TN 13 (12-10)

GN 04440.240 Mental Impairment Case Technical Corrective Action (TCA)

A. Introduction to mental impairment cases

The Social Security Disability Benefits Reform Act of 1984 requires the Commissioner, before determining that the individual is not under a disability, to make “every reasonable effort to ensure that a qualified psychiatrist or psychologist completes the medical portion of the case review and any applicable residual functional capacity (RFC) assessment” if the evidence indicates the existence of a mental impairment.

See Details:

For a further explanation of this requirement, see the following references:

B. Policy for mental impairment case TCA

1. Mental impairment case TCA

A mental impairment case contains a TCA when:

  • the disability determination is unfavorable or less than fully favorable;

  • the evidence indicates the existence of a mental impairment; and

  • a qualified psychiatrist or psychologist in the adjudicating component did not review the claim.

2. Documentation of a psychiatric or psychological review

Document a psychiatric or psychological review by:

  • a folder annotation stating that the psychiatrist or psychologist was consulted, or

  • a qualified psychiatrist or psychologist's signature on the SSA-2506-BK (Psychiatric Review Technique) or on an SSA-4734-F4-SUP (Mental Residual Functional Capacity) if the claimant’s impairment does not meet or equal the listings.

CAUTION: If these forms contain incorrect or clearly erroneous information that could affect the determination, cite other appropriately defined deficiencies.

C. Procedure for mental impairment case TCA

If a qualified psychiatrist or psychologist has not reviewed an unfavorable or less than fully favorable determination involving a mental impairment, either:

  • assume jurisdiction and have the appropriate medical consultant (MC) or psychological consultant (PC) review the case; or

  • return the case to the adjudicating component for corrective action.

For an explanation of adjudicating component corrective action procedures, see DI 30005.239.

CAUTION: If it is not clear that the signing physician is a qualified psychiatrist or psychologist, call the adjudicating component or center for disability, if preferred, to verify the physician's specialty. If the signing physician is not a qualified psychiatrist or psychologist, take appropriate action to correct the file or have the file corrected, as indicated in GN 04440.240C.1. or GN 04440.240C.2. in this section.

1. Case corrected in the review component

If the review component corrects the case:

  • Assume jurisdiction and have the appropriate regional medical contractor (MC) or regional psychological contractor (PC) review the case.

  • Ensure that the same quality reviewer and medical reviewer prepare and sign, where appropriate, all necessary forms, notices, and rationales.

  • Notify the adjudicating component of the TCA and, if applicable, include pertinent copies of documents prepared in the review component.

For procedures on assuming jurisdiction, see GN 04440.244 GN 04440.245.

NOTE: Retain the original Psychiatric Review Technique Form and RFC in file as part of the audit trail. Annotate the original “Do Not Process.”

2. Case corrected by adjudicating component

If returning the case to the adjudicating component for correction:

  • Prepare an informational 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 obtain the appropriate signatures;

  • 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 processing component.