“Notably, though, ALJs are no longer required to give controlling weight to a treating physician’s opinion, as was mandated by federal regulations and our caselaw in the past.”
How later courts described this case
- “Notably, though, ALJs are no longer required to give controlling weight to a treating physician’s opinion, as was mandated by federal regulations and our caselaw in the past.”
- relying on the same SSA policy statement for the definition of “frequent”
- “The party seeking to overturn the Commissioner’s decision has the burden to show that prejudice resulted from an error.”
- “This court will not consider arguments raised for the first time in a reply brief.”
Written by the judges who cited it.
The opinion
Case: 24-60485 Document: 54-1 Page: 1 Date Filed: 09/03/2025
United States Court of Appeals
for the Fifth Circuit
____________ United States Court of Appeals
Fifth Circuit
FILED
No. 24-60485 September 3, 2025
____________
Lyle W. Cayce
Elnora Madkins, Clerk
Plaintiff—Appellant,
versus
Frank Bisignano, Commissioner of Social Security Administration,
Defendant—Appellee.
______________________________
Appeal from the United States District Court
for the Northern District of Mississippi
USDC No. 3:24-CV-6
______________________________
Before Smith, Dennis, and Richman, Circuit Judges.
Per Curiam:
Elnora Madkins appeals the district court’s judgment affirming the
Social Security Administration Commissioner’s final decision denying
Madkins’s application for disability benefits. Because the Commissioner’s
final decision is supported by substantial evidence and any alleged errors did
not harm Madkins’s substantial rights, we affirm.
I
Elnora Madkins is a former machine operator with a high school
education who left her job following an injury in the workplace. Her medical
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No. 24-60485
issues include spinal stenosis, lumbar degenerative joint disease, bilateral
carpal tunnel syndrome, arthritis, depression, and anxiety. In November
2018, she applied for a period of disability and for disability insurance
benefits, alleging that her disability had begun in March of that year. Her
claim was initially denied, denied upon reconsideration, and denied following
a hearing before an administrative law judge (ALJ).
The Appeals Council of the Social Security Administration (SSA)
denied her request for a review of that decision, so she appealed to the
District Court for the Northern District of Mississippi. The district court
reversed and remanded the decision with the specific instruction that the
ALJ “evaluate the prior administrative medical findings and opinion
evidence, including the September 2020 opinion of William Booker, M.D.,
in accordance with 20 C.F.R. §§ 404.1520c, 416.920c.” The Appeals
Council, in turn, remanded the case to the ALJ, who held another hearing.
The evidence before the ALJ on remand included separate
psychiatric reviews and mental residual functional capacity evaluations from
psychologists and state agency consultants Dr. Vicki Prosser and Dr. Glenda
Scallorn, as well as a psychological test report and medical assessment of
Madkins’s mental ability to do work-related activities from psychologist Dr.
Pamela Buck. The record also consisted of a June 2018 report by the
Cooperative Disability Investigations Unit, an orthopedic evaluation by Dr.
Jane Eason, a medical evaluation and a physical residual capacity evaluation
from state agency consultant Dr. Glenn James, and a physical residual
functioning capacity assessment from Dr. Carol Kossman. Additionally, the
evidence included treatment notes, physician source statements, and medical
assessments of Madkins’s physical ability to do work-related activities from
her treating physician, Dr. William Booker. The hearing also involved
testimony from a vocational expert about the potential jobs available to a
2
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No. 24-60485
hypothetical individual with restrictions similar to those that the ALJ
ultimately attributed to Madkins.
On remand, the ALJ determined that Madkins suffered from the
“severe impairments” of depression, anxiety, tendonitis in her shoulders,
osteoarthritis, and degenerative disc disease, and that she could not perform
her past relevant work as a machine operator. Nevertheless, the ALJ found
that she has “the residual functioning capacity to perform light
work . . . except [she] can lift and carry up to ten pounds.” The ALJ
elaborated that she “can occasionally stoop,” “can frequently grasp, handle,
feel, and finger,” “can perform tasks that are simple in nature and can be
performed in a routine work setting,” and “can frequently interact with
others in the work setting” but “can never climb ladders, ropes, or
scaffolds.” Because “there are jobs that exist in significant numbers in the
national economy that [she] can perform” with those described limitations,
the ALJ determined that she is not disabled under the Social Security Act.
