When conducting a CDR, the disability determination services (DDS) can make a determination
to cease benefits without showing medical improvement in some situations known as
Group I and Group II exceptions, see DI 28020.001. Similar provisions reflecting the ability to engage in gainful activity (rather
than SGA), apply to a CDR that involves widow(er), surviving divorced spouse, and
childhood disability beneficiaries. FOs and processing centers (PCs) use the SGA exception
to find that a disabled individual’s disability ceases based on work activity. The
SGA exception does not apply until the individual completes an applicable trial work
period (TWP). For more information on the TWP, see DI 13010.035.
We use the MIRS in any DDS determination to determine whether the disabled individual
continues to have a disabling impairment(s) for purposes of continuing entitlement
under the work incentive provisions, such as extended period of eligibility (EPE),
extended Medicare eligibility and Title XVI Section 1619.
NOTE: Group I exceptions in DI 28020.001, do not apply to Title XVI cases when the individual is eligible under Section 1619
at the time of the continuing disability decision, or has been eligible at any time
within the last 12 months.
Do not apply the SGA exception in:
the DDS determination for medical severity during the EPE, or
any Title XVI case because if the Supplemental Security Income (SSI) recipient engages
in SGA he or she may still be eligible for benefits under the Section 1619 work incentive
provisions, see DI 13005.016.
NOTE: For more information on the procedures to the exceptions of MIRS, see DI 28020.000.