1 2 3 4 UNITED STATES DISTRICT COURT 5 NORTHERN DISTRICT OF CALIFORNIA 6 7 A.K., Case No. 25-cv-05010-EMC
8 Plaintiff, ORDER 9 v.
10 SSA COMMISSIONER, Docket Nos. 12-13 11 Defendant.
12 13 14 Plaintiff A.K. seeks review of the Commissioner’s final decision denying her Title II 15 application for disability insurance benefits. A.K. has exhausted her administrative remedies with 16 respect to her claim of disability. This Court has jurisdiction pursuant to 42 U.S.C. § 405(g). 17 A.K. asks that the final decision be reversed and the case remanded for additional administrative 18 proceedings. Having considered the parties’ briefs and the administrative record, the Court hereby 19 DENIES A.K.’s request for relief. 20 I. FACTUAL & PROCEDURAL BACKGROUND 21 On January 5, 2021, A.K. filed a Title II application for disability insurance benefits. See 22 AR 364-67 (application). She claimed a disability onset date of January 4, 2017, see AR 366, and 23 asserted both physical and mental impairments. See, e.g., AR 410 (Disability Report Adult, 24 submitted on 1/8/2021) (listing the following physical and mental conditions that limit ability to 25 work: depression; insomnia; bilateral arthritis in the knees; degenerative joint disease; chronic 26 knee pain; runner’s knee; bipolar disorder; and sciatica); AR 632 (prehearing memo filed with the 27 ALJ on 3/19/2022) (identifying the following physical and mental impairments: bipolar disorder; 1 joint disease bilateral knees; autistic disorder; PTSD; degenerative disc disease lumbar spine; and 2 diabetes mellitus). 3 As reflected in the administrative record, A.K. regularly sought treatment for her physical 4 and mental conditions. With respect to physical conditions, A.K. suffered, in particular, from 5 back and knee pain. She had some county in-home supportive services (“IHSS”) to help her, see 6 AR 386-91 (notice from county regarding change to IHSS), and at times used an assistive device 7 to ambulate. See, e.g., AR 1825 (medical record from Mr. Arroyo (chiropractor), dated 8 3/21/2022) (observing use of walker); AR 1311 (medical record from Dr. Gould, dated 12/2/2021) 9 (requesting “Standard 2-Wheel Walker”); AR 1176 (medical record from Mr. Ebert (PA), dated 10 3/11/2021) (observing use of walker). Imaging, however, did not suggest any significant issues, 11 and treating providers generally characterized the physical impairments as mild. See, e.g., AR 12 1312 (medical record from Dr. Gould, dated 12/2/2021) (noting that A.K. “briefly brought up the 13 idea of applying for ‘federal disability,’” but, “based on her exam and imaging, there is nothing 14 that I can see that would qualify for disability”); AR 1214 (MRI of lumbar spine on 4/13/2021) 15 (noting “[m]ild multilevel degenerative changes . . . without definite evidence of significant 16 central stenosis or focal nerve root impingement”); AR 1122 (medical record of Ms. Boley (NP), 17 dated 3/30/2021) (noting full range of motion in “all joints” and “[v]ery mild tenderness to 18 palpation over the anterior medial aspect of the [right] knee”); AR 1124 (MRI of right knee on 19 3/5/2021) (finding “[n]ormal MRI examination” – e.g., “visualized bony structures show normal 20 signal intensity[;] [t]he articular cartilage is maintained[;] [and] [t]here is no right knee joint 21 effusion or popliteal cyst”); AR 763, 825 (medical record from Dr. Kuntz, dated 12/27/2020) (in 22 evaluating right knee, noting “full range of motion without difficulty” and “[m]ild tenderness to 23 palpation along the medial aspect of the knee”; finding, after x-ray, mild degenerative disease); 24 AR 1705 (x-ray of bilateral knees on 6/23/2020) (finding “[m]ild joint space narrowing” in both 25 knees; stating “[m]ild degenerative disease”); AR 828 (x-ray of left knee on 6/19/2020) (finding 26 “[n]o acute fracture or dislocation[;] [j]oint spaces are maintained”). 27 As for mental conditions, A.K. suffered from, inter alia, bipolar and anxiety disorders. 