II-5-0-1.Introduction to the Appeals Council Interpretations
Last Update: 9/1/05 (Transmittal II-5-08)
When the original Social Security Board issued regulations in March 1940 to implement the 1939 Social Security Amendments and establish the appeals process, the Board stated that the work of the new organization would be directed by “...an adequate set of regulations and instructions prescribing the procedures to be followed and stating the approved interpretations of the statute....” The Board went on to note that substantive regulations would continue to emanate directly from the Board itself (roles assumed today by the Commissioner), but that the manual used by those administering the system could contain “significant decisions and procedural regulations and instructions governing the hearing and review system.”
With regard to the Appeals Council itself, the Board stated that it had “...decided to establish a[n]...Appeals Council...charged with the function of directing the work of a staff of referees, of reviewing their decisions, and of formulating suitable procedural regulations and instruction.” The Board described the Council as “...necessarily the source of policies and guiding principles.”
Over the years since 1940, the Council has provided the type of oversight and guidance of the appellate process envisioned in its original charter through various mechanisms. When the Council identifies the need for program policy clarification or elaboration, the Council may bring the matter to the attention of the Chair with a recommendation that the office responsible for that particular program's policy be alerted to the need for a revision to the regulations or the issuance of a ruling. On matters relating to adjudicatory policy at the hearings and appeals levels, the Council meets en banc to establish policy which is recorded in “Appeals Council Meeting Notes.”
As studies of the Council have indicated, the extent to which the Council has actively used these policy formulation mechanisms has varied widely over the years. At the request of the Social Security Administration, in 1987, the Administrative Conference of the United States (ACUS) conducted an extensive study of the role and function of the Council. In Recommendation 87-7, published in December 1987, ACUS suggested that “The Social Security Administration...should, as soon as feasible, restructure the Appeals Council in a fashion that redirects the institution's goals and operations...toward an emphasis on improved organizational effectiveness.” Specifically, ACUS recommended that SSA “make clear that the primary function of the Appeals Council is to focus on adjudicatory principles and decisional standards concerning disability law and procedures and transmit advice thereon to SSA policymakers and guidance to lower-level decisionmakers.”
This recommendation flowed from the study prepared by the consultants which noted that the “Appeals Council is admirably well-suited and well-situated to serve a major role in promoting policy integrity. The Appeals Council is the only unit in SSA which regularly receives and adjudicates a broad run of ordinary and extraordinary cases.”
The ACIs are designed to accomplish the following goals:
Surface and resolve issues arising from gaps in policy or unclear statements of policy to facilitate the adjudication of individual cases coming before the Council for consideration;
Promote greater consistency and uniformity in policy and its application both at the hearings and appeals levels and throughout the adjudicatory process;
Establish precedents at the hearings and appeals levels of adjudication upon which claimants and their representatives may rely; and
Enhance service to the public by identifying and resolving conflicts and inconsistencies in adjudicatory policy, and by identifying and surfacing to SSA policymakers conflicts or inconsistencies in program policy.
The ACIs establish a formal means for the Council to fulfill its responsibility under the regulations (20 CFR § 404.970(a)(4)) to review a case if “[t]here is a broad policy or procedural issue that may affect the general public interest” and under the Statement of Organization, Functions, and Delegations of Authority, published by the Commissioner of Social Security on August 6, 1988 (53 FR 29788), which provides that the Council “identifies cases which represent broad policy matters or have national impact and acts to resolve the issues in such cases, establishing binding adjudicatory standards and decisional principles that govern OHA's adjudicatory process.”
The Appeals Council established the following procedures:
The Appeals Council will meet en banc with the Chair to consider issues needing resolution.
When the matter concerns SSA program policy, and the Council finds that no extant statement of program policy disposes of the matter, the Council will:
issue an Appeals Council Interpretation establishing the Council's position on the issue such that the individual case (and any others raising the same issue) may be disposed of, and
the Chair will forward the Appeals Council's Interpretation to the appropriate program policy office for its consideration and any action that office deems appropriate.
Any Interpretation adopted under 2.a., above shall be effective as of the date it is adopted and shall be included in HALLEX (and otherwise disseminated as appropriate) to guide all decisionmakers. The Interpretation shall remain in effect until the Council rescinds it or it is rendered obsolete through the publication of revised regulations or rulings, or through amendments to the statute.
The Council will continue its past practice of identifying Administrative Law Judge and Appeals Council decisions which address significant issues so that the Chair may refer them to appropriate policymakers to be considered for publication as Social Security Rulings. The Council may also identify circuit court decisions which it believes may warrant the publication of an Acquiescence Ruling, and the Chair will forward any such decisions to the Office of Program Law in the Office of the General Counsel.
With regard to matters which relate to adjudicatory policy and procedures, the Council will meet en banc and prepare Appeals Council Interpretations (when necessary) to address adjudicatory issues at the hearings and appeals levels. The Council will issue an Interpretation establishing the Council's position on the issue such that the individual case (and any others raising the same issue) may be disposed of. However, if the Council identifies an issue, the resolution of which must include the earlier stages of adjudication, the Council will first send the Interpretation in draft to the appropriate component responsible for case adjudication at that level for its comment. After receiving such comments, if the Council believes an Interpretation is still necessary, it will include the Interpretation in HALLEX, dispose of, as appropriate, any cases affected, and also send the Interpretation (or other document, as appropriate) for the Chair to forward to the SSA component responsible for case adjudication at that level.
IV. Numbering of the Appeals Council Interpretations
ACIs follow a 4-digit numbering system similar to that used in other Volume II HALLEX issuances. The Roman numeral “II,” indicating the HALLEX volume number, precedes the 3 or 4-digit number in order to distinguish ACIs from Temporary Instructions (TI), the latter appearing in Volume I, Division 5.
The Roman numeral identifies the Volume, i.e., the Roman numeral for each ACI is a “II.”
The first digit identifies the Part, i.e., the first digit is a “5.”
The second digit identifies the subpart. There are four subparts.
5-0 Introductory Information
5-1 Administrative Matters
5-2 Retirement and Survivors Insurance and Supplemental Security Insurance (RSI/SSI) Matters
5-3 Disability Matters
The numerical order in which the ACIs are issued determines the remaining digit(s), e.g., the first ACI regarding administrative matters is II-5-1-1.
V. Maintaining and Using the Appeals Council Interpretations
The ACIs are arranged in numerical order. ACIs do not have expiration dates; however, an ACI will be rescinded or rendered obsolete through the publication of revised regulations or rulings, or through amendments to the statute. The fact that part or all of the content of an ACI appears in another section of HALLEX will not render the ACI redundant or obsolete since the ACI represents the adjudicatory principle or guideline that has not been clearly enunciated in the Act, regulations, or rulings. The appropriate HALLEX citation, however, will be cross-referenced in the ACI.
VI. Format of the Appeals Council Interpretations
ACIs are organized as follows:
The Subject will be a short description of the area to be discussed. The Issue will ordinarily be a one sentence question. The Discussion will give the Appeals Council's rationale on the issue. The Interpretation will be a succinct description of the adjudicatory principle or guideline to be followed, analogous to a holding in a court case. The Application will state what cases are affected by the interpretation. The Effective Date will be the date the Appeals Council adopts the policy discussed in the interpretation. The Cross-reference will include statutory, regulatory, rulings, and HALLEX citations relevant to the issue.