TN 3 (09-21)

DI 28090.055 Rationale Content – Groups I and II Exceptions

A. Exceptions in the rationale

Consider Group I exceptions when there is:

  • No medical improvement (MI); or

  • MI, but it is not related to the ability to work.

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 is not satisfied, include a brief explanation in the rationale stating why that exception did not apply.

Whenever the exception(s) to MI is 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) applies in a case, state this explanation 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.

C. References

  • 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 (MI)

  • DI 28020.900 Group II Exceptions

  • DI 28090.065 Rationale Content - Ability to Do Substantial Gainful Activity (SGA)

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DI 28090.055 - Rationale Content – Groups I and II Exceptions - 10/18/2011
Batch run: 09/22/2021