The SGA exception and step 1 of the adult continuing disability review (CDR) sequential evaluation process apply only to Title II cases. The SGA exception does not apply to Title XVI cases. Title II CDR cases with work during a period of disability are subject to trial work period (TWP) and extended period of eligibility (EPE) provisions. The SGA exception applies when an individual has completed a TWP or EPE, and continues to perform SGA. The exception cannot be applied to cases involving a TWP that is in progress. See additional exclusions below in DI 28020.050C.

In the event that the SGA issue is not discovered during initial development of the CDR at step 1 of the adult CDR sequential evaluation process, the SGA exception allows the adjudicator to evaluate the issue if it is discovered later in the adjudication process. An SGA issue for a Title II beneficiary must be referred to the FO to determine if this exception applies and will not require a medical determination.

The SGA exception applies when an individual has completed a TWP or EPE, and continues to perform SGA. Only the FO can find a cessation based on SGA. Many cases that have had an SGA cessation by the FO still require a DDS determination regarding medical severity. If the FO establishes that the work is not SGA, the FO will return the file to the DDS for a medical determination, as the SGA exception will not apply.

If the beneficiary is working, the FO should document which work incentive provisions, if any, apply.

• •

  For TWP, see DI 28050.010, DDS Role in Work Activity Cases.

• •

  For EPE, see DI 28055.025, DDS Evaluation and Processing of EPE Cases.

• •

  SGA is not a basis for cessation in Title XVI cases, see DI 28075.610, Disability Determinations Services (DDS) Development and Evaluation in 1619 Cases, for additional information.

If the beneficiary is working at the time of the CDR or may have completed a TWP or EPE and the FO did not address the work situation, clearly document the need for work development and return the file to the FO to determine if the SGA exception applies. If the DDS discovers work activity during the current period of disability that was not developed by the FO for possible TWP or EPE, follow the instructions in DI 28050.010.

The SGA exception does not apply in:

1. 1. 

   TWP cases within the current period of disability;

2. 2. 

   EPE cases;

3. 3. 

   Title XVI 1619 cases; or

4. 4. 

   CDRs with less than 9 months of work activity.

NOTE: Work that a beneficiary performs during a TWP or EPE in the current period of disability review is not considered past relevant work (PRW), although the same type of work may be relevant at the CDR if it was performed within the relevant period for the CDR. See DI 25001.001A.65, Medical and Vocational Quick Reference Guide, for additional information regarding the relevant period and DI 25005.015, Determination of Capacity for Past Work-- Relevance Issues, for information on assessing PRW.

DI 28005.015 Step-by-Step Discussion of the Title II and Adult Title XVI Continuing Disability Review (CDR) Sequential Evaluation Process

DI 28050.000 Work Activity Cases Trial Work Period - Table of Contents

DI 28055.000 Extended Period of Eligibility (EPE) Cases - Table of Contents

DI 28055.015 Disabling Impairment Requirement and When to Address the Issue

DI 28075.600 Overview of the 1619 Continuing Disability Review (CDR) Process