TN 30 (02-18)

GN 04440.231 12-Month Medical Evidence of Record (MER) Technical Corrective Action (TCA)

A. Policy for a 12-month MER TCA

Corrective action is necessary only when the determination is unfavorable or less than fully favorable.

B. Procedure for a 12-month MER TCA

When an unfavorable or a less than fully favorable determination does not contain 12-month MER as required by DI 22505.001A.3., and the file is not documented to indicate that every reasonable effort was made to obtain the MER, (see DI 22505.035) take the following actions:

  1. 1. 

    If the missing MER has the potential to change the disability determination, record a group I medical documentation deficiency and indicate that a 12-month MER TCA exists;

  2. 2. 

    If the missing MER has the potential to change the period of disability, record a group II medical documentation deficiency and indicate that a 12-month MER TCA exists;

  3. 3. 

    If it is unclear whether a group I or group II documentation deficiency is applicable; that is, you cannot ascertain what the missing MER may contain or address, take the following actions:

    • prepare a Form SSA-847-U3 (SSA Request for Case Action) to return the case to the adjudicating component;

    • include an explanation that a 12-month MER TCA exists;

    • ask the adjudicating component to obtain the MER, and if applicable, prepare an amended determination;

    • instruct the adjudicating component to return the case to the reviewing component upon completion of all actions; and

    • control the return.

  4. 4. 

    If a 12-month MER TCA occurs concurrently with a medical documentation TCA (GN 04440.234), code the medical documentation TCA in the technical documentation deficiency field of the Office of Quality Review legacy system.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0204440231
GN 04440.231 - 12-Month Medical Evidence of Record (MER) Technical Corrective Action (TCA) - 02/02/2018
Batch run: 02/02/2018
Rev:02/02/2018