TN 23 (09-14)

GN 04440.140 Vocational Review Policies

A. Policy on vocational review

1. Review sequence

The review component vocational consultant (VC) or designee, with requisite vocational training, addresses complex vocational issues presented by quality reviewers.

2. Cases requiring vocational review

Vocational review is required for cases:

  • with a group I deficiency (deficiency codes 20, 31, and 53, see DI 30005.570) requiring return to the adjudicating component for correction; and

  • when the quality reviewer requests VC review to assess or resolve complex vocational issues.

3. Vocational review issues

Vocational review issues include, but are not limited to:

  • ability to perform work within assessed Residual Functional Capacity (RFC)/Mental Residual Functional Capacity (MRFC) limitations;

  • relevancy of past work;

  • identification of job skills and duties;

  • identifying the claimant’s past occupation in the national economy;

  • transferability of skills;

  • application of borderline age;

  • onset and ending dates as it relates to the vocational assessment;

  • sufficiency of the vocational evidence in file;

  • special medical-vocational profiles;

  • illiteracy or inability to communicate in English;

  • providing guidance on Probability of Reversal (POR) issues when work history is incomplete; and

  • estimating the remaining occupational base.

NOTE: The VC is not responsible for determining whether a job qualifies as substantial gainful activity (SGA). However, the VC may comment when SGA is an issue that affects the ability to perform past relevant work (PRW) and may advise reviewers about conflicts in the evidence or missing documentation. The field office addresses SGA development issues (see DI 24001.005C).

B. Description of the VC’s review

The scope of the VC’s review includes assessing work history, ability to perform work within the limitations of the RFC or MRFC, and related vocational issues listed in GN 04440.140A.3. in this section. The VC’s review does not include addressing and weighing medical opinions, or making determinations regarding SGA.

The VC reviews the vocational facts of the case and the claimant’s ability to perform work within the functional limitations imposed by the RFC/MRFC. If the evidence in file supports the adjudicating component's policy compliant vocational assessment and the file is fully documented medically, the VC must not substitute his or her judgment and prepare an independent assessment of ability to perform work.

NOTE: The VC or designee may review cases and address vocational issues per GN 04440.140A.

C. Roles and responsibilities of the review component quality reviewer

1. Quality reviewer's role

The quality reviewer’s role in the vocational consultation process is to:

  • identify vocational issues that require specialized vocational advice or clarification;

  • clearly explain the issues for the VC on the SSA-1046 (Referral for Vocational Specialist Advice);

  • review the VC’s responses to ensure they adequately address all vocational issues identified; and

  • verify the VC’s responses are consistent with the documented facts of the case, as well as SSA policy and procedures.

2. Quality reviewer’s responsibilities

The quality reviewer’s responsibilities include, but are not limited to, the following actions:

  • ensuring that the RFC/MRFC is written in work-related terms;

  • resolving any internal inconsistencies prior to requesting VC review;

  • requesting an informal vocational analysis, if necessary;

  • requesting a formal vocational analysis, if necessary, on a Form SSA-1046 (see GN 04440.140C.3. in this section for instructions on completing the SSA-1046);

  • reviewing the VC’s comments provided on the Form SSA-1047 (Vocational Consultant Case Analysis), or elsewhere, including the Disability Determination Explanation; and

  • seeking clarification of the VC’s comments if conflicts exist in file.

3. Completing the SSA-1046

The quality reviewer completes the SSA-1046. Some key elements of the SSA-1046 include:

  • addressing technical issues when relevant to the vocational review (e.g., date last/first insured, Acquiescence Ruling requirements, reopenings);

  • identifying the claimant’s functional limitations for all known physical and mental medically determinable impairments;

  • reviewing summaries of relevant work history, including any inconsistencies in work history or job descriptions;

  • analysis of all remaining vocational issues; and

  • posing specific questions for the VC to answer.

The quality reviewer’s analysis should address all potential vocational issues so the VC can make a reasonable decision after the first review of the SSA-1046. A clear analysis is important since the VC’s response may result in a return to the adjudicating component.

NOTE: Do not upload the SSA-1046 to the electronic folder.

4. Reviewing vocational comments

The review component VC prepares an SSA-1047 in response to the SSA-1046. The quality reviewer reviews the comments on the SSA-1047 and requests clarification or additional information, when necessary. The quality reviewer must ensure that the SSA-1047 addresses all relevant vocational issues presented in the case.

The VC’s opinion is not binding. The quality reviewer has the responsibility for making the final determination on case issues (e.g., POR, Substitution of Judgment).

5. Retaining VC input

Retain all final forms the VC completes in the case file. The quality reviewer must explain and document all decisions to disregard VC opinions, if applicable.

D. Roles and responsibilities of the VC

1. The VC’s role

The VC’s role in the quality review process is to review and evaluate the vocational evidence in file following the policies for steps 4 and 5 of the sequential evaluation process. For additional vocational issues, see GN 04440.140A.3. in this section.

NOTE: The VC or designee may review cases and address vocational issues per GN 04440.140A.

2. VC responsibilities

VC responsibilities include, but are not limited to, the following actions:

  • ensuring the RFC/MRFC is written in work-related terms and no internal inconsistencies exist;

  • reviewing all electronic or paper vocational documentation in file;

  • responding to SSA-1046 from quality reviewers requesting vocational analysis;

  • consulting with quality reviewers, when necessary, to ensure clear communication; and

  • preparing an SSA-1047 when necessary.

NOTE: When the VC prepares an SSA-1047 requesting additional vocational documentation, the quality reviewer will provide a detailed description of the missing information to the adjudicating component. Do not specify how to obtain the documentation. Instead, describe the specific evidence needed (e.g., a complete 15-year work history) for a complete determination.

3. Completing the SSA-1047

Trained VCs and designees use the SSA-1047 to analyze complex vocational issues presented by quality reviewers on the SSA-1046. For an exhibit of the SSA-1047, please see GN 04440.916.

VCs will complete an SSA-1047 in every case where the Office of Quality Review (OQR) cites a group I deficiency involving vocational assessments. The SSA-1047 is optional in other cases involving vocational issues.

a. Procedure for completing the SSA-1047

  1. 1. 

    Vocational Factors: The VC identifies all pertinent information relevant to the listed vocational factors.

  2. 2. 

    Adjudicating component physical and mental RFC assessments: The VC cites the specific RFC limitations assessed by the adjudicating component. If the RFC changes over time or there are multiple RFCs assessed over the period considered, the VC may need to describe multiple assessments.

  3. 3. 

    OQR physical and mental RFC assessments: The VC notes RFC elements where OQR disagrees with the adjudicating component or must clarify a limitation. There is no need to repeat agreed upon RFC elements.

  4. 4. 

    OQR Vocational Analysis: This is VC’s analysis of the vocational elements, not a repeat of the adjudicating component’s analysis.

    1. a. 

      Step Four Assessment: Address all issues pertaining to the claimant’s ability to perform past relevant work (PRW) within the assessed limitations.

    2. b. 

      Step Five Assessment: If necessary, assess transferability, the ability to perform other work within the assessed limitations.

  5. 5. 

    Additional discussion if necessary: Address issues outside the scope of previous sections (e.g., onset, borderline age).

b. Disposition of the SSA-1047

The quality reviewer must include the final version of the SSA-1047 in the file.

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GN 04440.140 - Vocational Review Policies - 07/20/2016
Batch run: 07/20/2016