DI 30001.010 Disability Determination Services (DDS) Quality Assurance (QA) Authority and Responsibilities
The DDS Administrator has the authority and flexibility to design a QA function best suited to the needs of the agency and assigns roles accordingly. For additional information on the guidelines for providing a QA function, see DI 39515.001.
B. Staff roles for a DDS QA System
1. DDS Administrator
ensures the effectiveness of the internal DDS QA system;
establishes a system for resolving policy-issue differences between the quality assurance unit (QAU) and supervisors;
receives synthesized analyses of data from all QA reviews;
directs the implementation of corrective actions based on QA findings and recommendations, and,
may establish performance standards for QAU staff.
ensures that unit personnel meet DDS quality and processing standards;
reviews work of the unit;
provides feedback to examiners on the timeliness and appropriateness of their actions;
evaluates examiners’ work at various stages of development as part of an in-line quality review approach;
verifies that special workloads such as Presumptive Disability decisions, Quick Disability Determinations, Military Casualty Cases, and Compassionate Allowances are developed and adjudicated correctly;
approves requests for consultative examinations;
confirms compliance with internal referrals and procedures;
ensures adherence to Program Operational Manual System (POMS) adjudicative guidelines;
certifies the accuracy of determinations and decision notices;
reviews quality feedback and individual case returns from the QAU and SSA review components; and,
may assist in the preparation of claims to be submitted for Request for Program Consultation (RPC) referral.
3. Quality assurance unit (QAU) staff
reviews a random sample of cases;
reviews high-risk cases;
undertakes special studies;
records and provides data regarding the quality and characteristics of the cases reviewed;
may assist in the preparation of claims to be submitted for Request for Program Consultation (RPC) referral;
analyzes all available data on DDS performance;
provides recommendations for improvement; and,
may train and mentor staff.
4. Medical and Psychological Consultant (MC/PC)
An MC or PC other than the one who completed the assessment on the case should perform the QA review.
reviews QA sample cases with medical issues on behalf of the QAU;
analyzes cases with medical issues returned to DDS by SSA;
reviews special workloads and high risk cases as necessary; and,
may conduct peer reviews.
5. Vocational Specialist (VS)
ensures consideration of the Residual Functional Capacity (RFC) assessment with vocational factors such as age, education, training, and work experience; and,
trains and mentors staff on vocational issues.
6. Disability Examiner (DE)
keeps up to date on all disability program changes and resources;
considers alternative courses of development;
consults with the supervisor, QA staff, MC/PC, and VS as needed;
records the reasoning to support the decision in the file;
conducts a final review of the file before releasing the decision; and,
may assist in training and mentoring new DEs.