Last Update: 4/26/2016 (Transmittal I-3-139)
HA 01370.012 Remand for Evidence
from a Medical Expert
Renumbered from HALLEX section I-3-7-12
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 HA 01320.011. For more information
about when the AC will proffer an MSS report and offer a supplemental
hearing, see HALLEX HA 01320.016).
•
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.