I-2-5-32.Medical Experts — General
Last Update: 8/29/14 (Transmittal I-2-118)
A. General Description of Medical Expert (ME)
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.
MEs provide opinions by either testifying at a hearing or responding to written interrogatories. An administrative law judge (ALJ) may use an ME before, during, or after a hearing. The need for ME opinion evidence is generally left to the ALJ's discretion, except in the circumstances outlined in Hearings, Appeals and Litigation Law (HALLEX) manual I-2-5-34 B.
B. ME Opinions
The primary reason an ALJ will request an ME opinion is to help the ALJ evaluate the medical evidence in a case. When needed, use of an ME will result in a more complete record to support the ALJ's conclusion on the ultimate issue of disability. See HALLEX I-2-5-34 for examples of when an ALJ may need to obtain an ME opinion. See also HALLEX I-2-5-38 and hearing office electronic business process sections 3.3, 3.4, and 4.2 for procedures on obtaining ME testimony.
Before requesting an ME opinion, an ALJ will:
Review the evidence to determine if it adequately documents the course of the claimant's alleged impairment(s) and treatment;
Identify and obtain any additional evidence that is needed; and
Develop a list of questions to ask the ME. (See HALLEX I-2-5-93 for examples of questions that might be appropriate.)
An ME's opinion is not binding on an ALJ. For a claim(s) filed before March 27, 2017, the ALJ will consider the ME's opinion pursuant to 20 CFR 404.1527 and 416.927, and for a claim(s) filed on or after March 27, 2017, the ALJ will consider and articulate consideration of the ME's opinion pursuant to 20 CFR 404.1520c and 416.920c.
C. Special Considerations
An ALJ must be mindful of the following issues when using an ME. An ALJ may not:
Use an ME who has treated the claimant in the past or who has examined the claimant on a consultative basis.
Engage in off-the-record discussions with the ME about a claimant's case. 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.
Ask an ME to provide an opinion on vocational matters, even if the ME is a certified vocational expert.