Issue Preservation and Medical-Opinion Evaluation in Social Security Disability Appeals:
Commentary on Joshua Childress v. Social Security Administration, Commissioner (11th Cir., Dec. 15, 2025)

I. Introduction

This commentary analyzes the Eleventh Circuit’s unpublished, per curiam decision in Joshua Childress v. Social Security Administration, Commissioner, No. 25‑11313 (11th Cir. Dec. 15, 2025), a Social Security disability appeal arising from the Northern District of Alabama.

Although designated “NOT FOR PUBLICATION” and therefore non‑precedential under Eleventh Circuit rules, the opinion is an instructive application of:

• The “substantial evidence” standard governing judicial review of Social Security decisions;
• The post‑March 27, 2017 medical‑opinion regulations in 20 C.F.R. § 404.1520c;
• The doctrine of issue preservation and forfeiture in appellate practice; and
• The ALJ’s duty to distinguish and evaluate overlapping physical impairments (here, two distinct hernias) in formulating a Residual Functional Capacity (RFC).

Plaintiff‑Appellant Joshua Childress sought disability insurance benefits (DIB), asserting numerous impairments including back pain, morbid obesity, multiple hernias, and several mental health conditions (bipolar disorder, manic depression, anxiety, depression, panic disorder, and a specific learning disorder). An Administrative Law Judge (ALJ) found that, despite these impairments, Childress retained the capacity to perform a range of light work, and therefore was not disabled under the Social Security Act.

On appeal to the Eleventh Circuit, Childress challenged:

1. The ALJ’s treatment of his two separate hernias—arguing that the ALJ confused them and thereby minimized the severity of his condition in the RFC analysis; and
2. The ALJ’s evaluation of a physical‑capacity opinion authored by Dr. Michael Wood—arguing that the ALJ’s reasons for discounting that opinion were not supported by substantial evidence and were inconsistent with the governing regulation, 20 C.F.R. § 404.1520c.

The Eleventh Circuit affirmed, holding that the ALJ:

• Did not confuse the two hernias, and that her RFC findings were supported by substantial evidence; and
• Properly evaluated Dr. Wood’s opinion by examining “supportability” and “consistency” as required by § 404.1520c, with sufficient explanation to withstand judicial review.

The opinion is particularly notable for:

• Clarifying how a broadly stated issue in the district court preserves more specific legal arguments for appellate review; and
• Reinforcing that, under the new SSA medical‑opinion framework, ALJs need not use “magic words” but must substantively address supportability and consistency with record evidence.

II. Summary of the Opinion

A. Procedural Background

Childress applied for disability insurance benefits in February 2019. An ALJ initially denied the claim after an administrative hearing. The Appeals Council denied review, making that ALJ decision the Commissioner’s final decision under Doughty v. Apfel, 245 F.3d 1274, 1278 (11th Cir. 2001).

Childress then sought judicial review in federal district court. On the Commissioner’s unopposed motion under 42 U.S.C. § 405(g), the case was remanded for further proceedings. The Appeals Council vacated the first ALJ decision and remanded for a de novo hearing, leading to a second ALJ decision.

At the second hearing:

• Evidence showed two hernias:
  • An “incarcerated incisional” (small) hernia, later surgically repaired by Dr. Charles Newman, and
  • A “right flank” (large) hernia described by Childress as “the size of a basketball,” causing near‑constant pain.
• Dr. Michael Wood provided a Physical Capacities Form opining that Childress would need three hours per 8‑hour day lying down, sleeping, or sitting with legs elevated, but simultaneously stated that he did not expect absenteeism or off‑task behavior beyond normal breaks.
• Dr. Newman recommended and performed surgery on the smaller hernia, temporarily limiting lifting to 20 pounds for six weeks.
• Other medical records documented conservative hernia treatment (abdominal binder, over‑the‑counter pain medication) and largely normal musculoskeletal range of motion.

