Disability Appeals Council: Do I Still Have a Chance to Win?

Appealing to the Social Security Appeals Council is the third level of appeal for disability claims.  

What Are My Chances of Winning at the Appeals Council Level?

The Social Security Administration reports that on average, this is how Appeals Councils decisions end up:

• 72% of the Requests for Review are denied
• 22.5% of the cases are remanded to an ALJ
• 3% of the cases result in the Appeals Council issuing a new decision, and
• 2.5% of the cases result in a dismissal (because the request for review was not filed by the deadline).  

But don't let these figures discourage you from appealing your case. If your case is remanded, you have a good chance of eventually getting awarded partial or full benefits. Keep in mind that more time will have passed since the original ALJ decision, during which your condition may have deteriorated, and you can submit additional evidence at the remand hearing showing how your disability has worsened over time.

In addition, even if your review is denied, you can then take your case to the federal district court level where there is a greater likelihood of getting awarded disability benefits or receiving a remand.

The Appeals Council can also independently decide to review a favorable ALJ decision and then issue a new decision that is partially or fully unfavorable.

How You Can Improve Your Chances on Appeal

There are some common reasons why the Appeals Council would remand or award benefits in a case. These include situations where:

• The ALJ ignored an important medical condition. For example, if you had been diagnosed with depression and the ALJ failed to even discuss this condition in the decision, or failed to find it to be a significant or “severe impairment,” then this could be a basis for appeal.
• The ALJ failed to discuss the opinion of a treating or examining doctor, or failed to give the opinion any weight. For instance, your treating doctor said you were limited to two hours of walking and standing each day but the ALJ failed to mention this opinion in the decision.
• There was no vocational expert (VE) at the hearing. If the ALJ denied you disability benefits on account of there being other work you can do (besides your past work), but there was no VE at your hearing, your case should be remanded to a new hearing so that a VE can be present for questioning.
• There is additional evidence that the ALJ did not consider. If there are any medical statements or evidence about your disability that the ALJ did not consider in the hearing decision (especially any opinions from doctors), then you should send that evidence along with the Form HA-520.

It's helpful to send a short statement along with your Request for Review that outlines why the ALJ committed any of the above errors in your case, referring to the ALJ hearing record whenever possible. To help you with this,  request the exhibit file and a CD with the recording of the ALJ hearing.  

Of course, it can be difficult to know when and how the ALJ made a legal error.  An experienced disability  attorney will know which errors the ALJ may have committed and what new evidence should be submitted to help your case, so you should consider hiring a lawyer to help you with this type of appeal.

Also, it's helpful to send the ALJs' written opinion to your doctor or psychiatrist so that he or she can comment specifically on the judge's findings; if your doctor disagrees with any of the ALJ's points, ask your doctor make some written comments on the opinion.