1 (medical record from Dr. Goodwin, dated 1/14/2021). Notably, in mid-2019, A.K. was put on a 2 5150 hold for suicidal ideation. See AR 772 (medical record from Dr. Zernec, dated 5/26/2019); 3 AR 709 (medical record from Dr. Lewerenz, dated 6/3/2019). She was discharged after an 4 assessment was made that there was no indication she was a danger to herself or others, or she 5 would be unable to care for her basic needs at home. See AR 710. The incident appears to have 6 attributable to a change in medication. See AR 709 (medical record from Dr. Lewerenz, dated 7 6/3/2019) (in recounting history of present illness, stating that A.K.’s “suicidal thoughts occurred 8 in the context of medication adjustments[;] her outpatient psychiatrist had taken her off Seroquel 9 due to patient complaints of daytime sleepiness, and transitioning to Vraylar”); see also AR 718 10 (medical record from Ms. Mullis (MFT intern), dated 5/19/2020). A treating physician, Dr. 11 Goodwin, later took note that A.K. was reporting her depression was resolved. He also found her 12 mental status examination “unremarkable” on several visits. See, e.g., AR 726-27 (medical record 13 from Dr. Goodwin, dated 4/6/2020). According to Dr. Goodwin, A.K.’s “[p]resentation [was] 14 consistent with a working diagnosis of bipolar I [disorder], in remission, most recent episode 15 depressed.” AR 727 (adding that “[a]lternative diagnoses have been considered but are not 16 supported by the current presentation”); see also AR 733 (medical record from Dr. Goodwin, 17 dated 8/3/2020). Dr. Goodwin also did not support A.K.’s request for disability based on anxiety 18 or insomnia. See AR 738 (medical record from Dr. Goodwin, dated 1/14/2021) (taking note of 19 “request[] that she be placed on disability for social anxiety[;] this writer opined that anxiety is not 20 a reason for disability”); AR 726 (medical record from Dr. Goodwin, dated 4/6/2020) (taking note 21 of request for “disability for insomnia, which this writer did not support”). 22 A. First ALJ Decision 23 A.K.’s claim for disability was first presented to an ALJ in March 2022. See AR 203 (ALJ 24 decision). See AR 166 (ALJ decision). In July 2022, ALJ Mariani issued her decision denying 25 benefits. See AR 203-23. The ALJ applied the five-step sequential process provided for by the 26 federal regulations. See Corralejo v. Bisignano, No. 25-2250, 2025 U.S. App. LEXIS 34007, at 27 *1 (9th Cir. Dec. 31, 2025) (“Social Security regulations create a five-step sequential evaluation 1 At step one, the ALJ found that A.K. had not engaged in substantial gainful activity since 2 the alleged onset date of January 4, 2017. See AR 206 (noting that A.K. had made earnings in 3 2018 at the “SGA level”; but proceeding to the next step after “giving the claimant the benefit of 4 the doubt”). 5 At step two, the ALJ determined that A.K. had the following severe impairments: mild 6 degenerative disc disease; mild osteoarthritis in both knees; bipolar disorder; autistic disorder (by 7 history); anxiety and PTSD (by history); and obesity. See AR 206. 8 At step three, the ALJ concluded that A.K. did not have an impairment or combination of 9 impairments that met or medically equaled the severity of one of the listed impairments (physical 10 or mental) in 20 C.F.R. Part 404, Subpart P, Appendix 1. See AR 207. 11 At step four, the ALJ found that A.K. had the physical residual functional capacity 12 (“RFC”) to perform light work, with certain limitations (e.g., stand/walk 6 hours in an 8-hour day 13 and sit 6 hours in an 8-hour day). See AR 209. She did not address any mental RFC in her 14 decision, even though her decision included review of medical records on mental conditions. 15 Based on the physical RFC determination, the ALJ concluded that A.K. could perform her past 16 relevant work as a teacher’s aide, “as actually and generally performed,” and as a personal 17 attendant, but only as “generally performed.” AR 220. 18 Although the ALJ held that A.K. was not disabled based on the analysis above, she also 19 made an alternative finding at step five: specifically, given A.K.’s age, education, work 20 experience, and RFC, A.K. was “capable of making a successful adjustment to other work that 21 exists in significant numbers in the national economy.” AR 222. 22 A.K. appealed the ALJ’s decision to the Appeals Council, which granted review. The 23 Appeals Council vacated the ALJ’s decision, identifying several issues: 24 • The ALJ had determined that A.K. had moderate limitations with respect to 25 interacting with others and adapting or managing oneself. “However, [she] did not 26 include corresponding mental limitations in the [RFC] assessment or explain why 27 [A.K.] does not have any work-related mental limitations.” AR 235 (Appeals 1 • Although the ALJ did not impose any limitations on “work-related mental 2 activities,” she found “partially persuasive” and “generally persuasive” two medical 3 sources who opined that A.K. did have work-related mental limitations. AR 235- 4 36. The ALJ failed to “explain why she did not adopt the mental limitations 5 assessed in those medical opinions despite finding they are both persuasive.” AR 6 236. 