The ALJ, applying the five‑step sequential process of 20 C.F.R. § 404.1520:

1. Found no substantial gainful activity since the alleged onset date (step one);
2. Found several “severe” impairments (hernia, scoliosis, chronic pain disorder, hypertension, morbid obesity, depression, panic disorder, specific learning disorder) (step two);
3. Concluded no impairment met or equaled a Listing (step three);
4. Determined an RFC for light work with limitations; concluded that past relevant work was precluded (step four); and
5. Found that other jobs existed in significant numbers in the national economy that Childress could perform, based on vocational‑expert (VE) testimony (step five).

The Appeals Council again denied review; Childress again sought judicial review. The district court affirmed, rejecting his arguments relating to the RFC, Dr. Wood’s opinion, and the evaluation of his hernias. Childress then appealed to the Eleventh Circuit.

B. Issues on Appeal

The Eleventh Circuit framed two issues:

1. Whether the ALJ’s treatment of Childress’s hernias in formulating the RFC was supported by substantial evidence, or whether the ALJ confused the two hernias and discounted their severity.
2. Whether the ALJ’s analysis of Dr. Wood’s medical opinion complied with 20 C.F.R. § 404.1520c and was supported by substantial evidence.

C. Holding

The Eleventh Circuit affirmed the Commissioner’s decision. It held:

• Childress did not forfeit his general challenge to the ALJ’s treatment of his hernias, even though the specific “two‑hernia confusion” theory was first explicitly raised in his reply brief in the district court. Having preserved the broad issue that the ALJ discounted the severity of the hernias, he could develop a new legal argument on appeal explaining how that occurred.
• On the merits, the ALJ did not confuse the two hernias; she accurately distinguished them multiple times, acknowledged emergency care related to the large hernia, and relied on substantial evidence—conservative treatment, pain relief by OTC medication, and normal musculoskeletal findings—to support the RFC.
• The ALJ properly evaluated Dr. Wood’s opinion under § 404.1520c by analyzing its supportability and consistency. She reasonably found the three‑hour rest requirement unsupported by Dr. Wood’s own examination and inconsistent with contemporaneous medical records (including another report from Dr. Wood), while recognizing that his statement that Childress would not be absent or off‑task was consistent with other medical evidence (e.g., Dr. Newman’s temporary post‑surgical limitations).

III. Detailed Analysis

A. Precedents and Authorities Cited

1. Standard of Review and “Substantial Evidence”

The court reaffirmed familiar principles governing judicial review of Social Security decisions:

• Walker v. Soc. Sec. Admin., Comm'r, 987 F.3d 1333, 1338 (11th Cir. 2021): Courts review de novo the district court’s determination of whether substantial evidence supports the Commissioner’s decision, while deferring to the Commissioner’s factual findings if supported by substantial evidence.
• Foote v. Chater, 67 F.3d 1553, 1560 (11th Cir. 1995): Substantial evidence is:

  “more than a scintilla” — “such relevant evidence as a reasonable person would accept as adequate to support the conclusion.”

  The court also emphasized Foote’s requirement that all evidence—“favorable as well as unfavorable”—be considered.
• Ingram v. Comm'r of Soc. Sec. Admin., 496 F.3d 1253, 1260 (11th Cir. 2007): Substantial evidence does not require a preponderance of the evidence.
• Buckwalter v. Acting Comm'r of Soc. Sec., 5 F.4th 1315, 1320 (11th Cir. 2021): Appellate courts do not decide the facts anew, reweigh the evidence, or make credibility determinations.

These cases collectively underscore that the court’s role is narrow: it asks whether a reasonable person could have reached the ALJ’s conclusion on the record as a whole, not whether the evidence might also have supported a different outcome.

2. Finality and Appeals Council Review

Doughty v. Apfel, 245 F.3d 1274, 1278 (11th Cir. 2001) is cited for the principle that the ALJ’s decision becomes the “final decision” of the Commissioner once the Appeals Council denies review. That finality triggers the claimant’s right to seek judicial review under 42 U.S.C. § 405(g).

