TN 13 (12-10)
GN 04440.238 Correcting Incorrect or Missing Residual Functional Capacity (RFC) Assessment and Psychiatric Review Technique Forms (PRTF)
A. Policy for correcting incorrect RFC assessment and PRTF
An incorrect PRTF or RFC assessment form technical corrective action (TCA) exists when:
A Form SSA-2506-BK (Psychiatric Review Technique), or a Form SSA-4734-BK (Physical Residual Functional Capacity Assessment), or a Form SSA-4734-F4 SUP (Mental Residual Functional Capacity Assessment) has an incorrect conclusion; and
A group I decisional deficiency as defined in DI 30005.121C. does not exist.
NOTE: If the incorrect RFC assessment results in a deficiency, as defined in DI 30005.121C.6., cite a group I RFC decisional deficiency.
For an explanation of adjudicating component corrective action procedures, see DI 30005.236.
B. Procedure for correcting incorrect RFC assessment and PRTF
If the SSA-2506-BK, SSA-4734-BK, or SSA-4734-F4 SUP has an incorrect finding or RFC conclusion, either:
NOTE: Also base the decision to return the case on the review component's ability to assume jurisdiction.
1. Case corrected in the review component
If the review component corrects the case:
Assume jurisdiction and prepare a corrected SSA-2506-BK, SSA-4734-BK, or SSA-4734-F4 SUP, as appropriate. Retain the original PRTF and RFC assessment determination in file as part of the audit trail. Annotate the original “Do Not Process.”
Ensure that the same quality reviewer and medical reviewer prepare all necessary forms, notices, and rationales.
Notify the adjudicating component of the TCA and explain that they can view the prepared forms in the certified electronic folder, or include pertinent copies of documents prepared in the review component for paper folders.
For procedures on assuming jurisdiction, see GN 04440.244 – GN 04440.245.
2. Case corrected by adjudicating component
If you are returning the case to the adjudicating component for correction:
Prepare an SSA-847-U3 (SSA Request for Case Action) to return the case;
Annotate the return to indicate that you are not charging a deficiency;
Advise the adjudicating component of the TCA and ask them to correct the TCA;
Instruct the adjudicating component not to return the case to the review component, since follow-up review is not necessary; and
Advise the adjudicating component to forward the case to the appropriate component to effectuate the determination.
C. Policy for missing or incomplete RFC assessment and PRTF
A TCA exists when the RFC Assessment Form SSA-4734-BK, SSA-4734-F4 SUP, or an SSA-2506-BK:
Is required, but not in file; or
Is in file, but not all required entries on the form are complete.
This TCA is linked to the proper completion of the form and does not encompass whether the RFC assessment, or the level of psychiatric impairment severity, is correct.
For an explanation of when partial completion of the SSA-4734-BK or SSA-4734-F4 SUP is permissible, see DI 24510.066.
For an explanation of when partial completion of an SSA-2506-BK is permissible, see DI 24505.030E.
For an explanation of when adoption of an initial level SSA-2506-BK is permissible, see DI 24505.025I.
D. Procedure for missing or incomplete RFC assessment and PRTF
If the SSA-4734-BK, SSA-4734-F4 SUP, or SSA-2506-BK is missing or incomplete, take the following actions:
Assume jurisdiction and prepare a new SSA-4734-BK, SSA-4734-F4 SUP, or SSA-2506-BK. Retain the original incomplete PRTF or RFC assessment determination in file as part of the audit trail and annotate it “Do Not Process”; or
Return the case to the adjudicating component for correction if, in the judgment of the Office of Quality Review Field Management, the adjudicating component is frequently adjudicating cases with missing or incomplete RFC assessment forms or PRTFs.
NOTE: The review component also bases the decision to return the case on the ability to assume jurisdiction.