I-3-7-1.General

Last Update: 9/08/05 (Transmittal I-3-36)

Citations:

When the Appeals Council grants a request for review or reviews a case on its own motion, it may issue a decision, dismiss the request for hearing or remand the case to an Administrative Law Judge (ALJ) for further proceedings. Refer to I-3-3 for a discussion of when the Appeals Council will review a case.

Except for the two circumstances discussed below, the Appeals Council will vacate the ALJ's decision in its entirety when it remands a case. However, this in no way limits the authority or discretion of the Council to state in its remand order that it concurs with specific findings and conclusions, or agrees generally with portions of the decisional analysis. A remand order requires an ALJ to issue a new decision. In addition, the remand order may direct an ALJ to take further action(s), such as developing additional evidence or holding a supplemental hearing.

EXCEPTION:

The Appeals Council will not vacate the entire ALJ decision in the following situations:

  1. If the ALJ's decision is partially favorable and the Council agrees with the favorable conclusion on entitlement but not the entire decision, the Council will issue a combined Affirmation/Remand Order. If the favorable portion of the decision has not been effectuated, OAO branch staff will send photocopies of the decision and exhibits, other than medical evidence and vocational reports, to the effectuating component for payment of benefits.

  2. In concurrent claims under Titles II and XVI, when the Council finds the decision pertaining to one title to be supported by substantial evidence but not the decision under the other title:

    • In request for review cases, the Council will issue a separate notice denying the request for review under the appropriate title and an order remanding the claim under the other title to an ALJ. Because the claim files will be separated, branch staff will ensure that both files contain copies of the entire record including the hearing recording(s).

    • In own motion cases, the Council will issue a combined Affirmation/Remand Order.

The Appeals Council will remand a case to an ALJ if it finds significant evidentiary or procedural deficiencies. For example, the Appeals Council may remand a case because:

  • the ALJ applied the wrong law;

  • additional claimant or witness testimony is needed;

  • the claimant did not receive a fair hearing;

  • the ALJ issued the decision on the record but testimony is necessary;

  • evidence from an expert witness is needed;

  • additional development is needed—e.g., consultative examinations, hospital reports or evidence on work activity; or

  • the ALJ's decisional rationale is insufficient.

However, if the Appeals Council can obtain the additional evidence expeditiously and without adversely affecting the claimant's rights, it may do so and issue a decision.