3. Issue Preservation and Forfeiture

The court’s discussion of forfeiture and preservation relies on a line of Eleventh Circuit authority:

• Access Now, Inc. v. Sw. Airlines Co., 385 F.3d 1324, 1330–31 (11th Cir. 2004): An issue is forfeited on appeal if:
  1. It is not prominently raised on appeal,
  2. It is raised without supporting arguments and authorities, or
  3. It is raised for the first time in a reply brief.
• Juris v. Inamed Corp., 685 F.3d 1294, 1325 (11th Cir. 2012): To preserve an issue, a party must clearly present it to the district court so that the court has an opportunity to recognize and rule on it.
• United States v. Brown, 934 F.3d 1278, 1306–07 (11th Cir. 2019): Once an issue is preserved, a party may make any argument in support of the claim on appeal; it is not confined to the precise arguments offered below.

Applying these principles, the panel held that Childress preserved the issue that the ALJ improperly discounted the severity of his hernias. Thus, he was permitted on appeal to refine that contention into a more specific claim—that the discounting occurred because the ALJ allegedly confused the two hernias—despite that more specific theory emerging first in a reply brief below. This is a meaningful reaffirmation of the distinction between:

• Preserving a broad claim or issue; and
• Being free, later on appeal, to introduce new arguments, rationales, or theories in support of that preserved issue.

4. Evaluation of Medical Opinions Under § 404.1520c

For claims filed on or after March 27, 2017, the familiar “treating physician rule” no longer applies in the Eleventh Circuit’s Social Security jurisprudence. Instead, 20 C.F.R. § 404.1520c governs:

• No special deference or controlling weight is given to any medical source, including treating physicians. § 404.1520c(a).
• ALJs must evaluate opinions based on five factors:
  1. Supportability,
  2. Consistency,
  3. Relationship with the claimant,
  4. Specialization, and
  5. Other factors.
• The most important factors are supportability and consistency. § 404.1520c(b)(2). The ALJ must articulate how these two factors were considered.
• “Supportability” focuses on how well the opinion is explained and backed by objective medical evidence. § 404.1520c(c)(1).
• “Consistency” focuses on how the opinion fits with the entire record (other medical and nonmedical evidence). § 404.1520c(c)(2).

The panel also cited Raper v. Comm'r of Soc. Sec., 89 F.4th 1261, 1276 n.14 (11th Cir. 2024), cert. denied, 145 S. Ct. 984 (2024), for the proposition that an ALJ need not:

use “magic words” when describing how medical opinions are weighed or why they are discounted.

So long as the reasoning, viewed in context, shows consideration of supportability and consistency, the decision meets the regulatory and judicial requirements.

B. The Court’s Legal Reasoning

1. Issue Preservation: Was the Hernia Argument Forfeited?

The Commissioner argued forfeiture: that Childress only claimed in his reply brief below, for the first time, that the ALJ had “confused” his two hernias. Under Access Now, a party generally cannot introduce new issues in reply. But the Eleventh Circuit drew a key distinction:

• In the district court, Childress did raise the general issue that the ALJ’s decision was not supported by substantial evidence because it discounted the severity of his hernias.
• The “confusion between two hernias” theory was simply a new argument explaining why the ALJ had discounted the severity—not a brand‑new issue.

Relying on Juris and Brown, the court held that once the overarching issue (improper treatment of the hernias) is properly preserved, the claimant may refine or expand upon it with additional legal arguments on appeal. As the panel put it:

because Childress properly raised the issue that the ALJ discounted the severity of his hernias, he may argue on appeal that this mistake occurred because the ALJ confused his two hernias.

This approach is important for appellate practitioners in Social Security cases: counsel must ensure broad issues are clearly raised in the district court, but can then develop more detailed, nuanced theories in the court of appeals without being constrained to the exact phrasing or rationale used below.

2. Substantial Evidence and the Two Hernias

On the merits, the court analyzed whether the ALJ:

1. Actually confused the two hernias; and
2. Otherwise sufficiently considered the hernias’ impact on the RFC, in light of the whole record.

a. Distinguishing the Two Hernias

The record showed:

• Dr. Newman diagnosed both an “incarcerated incisional hernia” (small, subsequently repaired) and a “right flank hernia” (large and symptomatic);
• The smaller hernia was surgically corrected, with a temporary 20‑pound lifting restriction; and
• The larger hernia caused recurrent emergency‑room visits and ongoing pain complaints (Childress claimed pain 90% of the day and serious difficulty standing, sitting, and sleeping).

