No SSR 96-8p Explanation Required When the RFC Reasonably Harmonizes a Treating Physician’s Cane-and-Balance Opinion (Wilds v. Commissioner of Social Security, 6th Cir. 2025)

No SSR 96-8p Explanation Required When the RFC Reasonably Harmonizes a Treating Physician’s Cane-and-Balance Opinion

Arthur Wilds v. Commissioner of Social Security, No. 24-5504 (6th Cir. Mar. 31, 2025) (Not Recommended for Publication)

Introduction

This Sixth Circuit decision addresses a recurring question in Social Security disability adjudication: when must an Administrative Law Judge (ALJ) explain the omission of limitations from a medical opinion the ALJ otherwise credits? The court affirms a denial of Disability Insurance Benefits (DIB) to Arthur Wilds, holding that the ALJ’s residual functional capacity (RFC) did not “conflict” with a treating physician’s opinion about the claimant’s need for a cane “to maintain balance,” and therefore Social Security Ruling (SSR) 96-8p did not compel an additional explanation for non-adoption. The panel also underscores that an ALJ may harmonize general statements in a medical source statement with more specific qualifiers contained in the same opinion, so long as the resulting RFC reflects “the most” the claimant can do and is supported by substantial evidence.

The ruling is particularly salient for cases involving hand-held assistive devices and “balance” limitations. It explains how to read a treating physician’s assistive-device form holistically and how SSR 96-8p’s explanation requirement is triggered only when there is an actual conflict between the RFC and a medical-source opinion. The decision distinguishes a recent unpublished Sixth Circuit remand (Kinney v. Comm’r of Soc. Sec.) where the ALJ failed to explain the omission of a clearly identified limitation.

Summary of the Opinion

  • Procedural posture: After an earlier remand from district court and Appeals Council instructions to reconsider a treating physician’s “balance” opinion, a different ALJ issued a partially favorable decision—denying DIB but granting SSI as of the SSI application date. The district court affirmed the DIB denial, and the Sixth Circuit now does as well.
  • Core issue on appeal: Whether the ALJ violated SSR 96-8p by failing to incorporate, or explain the omission of, treating physician Dr. Jessica Pennington’s opinion that Wilds “required a cane to maintain balance.”
  • Holding: No SSR 96-8p error. The RFC did not “conflict” with the treating opinion when read as a whole, because Dr. Pennington also stated Wilds could walk up to 50 feet without the cane. The ALJ reasonably harmonized the two by requiring a cane for distances over 50 feet and limiting Wilds to “occasional” balancing. No additional explanation was required.
  • Substantial evidence: The RFC was supported by medical records documenting normal or nonantalgic gait at times, improvement with a cane, and the claimant’s own testimony about walking distances.
  • Outcome: Affirmed. Wilds remains ineligible for DIB (date last insured March 30, 2017), but his SSI award beginning on the SSI application date stands (tied to a later age-category change affecting step five).

Detailed Analysis

Procedural and Factual Background

Wilds filed for DIB in 2016, alleging disability beginning in July 2015. An initial unfavorable decision was remanded by the district court. On remand, the Appeals Council vacated the prior decision and specifically instructed a new ALJ to revisit Dr. Pennington’s February 2017 assistive-device opinion, which stated that Wilds needed a cane on all surfaces and “to maintain balance,” while also noting he could walk up to 50 feet without it. The ALJ consolidated the remanded DIB claim with a later (2020) SSI claim and held a new hearing.

The ALJ’s RFC limited Wilds to a reduced range of sedentary work with, among other things:

  • A requirement to use a handheld assistive device such as a cane when ambulating distances of more than 50 feet; and
  • A restriction to “occasional” balancing (defined in the decision as maintaining body equilibrium on narrow, slippery, or erratically moving surfaces).

