The automated sample selection process selects QR sample cases when the adjudicating
component inputs the determination and sends the case to the review component for
review, prior to effectuating the determination.
Quality reviewers conduct a review of the adjudicating component's determination using
the same policy and procedural guidelines the adjudicating components use. QR follows
the steps of sequential evaluation and considers all of the evidence before citing
a deficiency and returning a case to the adjudicating component.
The disability examiner records the review results, including any medical review,
directly to OQR’s legacy system. The legacy system automatically transmits review
data to OQR in Central Office, where the data are stored and used to produce national
When the case contains no returnable deficiency and is otherwise correct, the review
component effectuates the determination.
If the case is deficient, QR returns the case to the adjudicating component for correction,
based on the criteria listed in GN 04440.002D. of this section.
If the adjudicating component disagrees with the deficiency return, they can rebut
the deficiency (if the case involves paper) or file a Request for Program Consultation
(RPC) if the case is fully electronic. See GN 04440.002E. in this section and Resolving Deficiency Disagreements GN 04440.401.
NOTE: If the quality reviewer identifies a potential disability fraud issue during review,
the review component should send a fraud referral via an e8551 following local procedures.
If the review component is returning the case to the adjudicating component for a
returnable deficiency, they can instruct the adjudicating component to perform the
DI 23025.000 for an explanation of fraud or similar fault.
GN 04111.065 for instructions on preparing the e8551.