The RPC resolution panel is composed of one member each from ODP, the Office of Disability Determinations (ODD), and the Office of Quality Review (OQR).

The RPC panel discussion is a collaborative decision-making process. Panel members work in partnership to:

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  Collaboratively resolve policy and procedure disagreements between the DDSs and the DQBs regarding deficiencies;

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  Ensure adjudicative actions and the decisional outcome are supported by policy and comply with required procedures;

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  Ensure correct and consistent application of disability policy and procedures across components.

Each member of the RPC panel reviews the case in its entirety (including all prior certified electronic files (CEF)) prior to the RPC panel discussion in order to have a clear understanding of the medical, functional, and vocational evidence, issues, and policies and procedures involved. During the RPC panel discussion, the RPC panel evaluates the case and takes the following steps to reach resolution:

1. 1. 

   Determine whether program instructions support the DDS’s determination. If program instructions support the determination, the panel rescinds the deficiency. If program instructions do not support the determination, the panel goes to step two.

2. 2. 

   Determine whether program instructions support DQB’s deficiency citation. If program instructions support the deficiency, the panel affirms the deficiency. If program instructions do not support the deficiency, the panel goes to step three.

3. 3. 

   Determine the appropriate adjudicative and decisional actions needed to resolve the case, based on the evidence in the file, in accordance with disability policy and program instructions.

An RPC facilitator manages the RPC panel discussion.

NOTE: When RPC schedules an RPC panel discussion, the RPC tool automatically sends a notification email including place, time, and call-in information to the involved parties. The RPC panel discussion schedule is available on the RPC website.

The RPC panel discussion is open to anyone who wishes to attend. Voting is limited to the three panel members (one each from ODP, ODD, and OQR), who may participate in person or by telephone. During the RPC panel discussion, staff from the involved DDS, DQB, CD, or RO may raise policy issues not addressed in the panel discussion and clarify concerns. Observers present in the room may participate in the discussion. Telephone observers may not contribute to the call.

RPC’s Technical Expert (TE) regularly attends the panel discussion, either in person or on the phone. The TE is present as a resource for the panel members, providing input during the panel discussion, and does not vote.

Participating components should find coverage when a designated panel member cannot attend an RPC panel discussion. If a panel member is unavailable to attend the discussion and provides notice to RPC, the branch will consider re-scheduling the panel discussion. If an ODD or OQR panel member fails to attend the discussion without prior notice, the panel discussion will not proceed and will be rescheduled.

The panel discussion process resolves case-specific policy and procedural questions.

The RPC process must be transparent and impartial. The panel may not refer to personally identifiable information (PII), including names of claimants, treating sources, DDSs or DQBs. The panel members must base the discussion on the applicable policy/procedure, rather than representing or advocating for a particular component.

The role of the RPC facilitator is to:

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  Ensure all panel members introduce themselves and have an opportunity to participate in the discussion;

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  Ensure non-involved telephone listeners do not participate;

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  Ensure the RPC panel discussion is mutually respectful, professional, and follows the decision-making steps;

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  Ensure the RPC panel discussion remains focused on the applicable policy and procedure in relation to the case and is not influenced by bias;

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  Facilitate the discussion to determine appropriate actions when program instructions support neither the DDS’s nor the DQB’s position;

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  Ensure policy/procedure disagreements among the panel members are addressed and resolved by the appropriate ODP office responsible for the policy;

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  Ensure the panel discussion moves at an appropriate pace to allow full participation of all panel members, while meeting the allotted timeframe; and

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  Ensure that after the panel discussion, the panel follows each step in the decision making process to reach the appropriate resolution (see DI 30007.145G. in this section).

The ODP panel member identifies the RPC case number and presents the case facts, central issues, actions taken by the DDS, the DQB, and basis of the RPC submission, and opens the discussion. Subsequently the panel discusses all actions taken during adjudication and review, findings, and concerns about applying program instructions.

During the discussion and prior to the vote, if any of the panel members or DDS, DQB, CD, or RO participants have a policy question that is unresolved by the discussion, participants for the case in question may request a suspension of the discussion for more formal policy/medical guidance. Once guidance is received, the ODP panel member will share it with the original panel (or a representative, if an original panel member is not available), including the original DDS and DQB. Jointly, the members will determine whether the panel needs to reconvene for further discussion or if a vote can be taken.

NOTE: The panel will not discuss any post-adjudicative evidence until after RPC resolution. For discussion of post-adjudicative evidence, see DI 30007.145J.2. in this section.

After the RPC panel discussion and prior to the vote, the DDS, DQB, CD, and RO involved will have an opportunity to raise policy issues not addressed in the panel discussion and clarify concerns.

After the RPC panel discussion is finished, the facilitator asks the following questions sequentially to facilitate the decision-making process:

Prior to the vote, if the panel members are unable to agree on a policy-supported outcome, any panel member may request additional policy guidance.

Prior to the vote, if the panel members agree on a policy-supported outcome, the involved DDS, DQB, CD, or RO is not clear on how policy should be applied, and the panel members can explain their application of the policy, no further additional policy guidance will be requested.

Prior to the vote, if the panel members agree on a policy-supported outcome, the involved DDS, DQB, CD, or RO is not clear on how policy should be applied, and the panel members cannot explain their application of the policy, DDS, DQB, CD, or RO may request additional policy guidance.

NOTE: Any DDS, DQB, CD, and RO may seek policy clarification from the division in ODP responsible for the policy by sending policy questions to ^ODP Controls.

Once the ODP panel member receives the requested guidance, the panel member will share it with the original panel (or a representative if an original panel member is unavailable). ODP, ODD, and OQR will decide whether the guidance results in a resolution or merits reconvening the panel for discussion.