Step 5: Exceptions to Medical Improvement

According to SSA regulations and the POMS, medical improvement is the primary evidence for determining if an individual is no longer disabled and able to work. If an individual does not show medical improvement or if the medical improvement is not related to his/her ability to work, then the CDR examiner should determine if an exception to medical improvement applies to the case (Step 5). SSA categorizes the exceptions into two groups, as follows: Group I a. Advances in medical or vocational therapy or technology:     The individual is a beneficiary of advances in medical or     vocational therapy or technology (related to the ability to work). b. Participation in vocational therapy: The individual has     participated in vocational therapy (education or training) since     the CPD that is related to his/her ability to work. c. New or improved diagnostic techniques: New or improved     diagnostic techniques, which became generally available after     the CPD, show that the impairment(s) is not as disabling as it     was considered to be at the time of the CPD. d. Error: The prior determination was in error. Group II e. Fraud or similar fault f. Failure to cooperate with SSA/DDS g. Unable to locate beneficiary h. Failure to follow prescribed treatment If a Group II exception is used, the individual's benefits may be ceased or suspended without a medical assessment. The following questions apply to Step 5. Please answer the questions in terms of the cases in your state.

13.	Based on your experience, over the past 24 months, in approximately how many medical CDR cases did each of the following Group I exceptions apply? (Select one answer in each row.)

		All or almost all	Most	Some	Few	None	No basis to judge
	a. Advances in medical or vocational therapy or technology
	b. Participation in vocational therapy
	c. New or improved diagnostic techniques
	d. Error

14.	If you have any recommendations for modifications to the law or policies related to the exceptions to medical improvement, please describe them in the space below.

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Full Report: GAO-07-8

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