At step four, the ALJ found Wilds could not perform past relevant work. At step five, for the period relevant to DIB (which closed at the date last insured, March 30, 2017), the ALJ found jobs existed in significant numbers that Wilds could perform. Later age-category changes (to “closely approaching advanced age” as of December 17, 2017) combined with his RFC yielded disability under the SSI claim as of the SSI application date. The Appeals Council denied review, the district court affirmed the DIB denial, and Wilds appealed on the narrow SSR 96-8p/RFC rationale.

The Court’s Key Legal Conclusions

The Sixth Circuit affirms, emphasizing three strands of doctrine:

  1. No categorical duty to adopt every portion of a credited medical opinion. Even when an ALJ assigns “great weight” to a medical opinion, the ALJ need not incorporate every limitation verbatim (Reeves v. Comm’r of Soc. Sec., 618 F. App’x 267, 275 (6th Cir. 2015)).
  2. SSR 96-8p’s explanation duty arises only when there is a conflict. SSR 96-8p requires the ALJ to explain why an opinion was not adopted when the RFC “conflicts with” a medical source opinion. If the RFC reasonably harmonizes the opinion rather than contradicts it, SSR 96-8p is not triggered.
  3. Holistic reading of assistive-device opinions under SSR 96-9p. SSR 96-9p expects medical evidence to describe the circumstances in which an assistive device is “medically required” (e.g., distances, terrain, frequency). A statement that a claimant both “needs a cane for balance” and can “walk 50 feet without it” invites a harmonized reading that limits cane necessity to certain contexts (e.g., distances over 50 feet), consistent with the RFC here.

Precedents and Authorities Cited

  • Standard of review and substantial evidence:
    • Gayheart v. Comm’r of Soc. Sec., 710 F.3d 365, 374 (6th Cir. 2013) (de novo review of district court’s decision; appellate task is to determine whether the ALJ applied proper legal standards and whether substantial evidence supports the ALJ’s findings).
    • Rogers v. Comm’r of Soc. Sec., 486 F.3d 234, 241 (6th Cir. 2007) (substantial evidence standard).
    • Moats v. Comm’r of Soc. Sec., 42 F.4th 558, 561 (6th Cir. 2022) (substantial evidence is “more than a mere scintilla,” quoting Biestek v. Berryhill, 587 U.S. 97 (2019)).
    • Ulman v. Comm’r of Soc. Sec., 693 F.3d 709, 714 (6th Cir. 2012) (court affirms if substantial evidence supports the ALJ even when contrary evidence could support the opposite conclusion; quoting Bass v. McMahon).
    • Cole v. Astrue, 661 F.3d 931, 939–40 (6th Cir. 2011) (failure to follow agency rules can itself mean the decision lacks substantial evidence).
    • Miller v. Comm’r of Soc. Sec., 811 F.3d 825, 833 (6th Cir. 2016) (courts do not excuse failures to follow the agency’s own rules by resort to substantial evidence).
  • Treating physician rule and medical opinion handling (pre–March 27, 2017 claims):
    • 20 C.F.R. § 404.1527(c)(2) (treating source opinions may receive controlling weight when well-supported and not inconsistent with substantial record evidence).
    • Blakley v. Comm’r of Soc. Sec., 581 F.3d 399, 408 (6th Cir. 2009) (even if not controlling, treating opinions warrant deference under specified factors; referencing SSR 96-2p).
    • Cole v. Astrue, 661 F.3d at 937 (explaining when controlling weight applies).
    • Reeves v. Comm’r of Soc. Sec., 618 F. App’x 267, 275 (6th Cir. 2015) (ALJ not required to adopt every aspect of a credited opinion).
  • RFC assessment and assistive device rulings:
    • 20 C.F.R. § 404.1545 (RFC reflects the most a claimant can do notwithstanding impairments; based on all relevant evidence).
    • SSR 96-8p (ALJ must consider and address medical source opinions and explain non-adoption when the RFC conflicts with an opinion).
    • SSR 96-9p (for hand-held assistive devices, documentation should specify medical necessity and the circumstances of use—frequency, distances, terrain, etc.).
  • Distinguishing recent remand authority:
    • Kinney v. Comm’r of Soc. Sec., No. 23-3889, 2024 WL 2273365, at *3–4 (6th Cir. May 20, 2024) (remand required where the ALJ gave weight to a medical opinion but omitted a specific limitation without explanation; in Wilds, by contrast, there was no omission because the ALJ reasonably incorporated the limitation as qualified by the same opinion).

