TN 38 (07-21)

DI 28020.250 Group I Exception - New or Improved Diagnostic or Evaluative Techniques

A. Introduction to new or improved diagnostic or evaluative techniques

New or improved diagnostic or evaluative techniques show that the individual's impairment(s) is not as severe as it was previously determined in the most recent favorable medical decision.

B. How to apply the new or improved diagnostic or evaluative techniques exception

In order to apply this exception, all of the following criteria must be met:

  • Medical improvement (MI) has NOT occurred or MI is NOT related to the ability to work.

  • The new or improved diagnostic or evaluative technique must be generally available after the most recent favorable medical determination or decision.

  • The public has been notified of the new or improved technique.

  • The current evidence shows the individual is capable of engaging in substantial gainful activity or in a Title XVI childhood disability case, the child does not have an impairment(s) causing marked or severe limitations or that meets, medically equals, or functionally equals the listings.

Based on the above criteria, there will be limited situations where the exception applies. The diagnostic or evaluative procedure must be listed in the subchapter DI 33535.000.

1. New or improved techniques that may impact the disability determination

If a new or improved diagnostic or evaluative technique became generally available after the comparison point decision (CPD), consider the explanation of the techniques located in the appropriate section of DI 33535.000 and the impact of the technique on the disability determination.

2. Applying the exception

Decide whether the technique is the primary basis for showing the impairment(s) is not as disabling as previously thought. Apply the exception if the new or improved technique has an important impact on the determination as shown by the following:

  • an individual (with otherwise unchanged findings, allowed under the listing requirements) has no impairment(s) of listing severity; or

  • an individual has more functional capacity than previously thought (based on otherwise unchanged findings).

3. Referrals for review of medical diagnostic or evaluative techniques

When evidence includes results of techniques that appear newly developed or newly improved, which adjudicators have not encountered before, submit such cases (through the usual regional office channels) for consideration of adding the new technique to the cumulative list located in DI 33535.000. When submitting a technique for consideration, include a rationale explaining why the new or improved technique shows that the impairment(s) is not as disabling as previously determined.

4. Additional development

Apply the usual documentation requirements. Do not order a test or evaluation just to apply this exception. A technique listed in DI 33535.000 may be requested in a consultative examination if it is part of the usual documentation requirements for the impairment(s) involved and it is not received as part of the medical evidence of record.

C. Exclusions of the new or improved diagnostic or evaluative techniques exception

Do not apply this exception if the new or improved diagnostic or evaluative technique:

  • is not listed in DI 33535.000;

  • became generally available before the CPD, as shown in DI 33535.000; or

  • was available to the individual at the time of the CPD (as shown by CPD evidence).


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0428020250
DI 28020.250 - Group I Exception - New or Improved Diagnostic or Evaluative Techniques - 07/01/2021
Batch run: 07/01/2021
Rev:07/01/2021