TN 36 (09-15)

Citations:

20 CFR §404.1594(d)(1) and §416.994(b)(3)(i)

A. Introduction for advances in medical or vocational therapy or technology

Advances in medical or vocational therapy or technology are improvements in treatment or rehabilitative methods that have increased the individual’s ability to do basic work activities.

In virtually every case meeting this exception, there will be medical improvement (MI) related to the ability to work. Because we consider MI and MI related steps before this exception, the exception is rarely developed and used. If this exception applies based on advances in vocational therapy or technology, the vocational therapy exception would also apply. The vocational therapy exception is in DI 28020.150. For more information regarding MI and relating MI to the ability to work, see DI 28010.001 Medical Improvement Related Issues and DI 28015.001 Context and Scope to Relate Medical Improvement (MI) to the Ability to Work.

B. Policy on when to use Group I advances in medical or vocational therapy or technology exception

1. This exception may apply when evidence shows that the individual has received services that reflect advances in medical or vocational therapy or technology; and

2. This advance has decreased the severity of the beneficiary’s impairment(s) or the beneficiary is able to do basic work activities.

C. How to apply advances in medical or vocational therapy or technology exception

1. Advances in medical therapy or technology

1. For the medical portion of this exception to apply, therapy or technology must relate to the ability to work.

2. To apply the medical portion of this exception, use the two mechanisms for relating MI to the ability to work described in DI 28015.005.

3. Do not apply this exception, if

   • MI has occurred but MI is not related to the ability to work because the beneficiary continues to meet or equal the same listings that were met or equaled at the comparison point decision (CPD); or

   • The Medical Improvement Review Standard (MIRS) residual functional capacity (RFC) has not improved over the CPD RFC.

See DI 28010.015C.2 for additional information.

2. Advances in vocational therapy or technology

Consider cases involving possible “advances” in vocational therapy or technology under the vocational therapy Group I exception located in DI 28020.150. The Group I vocational therapy exception does not require “advances” to apply the exception.

Obtain Regional Office approval prior to cessation. The Regional Office Center for Disability must review any case that the Disability Determinations Services (DDS) adjudicator plans to cease because it appears to meet the “advances in vocational therapy or technology” exception but:

• the definition of MI not related to the ability to work; or

• the vocational therapy exception does not apply

  1. Submit a rationale to the Regional Office Center for Disability for approval prior to cessation.

  2. The rationale must cite DI 28020.100 and clearly explain why:

     • No MI (related to the ability to work) occurred;

     • The vocational therapy exception does not apply; and

     • The person benefited from “advances” in therapy or technology

D. Exclusions for Group I advances in medical or vocational therapy or technology exception

This exception does not apply to:

• Title XVI cases where the recipient is currently eligible under section 1619 or if the beneficiary has been eligible under section 1619 within the last 12 months;

• Title XVI child cases (as amended by PL 104-193, enacted August 22, 1996); or

• Cases involving certain disabled widow(er)’s or surviving divorced spouses’ benefits prior to January, 1991. Consider the “medical” part of this exception, but not the “vocational” part.

E. Examples of advances in medical or vocational therapy or technology

1. When this exception applies

A new surgical procedure or prosthesis has the overall effect of increasing functional capacity, therefore, decreasing severity.

2. When this exception does NOT apply (medical advances are not related to the ability to work)

Do not apply this exception, if MI is not related to ability to work because the impairment continues to meet or equal the same listings used in the CPD. For example, if beneficiary continues to meet listing 5.05 (esophageal varices) as it appeared in 1968, then find that medical therapy or technology is not related to the ability to work.