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

If you've received an unfavorable decision after your disability hearing with an administrative law judge (ALJ), you're probably wondering what your next steps should be. The Social Security Administration (SSA) has an additional level of review called the Appeals Council that gives you a chance to explain why you think the ALJ didn't decide your case correctly.

To appeal an ALJ denial to the Appeals Council, you'll need to file a formal request for review asking the council to take a look at the ALJ's decision. The council can grant, deny, or dismiss your request for review. If your request is granted, you'll have the opportunity for another hearing.

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

Winning your case at the Appeals Council is difficult, but not impossible. If, after reading your unfavorable decision, you might discover that the ALJ didn't address one of your medical conditions or missed an important piece of evidence. In that case, you could try to convince the Appeals Council to accept your request and remand (send back) your case for a new hearing.

Social Security reports that, as of 2021, the Appeals Council reviews cases only 14% of the time, and the council remands cases for a new hearing only 12% of the time. Keep in mind that, even if the Appeals Council does send your case back to the ALJ for a closer look, you'll still have to get approval from an ALJ before the SSA can award you benefits.

While the Appeals Council statistics aren't especially encouraging, if your case is remanded, you have a good chance of eventually getting awarded partial or full benefits.

You can improve your odds by reviewing your decision to see if the ALJ made a mistake significant enough for the Appeals Council to send your case back to the ALJ for correction.

Top 6 Reasons Why the Appeals Council Remands a Case

When the Appeals Council decides to remand your unfavorable decision, the council will let you know in writing why they're doing so. Social Security publishes statistics on the top reasons why the Appeals Council sends a case back to the hearing level:

• The ALJ didn't take mental restrictions into consideration. Any limitations you have due to a mental condition—including side effects from medication or dealing with pain—must be mentioned in the residual functional capacity (RFC) report that Social Security creates.
• The ALJ didn't address evidence in the record. ALJs are legally required to explain the reasoning behind their decision, with reference to evidence in your medical records. If the ALJ didn't mention important evidence about your condition, such as an X-ray, the Appeals Council will likely remand your case.
• The ALJ didn't discuss a medical source opinion. The SSA takes doctors' opinions seriously when deciding whether you're disabled. ALJs aren't allowed to ignore or disregard a medical opinion.
• The ALJ didn't have a good reason to find your symptoms weren't limiting. ALJs need to base the restrictions in your RFC on symptoms that are tied to objective evidence. If you have severe degeneration in your neck but the ALJ thinks you can lift 100 pounds, the council will want to see that the ALJ's reasoning makes sense.
• The ALJ didn't discuss why a medical opinion wasn't given much weight. ALJs don't have to agree with every doctor's opinion, but they must explain why they prefer one opinion over another. This is called giving an opinion "more weight."
• The ALJ didn't take all of your physical limitations into account. The RFC your ALJ created needs to reflect all physical restrictions in your medical records, including postural restrictions (bending, stooping, kneeling) and manipulative restrictions (using your hands and arms to reach, grasp, and move objects).

Additional reasons for an Appeals Council remand can include:

• not fully developing the record (the ALJ wrote the decision without having all the available evidence)
• incomplete testimony from a vocational expert, or
• not taking into consideration that you need to use an assistive device such as a cane or walker.

How Do I Get the Appeals Council to Remand My Case?

If you've reviewed your unfavorable decision and you think the ALJ made one of the mistakes listed above, you should send a short statement along with your request for review that outlines why the ALJ was wrong. You should refer to the hearing record and list of exhibits wherever possible.

For information on how to request your case file and a recording of the hearing (along with a transcript), see our article on reviewing your Social Security disability file before an appeal.

Help From an Attorney Can Improve Your Chances

Not all mistakes the ALJ makes are considered "reversible errors." The Appeals Council won't send your case back if the ALJ made a minor mistake that wouldn't affect the outcome, like saying you have two cats instead of three.

Knowing which mistakes to look for can be difficult. Consider getting help from an experienced disability attorney or advocate. Your representative can untangle the often complicated legal language used by the Appeals Council and in the unfavorable decision to discover which errors the ALJ might have made and what new evidence should be submitted to help your case.

_{Updated August 22, 2022}