Harmless Error, Moderate Social Limits, and Post‑2017 Opinion Articulation: The Fifth Circuit’s Clarification in Madkins v. Bisignano

Introduction

In Madkins v. Bisignano (5th Cir. Sept. 3, 2025), the Fifth Circuit affirmed the Social Security Administration’s denial of disability benefits to claimant Elnora Madkins. The decision addresses two recurrent issues in modern Social Security appeals: (1) whether an Administrative Law Judge’s (ALJ’s) failure to explicitly discuss a state agency psychologist’s opinion requires remand, and (2) how an ALJ should assess and articulate the persuasiveness of a treating physician’s restrictive residual functional capacity (RFC) opinions under the post‑March 27, 2017 regulatory framework (20 C.F.R. § 404.1520c).

The Fifth Circuit’s opinion is significant for three reasons. First, it fortifies a harmless‑error approach to omissions in discussing medical opinions where the omitted opinion does not clearly conflict with the RFC and the claimant cannot show prejudice. Second, it confirms that, in the post‑2017 regime, ALJs need not articulate the consideration of every discrete opinion from a single medical source; a collective, single‑analysis discussion is sufficient. Third, it clarifies the practical harmony between an RFC permitting “frequent” interaction (defined as one‑third to two‑thirds of the workday under SSR 83‑10) and “moderate” social limitations assessed by a consultant—an alignment that undermined the claimant’s prejudice argument.

Summary of the Judgment

The claimant, a former machine operator with physical and mental impairments (including degenerative disc disease, osteoarthritis, carpal tunnel syndrome, depression, and anxiety), alleged disability beginning March 2018. After a prior district court remand instructing the ALJ to evaluate medical findings and opinions (including those of treating physician Dr. William Booker) under 20 C.F.R. §§ 404.1520c, 416.920c, the ALJ again denied benefits. The ALJ found severe impairments and precluded past relevant work but assessed an RFC for light work with added restrictions (e.g., lifting up to 10 pounds; occasional stooping; no ladders/ropes/scaffolds; simple, routine tasks; frequent interaction with others).

On appeal, Madkins pressed two errors: (1) the ALJ failed to consider state agency psychologist Dr. Vicki Prosser’s opinion, and (2) the ALJ insufficiently considered Dr. Booker’s opinions. The Fifth Circuit affirmed:

Any failure to discuss Dr. Prosser’s opinion was harmless because her “moderate” social limitations did not clearly conflict with the RFC’s “frequent” interaction limitation (defined in SSR 83‑10 as one‑third to two‑thirds of the workday). The claimant also forfeited a related vocational‑expert‑hypothetical argument by raising it for the first time in reply.
The ALJ’s treatment of Dr. Booker’s records and restrictive assessments was proper and supported by substantial evidence. The ALJ discussed treatment notes, acknowledged decreased spinal range of motion, reasonably found internal inconsistencies in Dr. Booker’s opinions, and weighed those opinions against competing consultative and state‑agency assessments. The ALJ also permissibly declined to adopt an “off‑task” limitation where contradicted by the broader record and inadequately supported by Dr. Booker.

Applying the substantial‑evidence standard and the prejudice requirement for procedural errors, the court affirmed the district court’s judgment for the Commissioner.

Analysis

Precedents and Authorities Cited

Keel v. Saul; Whitehead v. Colvin; Taylor v. Astrue; Salmond v. Berryhill; Garcia v. Berryhill; Masterson v. Barnhart: These cases collectively state the Fifth Circuit’s deferential substantial‑evidence review, its prohibition on re‑weighing evidence, and the limited grounds for reversal (no substantial evidence or legal error).
Kneeland v. Berryhill (2017): Under the pre‑2017 regulatory framework (20 C.F.R. § 404.1527), the Fifth Circuit vacated and remanded where the ALJ failed to address an examining physician’s opinion that clearly conflicted with the RFC. Madkins distinguishes Kneeland based on both the absence of a clear conflict and the post‑2017 regulatory framework.
Webster v. Kijakazi; Williams v. Kijakazi (unpublished): These decisions recognize the regulatory shift effective March 27, 2017. ALJs no longer give controlling or presumptive weight to treating sources; instead, they assess persuasiveness, with a focus on supportability and consistency.
SSR 83‑10; Gallant v. Heckler; Villarreal v. Colvin: SSR 83‑10 defines frequency terms used in exertional categories; “frequent” means one‑third to two‑thirds of the time. The court used this definition to calibrate the RFC’s interaction limitation against Dr. Prosser’s “moderate” social limitations.
McCray v. Kijakazi (unpublished): The court has previously deemed an ALJ’s failure to consider a reviewing physician’s opinion harmless absent prejudice—supporting the approach taken in Madkins.
Loza v. Apfel: ALJs must not cherry‑pick evidence; they must consider all record evidence—a principle the court found satisfied here.
Perez v. Bruister: Arguments raised for the first time in a reply brief are forfeited.
DeJohnette v. Berryhill: The ALJ may discount conclusory, check‑box limitations unsupported by the broader record—relevant to rejecting an “off‑task” restriction here.
20 C.F.R. §§ 404.1520(a)(4), 404.1520c, 416.920c, 404.1567(b), 416.967(b): Governing the five‑step evaluation, medical‑opinion articulation and persuasiveness (post‑2017), and exertional categories (light work).

Legal Reasoning and Application

1) Omitted Discussion of Dr. Prosser’s Opinion: Harmless Error Absent Conflict or Prejudice

The claimant argued remand was required because the ALJ did not expressly evaluate Dr. Prosser’s state‑agency psychological opinion. The Fifth Circuit assumed Dr. Prosser offered a “medical opinion” but held that any omission was harmless because her opinion did not clearly conflict with the RFC. Specifically:

Dr. Prosser rated several social and adaptive capacities as “moderately limited” and noted the claimant could interact with coworkers and supervisors on a limited basis. The opinion did not quantify the limitation.
The ALJ’s RFC limited the claimant to “frequent” interaction with others—quantified by SSR 83‑10 as one‑third to two‑thirds of the workday. The court found no clear inconsistency between nonspecific “moderate” social limitations and an RFC restricting interaction to a time‑bounded “frequent” level.
The absence of conflict undermined any showing of prejudice—a prerequisite to reversal for procedural error. The court also noted it had, in at least one unpublished case (McCray), treated a similar omission as harmless for lack of prejudice.
A late‑raised argument that the ALJ’s hypothetical to the vocational expert was flawed because it omitted Dr. Prosser’s limitations was forfeited when presented for the first time in the reply brief.

By distinguishing Kneeland—which involved a direct conflict with the RFC and the pre‑2017 hierarchy favoring examining/treating opinions—the court clarifies that, in the post‑2017 regime, an omission will not warrant remand absent a clear conflict or prejudice.

2) Treatment of Dr. Booker’s Opinions: Consistent with § 404.1520c and Supported by Substantial Evidence

The claimant contended the ALJ ignored treatment notes, failed to account for decreased spinal range of motion, and inadequately considered diagnoses, symptoms, and “off‑task” time. The Fifth Circuit rejected each contention:

Treatment notes: The ALJ discussed multiple notes (e.g., April and May 2019), including musculoskeletal findings, satisfying the obligation not to cherry‑pick. The record refuted the assertion that the ALJ ignored them.
Decreased range of motion: The ALJ recognized degenerative disc disease as a severe impairment, repeatedly referenced decreased range of motion, and tailored the RFC accordingly (light work; lift‑carry up to 10 pounds; occasional stoop; no ladders/ropes/scaffolds). The ALJ explained why he did not adopt Dr. Booker’s more restrictive limitations (e.g., sit/stand/walk about two hours total per day).
Internal inconsistency and inconsistency with the record: The ALJ found Dr. Booker’s opinions internally inconsistent across time (e.g., changes in twisting and stair‑climbing limitations without explanation) and inconsistent with other evidence, such as Cooperative Disability Investigations observations (claimant bending to pick up a pen) and consultative/state‑agency assessments (Drs. Eason, James, and Kossman). This aligns with § 404.1520c’s focus on supportability and consistency.
Diagnoses and symptoms; articulation duty: The ALJ was not required to address “each medical opinion or prior administrative medical finding” from the same source individually. Section 404.1520c(b)(1) expressly permits a single analysis of all opinions from a source. The ALJ’s decision reflected consideration of Dr. Booker’s views and mirrored his major diagnoses and symptoms in the severe‑impairment findings. Any gap was not shown to prejudice the claimant.
“Off‑task” time: Dr. Booker opined the claimant would be off task 25% of the day. The ALJ reasonably declined to adopt this limitation given contrary evidence (e.g., the claimant repeatedly denied concentration problems; consultative and state‑agency psychologists reported adequate concentration over two‑hour blocks), and the absence of explanation or supporting narrative accompanying the check‑box estimation—an approach consistent with DeJohnette.

On balance, substantial evidence—including the detailed functional findings of Drs. Eason, James, and Kossman—supported an RFC at the light level with additional limitations. The court emphasized that conflicts in the medical record are for the ALJ to resolve; appellate courts do not re‑weigh.

