The review standard for QR cases is that the adjudicating component's determination
must conform to:
Social Security regulations and rulings;
Other written guidelines, such as the Program Operations Manual System (POMS); and
The documented facts in each case, including the medical and administrative documentation
in file, the rationales or explanations in all administrative forms, and notices in
file. For an explanation of what constitutes documentation and documentation requirements,
see GN 00301.285.
When evaluating if the evidence in file supports the disability determination, the
quality reviewer follows the preponderance of evidence standard. Establishment of
preponderance is that piece or body of relevant evidence that is more convincing when
weighed against the evidence in opposition.
For a complete explanation of the preponderance of evidence standard see DI 23025.001B.5.
NOTE: If you are a quality reviewer who receives a case from the adjudicating component
and the evidence is insufficient, even if the adjudicating component inadvertently
cleared the case, contact the adjudicating component and request the missing evidence.
If the adjudicating component does not fax the evidence necessary to make a disability
determination into the folder, or the review component does not receive it within
a reasonable amount of time, the quality reviewer may cite a deficiency. If the file
references the missing essential evidence, follow the instructions in “Correcting
Cases with Essential Evidence that is Missing or Illegible” GN 04440.242, and “Correcting Cases with Essential Evidence that is Missing or Illegible” DI 30005.241.