After completing a thorough review of the entire file(s), the review component 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).
The review component 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.
The review component 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 SSA-1774-U5, 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:
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:
• GN 04440.230 Introduction to Technical Corrective Actions (TCAs)
• GN 04440.231 Substantive Technical Corrective Actions (TCAs)
• GN 04440.232 Non-substantive Technical Corrective Actions (TCAs)