Pre-DLI RFC Must Be Supported by Function-by-Function Evidence, Not Post-DLI Improvements: The Eleventh Circuit’s Remand in Hayes v. Commissioner

Introduction

In Michael Hayes v. Commissioner, Social Security Administration, the Eleventh Circuit reversed and remanded a denial of disability insurance benefits (DIB), holding that the Administrative Law Judge’s residual functional capacity (RFC) assessment lacked substantial evidence because it relied principally on post–date last insured (post-DLI) improvements and failed to conduct the function-by-function analysis mandated by SSR 96-8p. Hayes suffered a lumbar compression fracture and knee injury when a tornado threw him in April 2011. He alleged disabling back pain, depression, anxiety, and insomnia from April 27, 2011, through his DLI of December 31, 2015. After an initial denial and a district court remand (for misapplication of the pain standard), a second ALJ decision again found no disability. The district court affirmed. The Eleventh Circuit reversed, emphasizing that an RFC must be grounded in evidence from the relevant insured period and be narrated function by function.

The key issues on appeal were:

Whether the ALJ improperly rejected Hayes’s subjective pain testimony (the panel noted serious flaws in that analysis but declined to decide it), and
Whether the RFC finding (sedentary work with certain postural limits) was supported by substantial evidence.

Summary of the Opinion

The Eleventh Circuit reversed because the ALJ’s RFC determination for the insured period (April 27, 2011–December 31, 2015) was not supported by substantial evidence:

The ALJ discounted both the treating pain specialist’s opinion (Dr. Mangieri) and the testifying orthopedic medical expert’s opinion (Dr. Ghazi), then effectively built the RFC by relying on Hayes’s reported post-2015 improvements with methadone (2016) and epidural injections (2021). The court held post-DLI improvements shed “very little light” on disability before the DLI—and, if anything, suggested greater limitations during the period at issue.
With no medical opinion supporting the RFC, the ALJ failed to perform the required function-by-function analysis under SSR 96-8p and did not explain how non-opinion evidence from the relevant period supported the specific capacities required for sedentary work.

While the panel did not reach the subjective pain issue, it expressly noted that the ALJ’s reliance on post-DLI treatments to discount Hayes’s testimony—and the mischaracterization of daily activities—appeared erroneous. The court remanded for further proceedings and suggested the agency consider reassignment because this was the second remand.

Analysis

Precedents and Authorities Cited

SSR 96-8p (61 Fed. Reg. 34,474): Requires the RFC assessment to identify functional limitations and assess work-related abilities on a function-by-function basis (e.g., sitting, standing, walking, lifting, carrying, postural and manipulative abilities) before expressing the RFC in exertional terms (sedentary, light, etc.). Also requires a narrative discussion linking specific evidence to each RFC conclusion.
20 C.F.R. § 404.1545 and § 404.1546: The ALJ is responsible for the RFC determination and must base it on all relevant evidence in the record.
20 C.F.R. § 404.1527(c)(2) (applicable because Hayes filed in February 2017, before March 27, 2017): The “treating physician rule,” requiring controlling weight to a well-supported treating opinion that is not inconsistent with other substantial evidence. The court acknowledged this framework, citing Winschel, but ultimately assumed (without deciding) that the ALJ articulated good cause for discounting the medical opinions.
Pupo v. Commissioner, 17 F.4th 1054, 1064–65 (11th Cir. 2021): Where no medical opinion supports a given exertional RFC, the ALJ must explain how the non-opinion evidence substantiates the claimant’s ability to perform all physical requirements of that exertional level. The court relied heavily on Pupo to find the ALJ’s RFC unsupported here.
Winschel v. Commissioner, 631 F.3d 1176 (11th Cir. 2011): Sets out the five-step sequential evaluation; underscores that courts will not reweigh evidence; and clarifies good cause to discount treating opinions.
Crawford v. Commissioner, 363 F.3d 1155 (11th Cir. 2004), and Simon v. Commissioner, 7 F.4th 1094 (11th Cir. 2021): Define the “substantial evidence” standard (more than a scintilla; less than a preponderance) and the court’s deferential review.
Moore v. Barnhart, 405 F.3d 1208 (11th Cir. 2005), and Cornelius v. Sullivan, 936 F.2d 1143 (11th Cir. 1991): Emphasize the requirement to apply correct legal standards and to provide sufficient reasoning.
Schink v. Commissioner, 935 F.3d 1245, 1260 (11th Cir. 2019): Non-examining opinions do not alone constitute substantial evidence—relevant to the ALJ’s rejection of the hearing medical expert here.
Doughty v. Apfel, 245 F.3d 1274 (11th Cir. 2001); Walker v. SSA, 987 F.3d 1333 (11th Cir. 2021): Frame the scope of review (final agency decision; substantial evidence; correct law).
Ingram v. Commissioner, 496 F.3d 1253 (11th Cir. 2007), and Crayton v. Callahan, 120 F.3d 1217 (11th Cir. 1997): Address exhaustion and waiver—mentioned as the Commissioner did not raise exhaustion below.
Sapuppo v. Allstate, 739 F.3d 678 (11th Cir. 2014): Issues raised for the first time in a reply brief are waived; used to reject an undeveloped record-development claim.