Impact and Forward‑Looking Significance

Harmless error for omitted opinions: The decision reinforces a practical rule for post‑2017 cases—failing to explicitly discuss a medical opinion will not require remand unless the omission conceals a clear, outcome‑determinative conflict with the RFC or otherwise prejudices the claimant. This aligns with the prejudice requirement from Jones v. Astrue and the court’s prior unpublished disposition in McCray.
Moderate social limits vs. “frequent” interaction: By pairing “moderate” social limitations with an RFC allowing “frequent” interaction (one‑third to two‑thirds of the day), the court signals that “moderate” restrictions may be compatible with significant, but not unlimited, workplace interaction—especially where the consultant did not quantify the limitation. Practitioners should supply quantitative or narrative specificity if they contend a “moderate” limitation precludes “frequent” interaction.
Post‑2017 articulation standard: The court gives force to § 404.1520c(b)(1)’s articulation rule that the ALJ may address multiple opinions from the same source in a single analysis rather than opinion‑by‑opinion, reducing remand risk for articulation defects absent prejudice.
Treating‑source opinions: The decision continues the Fifth Circuit’s recognition (Webster; Williams) that treating‑source opinions no longer receive controlling or presumptive weight. Persuasiveness—driven by supportability and consistency—controls, and internal inconsistency may justify discounting restrictive opinions.
Evidence breadth in RFC findings: The court’s acceptance of CDI observations, consultative exams, and state‑agency reviews underscores that an ALJ may rely on non‑treating evidence when it is consistent and supported, even against a treating source’s restrictive limitations.
Issue preservation: Arguments about vocational‑expert hypotheticals must be raised in opening briefs; raising them for the first time in reply is forfeiture (Perez v. Bruister).

Complex Concepts Simplified

Substantial evidence: A low threshold of proof on review—“more than a mere scintilla” but not necessarily a preponderance. If reasonable minds can reach the ALJ’s conclusion based on the record, the finding stands even if other evidence points the other way.
Harmless error and prejudice: Not every procedural misstep requires reversal. The challenger must show the error likely affected the outcome—i.e., caused prejudice to substantial rights.
Five‑step sequential evaluation: The SSA asks whether the claimant (1) is working at substantial gainful activity; (2) has severe, long‑lasting impairments; (3) meets a listed impairment; (4) can do past relevant work; and (5) can do other work in the national economy. The claimant has the burden at steps 1–4; the Commissioner bears the burden at step 5.
Residual Functional Capacity (RFC): What a claimant can still do despite impairments. It is an administrative finding based on all relevant evidence, not a medical opinion per se.
Light work: Generally involves lifting up to 20 pounds occasionally and 10 pounds frequently, often with considerable walking/standing. The ALJ here further restricted lifting to “up to 10 pounds,” reflecting a more limited light RFC.
“Frequent” vs. “moderate”: “Frequent” is a time‑based term from SSA policy (SSR 83‑10) meaning one‑third to two‑thirds of the time. “Moderate” is a degree‑of‑limitation descriptor often used in mental assessments but is not automatically quantized; without elaboration, it can align with various RFC calibrations.
Post‑2017 opinion rules (20 C.F.R. § 404.1520c): The SSA no longer gives inherent or controlling weight to treating or examining sources. ALJs evaluate all medical opinions for persuasiveness, focusing primarily on supportability (how well the opinion explains itself and cites evidence) and consistency (how well it fits with the rest of the record). ALJs may discuss multiple opinions from the same source in a single analytical block.

Practice Pointers

Demonstrate conflict and prejudice: When arguing an ALJ failed to discuss an opinion, show precisely how the omitted opinion conflicts with specific RFC findings and how adopting the opinion would change the vocational outcome.
Quantify “moderate” limitations: If “moderate” social limitations are outcome‑critical, provide narrative or quantitative explanation showing why they are inconsistent with “frequent” interaction as defined by SSR 83‑10.
Support treating‑source opinions: Treating opinions should explain internal changes over time and tie restrictions to clinical findings and longitudinal evidence to withstand § 404.1520c scrutiny.
Preserve VE‑hypothetical issues: Raise all vocational‑hypothetical challenges in the opening appellate brief to avoid forfeiture.

Conclusion

Madkins v. Bisignano consolidates two important currents in Social Security law within the Fifth Circuit. First, omissions in an ALJ’s opinion discussion will be viewed through a prejudice lens; absent a clear conflict between the omitted opinion and the RFC, the error is likely harmless. Second, the court continues to implement the post‑2017 medical‑opinion framework, emphasizing persuasiveness over hierarchy and permitting single‑analysis articulation for multiple opinions from the same source.

The court’s practical alignment of a “frequent” interaction RFC with non‑quantified “moderate” social limitations provides valuable guidance for RFC formulation and appellate challenges. Together with its reaffirmation of the substantial‑evidence standard and the bar on re‑weighing evidence, the decision will shape how claimants, counsel, and ALJs frame—and defend—RFC findings in disability adjudications across the circuit.