evidence as a whole, both medical and non-medical, is not sufficient to support a determination.

Do not purchase a CE in a CDR case when the impairment:

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  Continues to meets a listing (even when obsolete) as written at the comparison point decision (CPD) (DI 28030.020D.6).

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  Meets the requirement for certain Medical Improvement Not Expected (MINE) or MINE-equivalent cases, such as amputation of both hands or amputation of the leg at the hip (DI 28040.005 and DI 28040.125B.1).

Do not purchase a CE for diagnostic tests or procedures already performed by a medical source when there is no evidence to indicate a change to the claimant's condition.

When a test, evaluation, or procedure already performed by a medical source is needed, request the results of the test or procedure from the appropriate source. Only purchase a CE when the evidence is necessary to make a determination and every reasonable effort to obtain the evidence was made, but the attempt was unsuccessful (see DI 22510.005B.1).

Do not purchase a CE for diagnostic tests or procedures (e.g., a myelogram, arteriogram, or cardiac catheterization) that involve significant risk to the claimant. When uncertain about whether a diagnostic test or procedure poses significant risk, obtain the approval of the appropriate Disability Determination Services (DDS) management or medical consultant prior to purchasing the CE.

Do not purchase an SVT or other metrics designed to address inconsistent symptoms or behavior as part of a CE. There is no test that, when passed or failed, conclusively determines the claimants motivation. Malingering requires a deliberate attempt to deceive.

Examples of an SVT include, but are not limited to:

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  Rey 15 Item Memory Test (Rey-II),

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  Miller Forensic Assessment of Symptoms Test (M-FAST),

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  Millon Clinical Multiaxial Inventory,

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  Minnesota Multiphasic Personality Inventory, Second Edition (MMPI-2),

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  Malingering Probability Scale,

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  Structured Interview of Reported Symptoms,

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  Test of Memory Malingering (TOMM), and

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  Validity Indicator Profile.

When results of an SVT are part of the medical evidence of record, consider them along with all of the relevant evidence in the case record (DI 24583.050D.9). Evaluate symptoms using the two-step symptom evaluation process explained in DI 24501.021. Do not make adjudicative findings or conclusory statements about potential malingering as part of the final determination.

Do not purchase a CE for 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 (MDI), 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.

Do not purchase a CE without first resolving any outstanding SGA issue(s) that could preclude entitlement.

Do not purchase a CE when a technical factor will preclude entitlement. These situations include, but are not limited to: