diff --git a/org.hl7.fhir.validation/src/main/java/org/hl7/fhir/r5/validation/DefaultEnableWhenEvaluator.java b/org.hl7.fhir.validation/src/main/java/org/hl7/fhir/r5/validation/DefaultEnableWhenEvaluator.java
index 158839c9c..8634c2730 100644
--- a/org.hl7.fhir.validation/src/main/java/org/hl7/fhir/r5/validation/DefaultEnableWhenEvaluator.java
+++ b/org.hl7.fhir.validation/src/main/java/org/hl7/fhir/r5/validation/DefaultEnableWhenEvaluator.java
@@ -36,7 +36,7 @@ public class DefaultEnableWhenEvaluator implements IEnableWhenEvaluator {
     
     public boolean checkConditionResults(List<EnableWhenResult> evaluationResults,
             QuestionnaireItemComponent questionnaireItem) {        
-        if (questionnaireItem.hasEnableBehavior() && questionnaireItem.getEnableBehavior() == EnableWhenBehavior.ANY){
+        if ((questionnaireItem.hasEnableBehavior() && questionnaireItem.getEnableBehavior() == EnableWhenBehavior.ANY) || evaluationResults.size() == 1){
             return evaluationResults.stream().anyMatch(EnableWhenResult::isEnabled);
         } if (questionnaireItem.hasEnableBehavior() && questionnaireItem.getEnableBehavior() == EnableWhenBehavior.ALL){
             return evaluationResults.stream().allMatch(EnableWhenResult::isEnabled);
diff --git a/org.hl7.fhir.validation/src/main/java/org/hl7/fhir/r5/validation/InstanceValidator.java b/org.hl7.fhir.validation/src/main/java/org/hl7/fhir/r5/validation/InstanceValidator.java
index cc07d481e..d42ff4b5b 100644
--- a/org.hl7.fhir.validation/src/main/java/org/hl7/fhir/r5/validation/InstanceValidator.java
+++ b/org.hl7.fhir.validation/src/main/java/org/hl7/fhir/r5/validation/InstanceValidator.java
@@ -2954,14 +2954,18 @@ private boolean isAnswerRequirementFulfilled(QuestionnaireItemComponent qItem, L
     // ok, now we have a list of known items, grouped by linkId. We"ve made an error for anything out of order
     for (QuestionnaireItemComponent qItem : qItems) {
       List<Element> mapItem = map.get(qItem.getLinkId());
-      if (mapItem != null){
-    	  rule(errors, IssueType.INVALID, element.line(), element.col(), stack.getLiteralPath(), myEnableWhenEvaluator.isQuestionEnabled(qItem, questionnaireResponseRoot), "Item has answer, even though it is not enabled (item id = '"+qItem.getLinkId()+"')");
-        validateQuestionannaireResponseItem(qsrc, qItem, errors, mapItem, stack, inProgress, questionnaireResponseRoot);
-      } else { 
-    	//item is missing, is the question enabled?
-    	if (myEnableWhenEvaluator.isQuestionEnabled(qItem, questionnaireResponseRoot)) {    	  
-    	  rule(errors, IssueType.REQUIRED, element.line(), element.col(), stack.getLiteralPath(), !qItem.getRequired(), "No response found for required item "+qItem.getLinkId());
-    	}
+      validateQuestionannaireResponseItem(qsrc, errors, element, stack, inProgress, questionnaireResponseRoot, qItem, mapItem);
+    }
+  }
+
+  public void validateQuestionannaireResponseItem(Questionnaire qsrc, List<ValidationMessage> errors, Element element, NodeStack stack, boolean inProgress, Element questionnaireResponseRoot, QuestionnaireItemComponent qItem, List<Element> mapItem) {
+    if (mapItem != null){
+      rule(errors, IssueType.INVALID, element.line(), element.col(), stack.getLiteralPath(), myEnableWhenEvaluator.isQuestionEnabled(qItem, questionnaireResponseRoot), "Item has answer, even though it is not enabled (item id = '"+qItem.getLinkId()+"')");
+      validateQuestionannaireResponseItem(qsrc, qItem, errors, mapItem, stack, inProgress, questionnaireResponseRoot);
+    } else { 
+      //item is missing, is the question enabled?
+      if (myEnableWhenEvaluator.isQuestionEnabled(qItem, questionnaireResponseRoot) && qItem.getRequired()) {    	  
+        rule(errors, IssueType.REQUIRED, element.line(), element.col(), stack.getLiteralPath(), false, "No response found for required item (item id = '"+qItem.getLinkId()+"')");
       }
     }
   }