Reaffirming the SSI Application Prerequisite and SSR 18‑01p’s Threshold: Anthony v. Saul (2d Cir. 2025)

Note on precedential status: This is a Second Circuit Summary Order, which does not have precedential effect under Local Rule 32.1.1. It may nonetheless be cited as persuasive authority.

Introduction

This appeal arises from the denial of Disability Insurance Benefits (DIB) to Sunita Faith Anthony under Title II of the Social Security Act. The Administrative Law Judge (ALJ) found Anthony not disabled within the insured period from September 15, 2015 (alleged onset date) to December 31, 2015 (date last insured), and the district court affirmed. Before the Second Circuit, Anthony advanced three principal challenges:

That the ALJ should have treated her DIB application—which indicated she had filed or intended to file for Supplemental Security Income (SSI)—as a concurrent SSI claim, or should have adjourned the DIB hearing to allow her to file an SSI application.
That substantial evidence did not support the ALJ’s finding that, during the insured period, her depression, anxiety, and weight-loss-related impairments failed to meet the regulatory definition of disability; that the ALJ wrongly declined to accord controlling weight to her treating provider; and that the ALJ improperly relied on vocational expert (VE) testimony premised on a “low-stress” hypothetical.
That the ALJ erred by refusing to evaluate her DIB claim using an amended, earlier alleged onset date (AOD) of February 22, 2014, the date she began regular psychiatric treatment.

The Second Circuit affirmed, offering clear guidance on the SSI application prerequisite, ALJ discretion over hearing adjournments, the substantial evidence standard for mental impairments within a closed insured period, the limited status of nurse practitioner opinions under the pre‑2017 “treating physician rule,” the permissible scope of VE hypotheticals under SSR 85‑15, and the threshold for onset-date determinations under SSR 18‑01p.

Summary of the Opinion

SSI application prerequisite and adjournment: The ALJ correctly refused to adjudicate SSI because Anthony had not filed an SSI application, as required by 20 C.F.R. § 416.305(a). The ALJ also did not abuse his discretion in denying a last‑minute adjournment to allow an SSI filing, particularly given that counsel had represented Anthony for over a year and knew no SSI application was on file.
Substantial evidence: The record supported the ALJ’s finding that, during 9/15/2015–12/31/2015, Anthony’s weight loss was non‑severe (post‑DLI evidence was of little value), and her depression and anxiety imposed no more than “moderate” limitations under the Listings framework. Self‑reported activities of daily living and clinical notes (logical thought processes, concentration, intact judgment/memory, average intellect) supported the ALJ’s assessment. A 2018 opinion was not persuasive because it did not purport to relate back to the relevant period.
Treating source rule and nurse practitioner opinions: The ALJ did not err in declining “controlling weight” because the opinion at issue was from a nurse practitioner—an “other source” not eligible for controlling weight under the pre‑2017 rules (see Monette v. Colvin).
Vocational expert hypotheticals and SSR 85‑15: The ALJ’s hypothetical limiting the claimant to low‑stress, simple, routine, repetitive jobs with limited decision‑making and occasional contact was supported by record evidence and not barred by SSR 85‑15. Stress is “highly individualized,” but the ruling does not prohibit such hypotheticals.
Onset date and SSR 18‑01p: Because the ALJ found no disability during the period covered by the application, he was not required to determine an established onset date or accept an amended AOD. SSR 18‑01p’s onset analysis is triggered only after a finding of disability.

Analysis

Precedents and Authorities Cited

Schillo v. Kijakazi, 31 F.4th 64 (2d Cir. 2022): Reiterates that on appeal from a denial of benefits, courts review the administrative decision, not the district court’s analysis, and apply the “substantial evidence” standard.
Brault v. Soc. Sec. Admin., Comm’r, 683 F.3d 443 (2d Cir. 2012): Emphasizes the “very deferential” nature of substantial evidence review—findings are upheld unless a reasonable factfinder would have to conclude otherwise.
20 C.F.R. § 416.305(a)–(b): Establishes that an SSI claim requires a filed application; exceptions exist but were neither argued nor applicable here.
Mathews v. Eldridge, 424 U.S. 319 (1976): Supports that claims must be properly presented to the agency to generate a reviewable “decision.”
20 C.F.R. Pt. 404, Subpt. P, App. 1 (Listings): Governs the severity criteria (including the “B criteria”) for mental impairments like depressive and anxiety disorders.
Vilardi v. Astrue, 447 F. App’x 271 (2d Cir. 2012): Post‑date‑last‑insured (DLI) evidence showing later worsening is of little value to the insured period unless properly tied back.
Monette v. Colvin, 654 F. App’x 516 (2d Cir. 2016): Under pre‑2017 rules, nurse practitioners are not “acceptable medical sources” and their opinions cannot receive controlling weight.
McIntyre v. Colvin, 758 F.3d 146 (2d Cir. 2014): An ALJ may rely on VE testimony in response to a hypothetical that is supported by substantial evidence.
SSR 85‑15 (1985): Clarifies that reactions to work stress are individualized; job skill level does not necessarily predict stress tolerance.
SSR 18‑01p (2018): The agency establishes an onset date only after finding that a claimant is disabled and meets non‑medical requirements.
20 C.F.R. § 404.946(b)(1): The ALJ may, but need not, consider new issues (such as an amended onset date) at the hearing.
42 U.S.C. §§ 405(g), 1383(c)(3): Statutory provisions for judicial review and substantial evidence review.

