Unfavorable Decision Reversal by the Appeals Council
In a Social Security Disability hearing, the Administrative Law Judge (ALJ) reviews the Claimant's medical records and work history, takes testimony from the Claimant, and takes testimony from a Vocational Expert regarding the effect that the Claimant's limitations would have on their ability to work on a full time basis. The ALJ then makes a decision, reduces it to writing, and mails it to the Claimant and the Claimant's representative in an average of 90 to 120 days. If this decision is unfavorable toward the Claimant, the Claimant then must determine if they want to appeal the decision to the Appeals Council or file a new claim. The decision to appeal must be based on the facts of the case and the evaluation done by the ALJ in their decision. Once appealed, the Appeals Council will review the basis for appeal and either deny the appeal, remand the case back down to the ALJ with instructions on what they did wrong or, in rare cases, completely reverse the decision of the ALJ and grant the Claimant's claim of disability. In the following case, the ALJ's decision was completely reversed by the Appeals Council and the Claimant was granted their disability benefits.
In order to appeal a decision to the Appeals Council, there must be evidence that the ALJ violated Social Security rules, standards, or practices in evaluating the case and making their decision. The basis for appeal in this particular case was that the Claimant should have been found disabled based on Listing 12.05B 1(a), 2(a)(c)(d), and 3. The Claimant had significantly sub-average general intellectual functioning, with multiple IQ tests showing an IQ of 70 or below and significant deficits in adaptive functioning with a marked limitation in the ability to understand, remember, or apply information, concentrate, persist, or maintain pace, and adapt or manage themselves. The Claimant's representative wrote a brief to the Appeals Council detailing the errors by the ALJ in determining the Claimant's non-disability and the decision was reversed and the Claimant was found to be disabled.
The ALJ in this case failed to consider all of the Claimant's IQ testing and school records, leading to a finding of non-disability. This case illustrates the need for a representative in Social Security Disability cases. While a Social Security Disability claim must be initially filed by the Claimant, having an attorney to assist with the hearing and appeals process can be very beneficial.
For more information on Social Security disability benefits and VA benefits, contact an experienced Social Security disability attorney at Gardberg & Kemmerly, P.C. Gardberg & Kemmerly, P.C. represents Social Security disability claimants in Alabama, Mississippi, Florida, and Louisiana at all levels of the disability process from initial application to appeals to Federal Court. Gardberg & Kemmerly, P.C. has been helping Social Security claimants with their disability claims for over 50 years.