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I-3-5-30. Consideration of Legal Arguments or Contentions

In addition to addressing any additional evidence received, denial notices must address any legal arguments or contentions submitted in connection with the request for review.

The analyst must deal directly with the issue(s) raised by relying on the facts presented in the record and, when appropriate, by referring to pertinent authority in the law, regulations, or rulings. The denial notice must clearly explain to the claimant and a reviewing court why the Appeals Council found the ALJ hearing decision to be supported by substantial evidence.

1. When a claimant or representative makes a specific argument or contention or raises a question or issue which is pertinent to the matter(s) before the Appeals Council in a request for review, the analyst must draft responsive language to insert in the denial notice. The language must respond to each argument or point raised.

   • When the ALJ hearing decision addressed the specific contentions raised, the analyst must refer to the decision in the response. For example: “In reaching this conclusion, the Appeals Council considered your attorney's contention that .... The Administrative Law Judge discussed ... in his decision (see pages 4 and 5 of the ALJ hearing decision). He considered ... and found ....”

   • If the ALJ hearing decision did not specifically deal with the issue(s) raised, but a change in the decision is nevertheless not warranted, the response must deal directly with the issue(s) raised and, when relevant, cite appropriate regulations. However, the Appeals Council may not supply missing rationale. See I-3-5-40 B.

   • When the argument shows that the claimant or representative misunderstood or misinterpreted a statement or finding in the ALJ hearing decision, provide a clarification or explanation as appropriate in the denial notice.

2. When the claimant or representative simply makes a general statement objecting to the conclusion reached in the case, the analyst will draft a general response. For example, a general response will be provided to answer such statements as “I know I'm disabled” or “I know other people who are getting disability who aren't as bad off as I am.”

3. When the claimant or representative requests that the Appeals Council take a particular action, e.g., remand for a special consultative examination, and the record indicates that no further development or proceedings are warranted, add a specific explanation to the notice giving the reason(s) the Appeals Council believes that the proposed action is unnecessary.

4. If the analyst is unsure whether to respond to one or more of the questions raised, or needs to obtain direction from the Appeals Council before preparing a response, the analyst must consult with the branch chief and, as appropriate, with the Administrative Appeals Judge (AAJ) or Appeals Officer (AO).

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