I-4-3-30.Determining Whether Appeals Council Review Is Required

Last Update: 9/13/05 (Transmittal I-4-15)

If the OAO or CCPRB analyst determines that appeal or reargument is not warranted, the next consideration is whether AC review is required. AC review is necessary in the following situations:

  • The AC issued the final decision.

  • A circuit court remanded the case.

  • The court remanded the case as a result of the RVR process on the basis of the Commissioner's motion or a joint motion or stipulation between the Commissioner and the claimant. (Exception: AC review is not required in a Commissioner's motion remand to hold a de novo hearing because of a lost or inaudible recording if that is the only issue in the AC's remand order. AC review is required when other issues are included (e.g., obtaining a consultative examination, etc.).

  • The case is one of “first impression” which is adverse to the Commissioner; i.e., a case in which the court enunciates for the first time an interpretation of the Act, regulations, or a ruling which is contrary to the Commissioner's interpretation, and which is not being appealed (see I-4-3-10).

  • The analyst and Branch Chief agree after discussing the case that the AC could issue a decision (either favorable or unfavorable) without remanding the case to an ALJ.

  • The analyst and Branch Chief agree that the AC should remand the case to an ALJ and that the AC's remand order should contain specialized language because of circumstances unique to that case.