The Appeals Council deemed the ALJ decision the final decision of the SSA
Commissioner, and Madkins again appealed to the district court. Both
parties consented to a magistrate judge’s conducting of all proceedings in the
case and entering final judgment, and the magistrate judge affirmed the
decision of the SSA Commissioner. Madkins timely appealed to our court.
II
“We review the Commissioner’s denial of social security benefits
‘only to ascertain whether (1) the final decision is supported by substantial
evidence and (2) whether the Commissioner used the proper legal standards
to evaluate the evidence.’” 1 “Substantial evidence is merely enough that a
_____________________
1
Keel v. Saul, 986 F.3d 551, 555 (5th Cir. 2021) (quoting Whitehead v. Colvin, 820
F.3d 776, 779 (5th Cir. 2016)).
3
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No. 24-60485
reasonable mind could arrive at the same decision; though the evidence
‘must be more than a scintilla[,] it need not be a preponderance.’” 2 “A
finding of no substantial evidence is appropriate only if no credible
evidentiary choices or medical findings support the decision.” 3 “Any
findings of fact by the Commissioner which are supported by substantial
evidence are conclusive.” 4 “We will not ‘re-weigh the evidence’ nor, in the
event of evidentiary conflict or uncertainty, will we ‘substitute our judgment
for the Commissioner’s, even if we believe the evidence weighs against the
Commissioner’s decision.’” 5
Moreover, “[p]rocedural perfection in administrative proceedings is
not required as long as the substantial rights of a party have not been
affected.” 6 “The party seeking to overturn the Commissioner’s decision has
the burden to show that prejudice resulted from an error.” 7
To ascertain whether a claimant is disabled, the ALJ follows a five-
step analysis that is set out in 20 C.F.R. § 404.1520(a)(4). 8 That analysis
requires considering
_____________________
2
Webster v. Kijakazi, 19 F.4th 715, 718 (5th Cir. 2021) (alteration in original)
(quoting Taylor v. Astrue, 706 F.3d 600, 602 (5th Cir 2012)).
3
Salmond v. Berryhill, 892 F.3d 812, 819 (5th Cir. 2018) (quoting Whitehead, 820
F.3d at 779).
4
Taylor, 706 F.3d at 602 (citing Richarson v. Perales, 402 U.S. 389, 390 (1971)).
5
Garcia v. Berryhill, 880 F.3d 700, 704 (5th Cir. 2018) (quoting Masterson v.
Barnhart, 309 F.3d 267, 272 (5th Cir. 2002)).
6
Kneeland v. Berryhill, 850 F.3d 749, 761 (5th Cir. 2017) (quoting Audler v. Astrue,
501 F.3d 446, 448 (5th Cir. 2007)).
7
Jones v. Astrue, 691 F.3d 730, 734-35 (5th Cir. 2012).
8
Webster v. Kijakazi, 19 F.4th 715, 718 (5th Cir. 2021) (citing 20 C.F.R.
§ 404.1520(a)(4)).
4
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No. 24-60485
(1) whether the claimant is engaged in ‘substantial gainful
activity,’ (2) the severity and duration of the claimant’s
impairments, (3) whether the claimant’s impairment ‘meets or
equals’ one of the listings in the relevant regulations,
(4) whether the claimant can still do [her] ‘past relevant work,’
and (5) whether the impairment prevents the claimant from
doing any [other] relevant work. 9
“Before reaching step four, the Commissioner assesses the claimant’s
residual functional capacity . . . .” 10 A claimant’s residual functioning
capacity assessment “is a determination of the most the claimant can still do
despite his [or her] physical and mental limitations and is based on all relevant
evidence in the claimant’s record.” 11 “The claimant bears the burden on the
first four steps,” but on the fifth step, “the burden shifts to the
Commissioner to ‘prove the claimant’s employability.’” 12 “If the claimant
is found to be disabled or not disabled at a step, then that determination ends
the inquiry.” 13
Madkins advances two arguments on appeal. First, she argues that the
ALJ erred by failing to consider the opinion of Dr. Prosser in the decision
denying disability benefits. Second, she argues that the ALJ erred by
insufficiently considering the medical evidence from Dr. Booker.
