Last Update: 9/2/05 (Transmittal I-2-63)
At the beginning of every decision, the Administrative Law Judge (ALJ) must identify the claimant (by name and Social Security number); the wage earner (by name and Social Security number) if the claimant and wage earner are not the same person; and the type of claim being decided, e.g., a claim for “Period of Disability and Disability Insurance Benefits.” If the decision is a recommended decision, the ALJ must add “RECOMMENDED” (in capitals) above the word “DECISION.” In the decision, the ALJ must not use the case control system abbreviations; e.g., “SSDC,” “DIWC,” etc., when describing the type of claim.
The decision must state why the case is before the ALJ for a decision; provide the rationale for the ALJ's findings on the relevant issues and the ultimate decision; list the ALJ's findings on the relevant issues; and state the ALJ's ultimate decision in a decisional paragraph which includes the relevant dates.
The first part of the decision should explain why the case is before the ALJ for a hearing, provide other relevant background information, and indicate the ALJ's ultimate conclusion, by including the following:
The procedural history of the case.
Specific information as to whether the claimant was represented at the hearing, and whether an interpreter was used, or whether the claimant waived the right to a hearing and the decision is being issued “on the record.”
A statement of the issue(s) to be resolved, framed as specifically as possible.
A statement of the ultimate conclusion in the case.
The second part of the decision should provide the rationale for the ALJ's findings on the relevant issues and the ultimate conclusion, by including the following as applicable:
An explanation of the findings on each issue leading to the ultimate conclusion.
Appropriate reference to the applicable statutes, regulations and Social Security Rulings. Do not use boilerplate recitations of the law and regulations.
A discussion of the weight assigned to the various pieces of evidence in resolving conflicts in the overall body of evidence; e.g., conflicts between treating and nontreating sources, including a statement of which evidence is more persuasive and why. If SSA's Office of the Inspector General (OIG) has conducted a formal investigation attendant to a particular disability claim, the OIG Report of Investigation, as well as any supporting evidence documented in the report, should be addressed here.
Resolution of all subjective allegations, especially those regarding symptoms, and an assessment of the credibility of the evidence.
Any required specific language; e.g., acknowledgment of the shifting burden of proof (see f. below), the treating physician rule, etc., as well as an explanation of how the ALJ applied the case law contained in such statements.
In disability cases, an assessment of the case using the sequential evaluation process.
If the case is decided at the fifth, and final, step of the sequential evaluation process, include the following statement, or an equivalent statement, explicitly acknowledging that the burden of showing that the claimant can perform other work shifts to the Commissioner:
Once a claimant has established that he or she has no past relevant work or cannot perform his or her past relevant work because of his or her impairments, the burden shifts to the Commissioner to show that there are other jobs existing in significant numbers in the national economy which the claimant can perform, consistent with his or her medically determinable impairments, functional limitations, age, education and work experience.
Acknowledgement of the shifting burden is addressed in Appeals Council Interpretation (ACI) II-5-3-3.
The third part of the decision should provide findings that outline the issues that have been resolved and explained in the rationale. This part should include the following as applicable:
Findings on any pertinent threshold issues; e.g., insured status, age, dependency, relationship, etc.
In disability cases, all findings required by the sequential evaluation process.
Findings on the claimant's subjective complaints of pain and other symptoms.
All findings required by the courts.
In all disability decisions involving DAA, in which the claimant is found disabled, the ALJ must provide a complete supporting rationale in the decision as to whether DAA is a contributing factor material to the finding of disability pursuant to 20 CFR §§ 404.1535 and 416.935. In such cases, the ALJ must also make a specific enumerated finding as to whether the drug addiction or alcoholism is/is not a contributing factor material to the finding of disability pursuant to § 223(d)(2)(c) of the Social Security Act.
The ALJ should refer to the pertinent regulations to ensure that all issues that must be resolved in a certain type of claim have been addressed.
The fourth part of the decision should provide the ALJ's ultimate conclusion in the case. The decisional paragraph should be written in language which is brief and to the point.
If the decision is issued in the Integrated Findings format, the rationale and the findings as set out above are merged into one section.
The ALJ must write the decision so that the claimant can understand it. This is particularly important if the claimant does not have a representative.
The ALJ must not cite medical texts and medical publications as the authority for resolving any issue. If it is necessary to refer to a medical text or medical publication, the ALJ must submit the material to the claimant or the representative for review and comment, and make the material a part of the record.
The ALJ must avoid using non-prescribed standardized language; i.e., boilerplate, in the rationale.
The ALJ must not use emotionally charged words; e.g., “malingerer,” “hypochondriac,” etc.
The ALJ must not use the decision as a forum for criticizing other government components, the courts, the representative or the claimant.
The ALJ must proofread the decision carefully and verify that all dates, Social Security numbers, and citations are accurate.