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| A very small diabetic foot ulcer. Not my client's foot. |
There's a message tacked to the wall in the examining rooms at my physician's office telling diabetics to remove their shoes and socks since the physician will examine their feet. Probably, there's a similar message in the examining room where you're seen. That's standard medical practice. I'm a lawyer but I know very well that failing to examine the feet of a diabetic is bad medical practice even when the patient is not complaining of an ulcer on her foot. When a diabetic patient is complaining about her feet and specifically mentions a foot ulcer, failing to examine the feet is enough to make one's jaw drop in any situation other than a Social Security consultative examination. It's sort of what you expect in a Social Security consultative examination, though.
11 comments:
I was at a hearing with a client who had some serious left-sided weakness as a result of a stroke. The ALJ says to me, "How come the CE doesn't mention this?" Before I could respond, he said "the examiner doesn't have any skin in the game, why would he lie?" Here I am thinking that the CE is a joke and the examiner is incentivized to give reports that are unfavorable to the claimants because then that easy CE fee will keep rolling in. Or maybe I am overly cynical? I ended up winning the case but that CE still burns me.
It really depends on the name of the examiner.
I've won a number of cases recently because the CE's were so helpful. In one recent case, the ALJ essentially told me that had no choice but to allow the claim even though he could not believe that the two CE's limited the claimant to sedentary work.
Only about 60% to 70% of them are worthless.
In my experience, only about 15-20% are of even the slightest probative value. Charles has mentioned the usual professional negligence in not examining diabetics' feet. In my community we have a cardiologist who does general CEs--he doesn't have many patients who flock to his practice--he has a reputation among cardiovascular nurses, who don't want him ever touching them or their families. I've had 3 clients who were diagnosed by treating ophthalmologists to be totally blind, but who were all diagnosed by the cardiologist to have 20/200 vision. He doesn't have any skin in the game?
It's a real waste of government money to have x-rays done for cases in which only an MRI will show the cartilage of discs or nerves which are impinged--x-rays won't show them. Of course, that gives ALJ Turn'em Alldown some manufactured "objective" evidence to cite in his denials.
I check the credentials of the CEs in every case. Some of the CEs are residents and don't have a specialty. I have discovered physicians with suspensions, before and after the CE appointment. I have one case of a doctor who apparently was not licensed. Finally, in cases regarding pain there is a POMS section that the claimant should be examined by a Pain Specialist (Orthopedic, Neurologist, Psychologist). In many of my cases, I request and sometimes get a post-hearing CE with a specialist. I believe that Attorneys have a function at the hearing to zealously represent our clients.
Even if the ulcer were examined...what would it show. CE's are paid to evaluate physical capability. In this case, if her gait was observed, that's probably enough.
I've seen plenty of good, bad and ugly CE reports. I'm glad more reps are working to hold them accountable. Monitoring them for quality seems to be one of those jobs that SSA does not have the staffing to do adequately.
This assumes the "current reality," I.e., CE's performed by non-treating physicians. Although I never saw one in my 30+ years at ODAR, don't forget that, per regulation, SSA is supposed to use the treating physician as the primary source in performing a CE! Unless and until someone manages to hold SSA's feet to the fire, it will continue to use CE-mills and the like to obtain half-assed results.
Hey, don't forget that the treating physician can be used for a CE if they will agree. If they won't, that kind of says they feel the claimant isn't disabled and they don't want to endorse such??
Anon 9:47, there are many reasons a treating physician will not act as a CE. The fact that such an exam will not be covered by the patient's insurance is probably a big reason in most cases.
Sure an ulcer would be relevant. The gait is a symptom, the verification of the ulcer is the objective.
Justin
As to having treating physicians do CE's, I recently had an incredibly well developed case that clearly met a grid rule. DDS still scheduled a CE. I got annoyed and called DDS. I asked them why they weren't going to follow the rules and even ask the claimant's treating physician to do the CE, if they thought it was still needed.
Their response? "We would NEVER send a claimant to their own doctor for a CE."
He went to his CE, and we got a fully favorable on the initial level.
Justin
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