SSR 83-5a: SECTIONS 205, 216(i), 223(d), AND 1614(a)(3) (42 U.S.C. 405, 416(i), 423(d), AND 1382c(a)(3)) DISABILITY -- MEDICAL-VOCATIONAL GUIDELINES -- CONCLUSIVENESS OF RULES
20 CFR 404.1560-404.1569 and 416.960-416.969
- The Appeals Council disagreed with the administrative law judge's (ALJ) decision that the conclusions directed by the rules in Appendix 2, Subpart P of Regulations No. 4 constitute "rebuttable presumptions" of disability. Section 200.00(a) of Appendix 2 provides that where the findings of fact made regarding a claimant's vocational factors and residual functional capacity coincide with the criteria of a particular rule in that appendix, the rule directs a conclusion as to whether the claimant is or is not disabled. Section 200.00(a) also provides that individual findings of fact are subject to rebuttal and the claimant may furnish evidence to refute them. Consequently, in concluding that the rules in Appendix 2 are "conclusive" rather than "presumptive," the Appeals Council held that there is no provision in either the Social Security Act (the Act) or the regulations for an ALJ to rebut the conclusion directed by the regulations.
This case was before the Appeals Council for a review of the ALJ's decision on the claimant's application for disability benefits.
The ALJ found that the claimant had a severe impairment which prevented her from performing her usual work. The ALJ further found that the claimant's residual functional capacity and vocational factors (i.e., age, education, and work experience) met the requirements of Rule 201.10 in Table No. 1 of Appendix 2, Subpart P of Regulations No. 4. Although this rule directed a conclusion of "disabled," the ALJ nonetheless held that such a conclusion was only a "rebuttable presumption" of disability. The ALJ found that expert vocational testimony had established the existence of jobs which the claimant could perform and concluded that the "presumptive" disability directed by Rule 201.10 had been rebutted.
Section 205(a) of the Act provides, in part, that --
- "The Secretary shall have full power and authority to make rules and regulations . . . not inconsistent with the provisions of this title, which are necessary or appropriate to carry out such provisions. . . ."
Section 205(b) of the Act provides, in part, that --
- "The Secretary is directed to make findings of fact, and decisions as to the rights of any individual applying for a payment under this title. . . ."
With respect to the rules in Appendix 2, the preamble to the vocational factors regulations, as published in the Federal Register of November 28, 1978 (43 FR 55351), stated, in part that --
- "These rules are not presumptive, but are conclusive where the necessary findings with regard to each individual establish that a particular rule is met."
Section 200.00(a) of Appendix 2, Subpart P, Regulations No. 4 provides, in part, that --
- "Where the findings of fact made with respect to a particular individual's vocational factors and residual functional capacity coincide with all of the criteria of a particular rule, the rule directs a conclusion as to whether the individual is or is not disabled. However, each of these findings of fact is subject to rebuttal and the individual may present evidence to refute such findings."
The Appeals Council found that there is no provision in either the Act or the regulations for an ALJ, as a trier of fact for SSA, to rebut the conclusion directed by SSA's regulations. Therefore, the Appeals Council determined that the ALJ's rebuttal of the directed conclusion of disability was inconsistent with both the Act and its implementing regulations. Instead of reversing the ALJ's decision, however, the Appeals Council remanded the care for further proceedings because the evidence of record did not clearly establish that the claimant was unable to perform her prior work.