GN 04440: Federal Quality Review of Disability Determinations

Effective Dates: 12/20/2005 - Present

TN 8 (06-04)

A. Introduction

The adjudicating component may fail to correct the case after the first return. If the deficiency is not rebutted, a second return may be necessary.

B. Policy

If the review component disagrees with the adjudicating component corrective action and the adjudicating component does not rebut the deficiency, the review component will either:

assume jurisdiction and adjudicate the case, or
return the case to the adjudicating component again.

No additional deficiency will be cited.

C. Procedure - Review Component – Case Fully Documented

When the adjudicating component returns a case that is fully documented, and you disagree with the determination, follow the procedure in GN 04440.203C.1.-GN 04440.203C.4.

1. Initial and Reconsideration Cases – Disability Determination Incorrect

Apply the following procedure when the case is fully documented by the adjudicating component in response to the first return, but you disagree with the disability determination. Either:

Assume jurisdiction and prepare a new determination and notice;
Release the notice and effectuate the determination or route the folder to the appropriate component for effectuation;
Notify the adjudicating component of the action on the case; Or
Prepare a second SSA-1774-U5, and return the case to the adjudicating component.

NOTE: If the DHU has jurisdiction (e.g., a reconsideration affirmation of an adverse reopening), do not assume jurisdiction. Instead, return the case to the adjudicating component and ask them to route the case to the DHU. See GN 04440.310 for further instructions.

2. Initial and Reconsideration Cases – Onset and/or Ending Date Incorrect

Apply the following procedure when the case is fully documented by the adjudicating component in response to the first return, but you disagree with the onset and/or ending date determination.

Make a pen-and-ink correction to the onset or ending date.
Correct the notice, if necessary.
Release the notice and effectuate the determination, or route the folder to the appropriate component for effectuation.
Notify the adjudicating component of the action on the case.

NOTE: If the DHU has jurisdiction (e.g., a reconsideration affirmation of an adverse reopening), return the case to the adjudicating component and ask them to route the case to the DHU. See GN 04440.310 for further instructions.

3. CDR Cases - Reversal to Continuance

Apply the following procedure when the case is fully documented by the adjudicating component on the first return, but you disagree with the cessation determination, either:

Assume jurisdiction and prepare a new determination and notice;
Release the notice and effectuate the determination or route the folder to the appropriate component for effectuation; and
Notify the adjudicating component of the action on the case; Or
Prepare a second SSA-1774-U5, and return the case to the adjudicating component.

4. CDR Cases - Reversal to Cessation or Different Cessation Date

Apply the following procedure when the case is fully documented by the adjudicating component on the first return, but you disagree with the continuance determination or the cessation date.