Identification Number:
GN 04440 TN 83
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. 83, 11/22/2019

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 is a Quick Action Transmittal. These revisions do not change or introduce new policy or procedure.

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

Summary of Changes

GN 04440.425 Rescinding or Correcting Deficiencies

We made editorial changes throughout this POMS section to improve consistency, add clarity, and improve sentence structure.

We changed the lead in title from "Rescinding and Correcting Deficiencies" to "Rescinding and Correcting Deficiencies after Rebuttal".

Subsection B.:

We added the Informal Resolution Request (IRR) process and removed reference to the OQR rebuttal process.

The IRR process was implemented in October 2016. Current IRR process procedures are found in GN 04440.401.

OQR no longer samples paper cases as of December 2016. The OQR rebuttal process has been archived.

 

GN 04440.425 Rescinding or Correcting Deficiencies after Rebuttal

A. Review component policy for rescinding or correcting deficiencies after rebuttal

The decision to rescind or correct a deficiency after rebuttal is based on whether the adjudicating component’s disability determination conformed to the Social Security Act, regulations, rulings, and the POMS as of the date of the determination. When the review component agrees to rescind the deficiency following the adjudicating component’s successful rebuttal action, the review component removes the deficiency from the record.

1. Discovery of a wrong deficiency type in a deficient case

If the review component identifies a wrong deficiency type in a case, e.g., documentation vs decisional or group I vs group II, they correct the cited deficiency to reflect the subsequently identified correct deficiency type. They correct deficiency type is recorded in the OQR case processing system for performance accuracy purposes. There is no rescission of the deficiency. To ensure the correct deficiency type is recorded, the IRR web-based tool will send a system-generated email notification to the OQR Reports Branch.

2. Discovery of an additional deficiency type in a deficient case

If the review component rescinds an incorrectly cited deficiency, any subsequently identified policy deficiency is not recorded in the OQR case processing system for performance accuracy purposes (i.e., a new deficiency identified by the review component during the rebuttal evaluation and resolution, unrelated to the deficiency described in the original SSA-1774-U5, Request for Corrective Action). However, any new policy deficiencies identified by the review component during the rebuttal process must be corrected, if appropriate, or returned to the adjudicating component for correction.

See Details

GN 04440.501 Completion of the SSA-1774-U5 (Request for Corrective Action)

3. Citing more than one deficiency on the SSA-1774-U5

If the review component cites more than one policy deficient issue in the narrative of the SSA-1774-U5, Request for Corrective Action, and the adjudicating component successfully rebuts only one of the policy issues in the cited deficiency, the case remains deficient and the review component will not rescind the remaining deficiency.

For example, the review component may cite policy issues with both medical documentation and vocational history documentation in the deficiency. However, if the adjudicating component successfully rebuts the medical documentation deficiency, but the vocational history documentation deficiency remains, the review component will not rescind the deficiency because the case remains deficient based on documentation.

B. Adjudicating component procedures for processing rebuttal cases

The adjudicating component prepares the rebuttal submission, and takes the following actions:

  • submits an Informal Resolution Request (IRR) if the IRR criteria is met in GN 04440.401; or

  • submits a Request for Program Consultation (RPC) if the RPC criteria is met in GN 04440.405.

C. Review component procedures for processing rebuttal cases

The review component rescinds:

  • a group I deficiency, if the resolution is that no group I deficiency applies;

  • a group II deficiency, if the resolution is that no group II deficiency applies;

  • deficiencies in rebuttals requiring referral for resolution of policy issues only when the Office of Disability Policy (ODP), OQR, or other SSA component determines that the policy clarification was indeed necessary before the case could be adjudicated accurately.

The review component corrects, but does not rescind, the cited deficiency for:

  • group I deficiency, if the correct deficiency citation is determined to be a group II deficiency or other technical corrective action; or

  • group I or II deficiency, if the incorrect type was cited (decisional to documentation).

 

 


GN 04440 TN 83 - Federal Quality Review of Disability Determinations - 11/22/2019