Last Update: 9/08/05 (Transmittal I-3-36)
Appeals Council decisions have four basic parts.
The first part sets out why the case is before the Appeals Council; that is, the procedural history of the case. This provides jurisdiction, the issue(s) to be resolved, and the ultimate conclusion on the case. The decision must state the issues as specifically as possible. After setting forth the issue(s), the Appeals Council will state its ultimate conclusion because this is the reader's primary interest. Stating the ultimate conclusion in the opening section focuses the reader's attention on the rationale section which follows.
The second part contains the rationale for the decision. In the rationale, the Appeals Council must:
Discuss and resolve each issue in the case. See I-3-8-12 for more specific guidelines when writing the rationale in a disability case.
Discuss the weight it assigned to evidence in resolving conflicts in the record, stating which evidence is more persuasive and why.
Address subjective complaints and assess credibility when they are factors in the decision.
Cite the applicable sections of the statute and regulations, Social Security Rulings, and, as necessary, circuit court law.
In all disability decisions where the claimant is found disabled, but drug addiction and/or alcoholism (DAA) is involved, provide complete supporting rationale as to whether DAA is a contributing factor material to the finding of disability pursuant to 20 CFR 404.1535 and 416.935.
The third part 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 (second part) of the decision. In all disability decisions involving DAA in which the claimant is found disabled appropriate rationale must be provided in the Appeals Council's decision as to whether DAA is a contributing factor material to the finding of disability pursuant to 20 CFR 404.1535 and 416.935. In such cases, the Appeals Council must also make a specific enumerated finding as to whether drug addiction or alcoholism is/is not a contributing factor material to the finding of disability pursuant to Public Law (Pub. L.) 104-121.
The fourth part is the decisional paragraph. The decisional paragraph must contain a summary of the ultimate conclusion, reference to the appropriate sections of the Social Security Act and sufficient information for other components of the Social Security Administration (SSA) to effectuate the decision. In Title II disability cases the decisional paragraph must also reflect the date when the claimant's period of disability commenced. In cases involving DAA that are decided under Pub. L. 103-296, omit decisional paragraph language regarding the 36-month payment limitation and treatment provisions; retain language regarding representative payee requirements, and add language advising the claimant that entitlement to and/or eligibility for, disability benefits terminate effective January 1, 1997. In cases involving DAA that are decided under Pub. L. 104-121, use standard decisional paragraph language .