TN 10 (02-11)
DI 30005.110 General Criteria for Classifying Documentation Deficiencies
A. Introduction to documentation deficiencies and the probability of reversal rule
When a case does not contain complete medical or vocational documentation the SSA disability program policy requires, the quality reviewer must decide whether to cite a group I or group II documentation deficiency and return the case for correction or cite a technical corrective action (TCA). The quality reviewer employs the probability of reversal (POR) rule to classify medical and vocational documentation deficiencies as either a group I or group II deficiency, or a TCA.
For a further explanation of the POR rule and classifying documentation deficiencies, see GN 04440.110.
B. Policy for applying POR
1. General rule for citing a TCA
The quality reviewer cites a non-returnable TCA if the disability determination does not contain complete medical or vocational documentation the SSA disability program policy requires, but the evidence in file is sufficient for the quality reviewer to judge that the missing documentation is unlikely to:
Reverse the disability determination, or
Change the length of the period of disability,
2. General rule for citing a group I or group II documentation deficiency
When the disability determination that SSA disability program policy requires is not fully documented medically or vocationally, the quality reviewer classifies the deficiency as a group I or group II documentation deficiency and returns the case to the adjudicating component for correction unless he or she determines that the missing documentation is unlikely to:
C. Definition of the POR rule
POR is an administrative procedure, which only Federal quality reviewers may use to determine whether to cite a non-returnable medical or vocational documentation TCA; i.e., quality reviewers use it to determine when not to return a case for correction.
In order to make a POR determination, there must be sufficient medical and non-medical evidence in file (but not necessarily complete documentation under disability program policy) for the quality reviewer to make a judgment as to what level of impairment severity and residual functional capacity he or she infers from such evidence.
Adjudicating components may not use POR as a criterion for determining the adequacy of medical or vocational documentation.
For an explanation of how the quality reviewer makes POR determinations, see GN 04440.110 - GN 04440.114.
D. Policy when POR is not used
The review component does not use the POR rule in any of the following situations:
The determination is an unfavorable or less than fully favorable determination above the initial level of adjudication, or at the initial level in a prototype state.
The deficiency is a decisional deficiency.
The deficiency is a procedural documentation deficiency.
The deficiency is a 12-month medical evidence of record TCA.
The medical evidence is inadequate or there is no medical evidence.
For a more complete explanation of when the POR rule is not used, see GN 04440.112.