DI 30005: Adjudicating Component Actions on Deficient Cases
TN 12 (09-16)
A. Reviewing component policy for rescinding or correcting deficiencies
The decision to rescind or correct a deficiency is based on whether the adjudicating component’s disability determination conformed to the Social Security Act, regulations, rulings, and the POMS as of the date of the determination. When the reviewing component agrees to rescind the deficiency following the adjudicating component’s successful rebuttal action, the reviewing component removes the deficiency from the record.
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Discovery of a wrong deficiency type in a deficient case
If the reviewing component identifies a wrong deficiency type in a case, e.g., documentation vs decisional or group I vs group II, they correct the cited deficiency to reflect the subsequently identified correct deficiency type. They record the correct deficiency type in the OQR legacy system for performance accuracy purposes. There is no rescission of the deficiency.
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Discovery of an additional deficiency type in a deficient case
If the reviewing component rescinds an incorrectly cited deficiency, any subsequently identified deficiency is not recorded in the OQR legacy system for performance accuracy purposes (i.e., a new deficiency identified by the review component during the rebuttal evaluation and resolution, unrelated to the deficiency described in the original SSA-1774-U5, Request for Corrective Action). However, any new deficiencies identified by the reviewing component during the rebuttal process must be corrected, if appropriate, or returned to the adjudicating component for correction.
See Details
GN 04440.501, Completion of the SSA-1774-U5, Request for Corrective Action
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Citing more than one deficiency on the SSA-1774-U5
If the reviewing component cites more than one deficiency on the SSA-1774-U5, Request for Corrective Action, and the adjudicating component successfully rebuts only one of the cited deficiencies, the case remains deficient and the reviewing component will not rescind the remaining deficiency.
For example, the reviewing component may cite both a medical documentation deficiency and a vocational history documentation deficiency. However, if the adjudicating component successfully rebuts the medical documentation deficiency, but the vocational history documentation deficiency remains, the reviewing component will not rescind the deficiency because the case remains deficient based on documentation.
B. Adjudicating component procedures for processing rebuttal cases
The adjudicating component prepares the rebuttal submission, and takes the following actions:
Sends the rebuttal case to the Office of Quality Review (OQR) reviewing component if the OQR rebuttal process criteria are met in GN 04440.410, or
Submits a Request for Program Consultation (RPC) if the RPC criteria are met in GN 04440.405.