Substantial Evidence, Supportability, and Appeals Council Review: Clarifications from Wickham v. Commissioner of Social Security

Introduction

In Wickham v. Commissioner of Social Security, 24-2045 (2d Cir. May 16, 2025), the Second Circuit affirmed the denial of Supplemental Security Income (SSI) benefits to Lucas Elijah Wickham. Wickham sought disability benefits under the Social Security Act, alleging schizophrenia and related functional impairments. After two administrative hearings, an ALJ denied benefits at step three of the five-step sequential evaluation. The Appeals Council declined review, and the district court granted judgment on the pleadings to the Commissioner. On appeal, Wickham challenged (1) the ALJ’s step-three finding that he did not meet the listing for schizophrenia; (2) the ALJ’s rejection of a nurse practitioner’s opinion under the new “supportability and consistency” framework of 20 C.F.R. § 416.920c; and (3) the Appeals Council’s refusal to remand in light of new evidence submitted post-decision. The Second Circuit affirmed in all respects.

Summary of the Judgment

The ALJ found that Wickham did not satisfy the paragraph B criteria of Listing 12.03 (schizophrenia) because substantial evidence showed no extreme limitations in any one of the functional domains and only moderate limitations in the rest.
Under the post-March 27, 2017 regulations governing medical‐opinion evidence (20 C.F.R. § 416.920c), the ALJ properly evaluated Nurse Practitioner Hance’s opinion for supportability and consistency and permissibly found it unpersuasive.
The Appeals Council correctly incorporated and reviewed supplemental treatment records submitted after the ALJ’s decision and reasonably concluded that those records did not undermine the substantial-evidence finding of no disability.
The district court’s judgment affirming the Commissioner was affirmed, reiterating the robust standard of “substantial evidence” review and clarifying the treatment of new evidence at the appeals-council stage.

Analysis

1. Precedents Cited

Schillo v. Kijakazi, 31 F.4th 64 (2d Cir. 2022). Reiterated that on review of a disability denial, the Court focuses on the administrative record and upholds the decision if supported by substantial evidence.
Rubin v. O’Malley, 116 F.4th 145 (2d Cir. 2024). Confirmed the five-step evaluation and defined residual functional capacity (RFC) as “the most the [applicant] can still do despite [their] limitations.”
Bonet ex rel. T.B. v. Colvin, 523 F. App’x 58 (2d Cir. 2013) (summary order). Emphasized that the question is not whether appellate judges would reach the same conclusion but whether substantial evidence supports the ALJ’s decision.
Lesterhuis v. Colvin, 805 F.3d 83 (2d Cir. 2015). Clarified that when new evidence is submitted to the Appeals Council, the court reviews the whole record, including that evidence, to determine whether substantial evidence still supports the denial.

2. Legal Reasoning

A. Step Three—Listed Impairment Analysis: The Court explained the paragraph B criteria for a Listed Impairment under Listing 12.03 (schizophrenia), which requires extreme limitation in one domain or marked limitation in two. The ALJ’s assessment—drawing on state-agency psychologists’ opinions and consistent treatment notes—found only moderate limitations in four domains. Those findings were supported by:

Records of average or near-average cognitive testing in 2019.
Treatment notes documenting logical thought processes, intact cognition, good insight and judgment.
Evidence of social outings and appropriate interpersonal interaction documented by multiple providers.

B. Medical-Opinion Evidence under 20 C.F.R. § 416.920c: The new regulatory framework requires evaluation of each opinion’s supportability (objective evidence and rationale) and consistency (alignment with other evidence). NP Hance’s opinion of “marked” limitations was deemed unsupported by her own notes (which recorded intact cognition and no formal testing supporting severe deficits) and inconsistent with other providers’ observations. The finding that her opinion was unpersuasive was based on substantial evidence and a correct application of § 416.920c. C. Appeals Council and Supplemental Records: Even though new records from United Helpers were added after the ALJ’s decision, the Appeals Council properly considered them and the Second Circuit conducted the requisite plenary review. Because the new records corroborated the ALJ’s view (continued treatment compliance, independent living, social contacts, academic progress), they did not undermine the substantial-evidence finding. No remand was required.

3. Impact on Future Cases

Wickham reinforces several key principles for SSI adjudications:

Continued vitality of the substantial-evidence standard—an ALJ’s rational choice among competing interpretations will be upheld if supportable.
Clear guidance on applying the § 416.920c “supportability and consistency” factors in medical-opinion evaluation, especially for non‐physician providers under the post-2017 rules.
Procedural clarity that new evidence presented at the Appeals Council stage is part of the record on judicial review, but does not automatically trigger remand absent a reasonable probability of changing the outcome.

Complex Concepts Simplified

Substantial Evidence: More than a scintilla but less than a preponderance—simply whether a reasonable mind could accept the evidence as adequate.
Five-Step Sequential Evaluation: A decision tree that asks, in order: (1) is the claimant currently working? (2) is the impairment “severe”? (3) does it meet or equal a Listing? (4) can the claimant do past relevant work? (5) can the claimant do any other work?
Supportability & Consistency (20 C.F.R. § 416.920c): New rules require that medical opinions be evaluated primarily on how well they are supported by objective evidence (tests, imaging, clinical findings) and how consistent they are with other evidence in the record.

Conclusion

Wickham v. Commissioner reaffirms the robust deference courts must give to ALJs when supported by substantial evidence, clarifies the application of the § 416.920c factors in medical-opinion reviews, and confirms that appellate courts consider supplementally submitted evidence without necessarily remanding. The decision provides ALJs, practitioners, and claimants with concrete guidance on disability adjudication under the Social Security Act, especially in the age of post-2017 medical-evidence regulations.