GN 04440.118 Substitution of Judgment (SOJ) in the Quality Review (QR) Process
The title of this POMS section was revised to remove the "QR" acronym for Quality Review as this is not an acronym approved by OQR.
We retained much of the information in the existing Subsection A and added three bullets to describe when quality reviewers cite deficiencies.
We left this information as an introduction, but did not label it with a subsection letter.
We removed the reference to GN 04440.119D, because this POMS is being archived. The information from this archived section is being incorporated into GN
We moved the other hyperlinked references to Subsection F of this POMS.
In Subsection A, we:
Changed the title to "Defining SOJ".
Created a new first paragraph and bolded the entire second sentence to add emphasis to the information.
Added quality reviewer, regional office medical contractors (ROMCs, and medical advisors to identify the individuals for whom SOJ may be an issue.
Added a lead in title for the SOJ example and bolded the title.
Added a detailed example to better illustrate the concept of SOJ.
Used italics throughout the example to make it stand out and to help the reader easily see where it started and stopped.
In Subsection B, we:
We revised and reordered sentences in the first paragraph to add clarity.
In Subsection C, we:
Incorporated information from the existing GN 04440.119B., Determining Whether Substitution of Judgment (SOJ) is at Issue, into this new subsection, as GN
04440.119 is being archived.
Titled this subsection "Recognizing SOJ", as this better reflects the content.
Made editorial changes and added clarifying language and examples to the bulleted points.
Added the sentence, "Any material change to the assessment of severity or determination, or change that necessitates additional development by the adjudicating component, represents SOJ", to the last paragraph to improve clarity.
Bolded the first word "Any" in the sentence shown above to add emphasis.
In Subsection D, we:
Titled the subsection "When SOJ may be an issue".
Incorporated the information from Subsection C. of GN 04440.119 into this subsection, as GN 04440.119 is being archived at publication.
Added an example to improve clarity.
Corrected minor grammatical issues in this Subsection.
In Subsection E, we:
Titled the subsection "When SOJ is not an issue".
Incorporated the information from Subsection D. of GN 04440.119 into this Subsection, as GN 04440.119 is being archived at publication.
Added the titles of the POMS sections referenced in the first paragraph to better identify which POMS applied to group I and group II decisional deficiencies.
Removed the word "clearly" from two of the four items in the bulleted list as "clearly" is a subjective term that cannot be precisely defined.
Added a "CAUTION" to the end of this subsection to highlight and emphasize information regarding inadequate or missing determination rationales.
Added clarifying verbiage throughout the subsection to enhance clarity and corrected minor grammatical issues.
In Subsection F, we:
Titled the subsection "References".
Moved the additional hyperlinked and bulleted POMS references that are currently in Subsection A. of GN 04440.118 to this subsection.
We removed the phrase, "medical consultant's and psychological consultant's" from the second bulleted POMS reference, as "consultant" has been replaced by "contractor". We replaced it with "ROMC", which was previously defined in this POMS.