The Eleventh Circuit pointed to the ALJ’s RFC discussion as evidence that she understood and separately evaluated each condition. The ALJ:

• Noted that Childress testified to having surgery for an umbilical hernia in 2021 (the smaller/incisional hernia); and
• Recognized he also had a “basketball‑sized” hernia on his right side (the larger flank hernia); and
• Accurately referenced Dr. Newman’s diagnoses of “incarcerated incisional hernia” and “right flank hernia”; and
• Acknowledged emergency‑room visits for pain related specifically to the large hernia.

Citing these references, the court rejected the assertion that the ALJ conflated the two conditions. The opinion stresses that the ALJ:

accurately differentiated between the hernias in her RFC determination nine separate times.

b. Substantial Evidence Supporting the RFC

Beyond the question of “confusion,” the court examined whether the ALJ’s conclusions about functional limitations were grounded in substantial evidence. The ALJ had noted that:

• Childress’s hernias were treated conservatively with an abdominal binder;
• His pain was relieved with over‑the‑counter medications such as ibuprofen and Tylenol, according to medical records;
• Post‑injury and follow‑up evaluations (after rib fractures) recorded a normal range of motion in the back and musculoskeletal system; and
• There were no objective findings corroborating the extreme degree of limitation that Childress alleged (e.g., pain 90% of the day preventing even basic sitting/standing).

Given the deferential substantial‑evidence standard and the prohibition against reweighing evidence, the Eleventh Circuit found the ALJ’s RFC assessment adequately supported:

the ALJ’s evaluation of Childress’s hernias in deciding his RFC is supported by all “such relevant evidence as a reasonable person would accept as adequate to support the conclusion.”

Thus, even though another factfinder might have credited Childress’s subjective complaints more fully, the court could not substitute its judgment for that of the ALJ.

3. Evaluating Dr. Wood’s Opinion Under § 404.1520c

The second major issue was whether the ALJ lawfully and reasonably evaluated the opinion of Dr. Michael Wood, who completed a Physical Capacities Form. The key tension in Dr. Wood’s opinion was:

• On the one hand, he opined that Childress would need to be lying down, sleeping, or sitting with his legs elevated for at least three hours in an eight‑hour workday.
• On the other hand, he stated that he did not expect Childress to:
  • Fail to report to work due to symptoms; or
  • Be off task while at work, except during normal breaks.

The ALJ deemed Dr. Wood’s opinion only partially persuasive, noting:

1. It was “supported with an explanation and some evidence” that aligned with the record (thus, not rejected wholesale); but
2. The three‑hour rest requirement lacked support in Dr. Wood’s own examination findings and conflicted with other record evidence.

a. Supportability Analysis

Under § 404.1520c(c)(1), the ALJ must consider how well the medical source’s opinion is supported by objective findings and explanations. Here, the ALJ concluded that:

• Dr. Wood provided some explanatory basis—he noted conditions such as obesity and a “prolapsed internal organ” (relating to the hernia); but
• The specific three‑hour rest limitation was not tied to documented exam findings showing such extreme functional limitation.

Crucially, there was another medical report authored by Dr. Wood around the same time in which:

• Childress reportedly denied symptoms that would necessitate such substantial rest breaks.

The ALJ viewed this intra‑source inconsistency as undermining the supportability of the three‑hour rest requirement.

b. Consistency Analysis

Under § 404.1520c(c)(2), the ALJ must also assess consistency with the rest of the record. The ALJ:

• Found that the three‑hour rest limitation was inconsistent with Dr. Wood’s own earlier clinical note and with other medical evidence, which:
  • Did not document disabling pain levels on examination; and
  • Showed normal musculoskeletal function and conservative treatment.
• Found that Dr. Wood’s statement that Childress should not be expected to be off task or miss work was consistent with other record evidence, such as:
  • Dr. Newman’s post‑surgical lifting restriction (20 pounds) was temporary and did not imply an inability to sustain normal work attendance or attention.

