TN 36 (09-15)

Citations:

20 CFR §404.1594(d)(5)

NOTE: THIS IS A FIELD OFFICE (FO) DETERMINATION, NOT FOR Disability Determination Services (DDS) USE. The DDS must return the file to the FO to apply this exception.

A. Introduction to Group I SGA exception

The SGA exception and step 1 of the continuing disability review (CDR) sequential evaluation process apply to Title II cases, subject to trial work period (TWP) and extended period of eligibility (EPE) provisions.

This exception can apply upon completion of a TWP.

B. When to consider the Group I SGA exception

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 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 28055.015, Disabling Impairment Requirement and When to Address the Issue

• Although SGA is not a basis for cessation in Title XVI cases, see DI 28075.610, DDS development and Evaluation in 1619 Cases

If the beneficiary is working and the FO did not address the work situation, return the file to the FO.

C. Exclusions to Group I SGA exception to medical improvement

The SGA exception does not apply in:

1. TWP cases;

2. EPE cases;

3. Title XVI 1619 cases; or

4. CDRs with less than 9 months of work activity

D. When the SGA Group I exception may apply

The SGA exception applies when an individual has completed TWP or EPE, and continues to perform SGA.

E. References

• DI 28005.015B1, Continuing Disability Review (CDR) Evaluation Process – Step-by-step Discussion

• DI 28050.000, Work Activity Cases Trial Work Period

• DI 28055.000, Extended Period of Eligibility (EPE) Cases

• DI 28075.600, Overview of the 1619 CDR Process