Effective Dates: 05/26/2023 - Present Previous | Next

TN 43 (05-23)

DI 28020.150 Group I Exception - Vocational Therapy

CITATIONS:

20 CFR §404.1594(d)(2), 20 CFR §416.994(b)(3)(ii)

A. Introduction to the vocational therapy exception

Vocational therapy (related to the individual's ability to work) includes any additional education, training, or work experience since the comparison point decision (CPD) that improves the individual's ability to meet the vocational requirements of more jobs. The vocational therapy may be vocationally significant if it prepares an individual to do a specific job or provides background to do a number of jobs in the same field. The vocational therapy exception considers vocational factors, unlike the medical and vocational concepts that apply at step 4 of the adult continuing disability review (CDR) sequential evaluation process, when considering if medical improvement (MI) relates to the ability to work.

 

B. When the vocational therapy exception applies

This exception applies when an individual receives additional education, training, or work experience since the CPD that has enhanced the individual’s vocational profile. The additional education or training is focused on a specific job type or sufficient to apply a different vocational rule, resulting in the ability to meet the vocational requirements of more jobs.

NOTE: If vocational therapy is in progress or is not complete at the time of the review, do not apply the vocational therapy exception and document this information in a SSA-5002 Report of Contact or disability determination explanation (DDE).

C. How to apply the vocational therapy exception

1. Development

a. 

Obtain documentation of the type of vocational education, training or work experience the individual received since the CPD.

b. 

Include information about the nature, extent, type, and relevance of the education, training, or work experience.

c. 

Use the available information to determine whether the vocational therapy improved the individual's ability to perform and meet the skill and ability requirements of more jobs.

d. 

The disability determination services (DDS) must follow case development responsibilities as outlined in DI 22501.002. Documentation of vocational education, training, or work experience the individual has received since the CPD may be designated on the SSA-454. Some examples of documentation that may be received from a vocational therapy program are, but not limited to:

  • •

    records from the educational or training facility;

  • •

    progress reports or notes from vocational rehabilitation sessions; or

  • •

    a certificate of completion of an education program (such as a degree or training certificate).

NOTE: Do not apply the vocational therapy exception if evidence is not sufficient to determine if the vocational therapy has resulted in the individual's improved ability to meet the vocational requirements of more jobs.

2. Documentation sample for vocational therapy

If the information required in DI 28020.150C.1. is not in the file, consider contact with a third party if one is available as defined in DI 23007.001C, such as a job or training coach, rehabilitation counselor, or other party that closely worked with the individual during the course of the individual's training to obtain detailed information relating to the vocational therapy performance. If additional documentation is obtained, this information can be recorded in a SSA-5002 Report of Contact or the DDE.

Example: A Title II beneficiary completed specialized training to repair small appliances after the CPD. The individual provided the name of the rehabilitation program and course, and provided contact information for the instructor on the SSA-454. The adjudicator contacted the instructor and obtained information regarding the length of the course, the content and nature of the training, the names of specific small appliances that the individual learned about and practiced repair of in the training environment, and a description of the individual's performance in the program. The instructor verified that the individual successfully completed the program and demonstrated a level of understanding that could be applied to vocational settings in the field. The adjudicator documented this information in a SSA-5002 Report of Contact.

3. Decision

Apply this exception if all of the following criteria are met:

  • •

    MI has NOT occurred or MI is NOT related to the ability to work;

  • •

    evidence shows that the individual has received vocational therapy; and

  • •

    the additional vocational education or training, or work experience completed since the CPD has improved the individual’s ability to meet the vocational requirements of more jobs.

If the exception applies, the adjudicator must proceed to step 6 of the adult CDR sequential evaluation process.

D. Additional considerations for the vocational therapy exception

  • •

    When this exception applies, it is not sufficient by itself to find an individual capable of engaging in substantial gainful activity (SGA). Continue to the next step of the adult CDR sequential evaluation process.

  • •

    Do not substitute judgment if the individual's vocational profile is essentially unchanged after the individual has completed the vocational therapy.

  • •

    Do not confuse this exception with the 301 work incentives provision. Under the 301 provision, if the individual is participating in an approved vocational rehabilitation program, then disability benefits may continue even though the disability has ceased. See DI 28001.040, Cases with Vocational Rehabilitation (VR) Involvement (301 Cases).

  • •

    If disability continues but the individual is currently receiving training or education, consider a vocational diary described in DI 26525.050.

E. Exclusions to the vocational therapy exception

This exception does not apply to:

  • •

    Title XVI claims where the recipient is eligible under section 1619;

  • •

    cases where the individual has been eligible under section 1619 within the last 12 months, which in concurrent Title II and Title XVI cases, could result in cessation on Title II and simultaneous continuance in Title XVI;

  • •

    Title XVI child cases; or

  • •

    cases where the CPD determination was based on meeting or equaling the Listing of Impairments and there has been no MI related to ability to work.

F. Examples of the vocational therapy exception

1. Vocational therapy exception applies

CPD: An individual with an inability to read or write was an allowance based on medical and vocational factors.

CDR decision: The individual obtained additional education and now is able to read and write.

Explanation: The additional education is sufficient to apply a different vocational rule, therefore the exception applies. The adjudicator will apply the vocational therapy exception then proceed to the next step in the adult CDR sequential evaluation process. For additional information applying the medical-vocational guidelines, see DI 25025.005B1.

2. Vocational therapy exception applies

CPD: An individual was allowed on a medical-vocational basis at the CPD because of the inability to perform other work due to physical impairments. The individual's impairment limited the individual to a sedentary level of exertion. The individual had previous work that required a medium level of exertion. Considering the individual’s age, education, and work history, a sedentary residual functional capacity (RFC) resulted in an allowance.

CDR decision: The current evidence shows no MI. The individual can still complete sedentary work. Since the last favorable decision, the individual completed a specialized training course that qualified them for a job in data processing as a computer programmer.

Explanation: The additional education has an impact on the individual's vocational profile and is focused on a specific type of job. Therefore, the vocational therapy received is related to the ability to work and this exception applies. Even though there is no change in the individual's functional capacity, the individual is now able to engage in SGA, as the work of a computer programmer is sedentary in nature and does not exceed the individual's RFC. The adjudicator will apply the exception and proceed to the next step in the adult CDR sequential evaluation process.

3. Vocational therapy exception does NOT apply

CPD: An individual with a high school education was allowed based on medical and vocational considerations.

CDR decision: After the CPD, the individual attended a technical school and received a completion certificate. The education covered multiple subjects in a relatively short period and was not specific to a particular job or skill set. The individual attempted to work part time for approximately two months after obtaining their associate degree and ultimately stopped working due to their limitations.

Explanation: This exception does not apply because the additional education is not related to the ability to work. The education is not focused on a specific type of job or skill set resulting in the ability to meet the vocational requirements of more jobs.

G. References

DI 25015.010 Education as a Vocational Factor

DI 25015.015 Work Experience as a Vocational Factor

DI 28020.100 Group I Exception - Advances in Medical or Vocational Therapy or Technology

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0428020150
DI 28020.150 - Group I Exception - Vocational Therapy - 05/26/2023
Batch run: 05/26/2023
Rev:05/26/2023