_____________________
9
Id. (citing 20 C.F.R. § 404.1520(a)(4)).
10
Kneeland, 850 F.3d at 754 (citing Morgan v. Colvin, 803 F.3d 773, 776 n.2 (5th
Cir. 2015)).
11
Id. (alteration in original) (quoting Perez v. Barnhart, 415 F.3d 457, 461-62 (5th
Cir. 2005)).
12
Webster, 19 F.4th at 718 (citing Keel v. Saul, 986 F.3d 551, 555 (5th Cir. 2021)).
13
Keel, 986 F.3d at 555 (citing 20 C.F.R. § 404.1520(a)(4)).
5
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No. 24-60485
A
Madkins argues that it was error for the ALJ not to consider the
opinion offered by state agency consultant Dr. Prosser. The Commissioner
responds that Madkins’s argument should fail because she has not shown
that this alleged error prejudiced her. Federal regulations require that the
SSA, in “determining whether [a claimant] is disabled, . . . always consider
the medical opinions in [the claimant’s] case record together with the rest of
the relevant evidence [the agency] receive[s].” 14 The regulations further
state, “When a medical source provides one or more medical opinions or
prior administrative medical findings, we will consider those medical
opinions or prior administrative medical findings from that medical source
together using the factors listed in paragraphs (c)(1) through (c)(5) of this
section, as appropriate.” 15 “Medical opinions are statements from
physicians and psychologists or other acceptable medical sources that reflect
judgments about the nature and severity of [the claimant’s] impairment(s),
including [the claimant’s] symptoms, diagnosis and prognosis, what [the
claimant] can still do despite impairment(s), and [the claimant’s] physical or
mental restrictions.” 16
In Kneeland v. Berryhill, 17 we vacated and remanded an ALJ’s decision
denying a claimant social security benefits because the ALJ had failed to
address the opinion of a treating, examining physician that conflicted with
the ALJ’s conclusions. 18 The ALJ had determined that the claimant had the
_____________________
14
Kneeland, 850 F.3d at 759 (quoting 20 C.F.R. § 404.1527(b)).
15
20 C.F.R. § 404.1520c(a).
16
Kneeland, 850 F.3d at 759 (quoting 20 C.F.R. § 404.1527(a)(2)).
17
850 F.3d 749.
18
Id. at 758-62; see 20 C.F.R. § 404.1527(c) (explaining that, when evaluating
opinion evidence for claims filed before March 27, 2017, the Commissioner assigns greater
6
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No. 24-60485
ability to “perform light work, ‘limited to standing and walking two hours out
of an eight-hour day,’ among other limitations,” while the physician whose
opinion the ALJ did not consider “opined that she could stand for no longer
than 30 minutes.” 19 The Commissioner argued that “any error in not
addressing [the physician’s] statement was harmless,” but “the
Commissioner point[ed] to no cases in which an ALJ’s failure to address an
examining physician’s medical opinion [was] deemed harmless.” 20 We
reasoned that this dearth of cases was due to the fact that “such an error
makes it impossible to know whether the ALJ properly considered and
weighed an opinion, which directly affects the [residual functioning capacity]
determination.” 21 We remanded with instructions that the ALJ “complet[e]
a holistic evaluation of [the claimant’s] impairments that takes into account
the physical, cognitive, and psychological evidence and explain[s] what
weight he affords the various medical opinions.” 22
_____________________
weight to the opinions of treating and examining physicians than to non-examining
physicians). But see 20 C.F.R. § 404.1520c(a) (explaining that, for claims like Madkins’s
that were filed on or after March 27, 2017, the Commissioner does “not defer or give any
specific evidentiary weight, including controlling weight, to any medical opinion(s) or prior
administrative medical finding(s), including those from [the claimant’s] medical
sources”); Webster v. Kijakazi, 19 F.4th 715, 718-19 (5th Cir. 2021) (“Notably, though,
ALJs are no longer required to give controlling weight to a treating physician’s opinion, as
was mandated by federal regulations and our caselaw in the past.”); Williams v. Kijakazi,
No. 23-30035, 2023 WL 5769415, at *2 (5th Cir. Sep. 6, 2023) (“These new regulations
eliminate the old hierarchy of medical opinions, no longer provide for any inherent or
presumptive weight, and do away with the examining and non-examining physician
terminology.”).
