Tenth Circuit Clarifies: Mental-Health Progress Notes Without Functional Assessments Are Not “Medical Opinions” Under SSA’s Post-2017 Regulations

Introduction

In Parsons v. Commissioner, SSA (10th Cir. Oct. 9, 2025), the Tenth Circuit affirmed the denial of disability insurance and supplemental security income benefits to a claimant who argued that her mental health providers’ progress notes—Client Assessment Records (CARs)—should have been evaluated by the Administrative Law Judge (ALJ) as “medical opinions.” The panel (Judges Hartz, Baldock, and Phillips) rejected the argument, holding that CARs consisting primarily of a claimant’s reported symptoms and unexplained numerical ratings do not qualify as “medical opinions” under the Social Security Administration’s (SSA) post-2017 regulations unless they include a statement from a medical source describing what the claimant can still do despite her impairments and any associated work-related limitations.

The opinion also reinforces two longstanding administrative law principles in Social Security practice: (1) the ALJ need not discuss every piece of evidence and commits no error by failing to weigh non-opinion evidence as “opinions”; and (2) claimants bear the responsibility to develop the record before the ALJ, including submitting interpretive materials they later rely upon. Because the claimant did not supply the “Prior Authorization Manual” she invoked to interpret the CARs’ scores—and because that manual was outside the administrative record—the court declined to consider it on appeal.

Summary of the Opinion

Amy Kay Parsons alleged disability based on degenerative disc and joint disease, depressive disorder, schizoaffective disorder, anxiety disorder, and chronic pain disorder. The ALJ found she retained the residual functional capacity (RFC) for a limited range of light work and could perform other jobs existing in significant numbers (marker, garment sorter, cleaner/housekeeper). The Appeals Council denied review, and the district court affirmed.

On appeal, Parsons argued the ALJ erred by (a) failing to acknowledge and analyze three CARs from her treating mental health providers, and (b) failing to evaluate those CARs as “medical opinions” under 20 C.F.R. §§ 404.1520c and 416.920c. The Tenth Circuit disagreed on both counts:

The ALJ did acknowledge and discuss the CARs when formulating the RFC; ALJs are not required to discuss every piece of evidence.
The CARs were not “medical opinions” under 20 C.F.R. §§ 404.1513(a)(2) and 416.913(a)(2) because they contained no statement from a medical source about what Parsons could still do despite her impairments and no functional limitations tied to the demands of work.

Parsons also urged the court to use an Oklahoma Health Care Authority “Prior Authorization Manual” to translate the CARs’ numerical scores into functional limitations. The court refused, noting: (1) the manual was not in the administrative record and cannot be considered on appeal; and (2) in any event, the claimant had the duty to present such nonmedical interpretive materials to the ALJ if she intended to rely on them.

Accordingly, the Tenth Circuit affirmed the district court’s judgment.

Analysis

Precedents Cited and Their Role

Fischer-Ross v. Barnhart, 431 F.3d 729 (10th Cir. 2005): Cited for the five-step sequential evaluation framework. Here, the ALJ denied at step five after finding other work the claimant could perform given her RFC.
Keyes-Zachary v. Astrue, 695 F.3d 1156 (10th Cir. 2012): Provides the standard of review: courts examine whether the ALJ applied the correct legal standards and whether the decision is supported by substantial evidence. The Tenth Circuit adhered to this deferential standard.
Hackett v. Barnhart, 395 F.3d 1168 (10th Cir. 2005): Reinforces that appellate courts do not reweigh evidence or substitute their judgment for the Commissioner’s. This framed the court’s unwillingness to revisit the ALJ’s evidence-sifting where no legal error occurred.
Wall v. Astrue, 561 F.3d 1048 (10th Cir. 2009): Two related principles: (a) the ALJ need not discuss every piece of evidence but must address uncontroverted, significantly probative evidence she rejects; and (b) the claimant bears the burden to structure and present the case, including submitting relevant materials. Wall underpins both the court’s acceptance of the ALJ’s discussion and its rejection of Parsons’s reliance on an extra-record manual.
Staheli v. Commissioner, 84 F.4th 901 (10th Cir. 2023): Critical precedent on what qualifies as a “medical opinion” under the post-2017 regulations. Staheli held that a physician’s prognosis statements were not medical opinions because they did not address the claimant’s ability to perform the specific demands of work activities. Parsons extends this logic to mental-health progress notes: absent functional statements, they are not “medical opinions.”
Krauser v. Astrue, 638 F.3d 1324 (10th Cir. 2011): Evidence not before the agency is off-limits on judicial review. This foreclosed Parsons’s appellate reliance on the “Prior Authorization Manual.”

Legal Reasoning

The centerpiece of the court’s reasoning is the regulatory definition of a “medical opinion.” Under 20 C.F.R. §§ 404.1513(a)(2) and 416.913(a)(2), a medical opinion is a statement from a medical source about (a) what a claimant can still do despite impairments and (b) whether the claimant has one or more impairment-related limitations or restrictions in specific work-related functions (physical, mental, sensory, and environmental).

Applying this definition, the panel observed that the three CARs from the Oklahoma Community Mental Health Center did not include any provider statements about Parsons’s remaining functional capacities. Instead, they largely reflected Parsons’s own reports—variable moods, anxiety or depression, hallucinations at times, sleep issues, substance use history, family dynamics, an outstanding warrant, and similar topics—along with numerical scores assigned to ten domains. Those scores (ranging 20–39) had no explanation in the record connecting them to work-related functioning.

Parsons attempted to fill that gap by referencing a “Prior Authorization Manual” she claimed would translate the CARs’ scores into functional limitations. The court declined to consider the manual for two reasons:

It was not part of the administrative record; courts reviewing SSA decisions cannot consider extra-record materials (Krauser).
It was “information from a nonmedical source” about an issue in the claim under 20 C.F.R. §§ 404.1513(a)(4) and 416.913(a)(4), and therefore it was incumbent on Parsons to provide it to the ALJ if she intended to rely on it (Wall’s claimant-responsibility principle).

