“Play ALJ, Not Doctor”: Eleventh Circuit Affirms ALJ’s Authority Under Post‑2017 SSA Regulations to Reject Medical Opinion Limitations Based on Supportability and Consistency

Case: Marta Rivera v. Acting Commissioner of the Social Security Administration

Court: U.S. Court of Appeals for the Eleventh Circuit (Non-Argument Calendar; Not for Publication)

Date: October 3, 2025

Docket No.: 24-13090

Panel: Circuit Judges Rosenbaum, Abudu, and Tjoflat (per curiam)

Introduction

In this Social Security appeal, the Eleventh Circuit affirmed the denial of Supplemental Security Income (SSI) to claimant Marta Rivera, clarifying the scope of an Administrative Law Judge’s (ALJ) authority when assessing residual functional capacity (RFC) under the Social Security Administration’s post‑March 27, 2017 regulations. Rivera alleged disability due to multiple physical and mental impairments, including bipolar disorder, anxiety, depression, a pacemaker, insomnia, arthritis, and neuropathy. The ALJ found she could perform “light work” with limitations and denied benefits, a decision the district court upheld. On appeal, Rivera argued that the ALJ “played doctor” by rejecting state agency consultants’ opinions limiting her to two hours of standing/walking per day.

The Eleventh Circuit held that, under 20 C.F.R. §§ 416.920c, 416.945, and 416.946, the RFC determination is reserved to the ALJ, who may find medical opinions unpersuasive where inconsistent with other record evidence and insufficiently supported. The Court reaffirmed that this does not constitute impermissible substitution of lay judgment for medical expertise when the ALJ evaluates the entire record and articulates reasons grounded in supportability and consistency.

Summary of the Opinion

The Court affirmed the Commissioner’s decision, concluding:

The ALJ did not substitute his own medical judgment for that of experts by rejecting the state agency consultants’ two-hour standing/walking limitation. Rather, he fulfilled his role by weighing the entire record and explaining why that limitation was inconsistent with other medical evidence.
Under 20 C.F.R. § 416.920c (applicable to claims filed on or after March 27, 2017), the ALJ need not defer to any medical opinion, including those of state agency consultants; the “most important” factors are supportability and consistency.
Substantial evidence—“not a high” threshold per Biestek v. Berryhill—supports the RFC for light work with additional limitations, given findings such as normal gait, full motor strength, preserved range of motion, lack of knee instability, and conservative orthopedic treatment (physical therapy and viscosupplementation rather than surgery).
Because the ALJ properly determined Rivera’s RFC and concluded she could perform past relevant work as a housekeeper (and other jobs in significant numbers), the denial of SSI was supported by substantial evidence.

Procedural and Factual Background

Rivera filed for SSI in January 2021, alleging disability from November 2020. After a hearing, the ALJ applied the five-step sequential evaluation and found she retained the RFC for light work with additional limitations. In making that determination, the ALJ:

Considered Rivera’s physical and mental impairments and her testimony regarding symptoms.
Reviewed medical records, including:
- Primary care records noting normal gait, normal range of motion in all extremities, 5/5 motor strength, and “excellent” ambulatory status.
- Orthopedic records documenting knee issues but no instability, with treatment recommendations of physical therapy and viscosupplementation rather than surgery.
Assessed medical and psychological opinions of state agency consultants as “partially persuasive,” accepting a light exertional capacity with added postural and environmental limitations but rejecting a two-hour standing/walking restriction as inconsistent with the broader record.

The Appeals Council denied review, making the ALJ’s decision final. The district court (by consent magistrate judge) affirmed. Rivera appealed, focusing on the ALJ’s treatment of the two-hour standing/walking limitation and the substantial evidence supporting the RFC.

Detailed Analysis

1) Precedents and Authorities Cited

Doughty v. Apfel, 245 F.3d 1274 (11th Cir. 2001): When the Appeals Council denies review, the ALJ’s decision is the Commissioner’s final decision for judicial review. The Court applied that framework here.
Buckwalter v. Acting Commissioner of Social Security, 5 F.4th 1315 (11th Cir. 2021): Appellate review is de novo for legal principles and for whether the decision is supported by substantial evidence. The district court’s substantial-evidence analysis is also reviewed de novo. This set the methodological lens for the Court’s review.
Biestek v. Berryhill, 587 U.S. 97, 139 S. Ct. 1148 (2019): The “substantial evidence” standard “is not high,” requiring only such relevant evidence as a reasonable mind might accept as adequate to support a conclusion. The Court invoked Biestek to emphasize deference to reasonable factfinding.
Freeman v. Schweiker, 681 F.2d 727 (11th Cir. 1982): An ALJ may not substitute his own medical opinion for that of medical experts. Rivera relied on this principle to argue the ALJ “played doctor.”
Sharfarz v. Bowen, 825 F.2d 278 (11th Cir. 1987): An ALJ may reject any medical opinion if the evidence supports a contrary finding. The Court used Sharfarz to confirm the ALJ’s authority to find medical opinions unpersuasive where inconsistent with the record.
Regulations:
- 20 C.F.R. § 416.920: Five-step sequential evaluation for disability.
- 20 C.F.R. § 416.945: RFC is the most a claimant can do despite limitations; assessed from all relevant evidence.
- 20 C.F.R. § 416.946(c): The ALJ is responsible for assessing RFC.
- 20 C.F.R. § 416.920c: For claims filed on/after March 27, 2017, no deference (including controlling weight) to any medical opinion; the most important factors are supportability and consistency.

