TN 8 (04-04)

DI 30005.570 Exhibit - Group I/II Deficiency Codes

The deficiencies are listed in the same sequence as POMS DI 30005.121 DI 30005.126; the numbers on the left correspond to the defined deficiencies in those sections.

A. Group I decisional deficiencies

An incorrect decision regarding:

DICARS Code

1. Substantial gainful activity (SGA) - clear evidence the claimant is engaging in SGA

10

2. Impairment severity

11

3. Duration

12

4. Medical improvement (MI) and whether MI affects the ability to work

13

5. MI exceptions, including:

  • Whether an individual is a beneficiary of advances in medical or vocational therapy or technology,

  • Whether an individual has successfully undergone vocational therapy,

  • Whether new or improved diagnostic techniques demonstrate that an individual's impairment is not as disabling as of the last determination,

  • Whether a prior determination was made in error, or

  • Whether the prior determination was fraudulently obtained.

14

15

16

17

18

6. Residual Functional Capacity (RFC)

19

7. Evaluation of vocational factors including age, education, transferable skills, ability to do past relevant work or ability to do other work

20

8. Failure to follow prescribed treatment

21

9. Drug addiction and alcoholism (DAA) materiality

22

10. Onset of disability relative to a Title II eligibility period

23

11. Adopting a prior administrative law judge (ALJ) or appeals council (AC) finding when adjudicating a subsequent disability claim.

25

12. Collateral estoppel

26

B. Group I medical documentation deficiencies

The medical documentation is insufficient to determine:

1a. Impairment severity

41

1b. Duration

42

1c. MI, including whether MI affects the ability to work

43

1d. MI exceptions including:

  • Whether an individual is a beneficiary of advances in medical or vocational therapy or technology, or

  • Whether new or improved diagnostic techniques demonstrate that an individual's impairment is not as disabling as of the last determination

49

48

1e. RFC

44

1f. Failure to follow prescribed treatment

45

1g. DAA materiality

46

1h. Onset of disability relative to a Title II eligibility period

47

C. Group I vocational documentation deficiencies

The vocational documentation is insufficient to determine the effect of the following on an individual's ability to engage in SGA:

2a. Age

51

2b. Education, literacy, or the ability to communicate in English

52

2c. Work history including transferable skills, physical, mental and environmental demands of past work and the relevance of past work

53

2d. Advances in medical or vocational therapy or technology when there is new medical evidence and a new RFC but no MI

54

2e. Vocational therapy

55

D. Group I medical evaluation deficiency involving vocational documentation

3. An incorrect assessment of impairment severity or RFC makes additional vocational documentation necessary to determine disability

31

E. Group I procedural documentation deficiencies

The documentation is insufficient to show conformance to prescribed procedures for a determination based on the following:

4a. Prior determination in error

61

4b. Failure to follow prescribed treatment

62

4d. Whereabouts unknown

65

4e. Failure to cooperate

66

4f. Work activity

30

4g. Failure to obtain prior folder or copy of ALJ/AC ruling under an acquiescence ruling

60

F. Group I documentation deficiency - collateral estoppel involved

5. Insufficient documentation to determine if collateral estoppel applies, or an incorrect collateral estoppel adoption makes medical and/or vocational documentation necessary to determine disability on current claim.

36

G. Group II period of disability decisional deficiencies

The case contains sufficient documentation to support a different:

1. or 2. Onset date

71

3. Ending date

72

4. Cessation date

73

H. Group II period of disability documentation deficiencies

The case contains insufficient documentation to support:

1. Onset date

81

2. Ending date

82

3. Cessation date

83

4. Unresolved work activity that has potential to affect the period of disability

85


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0430005570
DI 30005.570 - Exhibit - Group I/II Deficiency Codes - 02/20/2013
Batch run: 02/20/2013
Rev:02/20/2013