TN 8 (04-04)

DI 30005.217 Correcting Group I SGA and Work Activity Deficiencies

A. Policy - corrective action

Group I decisional deficiencies involving clear evidence of SGA are sent to the FO for preparation of an SGA denial or cessation. Group I procedural documentation deficiencies involving work activity are sent to the FO for resolution of the work activity issue and, when appropriate, preparation of an SGA denial or cessation. See DI 30005.217B., if there is another returnable deficiency in addition to the SGA or work activity deficiency.

See GN 04440.210 and GN 04440.211 for a further explanation of FO corrective action procedures for group I work activity deficiencies.

B. Process

1. Review component action

The review component sends the case folder to the FO for corrective action and notifies the adjudicating component of the deficiency. Copies of relevant documentation supporting the deficiency are attached to the notification to the adjudicating component.

However, in the case of a procedural documentation deficiency involving work activity, if there is another deficiency that requires corrective action by the adjudicating component, the review component will send the case folder directly to the adjudicating component and ask them to contact the FO to develop the work activity. See GN 04440.211C.1.

2. FO action

The FO prepares the SGA denial or cessation, if appropriate. If the FO determines that an SGA denial or cessation is not appropriate, they will effectuate the allowance or continuance. However, if the FO determines that an SGA denial is not appropriate, and the onset date changes as a result of resolving the work activity issue, or an earlier onset date may be possible, the FO returns the case to the review component. See GN 04440.211D.3.a.

The review component will correct the onset date on the determination form if no further medical development is necessary to establish the onset date. If further medical development is needed to establish an earlier onset date, the review component will send the folder to the adjudicating component and request the additional documentation. See GN 04440.211D.3.b.

C. Procedure - DDS

1. Group I procedural documentation deficiency involving work activity and another returnable deficiency

When there is a group I procedural documentation deficiency involving work activity and another returnable deficiency, the review component will send the folder to the adjudicating component. Upon receipt of the folder from the review component:

  • Ask the FO to resolve the work issue and send their development to you.

  • Correct any other deficiency stated on the SSA-1774-U5.

  • Return the case to the review component if an SGA denial or cessation is not appropriate.

  • Send the case folder to the FO for an SGA denial or cessation, if appropriate, and notify the review component.

  • Ask the FO to send a copy of the SSA-831-C3/U3 or SSA-832/833-C3/U3 to the review component for results data input; (if preferred, the FO can notify the review component by phone or email when the determination is prepared rather than faxing or sending a copy of the SSA-831-C3/U3.)

2. Group I procedural documentation deficiency involving work activity and no other returnable deficiency

When there is a group I procedural documentation deficiency involving work activity and no other returnable deficiency, the review component will send the folder to the FO for resolution of the work activity issue. If, after the work activity issue is resolved, an SGA denial is not appropriate, and an earlier onset date may be possible, the review component will send you the folder if further medical evidence is necessary to establish the onset date.

Upon receipt of the case folder from the review component:

  • Take whatever corrective action is required as a result of FO development; e.g., develop an earlier onset date.

  • Return the corrected case to the review component.

See GN 04440.211D.3.b.


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