19
Kneeland, 850 F.3d at 759.
20
Id. at 761-62.
21
Id. at 762.
22
Id.
7
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No. 24-60485
Here, neither party disputes that Dr. Prosser’s assessment constitutes
a medical opinion. We agree that it so qualifies because it is a statement from
a psychologist about Madkins’s mental impairments, what she can still do
despite those impairments, and her mental restrictions. 23 However, the
instant case is distinguishable from Kneeland. While we viewed the
physician’s opinion as conflicting with the ALJ’s decision in Kneeland, it is
not at all apparent that Dr. Prosser’s opinion conflicts with the ALJ’s
assessment of Madkins’s mental and social limitations. Dr. Prosser opined
that Madkins could “interact appropriately to coworkers and supervisors on
a limited basis,” and she rated Madkins’s “ability to respond appropriately to
changes in the work setting,” “ability to interact appropriately with the
general public,” “ability to accept instructions and respond appropriately to
criticism from supervisors,” and “ability to get along with coworkers or peers
without distracting them or exhibiting behavioral extremes” as “[m]oderately
[l]imited.” Her evaluation did not elaborate on the parameters of those
moderate limitations, nor does Madkins provide any further clarity on the
matter in her briefing.
The ALJ, meanwhile, determined that Madkins could “frequently
interact with others in the work setting.” A policy decision from the SSA
defines “frequent” as meaning that the activity may occur “from one-third
to two-thirds of the time.” 24 So, the ALJ limited Madkins’s social
interactions at work to only one-third to two-thirds of the day, which does
not clearly conflict with the moderate limitations that Dr. Prosser proposed.
_____________________
23
See 20 C.F.R. § 404.1527(a)(2) (defining a medical opinion).
24
SSR 83-10, 1983 WL 31251, at *6 (Jan. 1, 1983); see also Gallant v. Heckler, 753
F.2d 1450, 1454 n.1 (9th Cir. 1984) (relying on the same SSA policy statement for the
definition of “frequent”); Villarreal v. Colvin, 221 F. Supp. 3d 835, 849 (W.D. Tex. 2016)
(same).
8
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No. 24-60485
Since Kneeland, we have on at least one occasion, in an unpublished decision,
deemed harmless an ALJ’s failure to consider a state agency reviewing
physician’s opinion because of the claimant’s failure to establish prejudice. 25
Given that the lack of conflict between Dr. Prosser’s opinion and the ALJ’s
determination means that Madkins’s substantial rights were not affected, any
error on this point was harmless. Moreover, to the extent that Madkins
argues that the failure to consider Dr. Prosser’s opinion undermined the
hypothetical question that the ALJ posed to the vocational expert during her
hearing, she has forfeited this argument by raising it for the first time in her
reply brief. 26
B
Madkins further argues that the ALJ did not sufficiently consider Dr.
Booker’s opinions in ascertaining whether Madkins is disabled. Specifically,
she claims that the ALJ (1) ignored Dr. Booker’s treatment notes, (2) did not
consider Madkins’s decreased range of motion in her spine, and (3) did not
consider Dr. Booker’s diagnoses, Madkins’s symptoms, and Dr. Booker’s
opinion regarding the amount of time Madkins would spend away from her
work station, as documented in his physician source statements. The
Commissioner responds that the ALJ reasonably assessed Dr. Booker’s
opinions and that substantial evidence supports the ALJ’s conclusions.
In determining whether a claimant is disabled, an ALJ “must consider
all the record evidence and cannot ‘pick and choose’ only the evidence that
_____________________
25
See McCray v. Kijakazi, No. 21-60401, 2022 WL 301544, at *2 (5th Cir. Feb. 1,
2022).
26
See Perez v. Bruister, 823 F.3d 250, 273 n.31 (5th Cir. 2016) (“This court will not
consider arguments raised for the first time in a reply brief.”).
