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Federal Register / Vol. 62, No. 28 / Tuesday, February 11, 1997 / Rules and Regulations6431determination or decision as it waswritten at that time, even if it has sincebeen revised or removed from theListing of Impairments. If thatimpairment(s) does not still meet orequal the severity of that listedimpairment, we will proceed to the nextstep. If that impairment(s) still meets orequals the severity of that listedimpairment as it was written at thattime, we will find that you are stilldisabled, unless one of the exceptions tomedical improvement described inparagraphs (e) or (f) of this sectionapplies.(i) If one of the first group ofexceptions to medical improvementapplies, we will proceed to step 3.(ii) If one of the second group ofexceptions to medical improvementapplies, we may find that your disabilityhas ended.(3) Are you currently disabled? Ifthere has been medical improvement inthe impairment(s) that we considered atthe time of our most recent favorabledetermination or decision, and if thatimpairment(s) no longer meets or equalsthe severity of the listed impairmentthat it met or equaled at that time, wewill consider whether you are disabledunder the rules in §§ 416.924(c) and (d).In determining whether you arecurrently disabled, we will consider allimpairments you now have, includingyou did not have at the time of our mostrecent favorable determination ordecision, or that we did not consider atthat time. The steps in determiningcurrent disability are summarized asfollows:(i) Do you have a severe impairmentor combination of impairment? If therehas been medical improvement in yourimpairment(s), or if one of the firstgroup of exceptions applies, we willdetermine whether your currentimpairment(s) is severe, as defined in§ 416.924(c). If your impairment(s) isnot severe, we will find that yourdisability has ended. If yourimpairment(s) is severe, we will thenconsider whether it meets or medicallyequals the severity of a listedimpairment.(ii) Does your impairment(s) meet ormedically equal the severity of anyimpairment listed in appendix 1 ofsubpart P of part 404 of this chapter? Ifyour current impairment(s) meets ormedically equals the severity of anylisted impairment, as described in§§ 416.925 and 416.926, we will findthat your disability continues. If not, wewill consider whether it functionallyequals the severity of a listedimpairment.(iii) Does your impairment(s)functionally equal the severity of anylisted impairment? If your currentimpairment(s) functionally equals theseverity of any listed impairment, asdescribed in § 416.926a, we will findthat your disability continues. If not, wewill find that your disability has ended.(c) * * * Although the decrease inseverity may be of any quantity ordegree, we will disregard minor changesin your signs, symptoms, and laboratoryfindings that obviously do not representmedical improvement and could notresult in a finding that your disabilityhas ended.* * * * *(d) * * * If so, your benefits willcontinue unless one of the second groupof exceptions applies (see paragraph (f)of this section). If not, we willdetermine whether an attempt should bemade to reconstruct those portions ofthe missing file that were relevant to ourmost recent favorable determination ordecision (e.g., school records, medicalevidence from treating sources, and theresults of consultative examination).* * *(e) First group of exceptions tomedical improvement. The law providescertain limited situations when yourdisability can be found to have endedeven though medical improvement hasnot occurred, if your impairment(s) nolonger results in marked and severefunctional limitations. These exceptionsto medical improvement are intended toprovide a way of finding that a personis no longer disabled in those situationswhere, even though there has been nodecrease in severity of theimpairment(s), evidence shows that theperson should no longer be considereddisabled or never should have beenconsidered disabled. If one of theseexceptions applies, we must also showthat your impairment(s) does not nowresult in marked and severe functionallimitations, before we can find you areno longer disabled, taking all yourcurrent impairments into account, notjust those that existed at the time of ourmost recent favorable determination ordecision. The evidence we gather willserve as the basis for the finding that anexception applies.(1) Substantial evidence shows that,based on new or improved diagnostictechniques or evaluations, yourimpairment(s) is not as disabling as itwas considered to be at the time of themost recent favorable decision.Changing methodologies and advancesin medical and other diagnostictechniques or evaluations have givenrise to, and will continue to give rise to,improved methods for determining thecauses of (i.e., diagnosing) andmeasuring and documenting the effectsof various impairment on children andtheir functioning. Where, by such newor improved methods, substantialevidence shows that your impairment(s)is not as severe as was determined at thetime of our most recent favorabledecision, such evidence may serve as abasis for a finding that you are no longerdisabled, provided that you do notcurrently have an impairment(s) thatmeets or equals the severity of any listedimpairment, and therefore results inmarked and severe functionallimitations.* * * * *(f) * * * In these situations, thedetermination or decision will be madewithout a finding that you havedemonstrated medical improvement orthat you are currently not disabledunder the rules in § 416.924. * * *(4) You fail to follow prescribedtreatment which would be expected toimprove your impairment(s) so that it nolonger results in marked and severefunctional limitations. If treatment hasbeen prescribed for you which would beexpected to improve your impairment(s)so that it no longer results in markedand severe functional limitations, youmust follow that treatment in order to bepaid benefits.(g) * * *(5) The first month in which you weretold by your physician that you couldreturn to normal activities, providedthere is no substantial conflict betweenyour physician’s and your statementsregarding your awareness of yourcapacity, and the earlier date issupported by substantial evidence; or* * * * *(i) Requirement for treatment that ismedically necessary and available. Ifyou have a representative payee, therepresentative payee must, at the time ofthe continuing disability review, presentevidence demonstrating that you areand have been receiving treatment, tothe extent considered medicallynecessary and available, for thecondition(s) that was the basis forproviding you with SSI benefits, unlesswe determine that requiring yourrepresentative payee to provide suchevidence would be inappropriate orunnecessary considering the nature ofyour impairment(s). If yourrepresentative payee refuses withoutgood cause to comply with thisrequirement, and if we decide that it isin your best interests, we may pay yourbenefits to another representative payeeor to you directly.(1) What we mean by treatment thatis medically necessary. Treatment that ismedically necessary means treatmentthat is expected to improve or restore