disability determination process is inherently judgmental.
Sometimes, adjudicating and reviewing components reach different disability determinations, in a case that is fully documented per policy, after considering the same facts and evidence. In the absence of any of the three issues
listed above, a differing opinion and/or disability determination from a quality
reviewer, regional office medical contractor (ROMC), or medical advisor is SOJ and
is contrary to SSA policy.
Example of SOJ
An adjudicating component requested medical evidence, followed up with all of the
claimant's treating sources per policy guidelines, obtained a complete vocational
history, and obtained functional information from the
The case is fully documented in accordance with SSA policy.
The adjudicating component medical consultant reviewed all of the evidence in
the file and determined the claimant retained the physical capacity to lift and
carry 20 pounds occasionally and 10 pounds frequently and stand, walk, and sit 6
hours in an 8-hour workday. The adjudicating component medical consultant found no
additional limitations and explained all supporting evidence findings on the
residual functional capacity (RFC) form. This proposed assessment would result in an
The ROMC reviewed all of the evidence in the file and determined the claimant
retained the physical capacity to lift and carry 50 pounds occasionally and 25
pounds frequently. The ROMC affirmed the capacities to stand, walk, and sit for 6
hours in an 8-hour workday. This proposed assessment would result in a
The ROMC explained his or her findings, but did not indicate that the
adjudicating component medical consultant overlooked material findings or evidence
or misapplied any SSA policy. In other words, the ROMC did not provide any evidence
or policy based reason not to accept the assessment proposed by the adjudicating
component medical consultant.
The ROMC and the adjudicating component medical consultant used the same
evidence to arrive at different RFC assessments and, ultimately, different
disability determinations. This constitutes SOJ by the ROMC and is prohibited by SSA
policy. In this example, the ROMC must accept the adjudicating
component medical consultant assessment and affirm the proposed allowance.