7 The Appeals Council thus remanded for further proceedings. 8 B. Second ALJ Decision 9 On remand, A.K.’s case proceeded before a different ALJ. In May 2024, ALJ Kwon 10 issued her opinion which again denied benefits. See AR 17-35 (ALJ decision). 11 At step one, the ALJ found that A.K. had engaged in substantial gainful activity in 2018 12 but not thereafter. See AR 20; see also AR 17 (noting the alleged onset date was January 4, 2017). 13 At step two, the ALJ determined that A.K. had the following severe impairments: arthritis 14 in both knees; degenerative joint disease; sciatica; depressive disorder; anxiety disorder; PTSD; 15 autistic disorder; and obesity. See AR 20. 16 At step three, the ALJ concluded that A.K. did not have an impairment or combination of 17 impairments that met or medically equaled the severity of one of the listed impairments (physical 18 or mental) in 20 C.F.R. Part 404, Subpart P, Appendix 1. See AR 21. 19 At step four, the ALJ found that A.K. had the physical RFC to perform light work, with 20 certain limitations (e.g., stand/walk 6 hours in an 8-hour day and sit 6 hours in an 8-hour day). See 21 AR 23. She also provided a mental RFC: “[A.K.] retains the capacity for simple work with 22 occasional interaction with others, with a maximum of occasional changes in a routine work 23 setting.” AR 23. Based on the physical and mental RFC determination, the ALJ could not 24 perform any past relevant work. See AR 33. 25 However, at step five, the ALJ concluded that, given A.K’s age, education, work 26 experience, and RFC, there were “jobs that exist in significant numbers in the national economy 27 that [she] can perform.” AR 34. The ALJ thus found that A.K. was not disabled. 1 II. DISCUSSION 2 A. Legal Standard 3 After a final decision on a claim of disability has issued, the claimant may seek judicial 4 review of that decision by a district court. See 42 U.S.C. § 405(g). The Commissioner’s decision 5 will be disturbed only if the ALJ committed legal error or if the ALJ’s findings are not supported 6 by substantial evidence. See Obrien v. Bisignano, 142 F.4th 687, 693 (9th Cir. 2025). 7 “Substantial evidence” is a legal term of art. It “means only[] such relevant evidence as a 8 reasonable mind might accept as adequate to support a conclusion.” Id. (internal quotation marks 9 omitted). In conducting its review, a court evaluates “the record as a whole, . . . weighing both the 10 evidence that supports and detracts from the ALJ's conclusion” to determine if substantial 11 evidence supports a finding. Mayes v. Massanari, 276 F.3d 453, 459 (9th Cir. 2001). If the 12 evidence supports “more than one rational interpretation,” a court must uphold the ALJ’s decision. 13 Burch v. Barnhart, 400 F.3d 676, 680-81 (9th Cir. 2005). 14 In the case at bar, A.K. essentially argues that the ALJ erred in her assessment of three 15 medical source opinions: Terri Vazquez, MA see AR 1719-21; J. Allen, MD, see AR 147, 151; 16 and Justin Ebert, PA. See AR 1162-63. Title 20 C.F.R. § 404.1520c addresses how the Social 17 Security Administration considers medical opinions:
18 (a) . . . . We will not defer or give any specific evidentiary weight, including controlling weight, to any medical 19 opinion(s) or prior administrative medical finding(s), including those from your medical sources. When a medical 20 source provides one or more medical opinions or prior administrative medical findings, we will consider those 21 medical opinions or prior administrative medical findings from that medical source together using the factors listed in 22 paragraphs (c)(1) through (c)(5) of this section, as appropriate. The most important factors we consider when 23 we evaluate the persuasiveness of medical opinions and prior administrative medical findings are supportability (paragraph 24 (c)(1) of this section) and consistency (paragraph (c)(2) of this section). . . . 25 . . . . 26 (c) . . . . 27 presented by a medical are to support his or her 1 medical opinion(s) or prior administrative medical finding(s), the more persuasive the medical opinions 2 or prior administrative finding(s) will be.
