TN 8 (04-04)

A. Definition - group II documentation deficiency

A group II period of disability documentation deficiency is a substantive deficiency that has the potential to affect the date when disability started, ended or ceased. The period of disability is significant because it may affect the Month of Entitlement (MOE), the Primary Insurance Amount (PIA) or the earnings freeze.

The defined group II period of disability documentation deficiencies are listed in DI 30005.126C.

B. Policy

A group II period of disability documentation deficiency exists when the file contains insufficient documentation to support the onset date, ending date or cessation date. Included in this category is failure to reopen a prior unfavorable determination or failure to consider a reopening issue when the alleged onset date (AOD) or the adjudicating component’s Established Onset Date (EOD) falls within a prior adjudicated period.

NOTE: Neither the adjudicating component, nor the review component, is responsible for determining whether the PIA, MOE, or disability freeze is actually affected; nor is this a factor in determining whether an onset date documentation deficiency exists. Onset date documentation deficiencies are based only on the potential impact of adjudicating components not following existing policy/procedure applicable to them. However, if the missing documentation involves establishing the correct day of the month, as opposed to establishing the correct month and/or year of onset, there is no potential impact on the period of disability, and no substantive deficiency exists, unless the first day of the month is involved.

C. Procedure - defined group II documentation deficiencies

1. Group II onset date documentation deficiency

Review components will cite a group II onset date documentation deficiency when the case contains insufficient documentation to support the adjudicating component's EOD. Included in this category is failure to consider a reopening issue when:

• the AOD or the adjudicating component's EOD falls within a period already adjudicated in the last unfavorable determination; and

• the prior folder is not associated with the current file.

NOTE: Review components will not cite a group II onset date documentation deficiency when the field office did not inform the adjudicating component of a prior determination, and there was no indication of a prior determination in the case file. Review components will not cite a Group II deficiency if an exact EOD is not required per DI 25501.300A.2, or the EOD meets the onset expedient criteria in DI 25501.300A.5.

2. Group II ending date documentation deficiency

Review components will cite a group II ending date documentation deficiency when an allowance case contains insufficient documentation to determine whether an open or a closed period of disability should have been established.

3. Group II cessation date documentation deficiency

Review components will cite a group II cessation date documentation deficiency when the case contains insufficient documentation to support the cessation date.

4. Group II work activity documentation deficiency

Review components will cite a group II work activity documentation deficiency when there is an unresolved work activity issue that has the potential to affect the onset date, ending date or cessation date when resolved.