What are Reasons the Appeals Council Remands a Denial of Social Security Disability Benefits?

 

If your claim for Social Security disability insurance (SSDI) or Supplemental Security Income (SSI) benefits is denied after a disability hearing before an administrative law judge, you have the right to file a Request for Review with the Appeals Council. The Appeals Council then decides whether to affirm the denial of benefits, reverse the denial of benefits, or remand your case for an additional evidentiary hearing before an administrative law judge.

 

This article explains some of the most common reasons that the Appeals Council remands cases for an additional hearing. Use this list when reviewing your unfavorable decision and see if any of the most common reasons may apply.

 

And remember, if you’re looking for legal representation or have a questions about your rights throughout the SSDI process, Richmond disability attorney and Norfolk Social Security lawyer Corey Pollard is just a call, text, or email away. Your consultation is free and there is no attorney fee unless you get a favorable decision from the Social Security Administration (SSA).

 

Did the Administrative Law Judge Evaluate the Medical Opinion Evidence Properly?

 

If the administrative law judge made any of these mistakes in his or her decision you may win on your appeal:

 

  • The administrative law judge failed to address all the opinions from your treating medical providers. This is important, especially if one of your doctors completed multiple assessment forms on different dates.

 

  • The administrative law judge said that he or she relied on the opinions from your treating medical providers but cherry-picked portions of the opinions while ignoring other portions that are supportive. This is common. A judge will find the doctor credible, but only those portions that help the judge deny the case.

 

  • The administrative law judge does not evaluate the opinions from your treating medical providers or explain the weight given to them. The judge must address every opinion and explain why it is given the weight it is.

 

  • The administrative law judge relies on a medical expert opinion to deny your case but the medical expert did not review all the evidence in your file. This is why it’s important that your attorney cross-examine the medical expert at hearing to determine what evidence was reviewed.

 

  • The administrative law judge finds you have no severe medical impairment even though your treating physician and the State agency reviewing physicians found that you do. The threshold for proving that a medical impairment is severe is low. So if the judge ignores impairments for which you’ve received extensive treatment, this is likely reversible error.

 

Did the Administrative Law Judge Evaluate Your Case Under the Listing of Impairments Correctly?

 

If applicable your attorney will argue that you meet one of the Social Security Administration’s (SSA) listings. If the administrative law judge makes the mistake below the denial decision may be reversed or remanded.

 

  • The administrative law judge states that you do not meet or equal a listing but does not provide an explanation of how he or she reached that decision. If your attorney argued that you meet a listing at your hearing then the judge must address it.

 

Did the Administrative Law Judge Evaluate Your Testimony Regarding Symptoms Properly?

 

The SSA has a specific standard for evaluating subjective complaints from claimants. You may have a valid appeal if the administrative law judge made the mistake below.

 

  • The administrative law judge fails to provide a sufficient explanation of why he or she rejected your testimony regarding your symptoms and limitations or found the symptoms not entirely credible. Usually the judge will use medical records that state you are doing “fine” or “ok” to find that your testimony is not credible. That’s why it’s important that you tell the doctor about all your complaints and symptoms.

 

Did the Administrative Law Judge Explain His or Her Residual Functional Capacity (RFC) Assessment Correctly?

 

In every case the administrative law judge will provide a residual functional capacity assessment. This is what he or she thinks you’re capable of doing on a sustained basis in the workforce. You may have a valid appeal if the judge made one of the following mistakes.

 

  • The administrative law judge gives a residual functional capacity (RFC) that finds you have a severe mental disorder but does not provide any mental limitations.

 

  • The administrative law judge gives a RFC that is overly broad and does not explain what your limitations are.

 

  • The administrative law judge fails to obtain vocational expert opinion evidence regarding nonexertional limitations when you suffer from a severe mental impairment.

 

  • The administrative law judge fails to obtain vocational expert opinion evidence on transferable skills.

 

These are just some of the reasons that the Appeals Council may reverse or remand an administrative law judge denial decision. Talk with an attorney before deciding to request review. Sometimes filing a new application is the best decision based on statistics that show the overwhelming majority of requests for review filed with the Appeals Council are denied.

 

Have a question about your case? Call, text, or email Corey Pollard today.