DI 30005.570 Exhibit - Group I/II Deficiency Codes

The deficiencies are defined in DI 30005.202, DI 30005.203 and DI 30005.204.

A. Group I decisional deficiencies

An incorrect decision regarding:	DEFICIENCY Code
1. Substantial gainful activity (SGA) - clear evidence the claimant is engaging in SGA	10
2. Impairment severity	11
3. Duration	12
4. Medical improvement (MI) and whether MI affects the ability to work	13
5. MI exceptions, including: • Whether an individual is a beneficiary of advances in medical or vocational therapy or technology, • Whether an individual has successfully undergone vocational therapy, • Whether new or improved diagnostic techniques demonstrate that an individual's impairment is not as disabling as of the last determination, • Whether a prior determination was made in error, or • Whether the prior determination was based upon fraudulent circumstances.	14 15 16 17 18
6. Residual Functional Capacity (RFC)	19
7. Evaluation of vocational factors including age, education, transferable skills, ability to do past relevant work, or ability to do other work	20
8. Failure to follow prescribed treatment	21
9. Drug addiction and alcoholism (DAA) materiality	22
10. Onset of disability relative to a Title II eligibility period	23
11. Incorrectly adopting, or not adopting, a prior administrative law judge (ALJ) or appeals council (AC) finding when adjudicating a subsequent disability claim.	25
12. Collateral estoppel	26

B. Group I medical documentation deficiencies

The medical documentation is insufficient to determine:

1a. Impairment severity	41
1b. Duration	42
1c. MI, including whether MI affects the ability to work	43
1d. MI exceptions including: • Whether an individual is a beneficiary of advances in medical or vocational therapy or technology, or • Whether new or improved methods of diagnostic or evaluative techniques show that the individual's impairment is not as severe as it was previously determined in the most recent favorable determination	49 48
1e. RFC	44
1f. Failure to follow prescribed treatment	45
1g. DAA materiality	46
1h. Onset of disability relative to a Title II eligibility period	47

C. Group I vocational documentation deficiencies

The vocational documentation is insufficient to determine the effect of the following on an individual's ability to engage in SGA:

2a. Age	51
2b. Education or illiteracy	52
2c. Work history, including transferable skills, physical, mental, and environmental demands of past work and the relevance of past work	53
2d. Advances in medical or vocational therapy or technology when there is new medical evidence and a new RFC but no MI	54
2e. Vocational therapy	55

D. Group I medical evaluation deficiency involving vocational documentation

3. An incorrect assessment of impairment severity or RFC makes additional vocational documentation necessary to determine disability

E. Group I procedural documentation deficiencies

The documentation is insufficient to show conformance to prescribed procedures for a determination based on the following:

4a. The prior determination was in error	61
4b. Failure to follow prescribed treatment	62
4d. Whereabouts unknown	65
4e. Failure to cooperate	66
4f. Work activity	30
4g. Failure to obtain a prior folder or copy of the ALJ/AC ruling under an acquiescence ruling	60

F. Group I documentation deficiency - collateral estoppel involved

5. There is insufficient documentation to determine if collateral estoppel applies, or an incorrect collateral estoppel adoption makes medical or vocational documentation necessary to determine disability on the current claim.

G. Group II period of disability decisional deficiencies

The case contains sufficient documentation to support a different:

1. Onset date	71
2. Ending date	72
3. Cessation date	73

H. Group II period of disability documentation deficiencies

The case contains insufficient documentation to support:

1. Onset date	81
2. Ending date	82
3. Cessation date	83
4. Unresolved work activity that has potential to affect the period of disability	85

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DI 30005.570 - Exhibit - Group I/II Deficiency Codes - 09/11/2020
Batch run: 09/11/2020
Rev:09/11/2020

Social Security

Program Operations Manual System (POMS)