TN 8 (06-04)

GN 04440.219 Correcting Group II Ending Date Deficiencies

A. PROCEDURE-ENDING DATE DOCUMENTATION DEFICIENCIES

1. Corrective Action Policy

Return group II ending date documentation deficiencies to the adjudicating component for corrective action.

2. Review Component Procedure

Prepare an SSA-1774-U5 and return the case to the adjudicating component for corrective action. Ask the adjudicating component to:

  • obtain the documentation and correct the deficiency;

  • prepare a new SSA-831-C3/U3 if necessary; and

  • return the case to the review component.

B. PROCEDURE-ENDING DATE DECISIONAL DEFICIENCIES

1. Corrective Action Policy

Group II ending date decisional deficiencies are either returned to the adjudicating component for correction or are corrected in the review component, depending upon the specifics of the case. When the review component corrects the deficiency, they will make a pen-and-ink correction to the ending date on the SSA-831-C3/U3.

2. Review Component Procedure

a. Case Returned to Adjudicating Component

Return the case to the adjudicating component for correction of the ending date deficiency (and request return of the corrected case) if:

  • The case has another deficiency or incorrect action which requires corrective action by the adjudicating component, or

  • The claimant is already receiving a non-disability Title II benefit, or

  • The determination has been inadvertently effectuated. Follow GN 04440.250 in these situations.

If you return the case to the adjudicating component for correction:

  • Prepare an SSA-1774-U5.

  • Request corrective action and return of the folder to the review component.

CAUTION: POTENTIAL ADVERSE REOPENING

Per DI 29001.001B.1., if the sample case is a reopening of either an initial or reconsideration determination, and correcting the ending date will result in an adverse reopening, alert the DDS to disability hearing notice requirements or DHU jurisdiction as indicated below. Note, however, that the medical improvement review standard (MIRS) applies to an adverse reopening of an ending date. Refer to DI 28005.001D.1.b. and GN 04440.250C.2.

  • If the adverse reopening is of an initial determination, the notice to the claimant must contain appeal rights which include the right to a disability hearing (DI 27501.005C.3.a. and DI 29001.001B.3.a.).

  • If the adverse reopening is of a reconsideration determination which has been effectuated, the DHU has jurisdiction and the claimant is notified of the proposed revision and right to a disability hearing before the revised determination is issued (DI 29001.001B.3.b.).

Refer to DI 27501.005C.2. for procedure for reopening and revision. Refer to DI 27525.001 and DI 27540.001 for due process pre-determination notice requirements in adverse reopenings in which the ending date is revised to a less favorable date.

NOTE: See GN 04440.250C.4. for instructions on reviewing adverse reopenings in sample cases that have been inadvertently effectuated prior to sample review.

b. Case Corrected in Review Component

If none of the conditions in GN 04440.219B.2.a. exist, correct the deficiency in the review component as follows:

  • Make a pen-and-ink correction to the ending date on the SSA-831-C3/U3 per GN 04440.217.

  • Do not indicate a controlled return.

  • Code the ending date decisional deficiency.

  • Prepare and release any necessary personalized notice.

  • Notify the adjudicating component of the deficiency.

  • Send the notification (or completed SSA-1774-U5) with a copy of the amended SSA-831-C3/U3 and SSA-4268-C4/U4 rationale.

  • Do not send the folder to the adjudicating component and do not make photocopies of the medical evidence.

  • Effectuate the determination, if possible, or send the case to the appropriate component