BASIC (03-86)

DI 43510.020 Consultative Examinations

A. Consultative examination - claimant in foreign country

Frequently, in claims for disability benefits, the available medical evidence from treating sources is not sufficient to make the disability decision. If it is determined that a consultative examination (CE) is necessary, initiate the CE request by means of an SSA-423-U6 to the FSP/VARO or SSA-5526-U3 to the Foreign Service Post in Manila, Philippines if the source is in the Philippines.

Requests to the FSP should clearly and concisely show who is to be contacted and what evidence is needed (e.g., orthopedic CE, x-rays of lumbar spine, pulmonary function studies, etc.) Open-ended authorizations should not be used. Guidelines as to what is needed in a consultative medical report and range of motion charts should be included with the SSA-423-U6/SSA-5526-U3 request. Background MER should be included for review by the consulting physician.

When requesting a consultative examination at government expense it is imperative that the examiner word the request in such a way as to prevent unnecessary examinations and expenses. Advise the FSP to inform the authorized consulting physician that expenses for hospitalization are not authorized because we believe that hospitalization is not necessary for the performance of the requested examination and/or laboratory tests including x-rays.

Also advise the FSP that generally SSA will pay for only the examinations and tests requested. However, requests by the consulting physician for additional inexpensive tests necessary for completion of the medical examination may be granted without prior approval by SSA.

The FSP accepts a copy of the SSA-423-U6/SSA-5526-U3 as INTPSC's intention that the SSA will pay the cost of getting additional medical and/ or nonmedical evidence.

B. Consultative examinations - claimant domestic

There will be situations when INTPSC will have jurisdiction in a domestic case because totalization is involved. If a consultative examination is necessary, and the claimant resides in the U.S., an SSA-847-U3 will be sent to the DDS having jurisdiction in the State where the claimant is residing. The SSA-847-U3 will include the type of CE and any laboratory tests, x-rays, etc., that are necessary. Be sure to include the claimant's address, telephone number, date of birth (DOB), alleged impairment, and onset date with your request. Also, send background MER for review by the evaluating physician. The folder will not accompany the SSA-847-U3 request. Be sure to show the disability examiner's name and telephone number on the request.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0443510020
DI 43510.020 - Consultative Examinations - 05/13/2014
Batch run: 05/13/2014
Rev:05/13/2014