Legal Reasoning: How the Court Reached Its Decision

  1. Framing the SSR 96-8p inquiry—Is there a conflict?

    SSR 96-8p requires the ALJ to explain why an opinion was not adopted when the RFC “conflicts with” a medical source opinion. The court therefore first asked whether the RFC conflicted with Dr. Pennington’s assistive-device statement. Dr. Pennington checked “Yes” to the question whether Wilds required a cane “to maintain balance,” but she also specified that he could walk “50 feet” without the cane. The ALJ’s RFC required a cane for distances exceeding 50 feet and otherwise allowed “occasional” balancing. The panel held that this was a permissible harmonization, not a conflict: the ALJ read the physician’s general balance statement in light of the physician’s specific distance qualification.

  2. Consistency with SSR 96-9p’s focus on circumstances.

    SSR 96-9p expects specificity about the circumstances of assistive-device use. The ALJ’s RFC keyed the cane requirement to distance (more than 50 feet), matching the treating physician’s explicit quantification. That fit SSR 96-9p’s emphasis on usage circumstances (when, how far, what terrain, etc.).

  3. “Great weight” does not equal wholesale adoption.

    Relying on Reeves, the court reiterated that the ALJ was not obliged to adopt every part of a medical opinion to which he assigned “great weight.” Since the RFC, on its face, did not contradict the treating opinion when read as a whole, there was no SSR 96-8p duty to expressly justify omitting “balance” language beyond what the RFC already captured.

  4. Substantial evidence.

    The court also found substantial evidence for the RFC’s balance and cane findings: notes of normal or nonantalgic gait at times (Drs. Cartia and James), improvement “walking better with the use of a cane” (Dr. Bukhari), Dr. Pennington’s own records reflecting normal gait early in treatment and only slowed gait later, and Wilds’s testimony that he could walk approximately 125–130 feet to his mailbox and back. Even if the record could support a more restrictive RFC, Ulman teaches that courts affirm so long as a reasonable mind could accept the ALJ’s view.

  5. Distinguishing Kinney.

    In Kinney, the ALJ clearly omitted a limitation from an opinion he otherwise deemed persuasive and failed to explain that omission—triggering SSR 96-8p. Here, by contrast, the agency did not concede an omission; the RFC reflected the limitation as qualified within the same medical source statement, so SSR 96-8p never came into play.

