Navigating the Social Security Disability (SSD) process can be challenging, especially when a case is remanded by the Appeals Council. Understanding the common reasons for remand can help applicants prepare more robust claims and avoid common pitfalls. Below are the top reasons for remands cited by the Appeals Council, along with strategies to address these issues.
- Examining Source Opinion Rejected Without Adequate Articulation
Explanation:
This occurs when the Administrative Law Judge (ALJ) does not provide sufficient reasoning for rejecting the opinion of an examining provider.
Solution:
Ensure that your provider’s opinion is well-documented and supported by medical evidence. If the ALJ rejects this opinion, they must provide clear and specific reasons. Be prepared to challenge any inadequate explanations through detailed counter-arguments.
- Inadequate Rationale for Symptom Evaluation Finding
Explanation:
The ALJ must provide a thorough rationale for their evaluation of the claimant’s symptoms, including pain.
Solution:
Maintain detailed records of symptoms and their impact on daily activities. Provide consistent and clear testimony. If the ALJ’s rationale is lacking, emphasize inconsistencies or omissions in their evaluation.
- Consultative Examiner – Inadequate Support/Rationale for Weight Given Opinion
Explanation:
The ALJ relies on consultative exams without sufficient rationale for the weight given to these opinions.
Solution:
Challenge any discrepancies between these reports and your provider’s findings. Highlight any lack of support or rationale in the ALJ’s decision.
- RFC – Mental Limitations Inadequately Evaluated
Explanation:
Residual Functional Capacity (RFC) assessments must consider mental limitations adequately.
Solution:
Provide thorough documentation of mental health issues, including treatment records and assessments from mental health professionals. Make sure mental limitations are clearly described and their impact on work capacity is well-articulated.
- Incomplete/Inaccurate Record – Record Inadequately Developed
Explanation:
The record lacks necessary information to make an informed decision.
Solution:
Submit all relevant medical records, including those from all providers and specialists. Ensure the record is complete and request the ALJ to obtain additional evidence if necessary.
- Non-Examining Source – Inadequate Support/Rationale for Weight Given Opinion
Explanation:
The ALJ gives undue weight to non-examining sources without adequate support.
Solution:
Focus on highlighting the strengths of the examining sources’ opinions. Challenge the sufficiency of non-examining sources’ rationales by emphasizing the lack of direct examination.
- New Evidence Presented Upon Administrative Appeal/Review
Explanation:
New evidence can lead to a remand if it significantly impacts the decision.
Solution:
Present any new, material evidence as early as possible in the process. Ensure that all relevant information is included in the initial application and during the hearing.
- VE and DOT Not Reconciled
Explanation:
Vocational Expert (VE) testimony must be consistent with the Dictionary of Occupational Titles (DOT).
Solution:
Highlight any inconsistencies to the Appeals Council.
- RFC – Exertional Limitations Inadequately Evaluated
Explanation:
Exertional limitations must be adequately assessed in the RFC.
Solution:
Provide detailed medical evidence on physical limitations and how they impact work capabilities. Ensure that exertional limitations are fully documented and considered.
- Mental Disorder Not Adequately Considered
Explanation:
The ALJ must thoroughly evaluate mental disorders.
Solution:
Submit comprehensive mental health evaluations and treatment records. Clearly articulate how mental disorders impact your ability to work.
- Non-Examining Source Opinion Accepted Without Adequate Articulation
Explanation:
The ALJ must provide sufficient reasoning for accepting non-examining sources’ opinions.
Solution:
Highlight the insufficiency of non-examining opinions compared to examining sources. Provide a detailed critique of the non-examining source’s findings.
- RFC – Other
Explanation:
Other issues with RFC evaluations can lead to remands.
Solution:
Ensure that all aspects of your limitations are covered in the RFC assessment. Provide comprehensive evidence and argue any inadequacies in the ALJ’s evaluation.
- Inadequate Rationale for Credibility Finding
Explanation:
The ALJ must provide a clear rationale for their findings on the claimant’s credibility.
Solution:
Maintain consistency in your statements and documentation. Challenge any findings of non-credibility by highlighting supportive evidence.
- Examining Source Opinion Not Identified or Discussed
Explanation:
The ALJ must identify and discuss all examining sources’ opinions.
Solution:
Ensure that all examining sources’ opinions are prominently included in the record. If the ALJ fails to address them, argue this oversight clearly.
- Other
Explanation:
Various other reasons can contribute to remands.
Solution:
Stay vigilant and address all potential issues thoroughly in your application and hearing.
- New Evidence Presented to Agency (Reasonable Probability)
Explanation:
New evidence presented to the agency that has a reasonable probability of affecting the outcome.
Solution:
Submit new evidence promptly and ensure it is significant and relevant.
- Incomplete/Inaccurate Record
Explanation:
The record is incomplete or inaccurate.
Solution:
Double-check the completeness and accuracy of the submitted record.
- RFC – Exertional Limitations Inadequately Evaluated
Explanation:
Exertional limitations not properly evaluated.
Solution:
Provide detailed documentation of physical limitations and their impact on work capacity.
By understanding these common remand reasons and addressing them proactively, claimants can strengthen their cases and improve their chances of a favorable outcome.
