Objective Cognitive Testing and Recordwide Review Can Outweigh a Treating Psychiatrist’s Subjective-Based Opinion; Unraised Theories Are Waived on Appeal

Introduction

In Jill Staniszewski v. Frank Bisignano (7th Cir. June 16, 2026) (nonprecedential order), the Seventh Circuit affirmed the denial of Disability Insurance Benefits under the Social Security Act, reviewing an Administrative Law Judge’s (ALJ) decision under 42 U.S.C. § 405(g). The claimant, Jill M. Staniszewski, alleged disability stemming primarily from bipolar disorder and related problems with memory, attention, and concentration. The Commissioner defended the agency’s denial.

The central issues were whether the ALJ permissibly gave little weight to the opinion of Staniszewski’s long-time treating psychiatrist (Dr. Mary Walsh) in favor of a testifying medical expert (Dr. Michael Carney), and whether additional theories raised for the first time on appeal could be considered.

Summary of the Opinion

The Seventh Circuit held that substantial evidence supported the ALJ’s assessment of the medical opinions and the resulting residual functional capacity finding. The court emphasized that the ALJ reasonably discounted Dr. Walsh’s marked-limitations opinion because it relied heavily on self-reported symptoms and was inconsistent with objective memory testing performed by other providers. The court also upheld the ALJ’s decision to give great weight to Dr. Carney, who reviewed the entire record and explained his conclusions. Finally, the court held that arguments about a “doctored” hearing transcript and a new diagnosis of hippocampal impairment were waived because they were not presented to the district court.

Analysis

Precedents Cited

  • Gedatus v. Saul, 994 F.3d 893 (7th Cir. 2021): The court used Gedatus as the governing articulation of deferential review—if substantial evidence supports the ALJ, the reviewing court will not reweigh evidence or resolve debatable conflicts. This framed the entire appeal as one about whether the ALJ had enough evidentiary basis, not whether other inferences were possible.
  • Richardson v. Perales, 402 U.S. 389 (1971): Quoted (via Gedatus) for the classic definition of “substantial evidence” as “such relevant evidence as a reasonable mind might accept as adequate.” The case supplies the administrative-law foundation for affirming agency findings supported by adequate evidence, even where the record contains contrary material.
  • Borovsky v. Holder, 612 F.3d 917 (7th Cir. 2010): Cited (via Gedatus) for the proposition that reversal is warranted only when the record “compels a contrary result,” underscoring the steep hurdle for claimants challenging factbound ALJ determinations.
  • Prill v. Kijakazi, 23 F.4th 738 (7th Cir. 2022): The court relied on Prill to support the key move in the opinion: an ALJ may discount a treating-source assessment where it conflicts with other evidence, including objective testing. Here, objective memory measures from Dr. Wegierek and Nurse Logan provided the kind of inconsistency that Prill treats as a valid basis for reduced weight.
  • Grotts v. Kijakazi, 27 F.4th 1273 (7th Cir. 2022): The court invoked Grotts to validate the ALJ’s reliance on Dr. Carney’s broader record review and consistency with the overall file. The precedent supports the idea that a well-explained opinion based on a fuller evidentiary view can be credited over more limited-source perspectives.
  • Swiecichowski v. Dudek, 133 F.4th 751 (7th Cir. 2025): Cited for appellate waiver/forfeiture: issues not presented to the district court generally cannot be raised for the first time on appeal. The court applied this rule to exclude the “doctored transcript” contention and the newly asserted hippocampal diagnosis theory.

Legal Reasoning

  1. Standard of review controlled the outcome. Applying the substantial-evidence framework from Gedatus v. Saul (and ultimately Richardson v. Perales), the panel focused on whether the ALJ built a reasonable evidentiary basis for her weighing of competing medical opinions, not whether the claimant’s preferred reading was plausible.
  2. Treating-source weight turned on regulatory factors and evidentiary conflict. The ALJ evaluated Dr. Walsh under 20 C.F.R. § 404.1527(c)—notably:
    • Treatment relationship (including “significant breaks”) (see § 404.1527(c)(2)(i));
    • Supportability, where the ALJ found memory/concentration complaints largely self-reported (see § 404.1527(c)(3));
    • Consistency with the full record, where objective tests did not match marked limitations (see § 404.1527(c)(4)).
    The Seventh Circuit emphasized that the ALJ’s discounting rationale was not a categorical rejection of psychiatry as “subjective,” but a case-specific determination that Dr. Walsh’s marked limitations conflicted with objective memory evidence.
  3. Objective testing and clinical observations supported “moderate,” not “marked,” limitations. The court highlighted two objective reference points:
    • Dr. Wegierek’s exam, describing cognitive faculties “grossly intact,” while noting some immediate-memory errors;
    • Nurse Logan’s Montreal Cognitive Test results, where Staniszewski recalled 4 out of 5 words after delay.
    These data points gave the ALJ a non-speculative basis to find that the record did not compel Dr. Walsh’s “marked limitations.”
  4. Deference to a record-reviewing medical expert was permissible. Citing Grotts v. Kijakazi, the court approved the ALJ’s reliance on Dr. Carney because he reviewed the entire file and provided a reasoned explanation tying his “moderate” assessments to both subjective reports and objective testing.
  5. Arguments raised too late were waived. Under Swiecichowski v. Dudek, the court declined to consider claims about transcript manipulation and a new hippocampal impairment diagnosis because they were not presented to the district court.

Impact

Although designated NONPRECEDENTIAL (and thus citable only under FED. R. APP. P. 32.1), the order reflects recurring Seventh Circuit themes likely to influence litigants’ strategy:

  • Objective anchors matter in cognitive-impairment cases. Where the record contains even modest objective cognitive measures (formal testing, structured screening tools, contemporaneous mental status observations), ALJs may use that evidence to test the extremity of treating-source limitations.
  • “Supportability” and “consistency” are decisive levers. The opinion reinforces that treating-source longevity does not secure deference when the opinion is weakly supported or inconsistent with other record evidence.
  • Preservation is essential. Claimants must raise all material theories and evidentiary objections at the district-court stage; new factual predicates (e.g., later diagnoses) typically require appropriate procedural vehicles rather than first-time appellate argument.

Complex Concepts Simplified

  • Substantial evidence: Not “most evidence” or “clear evidence,” but enough that a reasonable person could agree with the ALJ—even if other reasonable people might disagree.
  • Five-step disability analysis (20 C.F.R. § 416.920(a)(4)): A sequence asking (1) work activity, (2) severe impairment, (3) listing-level severity, (4) ability to do past work given one’s residual functional capacity, and (5) ability to adjust to other work.
  • Residual Functional Capacity (RFC): The most a claimant can still do in a work setting despite limitations, including nonexertional limits like attention, pace, and memory constraints.
  • Supportability and consistency (20 C.F.R. § 404.1527(c)): “Supportability” asks whether an opinion is backed by clinical findings and explanations; “consistency” asks whether the opinion matches the rest of the record.
  • Waiver/forfeiture on appeal: Courts generally will not decide issues that were not first presented to the lower court, because appellate review is meant to evaluate what the lower court decided, not to decide new disputes in the first instance.

Conclusion

The Seventh Circuit affirmed because the ALJ articulated legally valid reasons—grounded in the regulatory factors and supported by objective testing and recordwide review—for discounting a treating psychiatrist’s marked-limitations opinion and crediting a medical expert’s moderate assessments. The decision also underscores a strict preservation rule: theories not raised in the district court, including allegations of transcript irregularities or newly identified medical causes, are waived on appeal.