TN 2 (08-15)
DI 28090.055 Rationale Content – Groups I and II Exceptions
A. Exceptions in the rationale
Consider Group I exceptions when there is:
Consider Group II exceptions at any point they occur in the process.
B. Discussion of exceptions
For a Group I exception, the rationale must indicate whether there is no MI, or MI is not related to the ability to work. The rationale must also reflect consideration of the ability to engage in substantial gainful activity (SGA). For more discussion on SGA, see DI 28090.065.
If a Group II exception applies, and the evidence does not permit adjudication under another basis, discuss the relevant Group II exception(s). For a rationale example, see DI 28090.300R.
If the evidence raises a significant question as to whether a particular exception applies, but the requirement(s) of that exception are not satisfied, include a brief explanation in the rationale stating why that exception did not apply.
Whenever the exception(s) to MI are applied, the rationale must reflect the evidence that establishes the criteria for a particular exception(s). If more than one exception (or an exception(s) and MI) apply in a case, state this in the rationale. For a rationale example, see DI 28090.300J.
If no exception applies at this point in the continuing disability review (CDR) evaluation process, include a statement that no exception to MI applies and that disability continues.
DI 28005.010 The Continuing Disability Review (CDR) Evaluation Process Summary Chart for Title II and Adult Title XVI Individuals
DI 28020.001 General - Groups I and II of Exceptions to Medical Improvement
DI 28020.900 Group II Exceptions
DI 28090.065 Rationale Content - Ability to Do Substantial Gainful Activity (SGA)