3 (2) Consistency. The more consistent a medical opinion(s) or prior administrative medical finding(s) 4 is with the evidence from other medical sources and nonmedical sources in the claim, the more persuasive 5 the medical opinion(s) or prior administrative finding(s) will be. 6
7 (3) Relationship with the claimant [e.g., length of the treatment relationship, frequency of examinations, 8 purpose of the treatment relationship, extent of the treatment relationship, and examining relationship] . . 9 . .
10 . . . . 11 (4) Specialization. The medical opinion or prior 12 administrative medical finding of a medical source who has received advanced education and training to 13 become a specialist may be more persuasive about medical issues related to his or her area of specialty 14 than the medical opinion or prior administrative medical finding of a medical source who is not a 15 specialist in the relevant area of specialty.
16 (5) Other factors. We will consider other factors that tend to support or contradict a medical opinion or 17 prior administrative medical finding. This includes, but is not limited to, evidence showing a medical 18 source has familiarity with the other evidence in the claim or an understanding of our disability program’s 19 policies and evidentiary requirements. . . . 20 20 C.F.R. § 404.1520c(a).1 21 / / / 22 / / / 23
24 1 In her papers, A.K. also cites 20 C.F.R. § 404.1545(e) which provides that,
25 [w]hen you have a severe impairment(s), but your symptoms, signs, and laboratory findings do not meet or equal those of a listed 26 impairment in Appendix 1 of this subpart, we will consider the limiting effects of all your impairment(s), even those that are not 27 severe, in determining your residual functional capacity. 1 B. Medical Opinions – Mental 2 The Court begins with its analysis of Ms. Vazquez. Ms. Vazquez was a treating medical 3 source. She completed a medical source statement for A.K., addressing A.K.’s mental condition. 4 See AR 1719-21 (medical source statement from Ms. Vazquez, dated11/24/2021). Ms. Vazquez 5 stated that she had treated A.K. from August-November 2021 and diagnosed her with bipolar 6 disorder, current episode manic without psychotic features, depression, and PTSD. She listed 7 A.K.’s symptoms as, e.g., feelings of guilt and despair, anxiety, manic episode, pressured speech, 8 and social isolation. Ms. Vasquez opined that A.K. was moderately impaired with respect to the 9 ability to perform activities of daily living; to maintain social functioning; and to maintain 10 concentration, persistence, or pace. She also opined that A.K. had experienced episodes of 11 decompensation (“Seldom (one or two in one year, each lasting for two weeks)”); that the episodes 12 would cause A.K. to withdraw or to experience an exacerbation of signs or symptoms; that A.K. 13 had a history of at least one year of inability to function outside of a highly supported living 14 situation; that, even a minimal increase in mental demands or change would cause A.K. to 15 decompensate; and that, if A.K. became employed, A.K. would likely miss two days per month 16 from work due to psychologically based symptoms. See Op. Br. at 14 (emphasizing that Ms. 17 Vaquez’s opinions supported Paragraph C criteria for purposes of step three of the five-step 18 sequential process). 19 The ALJ found Ms. Vazquez’s opinions “partially persuasive.” She first noted that the 20 opinions were “only marginally supported with the claimant’s diagnoses and symptoms.” AR 29 21 (ALJ decision). She then noted that the opinions were not consistent with other evidence of 22 record, including but not limited to opinions rendered by a doctor who conducted a consultative 23 examination. See AR 1736-46 (psychological report from Dr. Bowerman, dated 5/14/2022). 24 Based on the totality of the evidence, the ALJ found that A.K. was able to do simple work, have 25 occasional interactions with others, and have occasional changes in routine work setting. See AR 26 29-30 (ALJ decision). 