I-2-5-32.Medical Experts — General

Last Update: 9/28/05 (Transmittal I-2-68)

MEs are physicians, mental health professionals and other medical professionals who provide impartial expert opinion at the hearing level on claims under Title II and Title XVI of the Social Security Act by either testifying at a hearing (in person, by telephone, or by video teleconference) or responding in writing to interrogatories. The need for ME opinion is left to the ALJ's discretion.

The primary reason an ALJ may obtain ME opinion is to gain information which will help him or her evaluate the medical evidence in a case, and determine whether the claimant is disabled or blind. When ME testimony is needed, use of an ME will result in a more complete record to support the ALJ's conclusion on the ultimate issue of disability.

Before requesting an ME to appear at a hearing or respond to interrogatories, the ALJ should review all of the evidence to determine if it adequately documents the course of the claimant's impairment(s) and treatment; identify and obtain any additional evidence that is needed; and develop a list of questions to ask the ME. All necessary development should be completed before requesting the ME to appear at a hearing. (See I-2-5-93 Sample Interrogatories to Medical Expert, for examples of questions which might be appropriate.)

The following rules apply to ME use:

  • The ALJ may use an ME before, during, or after the hearing.

  • The ALJ may not use an ME who has treated the claimant in the past.

  • The ALJ may not use an ME who has examined the claimant on a consultative basis.

  • The ALJ must avoid any off-the-record discussion with the ME. If such a discussion occurs, the ALJ must summarize the discussion on the record at the hearing or enter a written summary of it into the record as an exhibit.

  • The ALJ may not ask an ME to provide an opinion on vocational matters even if the ME is a certified VE.

  • An ME's opinion must be based on the signs and laboratory findings, not just the claimant's symptoms.

  • The weight an ALJ gives to an ME's opinion depends upon the extent to which the opinion is supported by the signs and laboratory findings, and is consistent with the other evidence of record in accordance with the provisions of sections 404.1527(f) and 416.927(f) of the regulations.

  • An ME's opinion is not binding on the ALJ And must be weighed together with all of the other evidence in the record, in accordance with the provisions of sections 404.1527(f) and 416.927(f) of the regulations.