BASIC (10-09)

DI 30001.010 Disability Determination Services (DDS) Quality Assurance (QA) Authority and Responsibilities

A. Authority

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.

2. Supervisor

  • 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;

  • prioritizes casework;

  • 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.

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DI 30001.010 - Disability Determination Services (DDS) Quality Assurance (Q