Fifth Circuit Affirms Denial in Williams v. Bisignano

The Fifth Circuit’s decision in Williams v. Bisignano reinforces two practical and procedural lessons for Social Security disability attorneys — one at Step 3 (Medical Equivalence) and one at Step 5 (Moderate Mental Limitations and VE Testimony).

For practitioners handling claims involving anxiety and other mental impairments, this case provides important guidance on how courts evaluate articulation, medical equivalence, and RFC translation issues.

Step 3: Medical Equivalence & SSR 17-2p

At Step 3, the claimant did not argue that he met:

• Listing 12.04 (Depressive disorders)

• Listing 12.06 (Anxiety disorders)

• Listing 12.11 (Neurodevelopmental disorders)

  
  

Instead, he argued the ALJ failed to properly articulate why his impairments did not medically equal a listing.

The Court’s Holding

The Fifth Circuit relied on Social Security Ruling 17-2p, which provides that:

• An ALJ’s statement that impairments do not medically equal a listing can be sufficient.

• The decision as a whole may supply the necessary reasoning.

• Detailed, formulaic articulation is not always required.

  
  

The claimant attempted to invoke Loper Bright Enterprises v. Raimondo to challenge agency deference principles.

The Fifth Circuit declined to engage that broader administrative law debate and held that SSR 17-2p does not conflict with governing regulations.

Practical Takeaway for Step 3 Appeals

In the Fifth Circuit:

• Courts look for whether they can trace the ALJ’s reasoning, not whether the ALJ used magic words.

• A Step 3 argument based solely on “the ALJ didn’t say enough” is unlikely to succeed.

• Medical equivalence arguments must be supported with specific medical findings showing equivalence in severity.

  
  

Step 5: The “Moderate” Limitation Problem

This is the portion of the opinion that has immediate practical implications.

The Setup

The State agency psychologist:

• Checked boxes reflecting several “moderate” limitations in concentration and persistence.

• In the narrative Mental Residual Functional Capacity (MRFC), concluded the claimant could:

  • Perform simple tasks

  • With routine supervision

    
    

The ALJ adopted the narrative MRFC and incorporated it into the RFC and hypothetical to the vocational expert (VE).

The Cross-Examination Strategy

On cross-examination, claimant’s counsel redefined “moderate” as:

Being unable to perform a task satisfactorily for 15–20% of the workday.

The VE testified that such an off-task percentage would preclude competitive employment.

Why the Argument Failed

The Fifth Circuit rejected the argument because:

• The 15–20% limitation did not appear anywhere in the medical opinion.

• The psychologist did not quantify “moderate” as an off-task percentage.

• The narrative MRFC — not the checkbox portion — controls.

  
  

The Court’s Core Principle

The narrative portion of the MRFC drives the analysis.Checkbox findings are inputs, not standalone RFC limitations.

Why This Decision Matters for Practitioners

1. The Narrative Controls

When reviewing a State agency mental opinion:

• Focus on the Section III narrative.

• Do not assume checkbox findings automatically translate into RFC restrictions.

• Courts will treat the narrative as the operative opinion.

  
  

2. Percentage-Based Hypotheticals Must Be Anchored in the Record

If you intend to:

• Argue off-task time (e.g., 15–20%), or

• Tie “moderate” to a quantifiable productivity limitation

  
  

You must have:

• A medical source statement explicitly defining it that way, or

• Supporting evidence that reasonably compels that interpretation.

  
  

Otherwise, courts will view it as attorney-created speculation.

3. Step 3 Articulation Challenges Require Substance

Stylistic complaints about insufficient explanation are rarely enough. Instead:

• Identify medical findings equaling listing criteria.

• Show how the evidence matches paragraph A and B (or C) criteria.

• Demonstrate harmful error — not just incomplete wording.

  
  

Q&A: Common Questions After Williams v. Bisignano

Q: Can I argue that “moderate” automatically means a claimant is off-task a specific percentage of the workday?

A: No. Unless the medical source explicitly defines “moderate” in quantifiable terms, courts will rely on the narrative MRFC, not attorney-imposed definitions.

Q: Does an ALJ have to provide a detailed written analysis of medical equivalence?

A: Not necessarily. Under SSR 17-2p, a clear statement that impairments do not equal a listing may be sufficient if the decision allows the court to follow the reasoning.

Q: Is Loper Bright likely to disrupt Social Security appeals?

A: Not in this context. The Fifth Circuit declined to find any conflict between SSR 17-2p and SSA regulations.

Final Takeaways from Williams v. Bisignano

• ✔ The narrative MRFC controls over checkbox findings.

• ✔ Percentage-based productivity limitations must be medically supported.

• ✔ Step 3 arguments require substantive equivalence evidence — not merely articulation critiques.

  
  

For attorneys litigating Social Security disability cases in the Fifth Circuit, this opinion is a reminder that precision in the record matters more than creative reframing on appeal.