I-4-3-85.Appeals Council Decisions — Writing

Last Update: 9/13/05 (Transmittal I-4-15)

Each decision issued by the AC must consist of four essential parts regardless of the ultimate conclusion or the length of the final product.

A. Introduction

Part I is the introduction. Here, the analyst must set forth:

  • A short procedural history of the case, beginning with the name of the district court which remanded the case and the date of the remand, so as to establish clear jurisdiction to take action.

  • The general and specific issue(s) to be resolved.

  • The ultimate conclusion on the case.

B. Summary and Evaluation

Part II contains the rationale which is a combination summary and evaluation of the evidence considered, rather than merely a chronological recitation of the contents on the medical evidence in the record. In explaining how the AC arrived at the ultimate decision, the analyst must:

  • Discuss and resolve each issue in the case. See section I-4-3-85 E. for more specific guidelines when writing the rationale in a disability case.

  • Weigh the evidence carefully, resolving any conflicts in the evidence, and discuss which evidence is more persuasive, including an explanation of why.

  • Address the claimant's subjective statements, the testimony of any witnesses and the credibility of each in light of the evidence as a whole.

  • Cite and apply the appropriate sections of the law and regulations, Social Security Rulings, Acquiescence Rulings and case law necessary to resolve the issues in the case.

C. Findings

Part III consists of the findings, which are usually reflected as a list of numbered statements of about one sentence each. The list of findings forms a brief summary of the issues which have been resolved and thoroughly explained in the rationale (Part II) of the decision.

D. Decisional Paragraph

Part IV is the decisional paragraph which must contain a summary of the ultimate conclusion, references to the appropriate sections of the Social Security Act and sufficient information for other components of SSA to effectuate the decision.

EXAMPLE:

It is the decision of the Appeals Council that, based on the application filed on _______________, the claimant is entitled to/eligible for (type of benefits) under sections __________________, respectively, of the Social Security Act, as amended.

In Title II disability cases, the decisional paragraph must also reflect the date when the claimant's period of disability commenced.

See I-4-3-85 E., below, for guidance with respect to the decisional rationale.

E. Elements of Rationale

In disability decisions, the following elements must be included in the rationale (Part II) in addition to the criteria set forth in I-4-3-85 B.:

· Evaluate the claimant's combined impairments under the sequential evaluation set forth in 20 CFR §§ 404.1520 ff. and 416.920 ff.

· Include the following statement, or an equivalent statement, when a Title II and/or Title XVI disability case is decided at the fifth, and final step of the sequential evaluation process:

Once a claimant has established that he or she has no past relevant work or cannot perform his or her past relevant work because of his or her impairments, the burden shifts to the Commissioner to show that there are other jobs existing in significant numbers in the national economy which the claimant can perform, consistent with his or her medically determinable impairments, functional limitations, age, education and work experience.

Acknowledgement of the shifting burden is addressed in AC Interpretation II-5-3-3.

· Evaluate the claimant's pain and credibility under the standards set forth in 20 CFR §§ 404.1529 and 416.929, in Social Security Rulings 96-3p, 96-4p and 96-7p, and in prevailing circuit case law.

· Explicitly identify all of the claimant's exertional and non-exertional limitations, if any, arising from the medically determinable impairments established by the record as a whole, including any limitations which may result from an impairment determined to be non-severe (see Social Security Ruling 96-8p).

· Discuss and evaluate all medical opinions of disability with special attention being given to those offered by the claimant's treating physicians, as well as all functional assessments from treating, examining and reviewing sources (see 20 CFR §§ 404.1527 and 416.927 and Social Security Rulings 96-2p, 96-5p, 96-6p).

· Carefully assess any mental impairment of record as required under sections 404.1520a and 416.920a. While a Psychiatric Review Technique Form (PRTF) is not required (see 20 CFR §§ 404.1520a(e)(2) and 416.920a(e)(2)), the text of the decision must include a complete analysis of the severity of any mental impairment of record.