I-3-7-11.Remand for Medical Evidence

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

A. Existing Evidence

The analyst should recommend a remand to obtain existing evidence such as hospital reports, treating source records, etc., when the file indicates that the ALJ did not obtain needed existing evidence. See Appeals Text Guide.

EXAMPLES:

  1. The ALJ did not obtain existing evidence to resolve a material conflict in the medical evidence.

  2. The most recent evidence in file is not current (e.g., more than 12 months old at the time the decision was issued), there is an indication that additional evidence exists and the claimant has a progressive impairment that is likely to affect ability to function, or there is an indication of a worsening of the impairment during the period at issue that is likely to affect ability to function.

B. Consultative Examinations (CEs) and Medical Tests

The analyst should recommend a remand to obtain a CE(s) and/or medical test(s) when additional evidence is necessary to establish the nature, severity, and/or duration of the claimant's impairment(s), and such evidence does not appear to be available from the claimant's medical sources. See Appeals Text Guide.

EXAMPLES:

  1. The onset of disability occurred less than 12 months ago and the impairment could prevent the claimant from engaging in SGA for at least 12 months, but there is no prognosis by an examining physician.

  2. The evidence indicates a significant psychiatric impairment, but the claimant's medical sources could not provide information concerning the effect of the impairment on the claimant's ability to function in a work setting.

C. Medical Development

When a case is referred to the Medical Support Staff (MSS), the MSS may identify specific additional tests or studies to request. The MSS will provide this information to the analyst and it will be incorporated into the remand order.

NOTE:

MSS narrative comments are advisory in nature and generally are not formally entered into the record or sent to the ALJ when the Appeals Council issues a remand (See I-3-8-6).

D. Limits on Specific CE Requests

In most circumstances, the Appeals Council's remand order does not direct that a particular type of specialist perform a consultative examination, or that a particular medical diagnostic test be performed because the desired specialist or test may not be available in the hearing office's service area. Remand orders requiring consultative examinations or tests should describe the purpose of the examination/test, not the specific sub-specialties or diagnostic tests. If there is some compelling reason for such instructions, qualify the order by specifically stating “if available” or “if possible.”

If directing an ALJ to obtain a CE or test, request only that development essential to a proper decision on the claim (e.g., do not order a complete CE if the only development needed is X-rays).

NOTE:

Do not direct the ALJ to obtain diagnostic tests or procedures that involve significant risk to the claimant, such as myelograms, arteriograms, or cardiac catheterizations.

Similarly, avoid instructing the ALJ to obtain a consultative psychiatric examination, which would limit the ALJ's flexibility to obtain a mental status examination by a psychologist in areas where there is a scarcity of psychiatrists (See Appeals Text Guide).