Identification Number:
GN 04440 TN 114
Intended Audience:See Transmittal Sheet
Originating Office:OARO Office of Quality Review
Title:Federal Quality Review of Disability Determinations
Type:POMS Transmittals
Program:Disability
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part GN – General
Chapter 044 – Quality Appraisal
Subchapter 40 – Federal Quality Review of Disability Determinations
Transmittal No. 114, 07/22/2020

Audience

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

Originating Component

OQR

Effective Date

07/17/2020

Background

The Office of Quality Review (OQR) is making editorial changes and completing updates throughout the quality review sections of the POMS to improve readability, add clarity, and ensure conformance with Plain Language Guidelines.

 

Summary of Changes

GN 04440.007 Quality Review Standard

We have removed subsection A as its content is covered in GN 04440.003H.

We have removed subsection B as its content is now covered in GN 04440.201.

We have moved the content that was in subsection C, covering the use of queries by reviewers, to subsection A.

We are changing the title of the section to "Use of Queries by the Office of Quality Review (OQR)" to reflect the information in this section and to make this information easier to locate.

GN 04440.007 Use of Queries by the Office of Quality Review (OQR)

A. Work history documentation

To properly document work history, the adjudicating component must address all material inconsistencies in a claimant’s work history. The adjudicating component:

  • May use SEQY, DEQY, or DISCO queries to address material work history inconsistencies.

  • Should only obtain a query when it is likely that the information the query contains will be useful in addressing the issue at hand (e.g., a material inconsistency in the claimant’s work history or in determining if a job is relevant).

  • Must place into the case file any query obtained to address material inconsistencies in the claimant’s work history.

  • Must explain the use of a query, if obtained or referenced.

  • Must address all material inconsistencies raised by a query, regardless of the reason the adjudicating component obtained or referenced the query.

  • Must address all material inconsistencies raised by a query that the adjudicating component did not obtain but are present in the case file.

1. Procedure when there is no query referenced or in file

When there is no query referenced or in file, the review component:

  • must not obtain a query, even if it appears that information from the query could resolve a material inconsistency in the claimant’s work history;

  • should return the case when material work history inconsistencies exist, specifying for the adjudicating component the inconsistencies they must resolve and explain; and

  • must not instruct the adjudicating component to obtain a query nor specify how the adjudicating component should address any material inconsistency identified by the review component.

2. Procedure when there is a query referenced or in file

When a query referenced is in file or referenced by the adjudicating component, the review component:

  • may use the query that is already in file or identified by name (but only the same query that is in the file, or a query the adjudicating component obtained, referenced, or used) to conduct their case review; and

  • may cite deficiencies based on the information the query contains.

NOTE: If the query the adjudicating component used is not in file, identified, or clear from the case record, then the review component may use the Summary Earnings Query (SEQY), Detail Earnings Query (DEQY) or Disability Insured Status Calculator Online (DISCO) in conducting the case review and may cite deficiencies based on the information the queries contain.

See Also:

DI 22515.020 – Resolving Insufficient Vocational Evidence using a Detail Earnings Query (DEQY) or a Summary Earnings Query (SEQY)


GN 04440 TN 114 - Federal Quality Review of Disability Determinations - 7/22/2020