The ALJ therefore credited parts of Dr. Wood’s opinion that were consistent with the broader record, while discounting the more extreme limitations as unsupported and inconsistent.

Court’s Conclusion on Dr. Wood’s Opinion

The Eleventh Circuit held that this analysis satisfied § 404.1520c(b)(2)’s requirement to address supportability and consistency. It explicitly endorsed:

• The ALJ’s characterization that the opinion was “supported with an explanation and some evidence” but still partly inconsistent with Dr. Wood’s own findings and other evidence; and
• The ALJ’s reliance on intra‑source inconsistency (between the form and contemporaneous clinical notes) as a valid basis for discounting the more restrictive aspects of the opinion.

Invoking Raper, the court reiterated that an ALJ need not use specific formulaic phrases (“magic words”), as long as the decision, read as a whole, demonstrates consideration of the required factors. Here, that standard was met.

C. Broader Impact and Doctrinal Significance

1. Issue Preservation in Social Security Appeals

The opinion clarifies and reinforces an important point for litigants:

• What must be raised in the district court is the claim or issue (e.g., “the ALJ’s evaluation of my hernias was not supported by substantial evidence”), not every specific argument or theory that may later support that issue.
• Once the issue is preserved, a party is free on appeal to advance new or refined arguments explaining why the ALJ’s decision on that issue was wrong.

For Social Security practitioners, this means:

• District court briefing should clearly identify each challenged aspect of the ALJ’s decision (e.g., RFC assessment for particular impairments, weighing of a particular medical opinion, evaluation of subjective complaints), but
• Counsel need not foresee and articulate every conceivable sub‑argument or nuance at that stage, so long as the broad issue is placed before the court.

2. Application of the New Medical‑Opinion Framework

The decision continues the Eleventh Circuit’s transition from the former “treating physician rule” to the post‑2017 regulatory regime. Key takeaways:

• No treating source receives automatic deference. Every opinion is measured primarily by:
  • How well it is supported (objective evidence + reasoning), and
  • How consistent it is with the entire record.
• ALJs may find an opinion persuasive in part and unpersuasive in part, provided they explain which portions are supported and consistent and which are not.
• Internal inconsistency within a single doctor’s records—e.g., between a checkbox form and clinical notes—is a legitimate reason to downgrade the persuasiveness of an opinion.

This opinion illustrates that an ALJ will be upheld where:

1. She acknowledges a medical opinion’s existence and describes its key conclusions;
2. She compares those conclusions to the objective findings and other record evidence; and
3. She draws reasonable inferences to accept or reject particular limitations based on supportability and consistency.

3. RFC and Complex Physical Impairments (Multiple Hernias)

The case also demonstrates how appellate courts review RFC determinations where the claimant has multiple structural impairments of similar type (here, two hernias):

• The ALJ must show awareness of each distinct impairment—its location, treatment history, and alleged functional effects.
• However, if the ALJ’s written decision clearly references and distinguishes the impairments several times, appellate courts will not infer confusion based on isolated phrasing.
• Conservative treatment, response to medication, and normal objective findings can provide substantial evidence for an RFC that allows light work, even in the presence of subjective reports of severe, constant pain.

Practically, claimants and advocates should ensure:

• That the administrative record comprehensively documents objective consequences of each impairment; and
• That any alleged extreme limitation (e.g., needing to lie down for hours each day) is supported by consistent medical documentation and provider explanation.

4. Limits of Judicial Review

The opinion is a textbook reminder of the limited scope of judicial review in SSA cases. The court explicitly notes it will not:

• Reweigh evidence;
• Make new credibility determinations; or
• Decide the facts anew.

If reasonable minds could reach the ALJ’s conclusion, the decision must be affirmed—even if another adjudicator could have reasonably found the claimant disabled on the same record.

IV. Complex Concepts Simplified

1. “Substantial Evidence”

“Substantial evidence” does not mean “most of the evidence” or “beyond a reasonable doubt.” It means:

Enough relevant evidence that a reasonable person could agree with the ALJ’s decision.

If there is such evidence, courts must uphold the agency’s decision even if other evidence points the other way.