Legal Reasoning

The panel’s reasoning proceeds in three main steps:

Timeframe discipline: post-DLI evidence cannot anchor pre-DLI RFC.
The ALJ’s central proof for a sedentary RFC before December 31, 2015 was Hayes’s reported improvement on methadone beginning in late 2016 and an “excellent response” to an epidural in 2021. The court held these facts say little about his pre-DLI capacities and, if anything, imply greater limitations during the insured period. An RFC must be supported by evidence “from the period at issue.” Reliance on later improvement is legally flawed when adjudicating a pre-DLI disability.
Function-by-function analysis is mandatory, especially in the absence of supporting medical opinions.
After giving “no weight” to the testifying medical expert (Dr. Ghazi) and “extremely limited weight” to the treating pain specialist (Dr. Mangieri), the ALJ did not explain how the remaining, pre-2016 record evidence established Hayes’s capacity to perform each functional component of sedentary work (sitting, standing/walking occasionally, lifting up to 10 pounds, and relevant postural tasks) as required by SSR 96-8p. Citing Pupo, the court held that when an ALJ lacks a medical opinion supporting a given exertional RFC, the decision must still show, with specificity, how non-opinion evidence supports each functional finding. That did not happen here.
Subjective testimony issue reserved—but errors flagged.
Although the court did not resolve whether the ALJ’s pain analysis independently warranted reversal, it noted two errors: (a) using post-DLI treatment response to discount testimony about pre-DLI pain, and (b) mischaracterizing daily activities by omitting limiting context (e.g., “light yardwork” comprised only a few minutes of riding a mower or picking up sticks; grocery trips were brief, painful, and required assistance). The court observed these facts aligned with, not contradicted, Hayes’s pain testimony.

The court assumed, without deciding, that the ALJ had good cause to discount the medical opinions under the pre-2017 treating physician rule. But even under that assumption, the RFC fell because there was no substantial pre-DLI evidence to substantiate a sedentary RFC and no SSR 96-8p-compliant narrative tying evidence to functional conclusions.

Impact

While designated “Do Not Publish,” the opinion reinforces controlling principles in this Circuit and carries several practical implications:

Temporal fidelity for RFCs: ALJs must ground RFC findings in evidence from the insured period. Post-DLI improvements or treatment responses generally cannot be used to negate disability during the insured period.
SSR 96-8p rigor: When ALJs discount all medical opinions on functional ability, they must still provide a granular, function-by-function RFC narrative that marshals non-opinion evidence for each functional capacity. Conclusory exertional labels (e.g., “sedentary”) are not enough.
Treating physician rule (pre-3/27/2017 filings): Even where the ALJ articulates “good cause” to discount a treating source, the RFC must still be supported by substantial evidence—often requiring development of retrospective evidence tied to the relevant period.
Daily activities must be contextualized: Minimal, intermittent, or accommodated activities cannot be used to undermine disability without acknowledging frequency, duration, intensity, and after-effects.
Record development on remand: For legacy cases with sparse pre-DLI records, ALJs may need to develop retrospective medical opinions or obtain medical expert testimony that explicitly ties functional limits to the insured period. The court’s note about possible reassignment signals the need for careful, fresh review.
Vocational implications: The VE confirmed that lying down off-task is incompatible with competitive employment and that off-task tolerances are narrow (about 15 minutes in an 8-hour day). Accurate function-by-function RFCs thus critically shape step-five outcomes.

