Fully Favorable Appeals Council Order

Friday, June 10th, 2011

After an Administrative Law Judge (“ALJ”) denies a Social Security Disability (“SSD”) application, a claimant can appeal to the Appeals Council (“AC”). The vast majority of the time, the AC either agrees with the ALJ’s denial, or remands the case to the ALJ for another hearing. Today I received a rare decision from the AC that accepted my appeal arguments, and ruled that my client, a 47 year old former pharmaceutical sales representative, is entitled to nearly seven years of SSD benefits, beginning as of July 23, 2004.

The AC originally agreed that the claimant was not disabled. At that point, I took over the case from another attorney, and filed a complaint in federal court. The United States Attorney who was representing Social Security believed that the decision of the ALJ was so legally untenable that it voluntarily asked the claimant to agree to have the case remanded. Because the claimant relocated, the claim was reassigned on remand to ALJ Sy Raynor, who then also denied the claim.

While my appeals comments contained many legal and factual arguments, they essentially boiled down to a single logical contention. The United States Attorney believed that the 2006 Decision was so legally untenable that it asked the claimant to agree to remand the case. The additional medical evidence I submitted at the second hearing with ALJ Raynor, which even more strongly supported the claimant’s allegations, showed that ALJ Raynor’s decision was even less legally tenable.

I showed how the medical evidence provided persuasive proof that the claimant lacked the ability to perform sedentary work, and that there was no basis to assume that further developing the record would unearth a contrary opinion from a doctor who examined the claimant. Since two ALJs had two separate chances to review the records and request medical evidence, yet failed to carry their burden of proving that the claimant could do sedentary work, and more than five years had passed since the claimant applied for SSD benefits, I argued that the case should be remanded solely for the calculation of benefits.

The AC agreed that the claim should be approved without further proceedings. The lesson from this case is that you should not give up on your valid SSD claim regardless of how many times it has been denied.

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