TN 4 (10-16)

DI 30007.146 Wrong Deficiency Cited

A. Introduction

A wrong deficiency situation occurs when a DQB cites one category of deficiency but program instructions support a different category.

EXAMPLE: The DQB cites a decisional deficiency, changing an allowance to a denial, but fails to identify that the DDS did not develop all allegations or medical sources. In such cases, the DDS must use the informal resolution request process (IRR, see GN 04440.401B) to request the DQB to change the deficiency to a documentation deficiency, agreeing that the evidence does not currently support an allowance, but acknowledging the DDS must develop all allegations or medical sources before making a denial determination.

EXAMPLE: The DQB cites a decisional deficiency, changing a denial to an allowance at Step 5 of sequential evaluation, but fails to identify that the DDS did not develop all past work. In such cases, the DDS must use the IRR process to request the DQB to change the deficiency to a documentation deficiency, agreeing that the evidence does not support a denial, but acknowledging the DDS must develop the past work history before making an allowance determination (see DI 25005.005D.1.).

NOTE: If the “wrong deficiency cited” issue remains unresolved by IRR, the DDS may submit the case for RPC. This is the only time DDS may submit a wrong deficiency cited case for RPC.

B. The panel identifies a Wrong Deficiency

When the RPC panel finds policy supports neither the DDS’s determination nor the DQB identified category of deficiency on the Form SSA-1774 (Request for Corrective Action), the panel will:

  • Not rescind the deficiency;

  • Determine what deficiency is appropriate to cite;

  • Determine appropriate corrective actions;

  • Return the case to the DDS with instructions to complete the corrective actions in accordance with disability policy;

  • Instruct the DQB to correct the deficiency category; and

  • Document the RPC resolution to indicate the correct deficiency citation and close the RPC submission.

NOTE: A wrong deficiency situation will not result in two deficiencies. As an example, if a DQB incorrectly cites a documentation deficiency when program instructions support a decisional deficiency, the DQB will change the documentation deficiency to a decisional deficiency, and vice versa. This results in only one deficiency, but in a different category.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0430007146
DI 30007.146 - Wrong Deficiency Cited - 10/04/2016
Batch run: 10/04/2016
Rev:10/04/2016