A deficiency is a specified occurrence of noncompliance with Social Security Administration (SSA) policies and procedures in a disability determination. Disability Quality Review (DQR) categorizes deficiencies as either group I or group II, according to their impact, or potential impact, on the disability determination.

DQR categorizes group I and group II deficiencies as decisional or documentation.

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  Group I and group II deficiencies are categorized as decisional when a case is fully documented in accordance with SSA policy and procedures, but the adjudicating component made an incorrect determination to allow, deny, cease, continue, or establish an incorrect period of disability.

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  Group I and group II deficiencies are categorized as documentation when the case requires additional medical or vocational development of evidence to make the correct determination or to determine the correct onset, ending, or cessation date.

After completing a thorough review of the entire file(s), DQR will determine if the documentation is policy compliant and supports the adjudicating component’s disability determination. This includes ensuring the file contains reports of the individual’s medical history, physical and mental examinations, laboratory studies, any prescribed therapy, and any responses to therapy needed to establish one or more medically determinable impairments, assess severity of the impairment(s), and determine the duration of the impairment(s).

DQR will cite a deficiency if the evidence:

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  is programmatically insufficient, including establishing the correct onset, ending, and/or cessation date,

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  does not support the determination, including establishing the correct onset, ending, and/or cessation date, or

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  contradicts the determination, including establishing the correct onset, ending, and/or cessation date.

DQR will identify all issues in a case and may cite multiple deficiencies, if appropriate. The most significant deficiency will be listed as “Primary” in the Disability Determination Explanation (DDE). While “Other” deficiencies may be recorded in the case processing system, the evaluation of performance accuracy or deficiency rate is predicated solely on the “Primary” deficiency cited. Deficiencies not designated as “Primary” will not impact the performance accuracy or deficiency rate of the adjudicating component. The Request for Corrective Action will identify and explain each item in the case that is deficient.

Complete descriptions of each type of deficiency can be found in:

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  QR 04440.202 Group I Decisional Deficiencies

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  QR 04440.203 Group I Documentation Deficiencies

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  QR 04440.204 Group II Deficiencies

NOTE: Even if a case does not contain a deficiency, it may still contain one or more technical corrective actions (TCAs).

More information on identification and correction of TCAs can be found in:

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  QR 04440.230 Introduction to Technical Corrective Actions (TCAs)

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  QR 04440.231 Substantive Technical Corrective Actions (TCAs)

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  QR 04440.232 Non-substantive Technical Corrective Actions (TCAs)

When explaining the deficient element(s) in a case, DQR must support the deficiency citation with specific reference to:

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  evidence in file,

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  programmatically required evidence, (DI 22505.001 Medical and Nonmedical Evidence), and

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  specific, relevant policy to include:

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    Program Operations Manual System (POMS)

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    Emergency Messages

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    Administrative Messages

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    Regional POMS supplements (ONLY for returns to adjudicating components in that particular region)

NOTE: DQR must not use Disability Policy memoranda, PolicyNet Questions & Answers, DDS Administrators’ Letters, Request for Program Consultation resolution responses, or other similar written guidelines, to justify or explain a deficiency.