Last Update: 10/31/13 (Transmittal I-3-57)
Under 20 CFR 404.979 and 416.1479, the Appeals Council (AC) may affirm, modify or reverse an administrative law judge's (ALJ) decision. Additionally, the AC may adopt, modify or reject an ALJ's recommended decision. For additional information on recommended decisions, see Hearings, Appeals, and Litigation Law (HALLEX) manual I-2-8-15 and I-3-1-6.
The primary purpose of an AC decision is to dispose of all issues in a case. If the ALJ did not consider all elements of eligibility or entitlement or if new and material evidence (HALLEX I-3-3-6) is submitted to the AC, the AC's decision may extend beyond the scope of the ALJ's decision. However, when issuing a favorable decision, the AC will generally only exercise its authority to issue a decision when onset is established on or before the date of the ALJ's decision.
C. Evidence Considered by AC
When the AC makes a decision, the AC will consider all the evidence of record and any additional evidence it received, subject to the regulatory limitations in 20 CFR 404.970(b), 404.976(b), 416.1470(b), and 416.1476(b).
If the ALJ issued the decision under Part 405, the AC will consider additional evidence subject to the regulatory limitations in 20 CFR 405.401.
D. Effect of AC Decision
An AC decision is binding on all parties unless it is reversed or modified as the result of a civil action, or unless it is reopened and revised.
E. Continuing Disability Reviews and Social Security Ruling 13-3p
On February 21, 2013, the Social Security Administration issued Social Security Ruling (SSR) 13-3p: Title II: Appeal of an Initial Medical Disability Cessation Determination or Decision. In the SSR, the agency adopted the holding in Difford v. Secretary of Health and Human Services, 910 F.2d 1316 (6th Cir. 1990) and extended the policy previously applied only in title XVI medical cessation claims to title II medical cessation claims. In sum, SSR 13-3p requires that, when issuing a determination or decision, an adjudicator evaluating a medical cessation claim must decide whether the beneficiary is under a disability at any time through the date of the adjudicator's determination or decision.