Clarifying the Persuasiveness Standard under 20 C.F.R. § 404.1520c: Evaluating Medical Opinions Based on Supportability and Consistency

Introduction

This commentary examines the Eleventh Circuit’s decision in Eric P. Hernandez v. Social Security Administration, Commissioner, which affirms the denial of disability insurance benefits. The case arose from Hernandez’s claim that his anxiety, depression, and bipolar disorder rendered him unable to work. The Administrative Law Judge (“ALJ”) found Hernandez had marked limitations in interacting with others, but retained the capacity to work alone with limited contact. Hernandez challenged the ALJ’s refusal to credit two medical opinions that he could not interact at all with supervisors or coworkers. The key legal issue is the proper application of the SSA’s 2017 regulations—codified at 20 C.F.R. § 404.1520c—for assessing the persuasiveness of medical opinions based on supportability and consistency.

Summary of the Judgment

In a per curiam opinion, the Eleventh Circuit affirmed the district court’s upholding of the ALJ’s decision. The ALJ had:

Found that Hernandez suffered from several severe impairments, including anxiety disorder, depression, and bipolar disorder.
Determined his residual functional capacity (“RFC”) allowed medium work “alone,” defined as no public contact, only incidental coworker contact, and occasional supervisor contact.
Deemed unpersuasive two medical-source statements—one from a licensed clinical social worker and one from a consulting psychologist—that Hernandez could not interact with coworkers or supervisors at all.
Relied on the 2017 SSA regulations, emphasizing the factors of supportability and consistency in evaluating medical opinions under 20 C.F.R. § 404.1520c.

The Court held that substantial evidence supported the ALJ’s finding that the “no contact” opinions lacked support in the treatment records and were inconsistent with other evidence.

Analysis

Precedents Cited

Viverette v. Commissioner, 13 F.4th 1309 (11th Cir. 2021): Confirmed that when the Appeals Council denies review, the ALJ’s decision is treated as final.
Wilson v. Barnhart, 284 F.3d 1219 (11th Cir. 2002): Restated the substantial-evidence standard governing judicial review.
Crawford v. Commissioner, 363 F.3d 1155 (11th Cir. 2004): Defined “substantial evidence” as relevant evidence a reasonable person would accept.
Biestek v. Berryhill, 587 U.S. 97 (2019): Held that the substantial-evidence threshold in Social Security cases is not high.
Mitchell v. Commissioner, 771 F.3d 780 (11th Cir. 2014): Emphasized that courts may not reweigh evidence.
Buckwalter v. Acting Commissioner, 5 F.4th 1315 (11th Cir. 2021): Affirmed that an ALJ’s decision stands if supported by substantial evidence.
Moore v. Barnhart, 405 F.3d 1208 (11th Cir. 2005): Set forth the claimant’s burden and the five-step sequential evaluation process.
Winschel v. Commissioner, 631 F.3d 1176 (11th Cir. 2011): Described the five-step analysis and the RFC requirement.
Schink v. Commissioner, 935 F.3d 1245 (11th Cir. 2019): Clarified that the RFC is an assessment of work ability despite impairments.
Freeman v. Schweiker, 681 F.2d 727 (11th Cir. 1982): Prohibited ALJs from substituting their own medical judgment for that of medical experts.
Harner v. Social Security Administration, 38 F.4th 892 (11th Cir. 2022): Upheld the validity of the 2017 regulation abrogating the treating-physician rule for claims filed after March 27, 2017.

Legal Reasoning

The Court applied the SSA’s 2017 regulatory framework, which replaced the former “treating-physician rule” with a more flexible “persuasiveness standard” under 20 C.F.R. § 404.1520c. Key points include:

No Preset Deference: The ALJ must not defer to or assign controlling weight to any medical opinion or prior finding.
Persuasiveness Factors: The ALJ evaluates medical opinions by examining five factors—supportability, consistency, relationship with the claimant (length, purpose, frequency, extent), specialization, and “other factors.”
Primary Considerations: Supportability and consistency are the most important factors and must be expressly discussed.
- Supportability: The degree to which a medical opinion is grounded in relevant objective medical evidence and explanations.
- Consistency: The harmony between a medical opinion and evidence from other medical and nonmedical sources.
Application to the Case: The ALJ found the “no interaction” opinions unpersuasive because:
- They extended back to April 2017, yet treatment records before May 2020 were sparse and did not corroborate the severe workplace limitations.
- Neither source offered clinical observations or reasoning tying symptoms to an absolute inability to interact with coworkers or supervisors.
- Other contemporaneous evidence—mental-status examinations showing normal thought process, insight, cognition, and only mild affective symptoms—undercut the claim of total non-interaction capacity.

Impact

This decision reinforces and clarifies how ALJs must apply 20 C.F.R. § 404.1520c in evaluating medical opinions:

It underscores that treating and examining source opinions are now subject to the same “persuasiveness” analysis—no more automatic deference to treating physicians.
It highlights the paramount importance of citing specific objective support and explaining inconsistencies when discounting an opinion.
It provides a roadmap for claimants and practitioners to structure medical-opinion evidence: link opinions to documented clinical findings and anticipate scrutiny of unsupported temporal extensions.
Future appeals will likely reference Hernandez to challenge or defend opinion-weighing under the new regulatory regime.

Complex Concepts Simplified

Residual Functional Capacity (RFC): A claimant’s maximum ability to perform work activities despite impairments, assessed by the ALJ based on all evidence.
Substantial Evidence: More than a mere scintilla; evidence that a reasonable person would find adequate to support a conclusion.
Supportability: How well a medical opinion is backed by objective medical data (e.g., test results, clinical findings).
Consistency: Whether a medical opinion aligns with other record evidence (e.g., treatment notes, mental-status exams).
Marked Limitation: A serious restriction in one’s ability to function independently, appropriately, or effectively on a sustained basis.

Conclusion

The Eleventh Circuit’s decision in Hernandez affirms the SSA’s revised medical-opinion framework under 20 C.F.R. § 404.1520c, emphasizing a transparent analysis of supportability and consistency. By upholding the ALJ’s careful reasoning, the Court confirms that medical opinions unsupported by contemporaneous evidence and uncorroborated by clinical findings may be deemed unpersuasive. This precedent guides ALJs, claimants, and practitioners in preparing, presenting, and reviewing medical opinions in disability claims filed after March 27, 2017, shaping the landscape of Social Security disability adjudication for years to come.