TN 16 (04-11)

GN 04440.114 Applying the Probability of Reversal (POR) Rule

A. Group I and group II criteria

1. General rule for citing group I and group II documentation deficiencies

When a disability determination is not fully documented medically or vocationally as required by SSA disability program policy, the quality reviewer classifies the deficiency as a group I or group II medical or vocational documentation deficiency and returns the case to the adjudicating component for correction unless he or she determines that the missing documentation is unlikely to either:

  • reverse the disability determination, or

  • change the length of the period of disability.

2. Citing a group I medical documentation deficiency

For the quality reviewer to cite a group I medical documentation deficiency, a Federal review physician must either:

  • agree that the medical evidence in file is insufficient (overall severity rated "07"), or

  • rate overall severity with a conditional severity rating (CSR).

B. Technical corrective action (TCA)

The quality reviewer does not cite a deficiency and classifies the discrepancy as a non-returnable TCA if a disability determination is not fully documented (i.e., full medical or vocational documentation) as required by SSA disability program policy, but the evidence in file is sufficient for the quality reviewer to judge that the missing documentation is unlikely either to:

  • reverse the disability determination, or

  • change the length of the period of disability.

C. When a CSR is neccessary

If there is insufficient medical evidence to establish a definitive overall severity rating, the review physician may provide a CSR. Base the CSRs on the evidence in file and not on speculation about what missing evidence might show. However, the CSR may include an opinion as to the potential effect of the missing documentation. While a CSR may facilitate the POR determination, quality reviewers must exercise extreme care when using a CSR to support a POR determination and the disability determination is unfavorable or less than fully favorable.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0204440114
GN 04440.114 - Applying the Probability of Reversal (POR) Rule - 04/21/2011
Batch run: 04/21/2011
Rev:04/21/2011