I-3-7-12.Remand for Evidence from a Medical Expert

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

Citations:

The Appeals Council may remand a case to an ALJ when it determines that evidence from a Medical Expert (ME) is necessary to decide the case. Evidence from an ME may help the ALJ resolve conflicts in the medical evidence of record or determine the significance of clinical or laboratory findings. Hearing offices maintain a roster of MEs (physicians and psychologists) who are available to provide impartial expert advice or medical opinion at an ALJ's request.

As appropriate, the ALJ or Appeals Council will solicit the judgment of an ME to determine whether the medical findings (symptoms, signs, and laboratory findings) are of at least equivalent clinical significance to the findings required for a listed impairment. Evidence from an ME may also be necessary to assess the claimant's functional limitations in determining equivalence.

The Appeals Council may remand a case to obtain evidence from a medical expert alone or in conjunction with other necessary development.

The Appeals Council may also remand a case for evidence from a medical expert if, in response to proffer of MSS comments, the claimant or representative requests to cross-examine the MSS physician and demonstrates that written interrogatories will not suffice.

NOTE:

If the Appeals Council determines that testimony from a medical expert with a specific specialty is necessary, the qualifiers “if available” or “if possible” should always be included in the language of the Appeals Council remand order to give the ALJ the flexibility of reasonably complying with the order.