Generally, an Administrative Law Judge (ALJ) must competently
read and understand medical terminology and medical records, and should
thoughtfully evaluate the specific circumstances of a case to determine
whether ME input is necessary. In some circumstances, an ALJ is required
to seek an ME's opinion, e.g., when a court orders the ALJ to do
so. In other cases ordering an ME opinion is discretionary.
The ALJ may obtain an ME opinion either through testimony at
a hearing or via written interrogatories. Before ordering an ME, the
ALJ must provide a written rationale explaining the need for the ME
to the Hearing Office Chief ALJ (HOCALJ), as outlined in Hearings,
Appeals and Litigation Law (HALLEX) manual HA 01250.034B.
1. When an ALJ Must Obtain an ME Opinion (Required)
The ALJ must obtain an ME opinion, after providing rationale to
their HOCALJ, when:
•
The Appeals Council or Federal court ordered the ALJ to
do so;
•
Compliance with an Acquiescence Ruling requires the use
of an ME; or
•
An ALJ believes a preponderance of evidence in the
record may support a finding that an individual is disabled based
upon medical equivalence at Step 3 of the sequential evaluation
process (SEP)(Social Security Ruling (SSR) 17-2p).
2. When an ALJ May Seek to Obtain an ME Opinion
(Discretionary)
An ALJ may seek an ME opinion, after providing rationale to their
HOCALJ, when the ALJ:
•
Needs further explanation of an uncommon medical
impairment(s) to determine equivalent listings or potential functional
limitations;
•
Needs evaluation regarding the accuracy of medical
test results reported or the background medical test data supporting
these results. For more information, see HALLEX HA 01250.014E;
•
Is assessing a claimant's failure to follow
prescribed treatment and the evidence in the claim is insufficient
to make the required assessments in the failure to follow
prescribed treatment determination (SSR 18-3p);
•
Believes a claimant's drug addiction or alcoholism may
be material to finding a claimant disabled (SSR 13-2p);
•
Needs to infer the date the claimant with a
non-traumatic or exacerbating and remitting impairment first met
the statutory definition of disability (SSR 18-1p).
An ALJ must never ask or permit
an ME to perform an examination of a claimant. If an ALJ finds
an examination is necessary because there is not enough evidence
about an impairment(s) for the ALJ to make a finding, the ALJ will
request a consultative examination. See HALLEX HA 01250.020.