27 / / / 1 The ALJ’s conclusion that Ms. Vazquez’s opinions were only partially persuasive is 2 supported by substantial evidence.2 First, as the ALJ noted, although Ms. Vazquez stated in the 3 medical source statement what A.K’s diagnoses and symptoms were, she did not cite any specifics 4 to support her opinions on A.K.’s limitations, such as a mental status examination or earlier 5 treatment notes. See R.W. v. Comm’r of Soc. Sec., No. 25-cv-02302-EMC, 2025 U.S. Dist. LEXIS 6 254050, at *26 (N.D. Cal. Dec. 3, 2025) (stating that “supportability is ultimately focused on how 7 a doctor reaches the medical opinion” – i.e., how did the doctor reach his or her findings). Nor has 8 A.K. pointed to any treatment records from Ms. Vazquez from the lengthy administrative record. 9 Indeed, as the government points out, it is not clear that Ms. Vazquez ever directly treated A.K. 10 herself. See Resp. Br. at 1 (“There is no evidence of any treatment from Ms. Vazquez in the 11 record.”). 12 Second, with respect to consistency, the ALJ did not – as A.K. contends – cherry pick 13 evidence from the administrative record or otherwise selectively cite facts that “highlighted largely 14 unremarkable symptoms.” Op. Br. at 16. Notably, the ALJ did not cite to just a handful medical 15 records. Rather, she cited to a number of records and from both consulting examiners (e.g., Dr. 16 Bowerman) as well as treating providers, including from most, if not all, of the facilities where 17 A.K. sought treatment (e.g., Hillside, Redwood Quality, Santa Cruz Behavioral Health, Adventist, 18 and Watsonville Community Hospital). See AR 29-30 (ALJ decision). See, e.g., AR 1745-46 (Dr. 19 Bowerman) (after conducting mental status examination and several tests, such as the Wechsler 20 Adult Intelligence Scale and Memory Scale, concluding that A.K. had only mild or moderate 21 impairments); AR 695 (Hillside) (noting normal memory as part of physical neurological 22 examination); AR 1108 (Redwood Quality) (reflecting the following based on mental status 23 examination: avoids eye contact, restless motor activity, pressured and excessive speech, but 24 oriented, intellectual functioning unimpaired, memory unimpaired, average fund of knowledge, 25
26 2 A.K. suggests that the ALJ should have considered Ms. Vazquez’s opinions at step three of the five-step sequential process because Ms. Vazquez concluded that A.K. had satisfied the Paragraph 27 C criteria. The failure to address Ms. Vazquez’s opinion at step three was, at most, harmless error. 1 appropriate affect, intact concentration, intact abstractions, intact judgments, adequate insight, and 2 no apparent hallucinations or delusions or ideations); AR 1799-800 (Redwood Quality) (reflecting 3 the following based on mental status examination: good eye contact, cooperative, normal speech, 4 normal/linear thought process, alert, oriented, good cognitive ability, euthymic/normal mood, 5 normal range of affect, and no delusions); AR 2121 (Santa Cruz County Behavioral Health) 6 (reflecting the following based on mental status examination: good eye contact, able to engage in 7 meaningful 1-to-1 conversation, normal speech, affect within normal limits, circumstantial and 8 tangential thought process at times, no delusional references, and cognition within normal limits). 9 Furthermore, A.K. glosses over the fact that the ALJ did find fairly restrictive mental limitations 10 for A.K. – concluding that she was able to do simple work only and could only have occasional 11 interactions with others or changes in routine work setting. See AR 29-30. This is not a situation 12 where the ALJ found no mental limitations at all or only minor limitations. Cf. AR 235-37 13 (Appeal Council decision) (remanding because the first ALJ decision did not address mental 14 limitations). The limitations found by the ALJ were supported by the medical records. 15 Equally tellingly, the evidence that A.K. cites in her favor does not establish the ALJ erred. 