2) Legal Reasoning

The Court’s reasoning has two central strands: assignment of decision-making responsibility and evidentiary sufficiency.

RFC determination is reserved to the ALJ: By regulation, the ALJ—not any medical source—assesses RFC, synthesizing all medical and non-medical evidence. The post‑2017 framework eliminates any hierarchical deference to medical opinions, including state agency consultants. Instead, the ALJ must consider the persuasive value of each opinion through supportability (how well the source explains and supports the opinion) and consistency (how well it accords with other record evidence).
No impermissible substitution of lay judgment: The Court distinguished prohibited “playing doctor” from permissible adjudicatory weighing. The ALJ did not invent a medical conclusion; he compared the consultants’ two-hour standing/walking restriction against objective findings—normal gait, full strength, preserved range of motion, lack of instability, and conservative treatment recommendations—and found inconsistency. That evaluative process is precisely what the regulations require.
Partial persuasiveness is acceptable: The ALJ reasonably accepted portions of the consultants’ opinions (light exertional capacity with added postural/environmental limits) while rejecting an outlier restriction that lacked support in the broader record. This granular approach is aligned with § 416.920c and longstanding Eleventh Circuit precedent permitting rejection of medical opinions if contradicted by other evidence.
Substantial evidence supports the RFC: Applying Biestek’s deferential standard, the Court held that the record contained more than adequate evidence for a reasonable mind to accept the ALJ’s conclusion. The normal objective findings and conservative orthopedic plan, taken together, reasonably undercut a two-hour total standing/walking cap and supported a light-work RFC with additional limitations.

3) Impact and Practical Implications

Although designated “not for publication” and therefore not binding precedent, the decision reflects and reinforces governing principles in the Eleventh Circuit under the post‑2017 regulations:

For ALJs: The decision underscores the importance of an evidence-integrated RFC analysis that expressly addresses supportability and consistency. ALJs may accept some restrictions and reject others within a single opinion if they articulate coherent reasons grounded in the record.
For claimants and counsel: “Playing doctor” arguments will likely fail where the ALJ ties the rejection of a medical limitation to specific objective findings and treatment records. Persuasion will turn on demonstrating that the challenged limitation is well-supported (e.g., by imaging, clinical signs, longitudinal findings) and consistent with the overall record.
For district courts: The opinion reiterates Biestek’s low threshold for substantial evidence and signals a reluctance to reweigh evidence where the ALJ has articulated reasons keyed to supportability and consistency.
For the SSA adjudicatory framework: The case illustrates the practical effect of § 416.920c’s abolition of the old “controlling weight” rule. No medical source, including state agency consultants, is presumptively dispositive; persuasiveness depends on explanation and harmony with the record.

Complex Concepts Simplified

Residual Functional Capacity (RFC): An assessment of the most a claimant can still do despite physical and mental limitations. It is a functional, not diagnostic, finding and is made by the ALJ after considering all evidence.
Light Work: A category of exertion typically involving lifting no more than 20 pounds occasionally and 10 pounds frequently, with a good deal of walking/standing or sitting with some pushing/pulling of arm or leg controls. Whether a claimant can perform light work depends on the totality of evidence.
Substantial Evidence: A deferential standard of review meaning “such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.” It is “not high” and does not allow courts to reweigh evidence.
Supportability (20 C.F.R. § 416.920c(c)(1)): How well a medical opinion is explained and supported by objective medical evidence and supporting rationale provided by the source.
Consistency (20 C.F.R. § 416.920c(c)(2)): How consistent a medical opinion is with the rest of the evidence in the record, including other medical and non-medical evidence.
“Playing Doctor” vs. Weighing Evidence: An ALJ “plays doctor” by inventing medical conclusions or ignoring uncontroverted medical evidence. By contrast, an ALJ properly weighs evidence by comparing medical opinions to objective records and articulating reasons for accepting or rejecting specific limitations.
State Agency Consultants: Non-examining medical and psychological experts who review the file at initial and reconsideration levels. Their opinions can be persuasive but are not entitled to deference under post‑2017 regulations.

Conclusion

The Eleventh Circuit affirmed the denial of SSI to Marta Rivera, holding that the ALJ acted within his regulatory mandate in determining RFC and in rejecting a specific two-hour standing/walking limitation as inconsistent with other medical evidence. Grounded in 20 C.F.R. §§ 416.920c, 416.945, and 416.946, and guided by Freeman and Sharfarz, the decision clarifies that an ALJ does not impermissibly “play doctor” by weighing medical opinions against objective findings and providing reasoned explanations. Applying Biestek’s deferential standard, the Court concluded that substantial evidence supported the light-work RFC with additional limitations and the ultimate finding of nondisability.

Key takeaway: Under the post‑2017 SSA regulations, the ALJ “plays ALJ”—not doctor—when he synthesizes the entire record, evaluates supportability and consistency, and explains why certain medical opinion limitations are unpersuasive. For claimants, the path to reversal lies in demonstrating a lack of articulated reasoning or a mismatch between the ALJ’s rationale and the objective record—not in the mere presence of a contrary medical opinion.

Note: This opinion is marked “Not for Publication.” While persuasive, it is not binding precedent in the Eleventh Circuit.