SSA - POMS: DI 28020.100 - Group I Exception - Advances in Medical or Vocational Therapy or Technology

A. Introduction to the advances in medical or vocational therapy or technology exception to medical improvement

Advances in medical or vocational therapy or technology are improvements in treatment or rehabilitative methods that have increased the individual’s ability to do basic work activities.

In many instances, an advanced medical therapy or technology will result in a decrease in severity as shown by symptoms, signs and laboratory findings; which will meet the definition of medical improvement.

There are very limited situations in which an individual receives treatment or rehabilitative methods through medical or vocational therapy or technology and does not exhibit medical improvement (MI) or MI that is related to the ability to work. Therefore, this exception will have very limited application and should be infrequently applied.

For more information regarding the comparison of signs, symptoms and laboratory findings, see DI 28010.015, "Comparison of Symptoms, Signs, and Laboratory Findings."

For more information regarding MI and relating MI to the ability to work, see DI 28010.001, "Medical Improvement (MI)", and DI 28015.001, "Context and Scope - Relating MI to Ability to Work."

B. When the advances in medical or vocational therapy or technology exception applies

Consider this exception if all of the following criteria are satisfied:

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MI has NOT occurred or MI is NOT related to the ability to work;

•

evidence shows that the individual has benefited from services that reflect advances in medical or vocational therapy or technology; and
•

these advances have decreased the severity of the impairment(s) or the individual is able to do basic work activities.

C. How to apply the advances in medical or vocational therapy or technology exception

1. Procedure for applying the advances in medical therapy or technology exception

For the medical portion of this exception to apply, therapy or technology must relate to the ability to work. If the criteria in DI 28020.100B are met and you determine the exception applies, provide a rationale in a SSA-5002 Report of Contact or the disability determination explanation (DDE) explaining how and why the exception applies. After applying the exception, continue to the next appropriate step in the sequential evaluation process.

2. Procedure for applying the advances in vocational therapy or technology exception

If the individual has received advances in vocational therapy that have resulted in the ability to complete basic work activities, apply the exception at step 5 of the adult CDR sequential evaluation process and proceed with the remaining steps in the sequential evaluation process.

Obtain approval from the Regional Office Center for Disability and Program Support prior to cessation based on advances in vocational therapy or technology IF the disability determination services (DDS) also finds the vocational therapy exception does NOT apply. The "advances" in vocational therapy or technology exception differs from the vocational therapy exception, further described in DI 28020.150. The Regional Office Center for Disability and Program Support must review any case that the DDS adjudicator plans to cease because it appears to meet the advances in vocational therapy or technology that meets all of the following criteria:

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there is no MI -or- MI is not related to the ability to work; and
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the individual received advances in treatment or rehabilitative methods that have increased the ability to do basic work activities but the therapy did not expand the individual's vocational capacity to perform more jobs.

If both criteria above apply, then:

a)

submit a rationale to the Regional Office Center for Disability and Program Support for approval prior to cessation.
b)
the rationale must cite DI 28020.100 and clearly explain why:
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  no MI (related to the ability to work) occurred;
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  the person benefited from “advances” in treatment or rehabilitative methods; and
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  the vocational therapy exception does not apply because the individual does not have the ability to meet the vocational demands of more jobs or the advances did not change the individual's vocational profile

D. Exclusions for the advances in medical or vocational therapy or technology exception

This exception does not apply to:

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Title XVI cases where the recipient is currently eligible under section 1619 or when the beneficiary has been eligible under section 1619 within the last 12 months; or
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Title XVI child cases (as amended by PL 104-193, enacted August 22, 1996).
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Cases where MI has occurred but MI is not related to the ability to work because the beneficiary continues to meet or equal the listing that was met or equaled at the comparison point decision (CPD).
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Cases where the medical improvement review standard (MIRS) residual functional capacity (RFC) has not improved over the CPD RFC.

E. Example of advances in medical or vocational therapy or technology

1.
Advances in vocational therapy exception applies, but vocational therapy exception does not apply:

CPD: An individual was allowed at the CPD based on their anxiety and was not able to sustain a normal workweek.

Continuing disability review (CDR) decision: At CDR, evidence from the individual’s primary medical source and activities of daily living do not demonstrate medical improvement of the individual's anxiety. The individual participated in a vocational rehabilitation program and records are received from the vocational rehabilitation program. The individual underwent exposure therapy sessions using virtual reality software during the vocational rehabilitation sessions.
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  The exposure therapy took place in the office setting that included specific virtual reality situations that were triggers for the individual’s anxiety. During these sessions, the individual was under medical surveillance and spoke with the psychologist about the event demonstrated on the screen. The psychologist offered coping mechanisms in various scenarios.
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  The psychologist indicated that the exposure therapy assisted the individual in the office setting and allowed the individual to respond to hypothetical scenarios in a calm manner without triggering an anxiety episode.
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  The psychologist noted successful completion of therapy and was confident in the individual's ability to perform work in a setting with minimal interaction with the public, performing duties without strict demands or quotas.
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  The individual then attempted two jobs, each lasting no longer than one week.
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  The individual was not able to perform duties for more than one hour at a time without experiencing anxiety symptoms that prevented the individual from performing the required duties.
Explanation: In this scenario, the individual did receive advanced rehabilitative methods that increased their ability to do basic work activities, but the improvement was not significant to perform a number of jobs and did not change the individual’s vocational profile. The adjudicator will follow procedures in DI 28020.100C2.

Social Security

Program Operations Manual System (POMS)

DI 28020.100 Group I Exception - Advances in Medical or Vocational Therapy or Technology