C.F.R. » Title 20 » CHAPTER III—SOCIAL SECURITY ADMINISTRATION › PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) › Subpart P—Determining Disability and Blindness

20 C.F.R. § 404.1513a

Evidence from our Federal or State agency medical or psychological consultants

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The following rules apply to our Federal or State agency medical or psychological consultants that we consult in connection with administrative law judge hearings and Appeals Council reviews:

(a) In claims adjudicated by the State agency, a State agency medical or psychological consultant may make the determination of disability together with a State agency disability examiner or provide medical evidence to a State agency disability examiner when the disability examiner makes the initial or reconsideration determination alone (see § 404.1615(c)). The following rules apply:

(1) When a State agency medical or psychological consultant makes the determination together with a State agency disability examiner at the initial or reconsideration level of the administrative review process as provided in § 404.1615(c)(1), he or she will consider the evidence in your case record and make administrative findings about the medical issues, including, but not limited to, the existence and severity of your impairment(s), the existence and severity of your symptoms, whether your impairment(s) meets or medically equals the requirements for any impairment listed in appendix 1 to this subpart, and your residual functional capacity. These administrative medical findings are based on the evidence in your case but are not in themselves evidence at the level of the administrative review process at which they are made. See § 404.1513(a)(5).

(2) When a State agency disability examiner makes the initial determination alone as provided in § 404.1615(c)(3), he or she may obtain medical evidence from a State agency medical or psychological consultant about one or more of the medical issues listed in paragraph (a)(1) of this section. In these cases, the State agency disability examiner will consider the medical evidence of the State agency medical or psychological consultant under §§ 404.1520b, 404.1520c, and 404.1527.

(3) When a State agency disability examiner makes a reconsideration determination alone as provided in § 404.1615(c)(3), he or she will consider prior administrative medical findings made by a State agency medical or psychological consultant at the initial level of the administrative review process, and any medical evidence provided by such consultants at the initial and reconsideration levels, about one or more of the medical issues listed in paragraph (a)(1)(i) of this section under §§ 404.1520b, 404.1520c, and 404.1527.

(b) Administrative law judges are responsible for reviewing the evidence and making administrative findings of fact and conclusions of law. They will consider prior administrative medical findings and medical evidence from our Federal or State agency medical or psychological consultants as follows:

(1) Administrative law judges are not required to adopt any prior administrative medical findings, but they must consider this evidence according to §§ 404.1520b, 404.1520c, and 404.1527, as appropriate, because our Federal or State agency medical or psychological consultants are highly qualified and experts in Social Security disability evaluation.

(2) Administrative law judges may also ask for medical evidence from expert medical sources. Administrative law judges will consider this evidence under §§ 404.1520b, 404.1520c, and 404.1527, as appropriate.

(c) When the Appeals Council makes a decision, it will consider prior administrative medical findings according to the same rules for considering prior administrative medical findings as administrative law judges follow under paragraph (b) of this section.

