Do not decide MI by formally assessing current severity, and then comparing current
severity to the prior assessment made by the CPD adjudicator.
Avoid the use of such a process because, despite having no change in symptoms, signs,
and laboratory findings, this could result in a finding of MI based on substitution
Substitution of judgment example:
At CDR: The individual complains currently of back pain and is taking over-the-counter medications
because he no longer has a regular doctor. He reports difficulty standing due to the
pain, but is able to perform some light household chores. Exams show he walks with
a slight limp on the right side. Recent x-rays show mild-moderate lumbar stenosis.
Based on this evidence the current adjudicator prepares a light residual functional
capacity (RFC) assessment. The individual’s benefits are ceased because the vocational
rules indicate “not disabled”.
At CPD: The individual reported difficulty standing and walking, and was taking medicine
prescribed by his pain management doctor. X-rays showed mild-moderate stenosis. The
CPD adjudicator prepared an allowance based on a sedentary RFC due to back pain.
Discussion: In the example provided, the individual currently complains of back pain and difficulty
standing and walking, and is taking pain medications (symptoms), he walks with a limp
(signs), and x-rays (lab findings) are consistent with films from the CPD. The current
adjudicator substituted judgment (a light RFC) for that of the CPD adjudicator (a
sedentary RFC). There was no need for a current RFC assessment since the symptoms,
signs and lab findings have not significantly changed since the CPD. The current adjudicator
should have prepared a “no MI” determination.