Because Social Security proceedings are not
strictly adversarial in nature, the Secretary of Health and Human Services has
a duty to develop an adequate record from which a reasonable conclusion can be
drawn. This responsibility increases in cases where the claimant is
unrepresented, where the claim itself seems on its face to be substantial,
where there are gaps in the evidence necessary to a reasoned evaluation of the
claim, and where it is within the power of the administrative law judge (ALJ),
without undue effort, to see that the gaps are somewhat filled. The Secretary's
duty is even greater when the claimant is obviously mentally impaired. If the
ALJ fails to fill those evidentiary gaps, and if they prejudice a plaintiff's
claim, remand is appropriate.
In an action for social security benefits,
if the evidence does not support a source's opinion and the administrative law
judge (ALJ) cannot ascertain the basis for the source's opinion, theALJ has an
obligation tomake every reasonable effort to recontact the source for
clarification. Specifically, the ALJ must recontact the treating doctor when
the doctor's records are inadequate, contain conflict or ambiguity, do not
appear to be based on medically acceptable diagnostic techniques, or appear incomplete.
The ALJ may carry out this duty by seeking additional evidence or clarification
from the source, telephoning the medical provider, or requesting copies of the
records, a new report, or more detailed report. In an action for social
security benefits, one can demonstrate prejudice by showing that additional
evidence would have been produced if the administrative law judge had fully
developed the record, and that the additional evidence might.
The Commissioner of Social Security's
failure to develop an adequate
record is grounds for reversing
theCommissioner's decision pursuant to sentence four of § 205(g) of the Social
Security Act, 42 U.S.C.S. § 405(g), and ordering the case remanded for further
proceedings have led to a different decision.