9
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No. 24-60485
supports his position.” 27 Regulations provide that the SSA “will consider”
the “medical opinions or prior administrative medical findings” provided by
a medical source. 28 However, “when a medical source provides multiple
medical opinion(s) or prior administrative medical finding(s), [the agency]
will articulate how [it] considered the medical opinions or prior
administrative medical findings from that medical source together in a single
analysis.” 29 The agency is “not required to articulate how [it] considered
each medical opinion or prior administrative medical finding from one
medical source individually.” 30
1
Madkins is incorrect in her assertion that the ALJ ignored Dr.
Booker’s treatment notes. The ALJ decision discussed Dr. Booker’s
treatment notes from Madkins’s April 2019 and May 2019 appointments
when evaluating her musculoskeletal disorders.
2
Madkins is also incorrect in stating that the ALJ failed to consider the
decreased range of motion in her spine. The ALJ determined that Madkins
suffered from degenerative disc disease, a spine condition, among other
“severe impairments.” The ALJ’s decision also repeatedly referenced
Madkins’s decreased range of motion in her back, and the ALJ restricted
Madkins to light work as defined in 20 C.F.R. §§ 404.1567(b) and 416.967(b),
with the added restrictions that she can lift and carry “up to ten pounds”
_____________________
27
Loza v. Apfel, 219 F.3d 378, 393 (5th Cir. 2000).
28
20 C.F.R. §§ 404.1520c(a), 416.920c(a).
29
Id. §§ 404.1520c(b)(1), 416.920c(b)(1).
30
Id. §§ 404.1520c(b)(1), 416.920c(b)(1).
10
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No. 24-60485
rather than the twenty pounds permitted by the regulations, while also
limiting her to occasional stooping and never climbing ladders, ropes, or
scaffolds. 31
To be sure, Dr. Booker opined that stricter restrictions were
necessary: his assessments noted that she could stand, walk, or sit for about
two hours in a normal workday, at most; restricted her to stooping and
climbing stairs either “rarely” or “never”; restricted her to twisting
“rarely” or “occasionally”; and restricted her to crouching and climbing
ladders “never.” In his May 2023 assessment, he opined that she could
“frequently” lift and carry fewer than ten pounds and “occasionally” lift and
carry ten pounds. Madkins argues that “[p]rejudice is established” by this
error “as these opinions by Dr. Booker reduce [her] below even a sedentary
capacity which would support a favorable decision in this claim from Ms.
Madkins’s onset date.” But the ALJ explained that he found these opinions
“unpersuasive because they are internally inconsistent and unsupported by
the remaining record.” For example, in June 2022, Dr. Booker opined that
Madkins could twist “occasionally” and never climb stairs. Then, in May
2023, he opined that she could twist only “rarely” while also climbing stairs
“rarely” without explaining why one of her physical abilities (climbing stairs)
had improved while another (twisting) had deteriorated. Additionally, his
assessment that she could “never” or “rarely” stoop conflicted with the
observation from a Cooperative Disability Investigations interview in June
_____________________
31
See id. § 404.1567(b) (defining light work as involving “lifting no more than 20
pounds at a time with frequent lifting or carrying of objects weighing up to 10 pounds” and
requiring “a good deal of walking or standing” or “sitting most of the time with some
pushing and pulling of arm or leg controls,” as well as noting that “[i]f someone can do
light work, we determine that he or she can also do sedentary work, unless there are
additional limiting factors such as loss of fine dexterity or inability to sit for long periods of
time”); id. § 416.967(b) (same).
11
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No. 24-60485
2018 that she bent over and straightened back up—albeit slowly—twice in
twenty-five minutes in order to pick up a pen.
Moreover, substantial evidence supports the limitation to perform
light work: following an examination, Dr. Eason opined that Madkins could
stand for a total of four hours, walk for a total of three hours, and sit for a total
of eight hours in an eight-hour workday. She also opined that Madkins could
occasionally lift and carry up to ten pounds and that she could occasionally
climb stairs and balance but could never stoop, crouch, kneel, crawl, or climb
ladders or scaffolds. Dr. James and Dr. Kossman both opined that she could
stand, walk, and sit for about six hours in an eight-hour workday, with Dr.
