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

Last Update: 4/26/16 (Transmittal I-3-139)

The Appeals Council (AC) may remand a case to an administrative law judge (ALJ) when it determines that evidence from a medical expert (ME) is necessary to decide the case. The AC may remand a case solely for the purpose of obtaining ME testimony, or may remand in conjunction with other necessary development.

Generally, the AC will not direct an ALJ to obtain an ME with a particular specialty. However, in the limited circumstances in which recommending a particular specialty is appropriate, the AC will use qualifiers such as “if available” or “if possible” in the remand order as MEs of a particular specialty may not be readily available in certain areas.

Common examples of when the AC may remand for ME testimony include, but are not limited to:

  • Evidence from an ME is needed to help the ALJ resolve conflicts in the medical record or determine the significance of clinical or laboratory findings.

  • The ALJ needs ME testimony to determine a claimant's impairment(s) equals the criteria of a medical listing(s).

  • The AC obtained and proffered a medical support staff (MSS) report to the claimant and appointed representative, if any, and the claimant requested a supplemental hearing after reviewing the MSS report. (For more information about MSS reports, see Hearings, Appeals and Litigation Law (HALLEX) manual I-3-2-11. For more information about when the AC will proffer an MSS report and offer a supplemental hearing, see HALLEX I-3-2-16).

  • The AC needs additional information to establish onset in accordance with Social Security Rulings 18-1p: Titles II and XVI: Determining the Established Onset Date (EOD) in Disability Claims, and 18-2p, Titles II and XVI: Determining the Established Onset Date (EOD) in Blindness Claims.

  • A medical opinion may resolve problems identified by the AC or would complete necessary development of the record to resolve problems identified by the AC.

  • A court ordered the agency to obtain the information.