The scope of the MC or PC review includes assessing impairment severity, the RFC,
and related medical issues listed in GN 04440.130A.3a. The MC or PC review does not include assessing the accuracy of the disability determination.
The MC or PC reviews the adjudicating component's medical assessment of the facts
of the case, using the quality review standard in “Quality Review (QR) Standard”,
GN 04440.007A. The MC or PC review is not a de novo review. See the definition of a “de novo review”
in GN 04440.003D.
During the case review, OQR’s MC or PC may independently arrive at a different assessment
of impairment severity or RFC than that of the adjudicating component as long as the
adjudicating component’s assessment complies with SSA disability program policy and
the evidence in file fully supports and documents the assessment. When preparing an
independent assessment of impairment severity or RFC, OQR’s MC or PC must not substitute
For a discussion of substitution of judgment, see “Substitution of Judgment (SOJ)
in the Quality Review (QR) Process” at GN