James concluding that she could occasionally stoop, crouch, kneel, crawl, and
climb ramps, stairs, ladders, ropes, and scaffolds, and Dr. Kossman
concluding that she had no postural limitations. Both Dr. James and Dr.
Kossman also opined that she could occasionally lift and carry up to twenty
pounds and could frequently lift and carry up to ten pounds. The ALJ found
all of these opinions “partially persuasive to the extent that they [were]
consistent with and supported by the remaining record.” The ALJ evaluated
Madkins’s decreased range of motion in her spine, and his determination is
supported by substantial evidence.
3
The ALJ likewise did not err in failing to address the contents of Dr.
Booker’s physician source statements, which included Madkins’s diagnoses
and symptoms, as well as Dr. Booker’s opinion about the amount of time she
would be off task during the workday. The ALJ discussed various opinions
from Dr. Booker, and the regulations do “not require[]” the agency “to
articulate how [it] considered each medical opinion or prior administrative
12
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No. 24-60485
medical finding from one medical source individually.” 32 The failure to
specifically mention each individual physician source statement was not error
when the ALJ had already discussed Dr. Booker’s medical assessments of
Madkins’s physical ability to do work-related activities.
Moreover, the diagnoses and symptoms listed in Dr. Booker’s most
recent physician source statement largely mirror Madkins’s severe
impairments listed in the ALJ decision. In May 2023, Dr. Booker wrote that
Madkins was diagnosed with spinal stenosis, lumbar degenerative joint
disease, bilateral carpal tunnel syndrome, and arthritis in multiple sites; he
also noted that her symptoms included pain, joint stiffness, weakness, and
anxiety. The ALJ determined that her severe impairments included
depression, anxiety, tendonitis in her shoulders, osteoarthritis, and
degenerative disc disease. These impairments would seem to account for Dr.
Booker’s diagnoses of conditions affecting her back and joints as well as her
symptoms of pain, joint stiffness, and anxiety. To the extent gaps exist
between the diagnoses and symptoms that Dr. Booker listed compared to the
ALJ decision’s list of severe impairments, Madkins has not explained how
such differences have affected her substantial rights, and therefore she has
not met her burden of showing prejudice. 33
Finally, substantial evidence supported the lack of any restriction in
the ALJ’s decision pertaining to the time that Madkins would likely be off
task during the workday. In Dr. Booker’s physician source statements, he
estimated that she would be off task for twenty-five percent of a normal
workday “due to [her] impairment[s].” But according to Dr. Booker’s own
_____________________
32
Id. §§ 404.1520c(b)(1), 416.920c(b)(1).
33
See Jones v. Astrue, 691 F.3d 730, 734-35 (5th Cir. 2012) (“The party seeking to
overturn the Commissioner’s decision has the burden to show that prejudice resulted from
an error.”).
13
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No. 24-60485
treatment notes from the appointments immediately preceding the June
2022 and May 2023 physician source statements, Madkins denied having
trouble concentrating. Dr. Eason also noted that her concentration was
“good,” and Dr. Buck described her attention and concentration as
“adequate.” Additionally, Dr. Prosser opined that she could “maintain
attention and concentration adequately for 2-hour periods in an 8-hour
workday.” Dr. Scallorn, whose opinion the ALJ deemed “persuasive to the
extent that it is consistent with and supported by the remaining record,”
likewise opined that Madkins was “[c]apable of understanding and following
directions” to complete “at least simple tasks” for two-hour periods during
an eight-hour workday. Given the presence of this evidence supporting
Madkins’s ability to concentrate, coupled with Dr. Booker’s failure to offer
any explanation as to why he believed her concentration capabilities to be so
limited, we cannot say that the ALJ erred in not restricting Madkins based
on her potential time off task.34
* * *
We AFFIRM the judgment of the district court.
_____________________
34
See DeJohnette v. Berryhill, 681 F. App’x 320, 321-22 (5th Cir. 2017) (holding
that “[t]he ALJ was well within its discretion to conclude that [the doctor’s] checking a
single box on a single form without any supporting medical evidence did not outweigh the
other substantial record evidence supporting” the ALJ’s finding).
14