## Facts

- Social Security disability claimants in certified New York and Vermont classes challenged how HHS evaluated treating-physician opinions when terminating or denying benefits.
- The Second Circuit had previously developed a claimant-favorable “treating physician rule,” giving substantial weight to treating-source opinions absent substantial contrary evidence.
- After earlier litigation, HHS promulgated regulations on medical-opinion evidence, including treating-source opinions, codified at 20 C.F.R. §§ 404.1527 and 416.927.
- The regulations provide that a treating-source medical opinion receives “controlling weight” only if it is well-supported by medically acceptable clinical and laboratory diagnostic techniques and is not inconsistent with other substantial evidence; otherwise, adjudicators weigh the opinion using specified factors (e.g., treatment relationship, supportability, consistency, specialization).
- Two district courts held the regulations valid for internal agency adjudications but ruled that federal courts would continue applying the pre-regulation, judicial treating-physician rule on review.
- The Secretary appealed the “dual-standard” approach; the claimant classes cross-appealed, arguing the regulations improperly diluted the treating-physician rule and conflicted with prior remedial directives.

## Issues

1. Whether the treating-physician regulations at 20 C.F.R. §§ 404.1527 and 416.927 are a valid and reasonable interpretation of the Social Security Act and consistent with prior court-ordered directives.
2. Whether, once validly promulgated, those regulations govern not only agency adjudications but also the standard federal courts must apply on judicial review, displacing prior circuit case law to the extent of conflict.

## Decision

- The Second Circuit upheld the treating-physician regulations as valid exercises of the Secretary’s rulemaking authority under the Social Security Act.
- The court held the regulations apply in both administrative proceedings and federal judicial review; courts may not apply a separate, more claimant-favorable, judge-made treating-physician rule.
- The court concluded the regulations supersede prior Second Circuit treating-physician precedent to the extent that precedent differs from the regulatory framework.
- The district court judgments were modified to eliminate the requirement that federal courts continue using the pre-regulation rule and were otherwise affirmed.

## Legal Principles

- When the Social Security Act does not codify a specific evidentiary rule, the Secretary may adopt reasonable regulations governing evaluation of medical opinions, and courts defer to those regulations if consistent with the statute.
- A treating-source opinion receives controlling weight only if it is well-supported by medically acceptable clinical and laboratory diagnostic techniques and not inconsistent with other substantial evidence in the record.
- If controlling weight is not given, adjudicators must evaluate the treating-source opinion under the regulatory factors, including the treatment relationship, supportability, consistency with the record, and specialization.
- Validly promulgated agency regulations may displace prior judge-made circuit standards that developed in the absence of governing regulations; federal courts reviewing agency disability determinations must apply the same regulatory standard used by the agency.

## Conclusion

The Second Circuit sustained HHS’s treating-physician regulations and required their use in both agency adjudications and federal court review, replacing the circuit’s earlier treating-physician case law where inconsistent with the regulatory framework.


Schisler v. Sullivan, 3 F.3d 563 (2d Cir. 1993)