Identification Number:
GN 04440 TN 96
Intended Audience:See Transmittal Sheet
Originating Office:OARO Office of Quality Review
Title:Federal Quality Review of Disability Determinations
Type:POMS Transmittals
Program:All Programs
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part GN – General
Chapter 044 – Quality Appraisal
Subchapter 40 – Federal Quality Review of Disability Determinations
Transmittal No. 96, 02/18/2020

Audience

PSC: DE, DEC;
OCO-OEIO: FDE;
DQB: DE, PL;
OCO-ODO: DE, DEC, DS, RECONE;

Originating Component

OQR

Effective Date

Upon Receipt

Background

This section's formatting is updated and now includes additional deficiency information.

Summary of Changes

GN 04440.946 Definitions of Group II Deficiencies

The policy sections are now in a chart so it has better readability and is more organized. Category numbers are now in the chart. The determination type related to the cited deficiency is now in the chart.

GN 04440.946 Definitions of Group II Deficiencies

For a complete explanation of group II deficiencies and the corresponding policy, refer to DI 30005.125DI 30005.126. In addition, for a complete list of deficiency codes for group I and group II deficiencies, refer to GN 04440.950 .

A. Group II decisional deficiencies

1. Onset date decisional deficiency

The evidence is sufficient to show:

OQR Legacy System Code

Determination Level(s)

The adjudicating component established an incorrect onset date (i.e., the case contains sufficient documentation to support a different onset date than the adjudicating component’s established onset date (EOD)). The correct onset date is material.

In reopening situations, cite a group II, 71 when:

  • The adjudicating component did not reopen a prior determination when they should have (even if the EOD was correct).

  • The adjudicating component did not reopen a prior determination and established the onset within a previously adjudicated period when they should have.

  • The adjudicating component correctly reopened the prior determination but established an incorrect onset date that is material.

See DI 30005.125B to determine materiality, and DI 30005.125C for more information on decisional onset date deficiencies due to reopening issues.

71

Initial

or

Reconsideration

2. Ending date decisional deficiency

The evidence is sufficient to show:

OQR Legacy System Code

Determination Level(s)

The adjudicating component established an incorrect ending date for the closed period allowance.

The adjudicating component should not have established a closed period allowance because there is sufficient evidence to show that disability did not end.

The adjudicating component should have established a closed period but did not. There is sufficient evidence supporting an ending date, rather than an open period allowance.

DI 30005.125C3

72

Initial

or

Reconsideration

3. Cessation date decisional deficiency

The evidence is sufficient to show:

OQR Legacy System Code

Determination Level(s)

The adjudicating component has established an incorrect cessation date.

DI 30005.125C4

73

Continuing disability review (CDR)

B. Group II documentation deficiencies

1. Onset date documentation deficiency

The evidence is insufficient to determine:

OQR Legacy System Code

Determination Level(s)

The adjudicating component's EOD.

 

This includes situations where the adjudicating component's EOD falls within a period previously adjudicated, and there is insufficient evidence to determine whether the prior denial determination can be reopened.

NOTE: Do not cite a Group II onset date documentation deficiency when the field office did not inform the adjudicating component of a prior determination, and there was no indication of a prior determination in the case file.

DI 30005.126C1.

81

Initial

or

Reconsideration

2. Ending date documentation deficiency

The evidence is insufficient to determine:

OQR Legacy System Code

Determination Level(s)

Whether the adjudicating component should have established an open or closed period of disability.

Whether the adjudicating component established the correct ending date in a closed period allowance.

DI 30005.126C2.

82

 

Initial

or

Reconsideration

3. Cessation date documentation deficiency

The evidence is insufficient to determine:

OQR Legacy System Code

Determination Level(s)

Whether the adjudicating component established the correct cessation date.

DI 30005.126C3.

83

CDR

4. Work activity documentation deficiency

There is unresolved work activity that could affect the:

OQR Legacy System Code

Determination Level(s)

  • Onset date,

  • Ending date, or

  • Cessation date.

 

 

DI 30005.126C4.

85

Initial

or

Reconsideration

or

CDR


GN 04440 TN 96 - Federal Quality Review of Disability Determinations - 2/18/2020