One of the principles of quality review is that federal quality reviewers and regional medical contractors (MC) or psychological contractors (PC) must not substitute their judgment for that of the adjudicating component's MCs, PCs, or disability examiners. Federal quality reviewers and regional MCs and PCs must be aware of the SOJ concept, as a review principle, to ensure that they do not perform de novo
case reviews. (For an explanation of de novo review, see GN 04440.003D.) Quality reviewers must be aware of SOJ, as a review principle, in potential decisional deficiency considerations.
When the adjudicating component's disability determination is compliant with SSA policy, federal quality reviewers and regional MC and PC staff must avoid substituting their judgment. In instances of SOJ, the review component will not cite a group I or group II decisional deficiency even if, after considering all the facts, they believe that the evidence directs a different determination.
The intent of the SOJ policy is to ensure that the review component does not cite a decisional deficiency, unless the adjudicating component has clearly not followed specific policy or procedure, or the evidence of record does not support the determination. If the adjudicating component's determination does not comply with SSA disability program policy, or if the evidence in a fully documented file does not support the determination, the review component will cite a group I or group II decisional deficiency.
For a complete explanation of SOJ, see GN 04440.118. For an explanation of SOJ and the medical review, see GN