SOCIAL SECURITY ADMINISTRATION



Refer to: TLC[SSN][XSSN] SOCIAL SECURITY ADMINISTRATIONOffice of Disability Adjudication and Review5107 Leesburg PikeFalls Church, VA 22041-3255Telephone: (877) 670-2722Date: NOTICE OF ORDER OF APPEALS COUNCILREMANDING CASE TO ADMINISTRATIVE LAW JUDGE[Addressee] [for] [NOTE: If there is no addressee entry, this line will not be generated] [Claimant Name] [Claimant Address1] [Claimant Address2] [Claimant CSZ] 22860027432000What This Order MeansWe have sent your case back to an Administrative Law Judge. In the enclosed order, we explain why we did this and what the Administrative Law Judge will do about your claim.In addition to what we ordered the Administrative Law Judge to do, the Administrative Law Judge may also do anything else needed to complete the claim.What Happens NextAn Administrative Law Judge will contact you to tell you what you need to do.If You Have Any QuestionsIf you have any questions, you may call, write, or visit any Social Security office. If you do call or visit an office, please have this notice with you. The telephone number of the local office that serves your area is XXX-XXX-XXXX. Its address is:Social Security Administration[Street Address][City, State, Zip] <BSP> </BSP><BSP>Administrative Appeals Judge</BSP>cc:[Rep Name][Rep Firm] [Rep Address1] [Rep Address2] [Rep CSZ]SOCIAL SECURITY ADMINISTRATIONOFFICE OF DISABILITY ADJUDICATION AND REVIEWORDER OF APPEALS COUNCILREMANDING CASE TO ADMINISTRATIVE LAW JUDGEIn the case ofClaim for Period of Disability andDisability Insurance Benefits(Claimant) (Wage Earner) (Leave Blank if same as above)(Social Security Number)The Administrative Law Judge issued a decision on [ALJ decision date]. Under section 205(u) of the Social Security Act, the Administrative Law Judge disregarded certain evidence in deciding the case because there was reason to believe fraud or similar fault was involved in the claimant’s application for benefits. The New York County District Attorney's (DA) Office and the Office of the Inspector General of Social Security Administration conducted an extensive criminal investigation that resulted in the criminal indictment and conviction of Raymond Lavallee, Thomas Hale, Joseph Esposito, and John Minerva, who admitted to conducting a scheme to make false statements or other representations to SSA in order to obtain fraudulent benefits for others. Numerous individual beneficiaries have also been indicted and convicted in connection with the DA's investigation. The DA referred this case to the Social Security Administration (SSA) as one where Mr. Lavallee was the claimant's attorney representative and the facts of the case are similar to those involved in the fraudulent scheme. The file contained evidence from one or more of the four principal facilitators responsible for the scheme regarding a mental impairment(s) alleged in the case.After disregarding certain evidence in the claim file, the Administrative Law Judge considered all remaining evidence and decided the case on that evidence. The claimant appealed the [ALJ decision date] decision of the Administrative Law Judge and the Appeals Council now grants the request for review under the substantial evidence provision of the Social Security regulations (20 CFR 404.970). Under the authority of 20?CFR?404.977, the Appeals Council vacates the decision and remands this case to an Administrative Law to narrow the scope of disregarded evidence. On remand, the Administrative Law Judge will not consider evidence from the following sources when it is dated between January 1, 1988 and December 18, 2013:Any evidence regarding a mental impairment submitted by one of the four named individuals; andMedical evidence from two psychiatrists identified by the DA as participating in the alleged scheme, Dr. Edward Sodaro and Dr. Raymond Pierre-Paul.The Administrative Law Judge will consider all remaining evidence and decide the case on that evidence. If evidence was previously disregarded that is outside the scope described above, the Administrative Law Judge will now consider that evidence. In compliance with the above, the Administrative Law Judge will offer the claimant an opportunity for a hearing, take any further action needed to complete the administrative record and issue a new decision.APPEALS COUNCIL<OSB>______________________________<BSP> </BSP><BSP>Administrative Appeals Judge</BSP><OSB>______________________________<BSP> </BSP><BSP>Administrative Appeals Judge</BSP>Date: ................
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