PROGRAM OPERATIONS MANUAL SYSTEMPart GN – GeneralChapter 044 – Quality AppraisalSubchapter 40 – Federal Quality Review of Disability DeterminationsTransmittal No. 96, 02/18/2020
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.
For a complete explanation of group II deficiencies and the corresponding policy, refer to DI
30005.125 – DI
30005.126. In addition, for a complete list of deficiency codes for group I and group II deficiencies, refer to GN 04440.950 .
The evidence is
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.
The evidence is sufficient to show:
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.
The adjudicating component has established an incorrect cessation date.
Continuing disability review (CDR)
The evidence is insufficient to
The adjudicating component's EOD.
Do not cite a Group II onset date documentation deficiency when the field office did not inform the adjudicating component of a prior determination, and there was no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.
The evidence is insufficient
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.
Whether the adjudicating component established the correct cessation date.
unresolved work activity
could affect the:
Ending date, or