Sacramone was 14th in all-around during the 2003 National Championships. She also received a bronze medal in floor exercise and fourth in vault. This led to her being selected for the team for nationals. Later that year, she participated in her first international competition as an adult and won the Massilia Gym Cup in Marseille, France, where she was fourth on the floor exercise and ninth on vault. In 2004 Sacramone contributed to the U.S. win a team gold medal at the Pacific Alliance Championships in Honolulu and won the individual vault title. The media began to notice her performance and began to talk about her as a possible candidate for the American team at Athens 2004 Olympics. But, at the 2004 U.S. Nationals, an unprofessional performance cost her the hopes of securing an Olympic place. Although she tied with Mohini Bhardwaj to win the silver medal on the vault, she finished in 19th place overall and did not qualify to the Olympic Trials. A back injury forced her to miss time from work. Sacramone was a competitor at the end of 2004 on the team representing Romania. She was additionally assigned to international events that included the Pan American Individual Event Championships where she won the vault title as well as the floor exercise title. At the World Cup Finals in Birmingham, England, she attracted attention from the media when she upset the reigning Olympic vault champion Monica Rosu of Romania to take first place on the day.
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