TN 1 (04-89)

GN 04442.215 Correcting Deficient Railroad Disability Determinations

A. Operating Policy

1. CLASSIFIED DEFICIENCIES

Most deficient determinations are classified by the Group I, II, and III categories. These determinations are returned by the DQB to the DRS for corrective action.

2. NON-CLASSIFIED DEFICIENCIES

The DQB may find some situations with incorrect (or potentially incorrect) determinations where the deficient action is not classified by a category. In these situations, the DQB must return the claim to the DRS for corrective action but no deficiency will be cited.

B. Procedure

1. GROUP I AND II DEFICIENCIES

  1. Return all Group I and Group II deficiencies to the DRS for correction on an SSA-1774-U5.

  2. EXCEPTION: Return a Group I vocational deficiency to the DRS for correction on an SSA-5526-U3, Request for Assistance-Disability, when a DQB vocational consultant assisted the DRS in evaluating vocational aspects.

NOTE: Do not charge a deficiency.

2. TECHNICAL DEFICIENCIES

  1. Correct any technical deficiencies on the SSA-831-U5, SSA-832-U5 and SSA-833-U5.

  2. Initial the corrections.

  3. Enter a statement in the “Remarks” section that corrections were made by Chicago DQB.

3. DIAGNOSIS DEFICIENCIES

When the diagnosis in item 16 on the SSA-831-U5 or in item 17 on the SSA-833-U5 is deficient:

  1. Refer the claim to RMCS with an SSA-448, Request for Medical Advice.

  2. Request correct diagnosis.

4. ICD CODE ERRORS

When the International Classification of Diseases(ICD) code is incorrect and the diagnosis is correct:

  1. Correct the ICD code.

  2. Initial the correction.

5. WORK ACTIVITY DEFICIENCIES

Return deficient claims to the DRS. Indicate on the SSA-5526-U3 that field office (FO) action is needed to correct the deficiency.

6. NOTICE DEFICIENCIES

  1. If the notice is technically deficient, identify the deficiency directly on the notice.

  2. If the technically deficient notice is the only deficiency, return the claim to the DRS via an SSA-559. Annotate the SSA-559 “Deficient Notice, Corrected Notice Required.”

  3. Otherwise, mention the technical notice deficiency on the SSA-1774-U5 or SSA-5526-U3 being used to request corrective action on other deficiencies.

7. FORM SSA-4734-F4 DEFICIENCIES

Since RMCS provides the RFC assessment on railroad disability determinations, do not use the SSA-392-F4, Medical Consultant's Review of RFC Assessment, to review these determinations. Instead:

  1. Refer the claim directly to RMCS to prepare form SSA-4734-F4, Residual Functional Capacity Assessment.

  2. Do not send the claim back through the DRS.

8. DEFICIENCIES THAT REQUIRE FO ACTION

Return deficient claims to the DRS. Indicate on the SSA-5526-U3 that FO action is needed to correct the deficiency.

9. OTHER DEFICIENCIES

a. Diary Action

- Correct the entry on item 17 of the SSA-831-U5 or item 18 of the SSA-833-U5.

b. Vocational Rule is Applicable But Not Entered

- Enter the correct rule on the SSA-831-U5 or the SSA-833-U5.

c. Vocational Rule Not Applicable But Was Entered

- Delete the vocational rule from the SSA-831-U5 or the SSA-833-U5.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0204442215
GN 04442.215 - Correcting Deficient Railroad Disability Determinations - 02/03/1997
Batch run: 01/27/2009