Diabetic Woman at a Medical Appointment

If you have a physical impairment or medical condition that prevents you from working, you may be entitled to Social Security disability benefits. However, to qualify for benefits, you will be required to undergo an SSDI medical exam to show proof of your limitations.

How Does the SSDI Medical Exam Determine Physical Capability?

When you apply for Social Security disability insurance (SSDI), the Social Security Administration (SSA) must review your initial application for benefits based on nonmedical information such as your age, marital status, work history, work credits earned, and Social Security taxes paid. After the SSA reviews your initial application, it is forwarded to a local field office, Disability Determination Service (DDS), for a further evaluation of your disability based on your impairment or medical condition that prevents you from working or maintaining gainful employment.

While the SSA is responsible for reviewing nonmedical requirements for Social Security disability, the DDS is responsible for developing an applicant’s medical evidence and making the initial determination on whether the applicant is disabled or blind according to the law. DDS offices are State agencies funded by the Federal Government. Once the DDS receives your application, they will first try to obtain your medical evidence by reviewing your medical records. If that evidence is insufficient or unavailable to the DDS so they can’t make a determination, they will arrange for a consultative examination (CE) from your treating physician or from an independent medical professional.

The CE medical exam determines an applicant’s physical capabilities by assessing his or her ability to do the following:

  1. Carrying – How much weight can the person carry or lift while working? Can the person carry or lift items frequently (two-thirds of the time) or occasionally (less than one-third of the time)?
  2. Standing and Walking – Can the person remain on his or her feet while working? How many hours during a normal eight-hour workday can the person stand and walk (with breaks)? Does the person require assistive devices to stand or walk?
  3. Sitting – Can the person remain seated while working? How many hours during an eight-hour workday can the person sit at a time (with breaks)? Does the person need to alternate between sitting and standing to alleviate discomfort or pain?
  4. Pushing and Pulling – Does the person have any limitations on his or her ability to push or pull items with his or her hands or feet? Can the person operate controls on equipment, machinery, and vehicles? Does the person have limitations affecting his or her upper or lower extremities?
  5. Posture – Does the person have any limitations on his or her ability to balance, bend over, crawl or crouch, kneel, or climb ladders, ramps, stairs, or scaffolds? Do these limitations impact the person frequently (two-thirds of the time) or occasionally (less than one-third of the time)?
  1. Reach – Does the person have any limitations on his or her ability to reach in different directions, including over his or her head?
  2. Communication – Are there any limitations impacting the person’s ability to hear or speak?
  3. Vision – Does the person have any visual impairments impacting his or her ability to see items close up or at a distance? Does the person have limitations that impact his or her depth perception, field of vision, or ability to distinguish between different colors?
  4. Environment – Does the person need to avoid exposure to extreme cold or heat, humidity or moisture, heights, loud noises, or vibrations? Does the person need to avoid concentrated exposure, moderate exposure, or all exposure to these factors?

Based on the results of the above assessments for injuries or medical conditions, an applicant may be found capable of performing certain types of work or may be limited to light or sedentary work. These assessments are also used to determine if an applicant is capable of performing previous work duties or other jobs that fit his or her physical limitations.

What to Expect at the Medical Exam

A consultative exam (CE exam) includes a complete physical examination by a licensed physician. The CE exam focuses on the applicant’s minor and major complaints in detail, the nature and severity of the impairment, the length of the impairment, and the diagnosis and prognosis of the impairment. During the exam, the patient may be requested to undergo the following:

  • A complete physical examination
  • Lab tests including blood and urine samples
  • Image tests including X-rays, MRIs, and ultrasounds
  • Hearing, speech, and vision tests
  • Motor skills tests
  • Physical and mental capability tests

Conclusions in the CE report must be consistent with the clinical findings of the examination, the patient’s symptoms, laboratory and image tests, and the patient’s medical history. All CE reports must be personally reviewed and signed by the medical professional who performed the actual CE examination.

Common Conditions That Qualify for SSDI

The SSA Blue Book contains a list of impairments that qualify for SSDI. Part A impairments that apply to adults who are 18 years old or older include disorders of the following body functions: cardiovascular system, digestive system, endocrine system, immune system, musculoskeletal system, neurological system, and respiratory system.

According to the SSA guidelines, the definition of disability only allows disability payments to people who have a total disability. SSA guidelines restrict disability benefits for people who have a partial disability or a short-term disability. In addition, an applicant filing for SSDI must have a medical condition that matches a condition shown in the SSA Blue Book list of impairments, and the medical condition must be severe enough to prevent the applicant from maintaining gainful employment.

If you need to file for Social Security disability in Illinois, it’s best to talk to a Chicago disability lawyer who understands and practices disability law. Your lawyer can help you file your application with the SSA, gather required medical evidence for an SSDI medical exam, submit timely information to the DDS, and oversee your application from start to finish, ensuring a higher probability of approved benefits.