Impact and Practical Implications

  • Harmonization principle for assistive-device opinions: When a treating source expresses both a general limitation (e.g., “needs a cane for balance”) and a specific qualifier (e.g., “can walk 50 feet without the cane”), an ALJ may reconcile these by limiting cane usage to the specified circumstances. Courts will treat this as incorporation—not omission—if the reading is reasonable and supported by the record.
  • Scope of SSR 96-8p’s explanation duty is narrowed to true conflicts: Claimants arguing for SSR 96-8p remands should identify a concrete, unincorporated limitation in a medical opinion that the ALJ otherwise accepted. Absent a clear conflict, remand is unlikely.
  • Drafting medical source statements under SSR 96-9p: Practitioners should ensure treating opinions about assistive devices specify the circumstances of use—“all the time,” “during any standing,” “beyond 10 feet,” “on uneven terrain,” “when carrying items,” etc.—and, if appropriate, whether balance deficits require the cane even for short ambulation or for static standing. Ambiguity invites ALJ harmonization toward less restrictive RFCs.
  • Understanding “balancing” in vocational terms: The ALJ here defined “balancing” as maintaining equilibrium on narrow, slippery, or erratically moving surfaces. That definition (drawn from the Dictionary of Occupational Titles) is narrower than everyday “balance” complaints. Counsel should translate clinical balance deficits into vocational terms, clarifying whether they limit the DOT postural activity of “balancing” or instead necessitate a cane per SSR 96-9p.
  • Pre- vs. post–March 27, 2017 regime: This case applied the pre-2017 treating-physician rule (20 C.F.R. § 404.1527). For later-filed claims under 20 C.F.R. § 404.1520c (persuasiveness factors), the core SSR 96-8p principle remains relevant: the ALJ must explain omissions where the RFC actually conflicts with a medical opinion.
  • Date Last Insured (DLI) and age-category effects: Wilds’s DIB denial turned in part on his DLI (March 30, 2017). Although his age-category change in December 2017, combined with his RFC, supported an SSI award as of his SSI application date, it could not retroactively establish DIB. Practitioners should build the record for the insured period and be mindful that later changes (e.g., age categories under the Medical-Vocational Guidelines) may lead to divergent outcomes for DIB versus SSI.
  • Not for publication but persuasive: Though “Not Recommended for Publication,” the decision provides persuasive guidance in the Sixth Circuit on how courts will treat harmonization of assistive-device and balance opinions vis-à-vis SSR 96-8p.

Complex Concepts Simplified

  • DIB vs. SSI: DIB requires proving disability on or before the Date Last Insured (DLI), tied to prior earnings history. SSI is a needs-based program; entitlement cannot begin before the SSI application date.
  • Residual Functional Capacity (RFC): The most someone can still do despite impairments. The ALJ formulates it after step three and uses it at steps four and five to decide whether the claimant can perform past work or other work in the national economy.
  • “Occasional” and “frequent” (vocational usage): “Occasional” generally means up to one-third of the workday; “frequent” means one-third to two-thirds.
  • “Balancing” (DOT/SSA usage): A postural activity defined more narrowly than lay notions of balance—maintaining equilibrium on narrow, slippery, or moving surfaces.
  • SSR 96-8p: Requires ALJs to consider medical opinions and explain non-adoption when an RFC conflicts with an opinion. No explanation is required absent a conflict.
  • SSR 96-9p: For hand-held assistive devices, medical evidence should specify the conditions of necessity (all the time vs. distances or terrains, etc.). These details can significantly affect the unskilled sedentary occupational base.
  • Treating physician rule (pre–3/27/2017): Treating opinions may receive controlling weight when well-supported and not inconsistent with other substantial evidence. Even if not controlling, they get deference under regulatory factors.
  • Substantial evidence: A deferential standard—more than a scintilla; enough that a reasonable mind could accept. Courts will affirm even if other evidence could support a different outcome, provided the ALJ followed the rules.

Conclusion

The Sixth Circuit’s decision in Wilds v. Commissioner of Social Security clarifies that SSR 96-8p’s duty to explain the non-adoption of medical opinion limitations arises only when the RFC conflicts with a medical opinion. Where a treating physician’s assistive-device opinion contains both a general statement (“needs a cane to maintain balance”) and a more specific qualifier (“can walk 50 feet without it”), an ALJ may reasonably harmonize the two—here, by requiring a cane for distances over 50 feet and limiting the claimant to “occasional” balancing. Because that harmonized RFC matched the opinion’s qualified content and was backed by substantial evidence, no further SSR 96-8p explanation was necessary.

Practically, the case encourages precise, circumstance-specific medical documentation of assistive-device needs under SSR 96-9p and cautions advocates to frame SSR 96-8p arguments around genuine RFC-opinion conflicts, not merely differing interpretations that can be reasonably reconciled. It also illustrates the pivotal importance of the DLI and age-category shifts in producing differing outcomes between DIB and SSI. Even as an unpublished decision, Wilds offers persuasive guidance for litigants and ALJs in the Sixth Circuit on the treatment of cane and balance limitations within the RFC framework.

Case Details

Year: 2025
Court: Court of Appeals for the Sixth Circuit

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