[82 FR 5866, Jan 18, 2017]
Notes of Decisions
Cited in 15 cases (12 in the last 5 years), 2020–2026 · leading case: Emery v. Comm'r of Soc. Sec. (N.D. Miss. 2023).
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Emery v. Comm'r of Soc. Sec. (N.D. Miss. 2023). · cites it 3× “ure to Comply with the Appeals Council’s Remand Order As to the first issue, in the Appeals Council’s remand order dated April 27, 2021, a portion of the order stated that upon remand, the Administrative Law Judge will: “If available, obtain evidence from a medical expert…”
Nguyen v. Comm'r of Soc. Sec. (N.D. Ohio 2024). · cites it 2× “4 (20 CFR 404.1513a(b)(2) and SSR 17-2p)”; and  “Give further consideration to the claimant’s maximum residual functional capacity during the entire period at issue and provide rationale with specific references to evidence of record in support of assessed limitations (Social…”
Turpin v. Comm'r of Soc. Sec. (C.D. Ill. 2023). “BRK Upon remand, the Administrative Law Judge will: If necessary, obtain evidence from a medical expert related to the nature and severity of and functional limitations resulting from the claimant's impairments (20 CFR 404.1513a(b)(2) and 416.913a(b)(2)).”
Lee v. Saul (D. Minnesota 2020). “See 20 C.F.R § 404.1513a(b)(1). An ALJ can rely on the reviewing physician’s opinion, even when it directly contradicts the treating provider’s.”
Sternkopf v. Comm'r of Soc. Sec. (D.N.J. 2022). “2 • If available, obtain evidence from a medical expert related to the nature and severity of and functional limitations resulting from the claimant’s mental impairments (20 CFR 404.1513a(b)(2)). • Give further consideration to the claimant’s maximum residual functional capacity…”
Paradise v. Comm'r of Soc. Sec. (D.N.J. 2022). “• Further, if necessary, obtain evidence from a medical expert related to the nature and severity of and functional limitations resulting from the claimant's impairment 3 (20 CFR 404.1513a(b)(2) and 416.913a(b)(2)).”
Walker III v. Comm'r of Soc. Sec. (D.N.J. 2023). “• Further, if necessary, obtain evidence from a medical expert related to the nature and severity of and functional limitations resulting from the claimant’s impairments (20 CFR 404.1513a(b)(2) and 416.913a(b)(2)).”
Cur v. Comm'r of Soc. Sec. (W.D.N.Y. 2020). “See 20 C.F.R. 404.1513a(b)(2), 416.913a(b)(2) (“Administrative law judges may also ask for medical evidence from expert medical sources.”
Smith v. Comm'r of Soc. Sec. (E.D. Pa. 2020). “20 C.F.R. 404.1513a(b)(1) at 404.1527(c).”
Shipman v. Kijakazi (M.D. Penn. 2023). “• Further, if necessary, obtain evidence from a medical expert related to the nature and severity of and function limitations resulting from [Shipman]’s impairment (20 CFR 404.1513a(b)(2)). • Obtain supplemental evidence from a vocational expert to clarify the effect of the…”
Mcmartin v. Comm'r of Soc. Sec. (N.D. Iowa 2022). “4 (20 CFR 404.1513a(b)(2) and 416.913a(b)(2)).”
Nielson v. Kijakazi (D. Utah 2023). “On remand, the Appeals Council stated the ALJ will, among other things: “If warranted, obtain evidence from a medical expert related to the nature and severity of and functional limitations resulting from the claimant’s impairments (20 CFR. 404.1513a(b)(2) and 416.913a(b)(2))”)1…”
Show all 15 citing cases →
— 20 C.F.R. § 404.1513a(b)(1) — 2 cases
Lee v. Saul (D. Minnesota 2020). “See 20 C.F.R § 404.1513a(b)(1). An ALJ can rely on the reviewing physician’s opinion, even when it directly contradicts the treating provider’s.”
Smith v. Comm'r of Soc. Sec. (E.D. Pa. 2020). “20 C.F.R. 404.1513a(b)(1) at 404.1527(c).”
— 20 C.F.R. § 404.1513a(b)(2) — 13 cases
Emery v. Comm'r of Soc. Sec. (N.D. Miss. 2023). “ure to Comply with the Appeals Council’s Remand Order As to the first issue, in the Appeals Council’s remand order dated April 27, 2021, a portion of the order stated that upon remand, the Administrative Law Judge will: “If available, obtain evidence from a medical expert…”
Nguyen v. Comm'r of Soc. Sec. (N.D. Ohio 2024). “4 (20 CFR 404.1513a(b)(2) and SSR 17-2p)”; and  “Give further consideration to the claimant’s maximum residual functional capacity during the entire period at issue and provide rationale with specific references to evidence of record in support of assessed limitations (Social…”
Turpin v. Comm'r of Soc. Sec. (C.D. Ill. 2023). “BRK Upon remand, the Administrative Law Judge will: If necessary, obtain evidence from a medical expert related to the nature and severity of and functional limitations resulting from the claimant's impairments (20 CFR 404.1513a(b)(2) and 416.913a(b)(2)).”
Sternkopf v. Comm'r of Soc. Sec. (D.N.J. 2022). “2 • If available, obtain evidence from a medical expert related to the nature and severity of and functional limitations resulting from the claimant’s mental impairments (20 CFR 404.1513a(b)(2)). • Give further consideration to the claimant’s maximum residual functional capacity…”
Paradise v. Comm'r of Soc. Sec. (D.N.J. 2022). “• Further, if necessary, obtain evidence from a medical expert related to the nature and severity of and functional limitations resulting from the claimant's impairment 3 (20 CFR 404.1513a(b)(2) and 416.913a(b)(2)).”
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