Complex Concepts Simplified

Date Last Insured (DLI): To receive DIB, a claimant must prove disability before insurance coverage for Social Security purposes expires. For Hayes, the DLI was December 31, 2015. Evidence after that date is generally relevant only if it illuminates the pre-DLI condition; improvements after the DLI cannot show non-disability before it.
Residual Functional Capacity (RFC): The most a claimant can do despite impairments, assessed on a function-by-function basis (e.g., sitting, standing, walking, lifting), then expressed, if appropriate, in exertional categories (sedentary, light, etc.).
SSR 96-8p: A Social Security Ruling requiring ALJs to narratively link each RFC finding to specific record evidence and to assess functions individually before assigning an exertional level.
Sedentary Work (20 C.F.R. § 404.1567(a)): Involves mostly sitting, with occasional standing/walking, and lifting no more than 10 pounds. “Occasional” generally means up to one-third of the workday.
Treating Physician Rule (pre-3/27/2017 filings): A treating doctor’s well-supported opinion that is not inconsistent with substantial record evidence must be given controlling weight. It can be discounted only for “good cause” (e.g., inconsistency, lack of support).
Listing 1.15: Covers disorders of the skeletal spine resulting in compromise of a nerve root(s). A medical expert testified Hayes “equaled” this Listing, but the ALJ rejected that view; the panel did not decide the listing issue because it reversed on the RFC ground.
Substantial Evidence: A deferential standard: more than a scintilla, less than a preponderance. Courts do not reweigh evidence but require correct law and enough reasoning to trace how the decision was reached.

Additional Observations

Tension in the ALJ’s listing discussion: The ALJ wrote that “no acceptable medical source designated to make equivalency findings” concluded Hayes medically equaled a Listing, yet Dr. Ghazi (an orthopedic surgeon called as a medical expert) testified Hayes equaled Listing 1.15. The panel did not resolve this inconsistency, focusing instead on the RFC deficiency.
Daily activities as double-edged evidence: The opinion underscores that limited, sporadic activities (minor yardwork for a few minutes; brief, assisted shopping) can be consistent with disabling pain and do not, without more, undermine credibility or prove sustained work capacity.

Practice Pointers

For ALJs:
- Anchor the RFC in pre-DLI evidence. If later records are considered, explain how they retrospectively illuminate the insured period.
- When medical opinions are discounted, include a meticulous SSR 96-8p function-by-function narrative that cites specific, contemporaneous evidence for each functional capacity.
- Accurately contextualize daily activities (frequency, duration, assistance, after-effects).
- Consider obtaining retrospective medical expert opinions focused expressly on the insured period.
For Claimants and Counsel:
- Develop detailed pre-DLI records where possible; if sparse, seek retrospective opinions that explain functional limits during the insured period.
- Document the limits and after-effects of daily activities and any need to lie down, off-task behavior, or positional changes.
- Challenge reliance on post-DLI treatment response to negate pre-DLI disability.

Conclusion

Hayes reinforces core principles in Eleventh Circuit Social Security adjudication: an RFC must be supported by substantial evidence from the relevant period and articulated through an SSR 96-8p-compliant, function-by-function analysis. When ALJs discount all medical opinions on functional capacity, they cannot fill the gap with post-DLI improvements or generalized references to daily activities. Instead, they must tie contemporaneous, pre-DLI evidence to each functional ability required for the assigned exertional level. Although unpublished, this decision—grounded in Pupo and longstanding RFC rules—offers a clear roadmap for future cases: temporal fidelity in evidence, rigorous function-by-function reasoning, and accurate characterization of daily activities. On remand, the agency is advised to reassess the record with those requirements in mind, potentially before a different adjudicator.