Identification Number:
DI 28020 TN 37
Intended Audience:See Transmittal Sheet
Originating Office:ORDP ODP
Title:Exceptions to Medical Improvement
Type:POMS Transmittals
Program:Disability
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part DI – Disability Insurance
Chapter 280 – Continuing Disability Review Cases
Subchapter 20 – Exceptions to Medical Improvement
Transmittal No. 37, 07/22/2019

Audience

PSC: CS, DE, DEC, DTE, IES, RECONR, SCPS, TSA, TST;
OCO-OEIO: CR, ERE, FDE, RECONE;
OCO-ODO: BET, CR, CTE, CTE TE, DE, DEC, DS, PETE, PETL, RECONE;
ODD-DDS: ADJ, DHU;

Originating Component

ODP

Effective Date

Upon Receipt

Background

This is a Quick Action Transmittal. These revisions do not change or introduce new policy or procedure” under Background.

Summary of Changes

DI 28020.250 New or Improved Diagnostic or Evaluative Techniques

We are removing the examples in DI 28020.250B.4., and DI 28020.250D because they are no longer valid or pertain to policy.

DI 28020.250 New or Improved Diagnostic or Evaluative Techniques

A. Introduction to new or improved diagnostic or evaluative techniques

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

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

To apply this exception:

  • the new or improved diagnostic or evaluative technique must be generally available after the most recent favorable medical decision; and

  • the public has been notified of the new or improved technique; and

  • the current evidence shows the individual is capable of engaging in SGA; or

  • in a Title XVI childhood disability case, the child does not have an impairment that meets or equals any current listing.

1. Consideration of the impact of the technique on the disability determination

If a new or improved diagnostic or evaluative technique became generally available after the comparison point decision (CPD), consider the techniques explanation located in the appropriate section of DI 33535.001 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:

  • The 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 made to add to the list

When evidence includes results of techniques that appear newly developed or newly improved, which experienced 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 33535.001. In any such submittal, 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 33535.001 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 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 33535.001 Scope of the Subchapter - Cumulative List of Medical Diagnostic or Evaluative Techniques;

  • Became generally available before the CPD, as shown in DI 33535.001; or

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


DI 28020 TN 37 - Exceptions to Medical Improvement - 7/22/2019