Identification Number:
QR 04440 TN 8
Intended Audience:OQR
Originating Office:OARO Office of Quality Review
Title:Federal Quality Review of Disability Det
Type:POMS Full Transmittals
Program:All Programs
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM

Part QR – Quality Review

Chapter 044 – Quality Appraisal

Subchapter 40 – Federal Quality Review of Disability Det

Transmittal No. 8, 07/23/2025

Originating Component

OQR

Effective Date

Upon Receipt

Background

Quality Review is moving materials from Part GN Chapter 044 to the appropriate Part QR new Chapter 044. This new section is part of a conversion series of Quality Review GN sections to the new QR Chapter 044.

Summary of Changes

QR 04440.205 Quality Review Subsequent Returns

We copied GN 04440.205 to establish QR 04440.205.

QR 04440.205 Quality Review Subsequent Returns

A. Introduction to subsequent returns

A subsequent return occurs when a review component returns a claim to an adjudicating component for additional development and/or correction, and the adjudicating component either:

  • does not complete all of the requested actions before routing the claim back to the review component, or

  • new, potentially material, issues arise because of the actions taken by the adjudicating component.

NOTE: The review component will not change the original deficiency nor cite additional deficiencies on subsequent returns.

For subsequent returns, which are precluded from the informal resolution request (IRR)/request for program consultation (RPC) process, the adjudicating may choose to contact the review component directly to discuss concerns informally prior to completion of the action(s) noted in the Request for Corrective Action form.

B. Correcting subsequent returns

When an adjudicating component does not complete all of the corrective actions delineated on the Request for Corrective Action, or when subsequent case development raises material issues, the review component will either correct the case or return the case to the adjudicating component for correction.

1. Case corrected in the review component

When the adjudicating component fully documents a case in response to a return, but the final determination, onset date, or ending date is incorrect, the review component will:

  1. a. 

    annotate all of the adjudicating component’s original determination and medical assessment forms, as well as notices, in the certified electronic folder (CEF) as “Do Not Process” or “Do Not Release”, as applicable,

  2. b. 

    code the subsequent return in the case processing system,

  3. c. 

    notify the adjudicating component, via a Request for Case Action, to explain the additional actions taken on the case, and why further corrections were needed,

  4. d. 

    either correct the onset or ending date or assume jurisdiction to correct the final determination,

  5. e. 

    prepare and release any necessary personalized notices, and

  6. f. 

    route the case to the field office.

NOTE: Do not assume jurisdiction for cases when the next level of appeal is a disability hearing at reconsideration. This includes:

  • continuing disability review medical cessations,

  • adverse reopenings of favorable initial determinations based on medical factors,

  • adverse reopenings of reconsideration reversals based on medical factors, and

  • adverse reopenings of cessations that change only the basis for the cessation.

These cases must always be returned to the adjudicating component for correction.

NOTE: All of the adjudicating component’s original determination and medical assessment forms, as well as notices, must remain in the CEF as part of the audit trail.

EXCEPTION: If the case has another deficiency or technical corrective action requiring corrective action by the adjudicating component, or changing the ending date results in an adverse reopening of either an initial or a reconsideration case, the review component will follow the instructions in GN 04440.204B.1.

2. Case returned to the adjudicating component for corrective action

When the adjudicating component’s documentation is still insufficient to make the final determination or to determine the correct onset or ending date, the review component will:

  1. a. 

    code the subsequent return in the case processing system,

  2. b. 

    notify the adjudicating component, via a new Request For Corrective Action, to acknowledge the corrective actions already completed, explain why the case is still not policy compliant, and specify what additional actions are needed,

  3. c. 

    annotate the heading of the new Request for Corrective Action, “Second Return – No Additional Deficiency Cited”,

  4. d. 

    route the case to the adjudicating component for correction as a controlled return, and

  5. e. 

    follow-up with the adjudicating component in 60 days if the corrected determination has not been returned to the review component.



QR 04440 TN 8 - Federal Quality Review of Disability Det - 7/23/2025