I-3-3-4.ALJ's Action, Findings or Conclusions Not Supported by Substantial Evidence

Last Update: 9/08/05 (Transmittal I-3-36)

A. General

Under the provisions of the regulations of 20 CFR 404.970 and 416.1470, if the decision of an ALJ is supported by “substantial evidence,” the Appeals Council will deny the request for review or decline own motion review on this basis even though the Appeals Council might reach a different conclusion if it considered the case de novo under the “weight of the evidence” rule. The Appeals Council applies the same “substantial evidence” standard of review as the United States district courts.

B. Weight of the Evidence

“Weight of the evidence” is defined as the balance or preponderance of evidence; the inclination of the greater amount of credible evidence to support one side of the issue rather than the other.

C. Substantial Evidence

“Substantial evidence” is defined as that evidence which, although less than a preponderance, nevertheless is sufficient to convince a reasonable mind of the credibility of a position taken on an issue, when no evidence on the opposing side clearly compels another finding or conclusion. Therefore, the “substantial evidence” rule requires less in support of a finding or conclusion than the “weight of the evidence” rule. Evidence on one side of an issue need not possess greater weight or be more convincing and credible to be “substantial.”

D. Applying Substantial Evidence Rule

To determine whether an ALJ's decision is supported by substantial evidence, the analyst first must study each finding made to resolve an issue in the case and the evidence the ALJ cites to support the finding. The analyst must then study the record as a whole (i.e., the evidence cited by the ALJ in support of his or her findings and all other evidence of record) to determine whether the ALJ reached a conclusion consistent with those findings.

The Appeals Council will not substitute its judgment for that of the ALJ. The fact that the ALJ could have made different findings based on the evidence of record is irrelevant. When the ALJ clearly misinterpreted or incorrectly evaluated evidence upon which the decision was based, the decision is not supported by substantial evidence.

If the evidence cited by the ALJ is not substantial, but other substantial evidence in the record supports the ALJ's conclusion, the Appeals Council will grant review for corrective action. If the record is otherwise complete, the Appeals Council will issue a decision. However, where the record is incomplete or credibility and/or subjective complaints are at issue, the Appeals Council will remand the case to an ALJ for further proceedings. The Appeals Council generally will not review a favorable decision on its own motion if the record contains substantial evidence to support the ALJ's ultimate conclusion.