BASIC (10-09)

A. Authority

The DDS Administrator has the authority and flexibility to design a QA function best suited to the needs of the agency and assigns roles accordingly. For additional information on the guidelines for providing a QA function, see DI 39515.001.

B. Staff roles for a DDS QA System

1. DDS Administrator

• ensures the effectiveness of the internal DDS QA system;

• establishes a system for resolving policy-issue differences between the quality assurance unit (QAU) and supervisors;

• receives synthesized analyses of data from all QA reviews;

• directs the implementation of corrective actions based on QA findings and recommendations, and,

• may establish performance standards for QAU staff.

2. Supervisor

• ensures that unit personnel meet DDS quality and processing standards;

• reviews work of the unit;

• provides feedback to examiners on the timeliness and appropriateness of their actions;

• evaluates examiners’ work at various stages of development as part of an in-line quality review approach;

• verifies that special workloads such as Presumptive Disability decisions, Quick Disability Determinations, Military Casualty Cases, and Compassionate Allowances are developed and adjudicated correctly;

• approves requests for consultative examinations;

• confirms compliance with internal referrals and procedures;

• ensures adherence to Program Operational Manual System (POMS) adjudicative guidelines;

• certifies the accuracy of determinations and decision notices;

• reviews quality feedback and individual case returns from the QAU and SSA review components; and,

• may assist in the preparation of claims to be submitted for Request for Program Consultation (RPC) referral.

3. Quality assurance unit (QAU) staff

• reviews a random sample of cases;

• reviews high-risk cases;

• undertakes special studies;

• records and provides data regarding the quality and characteristics of the cases reviewed;

• may assist in the preparation of claims to be submitted for Request for Program Consultation (RPC) referral;

• analyzes all available data on DDS performance;

• provides recommendations for improvement; and,

• may train and mentor staff.

4. Medical and Psychological Consultant (MC/PC)

• An MC or PC other than the one who completed the assessment on the case should perform the QA review.

• reviews QA sample cases with medical issues on behalf of the QAU;

• analyzes cases with medical issues returned to DDS by SSA;

• reviews special workloads and high risk cases as necessary; and,

• may conduct peer reviews.

5. Vocational Specialist (VS)

• ensures consideration of the Residual Functional Capacity (RFC) assessment with vocational factors such as age, education, training, and work experience; and,

• trains and mentors staff on vocational issues.

6. Disability Examiner (DE)

• keeps up to date on all disability program changes and resources;

• prioritizes casework;

• considers alternative courses of development;

• consults with the supervisor, QA staff, MC/PC, and VS as needed;

• records the reasoning to support the decision in the file;

• conducts a final review of the file before releasing the decision; and,

• may assist in training and mentoring new DEs.