Legal Reasoning

1) SSI Claim Handling and Hearing Management

The court grounded its analysis in the text of § 416.305(a): SSI entitlement requires an application. Anthony’s DIB filing indicated she had filed or intended to file for SSI, but she never actually filed an SSI application. Without an application, the agency cannot issue a formal eligibility determination, foreclosing ALJ adjudication and Article III review. The panel also upheld the ALJ’s refusal to adjourn the DIB hearing to enable a last‑minute SSI filing, noting that Anthony had long been represented and her counsel knew an SSI claim had not been filed. The ALJ reasonably observed that Anthony could file a separate SSI application without delaying the DIB proceeding.

2) Substantial Evidence within the Closed Insured Period

On the merits, the panel applied the highly deferential substantial evidence standard. The ALJ found:

Weight loss: Non‑severe, because probative evidence of weight loss post‑dated the insured period and did not shed light on severity during 9/15/2015–12/31/2015 (citing Vilardi).
Depression and anxiety: The record did not show the required degree of functional limitation to meet or equal a mental health Listing during the relevant period. Treatment was relatively conservative (brief medication management and weekly therapy), contemporaneous notes documented logical, goal‑directed thought processes, intact concentration and memory, and stable symptoms, and Anthony independently performed activities of daily living such as living alone and preparing meals. These data points supported findings of no more than “moderate” limitations in the broad mental functional areas.
2018 opinion evidence: Not persuasive because it did not purport to relate back; retrospective linkage is essential when the insured period is closed.

3) Treating Source Rule and Nurse Practitioner Opinions

Because the claim is governed by the pre‑March 27, 2017 regulations, a nurse practitioner is not an “acceptable medical source” and cannot receive “controlling weight” under the treating physician rule. The ALJ nonetheless assigned some weight, but properly declined controlling weight. The Appeals Council’s later receipt of a psychiatrist’s mere signature endorsing the nurse practitioner’s opinion—absent treatment during the relevant period or a retroactive rationale—did not create a reasonable probability of a different outcome.

4) VE Hypotheticals and SSR 85‑15

The ALJ’s VE hypothetical limited the work to low‑stress, simple, routine, repetitive tasks, with limited decision‑making and occasional contact with others. The court held that such a hypothetical is permissible where supported by substantial evidence in the record. SSR 85‑15 does not bar “low‑stress” hypotheticals; rather, it cautions that stress is highly individualized and must be accounted for on the facts of the case. The ALJ’s individualized assessment satisfied that requirement. To the extent conflicting medical opinions existed, the court noted they post‑dated the relevant period and lacked controlling relevance.

5) Onset Date and SSR 18‑01p

Anthony sought to amend her alleged onset date back to February 22, 2014. The court affirmed the ALJ’s refusal to do so. SSR 18‑01p makes clear that an established onset date is determined only if the agency first finds the claimant disabled and meeting non‑medical criteria during the period covered by the application. Without a threshold disability finding, the ALJ was not required to adjudicate an amended onset date, and the regulations give ALJs discretion—not an obligation—to inject new issues at hearing (20 C.F.R. § 404.946(b)(1)).

