TN 14 (12-10)

GN 04440.950 Exhibit of Group I and Group II Deficiency Codes in the Office of Quality Review (OQR) Legacy System

The deficiencies are listed in the same sequence as in DI 30005.121 DI 30005.126; the numbers on the left correspond to the defined deficiencies in those sections.

A. Group I decisional deficiencies

OQR Legacy System
Code

An incorrect decision regarding:

10

1. Substantial gainful activity (SGA) – clear evidence the claimant is engaging in SGA

11

2. Impairment Severity

12

3. Duration

13

4. Medical improvement (MI) and whether MI affects the ability to work

5. MI exceptions, including :

14

  • Whether an individual is a beneficiary of advances in medical or vocational therapy or technology,

15

  • Whether an individual has successfully undergone vocational therapy,

16

  • Whether new or improved diagnostic techniques demonstrate that an individual's impairment is not as disabling, as of the last determination,

17

  • Whether a prior determination was made in error, or

18

  • Whether the prior determination was based upon fraudulent circumstances.

19

6. Residual Functional Capacity (RFC)

20

7. Evaluation of vocational factors including age, education, transferable skills, ability to do past relevant work, or ability to do other work

21

8. Failure to follow prescribed treatment

22

9. Drug addiction and alcoholism (DAA) materiality

23

10. Onset of disability, relative to a Title II eligibility period

25

11. Incorrectly adopting, or not adopting a prior administrative law judge (ALJ) or appeals council (AC) finding when adjudicating a subsequent disability claim.

26

12. Collateral estoppel

B. Group I medical documentation deficiencies

 

The medical documentation is insufficient to determine:

41

1a. Impairment severity

42

1b. Duration

43

1c. MI, including whether MI affects the ability to work

1d. MI exceptions including:

49

  • Whether an individual is a beneficiary of advances in medical or vocational therapy or technology, or

48

  • Whether new or improved diagnostic techniques demonstrate that an individual's impairment is not as disabling, as of the last determination

44

1e. RFC

45

1f. Failure to follow prescribed treatment

46

1g. DAA materiality

47

1h. Onset of disability relative to a Title II eligibility period

C. Group I vocational documentation deficiencies

 

The vocational documentation is insufficient to determine the effect of the following on an individual's ability to engage in SGA:

51

2a. Age

52

2b. Education, literacy, or the ability to communicate in English

53

2c. Work history, including transferable skills, physical, mental, and environmental demands of past work and the relevance of past work

54

2d. Advances in medical or vocational therapy or technology when there is new medical evidence and a new RFC but no MI

55

2e. Vocational therapy

D. Group I medical evaluation deficiency involving vocational documentation

31

3. An incorrect assessment of impairment severity or RFC makes additional vocational documentation necessary to determine disability

E. Group I procedural documentation deficiencies

 

The documentation is insufficient to show conformance to prescribed procedures for a determination based on the following:

30

4a. Work activity

60

4b. Failure to obtain a prior folder or copy of the ALJ/AC ruling under an acquiescence ruling

61

4c. The prior determination was in error

62

4d. Failure to follow prescribed treatment

65

4e. Whereabouts unknown

66

4f. Failure to cooperate

F. Group I documentation deficiency involving collateral estoppel

36

5. There is insufficient documentation to determine if collateral estoppel applies, or an incorrect collateral estoppel adoption makes medical or vocational documentation necessary to determine disability on the current claim.

G. Group II period of disability decisional deficiencies

 

The case contains sufficient documentation to support a different:

71

1. Onset date

72

2. Ending date

73

3. Cessation date

H. Group II period of disability documentation deficiencies

 

The case contains insufficient documentation to support the:

81

1. Onset date

82

2. Ending date

83

3. Cessation date

85

4. Unresolved work activity that has potential to affect the period of disability


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0204440950
GN 04440.950 - Exhibit of Group I and Group II Deficiency Codes in the Office of Quality Review (OQR) Legacy System - 02/26/2014
Batch run: 02/26/2014
Rev:02/26/2014