I-3-3-4.Administrative Law Judge's Action, Findings, or Conclusions Not Supported by Substantial Evidence
Last Update: 11/10/15 (Transmittal I-3-127)
An administrative law judge (ALJ) uses a preponderance of the evidence standard when making a decision. As defined in 20 CFR 404.901 and 416.1401, a preponderance of the evidence means that after considering the evidence as a whole, the existence of the fact to be proven is more likely than not. This is sometimes referred to as the “weight of the evidence” standard. See Hearings, Appeals and Litigation Law manual I-3-3-6 C NOTE.
However, when the Appeals Council (AC) reviews an ALJ's decision, it uses a substantial evidence standard rather than a preponderance of the evidence standard. As defined in 20 CFR 404.901 and 416.1401, substantial evidence means such relevant evidence as a reasonable mind might accept as adequate to support a conclusion. Substantial evidence requires less in support of a finding or conclusion than a preponderance of the evidence.
Under the standard set forth in 20 CFR 404.970 and 416.1470, if an ALJ's action, findings, or conclusions is supported by substantial evidence and there is no other basis for review present, the AC will deny the request for review or decline to take own motion review.
B. Applying the Substantial Evidence Standard of Review
1. Recommendation to the AC
When determining whether to recommend to the AC that an ALJ's decision is supported by substantial evidence, an Office of Appellate Operations analyst will consider the ALJ's action, findings, and conclusions, as well as any evidence the ALJ cited in the decision. Additionally, the analyst will evaluate the entire record, including the evidence the ALJ did not cite in the decision.
An analyst will recommend that the AC deny review or not take own motion review when the evidence shows that the ALJ's action, findings, and conclusions are supported by substantial evidence, and there is no other basis for granting review or taking own motion review.
When the AC is considering whether to take own motion review, it “will not ordinarily review a hearing decision where the end result would remain unchanged unless there is a compelling need to do so.” See Social Security Ruling 82-13, Program For Ongoing Review of Hearing Decisions Pursuant To Section 304(g) of Public Law (P.L.) 96-265 Appeals Council's Review Authority.
2. AC Review
When evaluating whether an ALJ's action, findings, and conclusions are supported by substantial evidence, the AC will not substitute its judgment for that of the ALJ. If the ALJ's action, findings, and conclusions are supported by substantial evidence, and no other basis for granting review or taking own motion review is present, the AC will deny review or not take own motion review. It is irrelevant whether the ALJ could have made different findings based on the evidence of record or whether the AC agrees with the ALJ's findings. Because the AC uses a substantial evidence rule, an AC denial action or refusal to take own motion review does not equate to AC “agreement” with the prior adjudication.