GN 04440: Federal Quality Review of Disability Determinations
TN 14 (12-10)
The deficiencies are listed in the same sequence as in DI 30005.121 – DI 30005.126; the numbers on the left correspond to the defined deficiencies in those sections.
A. Group I decisional deficiencies
OQR Legacy System |
An incorrect decision regarding: |
---|---|
10 |
1. Substantial gainful activity (SGA) – clear evidence the claimant is engaging in SGA |
11 |
2. Impairment Severity |
12 |
3. Duration |
13 |
4. Medical improvement (MI) and whether MI affects the ability to work |
5. MI exceptions, including : | |
14 |
|
15 |
|
16 |
|
17 |
|
18 |
|
19 |
6. Residual Functional Capacity (RFC) |
20 |
7. Evaluation of vocational factors including age, education, transferable skills, ability to do past relevant work, or ability to do other work |
21 |
8. Failure to follow prescribed treatment |
22 |
9. Drug addiction and alcoholism (DAA) materiality |
23 |
10. Onset of disability, relative to a Title II eligibility period |
25 |
11. Incorrectly adopting, or not adopting a prior administrative law judge (ALJ) or appeals council (AC) finding when adjudicating a subsequent disability claim. |
26 |
12. Collateral estoppel |
B. Group I medical documentation deficiencies
The medical documentation is insufficient to determine: |
|
41 |
1a. Impairment severity |
42 |
1b. Duration |
43 |
1c. MI, including whether MI affects the ability to work |
1d. MI exceptions including: | |
49 |
|
48 |
|
44 |
1e. RFC |
45 |
1f. Failure to follow prescribed treatment |
46 |
1g. DAA materiality |
47 |
1h. Onset of disability relative to a Title II eligibility period |
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: |
|
51 |
2a. Age |
52 |
2b. Education, literacy, or the ability to communicate in English |
53 |
2c. Work history, including transferable skills, physical, mental, and environmental demands of past work and the relevance of past work |
54 |
2d. Advances in medical or vocational therapy or technology when there is new medical evidence and a new RFC but no MI |
55 |
2e. Vocational therapy |
D. Group I medical evaluation deficiency involving vocational documentation
31 |
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: |
|
30 |
4a. Work activity |
60 |
4b. Failure to obtain a prior folder or copy of the ALJ/AC ruling under an acquiescence ruling |
61 |
4c. The prior determination was in error |
62 |
4d. Failure to follow prescribed treatment |
65 |
4e. Whereabouts unknown |
66 |
4f. Failure to cooperate |
F. Group I documentation deficiency involving collateral estoppel
36 |
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: |
|
71 |
1. Onset date |
72 |
2. Ending date |
73 |
3. Cessation date |
H. Group II period of disability documentation deficiencies
The case contains insufficient documentation to support the: |
|
81 |
1. Onset date |
82 |
2. Ending date |
83 |
3. Cessation date |
85 |
4. Unresolved work activity that has potential to affect the period of disability |