Impact and Practical Implications

SSI application is indispensable: Claimants must file an actual SSI application for the agency to adjudicate SSI entitlement. Checking a box indicating an intent to file is insufficient. Counsel should ensure that concurrent claims are properly and timely filed when simultaneous DIB and SSI coverage is sought.
Adjournments are not guaranteed: ALJs have broad discretion over hearing management. Last‑minute adjournment requests to cure known filing omissions (like a missing SSI application) may be denied without constituting an abuse of discretion.
Closed period evidence must be anchored: For insured‑period claims, contemporaneous records carry outsized weight. Post‑DLI evidence is of limited probative value unless a medical source explicitly ties it back to the relevant period with a reasoned, retrospective analysis.
Nurse practitioners under pre‑2017 rules: For claims governed by the pre‑2017 regulations, NPs are “other sources” and cannot receive controlling weight. Their opinions can still be considered and given appropriate weight, but controlling‑weight arguments must rest on acceptable medical sources (e.g., treating psychiatrists/psychologists). Practitioners should consider obtaining retrospective opinions from acceptable medical sources explicitly addressing the insured period.
VE hypotheticals may use “low‑stress” constructs: SSR 85‑15 does not prohibit such limitations; it requires that stress‑related limitations reflect the individual’s record. Claimants challenging hypotheticals should marshal in‑period evidence that concretely expands limitations beyond what the ALJ included.
SSR 18‑01p’s trigger: Onset date determinations are downstream of a disability finding. Absent that finding, the ALJ is not obligated to establish or amend an onset date, and may decline to consider an early AOD as a new issue.
Judicial review constraints: The substantial evidence standard is exceptionally deferential. Appellants must demonstrate that no reasonable factfinder could reach the ALJ’s result on the record as a whole.

Complex Concepts Simplified

DIB vs. SSI: DIB (Title II) is insurance‑based; claimants must be insured and prove disability during the insured period. SSI (Title XVI) is needs‑based and requires filing a separate SSI application. One does not substitute for the other.
Date Last Insured (DLI): The last date the claimant met insured status for DIB. The claimant must prove disability on or before the DLI.
Alleged Onset Date (AOD) vs. Established Onset Date (EOD): AOD is what the claimant alleges; EOD is what the agency determines if—and only if—it first finds the claimant disabled (SSR 18‑01p).
Substantial Evidence Standard: A deferential appellate standard. The court asks whether the ALJ’s finding is supported by “more than a mere scintilla”—relevant evidence that a reasonable mind might accept as adequate—even if the court might have reached a different conclusion.
Mental Health Listings and “B criteria”: For disorders such as depressive (Listing 12.04) or anxiety (Listing 12.06), a claimant must meet diagnostic criteria and show either one “extreme” or two “marked” limitations across broad functional areas (e.g., understanding/remembering/applying information; interacting with others; concentration/persistence/pace; adapting/managing oneself). “Moderate” limitations generally do not satisfy the Listings.
Treating Physician Rule (pre‑2017 claims): Opinions from acceptable medical sources with an ongoing treatment relationship can receive “controlling weight” if well‑supported and not inconsistent with the record. Nurse practitioners were not acceptable medical sources under the pre‑2017 rules.
Vocational Expert (VE) Hypotheticals: An ALJ may rely on VE testimony in response to hypotheticals that reflect the claimant’s credibly established limitations. SSR 85‑15 underscores that stress tolerance is individualized and must be supported by record evidence.
Appeals Council “reasonable probability” standard: New evidence submitted after the ALJ’s decision must have a reasonable probability of changing the outcome; mere signatures or conclusory endorsements typically do not suffice without substantive, period‑specific analysis.

Conclusion

Anthony v. Saul reaffirms several bedrock principles of federal disability adjudication—even if in a nonprecedential posture. First, SSI entitlement requires an actual filed application; intent to file is not enough, and ALJs need not adjourn DIB hearings to facilitate belated SSI filings. Second, within a closed insured period, substantial evidence review is notably deferential, and claimants must provide period‑anchored medical proof of marked or extreme functional limitations to meet mental health Listings. Third, for pre‑2017 claims, nurse practitioners’ opinions cannot receive controlling weight under the treating physician rule, though they may be considered. Fourth, VE hypotheticals may permissibly include “low‑stress” parameters where supported by the record, consistent with SSR 85‑15. Finally, SSR 18‑01p’s onset‑date determination is triggered only after a disability finding; absent such a finding, ALJs are not required to set or amend an onset date.

For practitioners, this decision underscores the importance of early, correct filings (especially for concurrent DIB/SSI claims), obtaining retrospective medical opinions that explicitly tie limitations to the insured period, and framing VE challenges with concrete, in‑period evidence. For adjudicators and reviewing courts, it illustrates the disciplined application of substantial evidence review and the proper use of SSRs in evaluating mental impairments and onset determinations.