POMS Reference

GN 04440: Federal Quality Review of Disability Determinations

TN 8 (06-04)

A. Policy-Corrective Action

Group II onset date decisional deficiencies are either returned to the adjudicating component for correction or are corrected in the review component, depending upon the specifics of the case. When the review component corrects the deficiency, they will correct the onset date on the SSA-831-C3/U3.

B. Procedure-Review Component

1. Case Returned To Adjudicating Component

Return the case to the adjudicating component for correction

if:

  • the case has another deficiency or incorrect action which requires corrective action by the adjudicating component, or

  • the determination has been inadvertently effectuated. Follow GN 04440.250 in these situations.

If you return the case to the adjudicating component for correction per the above:

  • Prepare an SSA-1774-U5.

  • Request corrective action and return of the folder to the review component.

CAUTION: POTENTIAL ADVERSE REOPENING

Per DI 29001.001B.1., if the sample case is a reopening of either an initial or reconsideration determination, and correcting the onset date will result in an adverse reopening, alert the DDS to disability hearing notice requirements or DHU jurisdiction as follows:

  • If the adverse reopening is of an initial determination, the notice to the claimant must contain appeal rights to a reconsideration, including the right to a disability hearing (DI 27501.005C.3.a. and DI 29001.001B.3.a.).

  • If the adverse reopening is of a reconsideration determination which has been effectuated, the DHU has jurisdiction and the claimant is notified of the proposed revision and right to a disability hearing before the revised determination is issued (DI 29001.001B.3.b.).

Refer to DI 27501.005C.2. for procedure for reopening and revision. Refer to DI 27525.001, DI 27525.005 and DI 27540.001.for due process pre-determination notice requirements in adverse reopenings in which the onset date is revised to a later date.

NOTE: See GN 04440.250C. for adverse reopenings in sample cases that have been inadvertently effectuated prior to sample review.

2. Case Corrected In Review Component

If none of the conditions in GN 04440.220B.1. exist, correct the deficiency in the review component as follows:

  • Correct the onset date on the SSA-831-C3/U3 per GN 04440.217.

  • Correct the rationale when appropriate. See GN 04440.217B.2.

  • Code the group II onset date decisional deficiency.

  • Do not indicate a controlled return.

  • Prepare and release any necessary personalized notice.

  • Notify the adjudicating component of the deficiency.

  • Send the notification (or completed SSA-1774-U5) with a copy of the amended SSA-831-C3/U3 and SSA-4268-C4/U4 rationale.

  • Do not send the folder to the adjudicating component and do not make photocopies of the medical evidence.

  • Effectuate the determination, if possible, or send the case to the appropriate component for effectuation.

NOTE: If the DDS decides to rebut the deficiency, they may secure the original folder from the FO after effectuation.