Because the CARs lacked functional assessments, they were not “medical opinions,” and the ALJ was not obligated to evaluate them under 20 C.F.R. §§ 404.1520c and 416.920c (the “supportability” and “consistency” analysis for medical opinions). The court also rejected Parsons’s argument that the ALJ had to “assign weight” to the CARs; under the post-2017 regulations, ALJs do not assign weight or deference to medical opinions at all (Staheli), and, in any event, these CARs were not opinions to begin with.

The panel further found that the ALJ did not ignore the CARs. The decision cited the relevant exhibits and summarized their contents in the RFC discussion. Under Wall, the ALJ’s treatment was adequate: an ALJ must address significantly probative evidence she rejects, but she is not required to discuss every entry in a voluminous record.

Impact

Although issued as a nonprecedential order and judgment, Parsons provides persuasive guidance in the Tenth Circuit on the treatment of mental-health progress notes and analogous records:

Clear line between progress notes and medical opinions: Progress notes that collect patient self-reports, clinical observations, and even numerical or categorical ratings are not “medical opinions” unless they include a provider’s statement tying impairments to specific functional abilities and work-related limitations (e.g., the claimant can maintain concentration for X minutes, can perform routine tasks with superficial contact with others, can sit/stand for specified durations, etc.). Absent such statements, ALJs need not perform a 20 C.F.R. § 404.1520c “supportability/consistency” analysis on those records.
Record-development responsibilities fall squarely on claimants: If a claimant intends to rely on clinic tools, scales, or manuals to argue that numeric scores equate to functional limitations, those materials must be submitted to the ALJ and explained at the hearing level. Courts will not consider extra-record interpretive sources on appeal.
Practical drafting for providers and representatives: Counsel representing claimants should seek explicit, function-by-function opinions from treating sources when possible. Mental-health providers can bolster the evidentiary value of their treatment notes by adding clear, work-focused statements (e.g., limitations in understanding, remembering, applying information; interacting with others; concentrating, persisting, or maintaining pace; adapting or managing oneself).
ALJ decision-writing: While ALJs must consider all evidence, Parsons supports the proposition that ALJs are not required to treat narrative progress notes or clinic scoring tools as “medical opinions” absent functional content. ALJs should still address any uncontroverted, significantly probative evidence they choose to reject to avoid remand.
Post-2017 regulatory framework reaffirmed: Parsons, following Staheli, underscores that “weights” are out; “persuasiveness” grounded in supportability and consistency applies only to true medical opinions. Other medical evidence remains relevant to the overall RFC but is not subject to the § 404.1520c/§ 416.920c framework.

Complex Concepts Simplified

Residual Functional Capacity (RFC): The most a claimant can do despite limitations from medically determinable impairments. RFC is expressed in vocational terms (e.g., “light work” with specified postural, environmental, or mental/social restrictions).
Step Five Determination: After determining a claimant cannot do past relevant work, the SSA must show there are other jobs in significant numbers in the national economy that the claimant can perform given the RFC, age, education, and work experience.
Medical Opinion (post-2017 regulations): A statement from a medical source that describes what a claimant can still do and identifies work-related limitations. Opinions must connect impairments to functional capacity (e.g., lifting, standing, sitting, interacting with others, concentration, etc.).
Other Medical Evidence vs. Medical Opinion: Progress notes, clinical observations, lab results, and similar records are “other medical evidence” unless they include explicit functional assessments. “Other medical evidence” informs the RFC but is not evaluated under the “supportability/consistency” factors reserved for medical opinions.
Supportability and Consistency: The two most important factors when evaluating a “medical opinion.” Supportability asks whether the source explains the opinion with objective medical findings; consistency asks whether the opinion aligns with the broader record. These factors are applied only if there is a medical opinion in the first place.
Substantial Evidence Review: A deferential standard; the court asks whether a reasonable mind could accept the evidence as adequate to support the ALJ’s findings. Courts do not reweigh evidence or substitute their judgment for the ALJ’s.
Nonmedical Source Information: Materials from nonmedical sources (like agency manuals or policy documents) that may contextualize evidence. If a claimant relies on such information, it must be submitted at the administrative level to be considered on judicial review.
Nonprecedential Order and Judgment: This type of disposition is not binding precedent (except under law of the case, res judicata, collateral estoppel) but may be cited for its persuasive value under Fed. R. App. P. 32.1 and 10th Cir. R. 32.1.

Conclusion

Parsons v. Commissioner, SSA provides clear guidance in the Tenth Circuit: mental-health progress notes and clinic assessment tools that summarize a claimant’s reported symptoms and assign uninterpreted numerical domain scores do not, without more, constitute “medical opinions” under 20 C.F.R. §§ 404.1513(a)(2) and 416.913(a)(2). Because the CARs did not include provider statements about what the claimant could still do despite her impairments or specify functional limitations related to work, the ALJ had no obligation to analyze them under the medical-opinion framework or to assign them “weight.”

The decision also reinforces procedural guardrails central to Social Security practice: claimants must develop the evidentiary record—including any interpretive manuals or nonmedical sources they intend to rely upon—at the administrative level, and courts on judicial review will not consider materials outside the record. For practitioners and providers, the lesson is practical and immediate: obtain and submit explicit, function-focused opinions when functional limitations are at the heart of a disability claim, and ensure that any specialized scoring systems are properly documented and explained to the ALJ. While nonprecedential, Parsons is likely to be influential in how ALJs, advocates, and district courts within the Tenth Circuit treat similar progress-note evidence going forward.