2. Residual Functional Capacity (RFC)

RFC is an administrative finding about what a claimant can still do on a sustained basis despite physical and mental limitations. It is expressed in terms of:

• Exertional level (sedentary, light, medium, heavy, very heavy); and
• Specific abilities and limitations (sitting, standing, walking, lifting, carrying, postural activities, mental functions, etc.).

In this case, the ALJ found Childress capable of “light work,” which typically requires:

• Standing or walking for about 6 hours in an 8‑hour workday; and
• Frequent lifting or carrying of objects up to 10 pounds and occasional lifting up to 20 pounds (subject to additional restrictions).

3. Light Work, Hernias, and Conservative Treatment

Many claimants argue that hernias and chronic pain preclude even light work. The key for SSA and the courts is how the medical record depicts:

• The severity and frequency of symptoms;
• The degree of functional restriction on examination;
• The nature of treatment (surgical vs. conservative); and
• Response to treatment (e.g., relief with routine pain medications).

Where treatment is conservative and exams are largely normal, ALJs often find claimants capable of at least light work, as occurred here.

4. “Supportability” vs. “Consistency” in Medical Opinions

Under § 404.1520c:

• Supportability looks inward: does the doctor’s opinion rest on clear medical findings (e.g., imaging, lab results, documented exam abnormalities) and thorough explanation?
• Consistency looks outward: does the opinion align or clash with other medical and nonmedical evidence (e.g., other doctors’ notes, diagnostic tests, claimant’s own reports, activities of daily living)?

An opinion may be:

• Well supported but inconsistent with the broader record (and thus less persuasive); or
• Poorly supported yet coincidentally consistent with other weak evidence (still not very persuasive); or
• Both well supported and consistent—in which case it is highly persuasive.

Here, the ALJ found Dr. Wood’s “three‑hour rest” limitation neither well supported by his own findings nor consistent with other evidence; but found his statement about attendance and on‑task behavior consistent with the record. Hence, partial persuasiveness.

5. Non‑Argument Calendar and Unpublished Status

The case was decided on the “Non‑Argument Calendar,” meaning:

• The court resolved the appeal based on the briefs without oral argument;
• This usually signals that the panel found the issues straightforward or governed by settled law.

The “NOT FOR PUBLICATION” label means:

• The decision is unpublished and not binding precedent in the Eleventh Circuit, though it may be cited as persuasive authority (subject to court rules).
• It still provides meaningful guidance on how panels are practically applying the law, especially in routine Social Security appeals.

V. Conclusion

The Eleventh Circuit’s decision in Childress, though unpublished, provides a clear, practical illustration of how appellate courts:

• Apply the substantial‑evidence standard to uphold an ALJ’s RFC determination where conservative treatment, largely normal examinations, and modest objective findings reasonably support the conclusion that a claimant can perform light work despite significant subjective complaints;
• Interpret the post‑2017 SSA medical‑opinion regulation (§ 404.1520c) to require substantive, but not formulaic, discussion of supportability and consistency, and to permit partial acceptance and partial rejection of a single physician’s opinion;
• Distinguish between preserving an issue in the district court and refining arguments on appeal, holding that once a broad challenge to the ALJ’s treatment of an impairment is properly raised, more specific theories (such as alleged confusion between two similar impairments) may be advanced later; and
• Decline invitations to reweigh evidence or substitute their judgment for the ALJ’s where a reasonable factfinder could accept the ALJ’s reading of the record.

For Social Security practitioners, Childress underscores the importance of:

• Clearly preserving each contested component of the ALJ’s decision in district court briefs;
• Developing medical records that substantively support claimed functional limitations—especially extreme limitations such as multi‑hour daily rest requirements;
• Addressing internal inconsistencies within medical opinions before they become grounds for discounting those opinions; and
• Recognizing the limited, but critical, role of appellate courts in reviewing ALJ decisions under the substantial‑evidence framework.

Although it does not create binding precedent, the opinion offers a useful roadmap for evaluating similar disputes over RFC, medical opinions, and issue preservation in Social Security disability appeals within the Eleventh Circuit.