16 A.K. points to a therapist note from July 2019 but this was still shortly after she was hospitalized 17 in May/June 2019. See Op. Br. at 17; AR 715 (medical record from Ms. Singh (counselor), dated 18 7/6/2019) (stating that A.K. “is currently experiencing a manic episode, evidenced by expansive 19 mood and increased energy accompanied by grandiosity (observed), decreased need for sleep (‘I 20 haven’t been able to sleep, maybe 3-4 hours per might’), pressured speech (observed), flight of 21 ideas (observed) and distractability (observed)”; A.K.’s “symptoms have resulted in significant 22 impairments to her daily living (marked mood episodes), social (tendency to isolate when 23 depressed and additional difficulty navigating social interactions) and occupational (difficulty 24 maintaining employment due to mood episodes complicated by her deficits in social-emotional 25 reciprocity) functioning”). The record indicates that that incident was somewhat unique as A.K. 26 herself attributed the incident to a medication change. See AR 718 (medical record from Ms. 27 Mullis (MFT intern), dated 5/19/2020); AR 709 (medical record from Dr. Lewerenz, dated 1 thereafter, with one of her treating physicians (Dr. Goodwin) later stating, e.g., that her bipolar 2 disorder was in remission. See infra. 3 A.K. also relies on a medical record from a MFT intern in May 2020. See Op. Br. at 17- 4 18; AR 719 (medical record from Ms. Mullis, dated 5/19/2020) (stating that A.K. “has a history of 5 manic episodes (racing thoughts, decreased need for sleep, decreased appetite, increased goal- 6 directed behavior) lasting days at a time” and “also experiences depressive episodes (persistent 7 depressed mood, decreased interest in most activities, lethargy, suicidal ideation) lasting months at 8 a time and resulting in her May 2019 involuntary psychiatric hospitalization”). But notably, that 9 record conflicts with the records of her main treating physician (Dr. Goodwin) – who, it appears, 10 provided treatment to A.K. at the same facility. Those records indicate mild or no disability based 11 on A.K’s mental condition. See, e.g., AR 727, 730, 733, 736, 739 (medical records from Dr. 12 Goodwin, dated 4/16/2020, 5/7/2020, 8/3/2020, 9/24/2020, and 1/14/2021) (stating that A.K.’s 13 “[p]resentation [was] consistent with a working diagnosis of bipolar I [disorder], in remission, 14 most recent episode depressed”; adding that “[a]lternative diagnoses have been considered but are 15 not supported by the current presentation”); see also AR 726, 733 (medical records from Dr. 16 Goodwin, dated 8/3/2020 and 4/16/2020) (not supporting A.K.’s request for disability based on 17 anxiety or insomnia); AR 1114-16 (medical source statement from Dr. Goodwin, dated 3/23/2021) 18 (stating that A.K.’s ability in all areas of psychological functioning associated with work tasks was 19 “good” – defined as “[t]he effects of the mental disorder do not significantly limit the individual 20 from consistently and usefully performing the activity”). 21 The Court therefore finds no error with respect to the ALJ’s determination as to Ms. 22 Vazquez’s mental impairments. 23 C. Medical Opinions – Physical 24 A.K. argues next that the ALJ erred in evaluating two medical source opinions related to 25 her physical condition. The two medical sources are Dr. Allen (a state agency consultant) and Mr. 26 Ebert (a treating PA). Dr. Allen opined, inter alia, that A.K. could carry or lift 20 pounds 27 occasionally and 10 pounds frequently and could stand or walk, as well as sit, about 6 hours in an 1 distances/uneven terrain.” AR 151 (medical notes from Dr. Allen, dated 5/18/2021). Mr. Ebert, in 2 turn, provided a medical source statement. He opined, inter alia, that A.K. could lift or carry less 3 than 10 pounds occasionally or frequently, could stand or walk less than 2 hours in an 8 hour-work 4 day, and could sit less than 6 hours in an 8-hour work day. Mr. Ebert also noted that A.K. used an 5 assistive device – specifically, a walker – which was self-prescribed, although medically necessary 6 as it improved stability. See AR 1162 (medical source statement from Mr. Ebert, dated 7 4/22/2021). 8 With respect to Dr. Allen, the ALJ found his opinions partially persuasive. See AR 31 9 (ALJ decision). As for Mr. Ebert, the ALJ found his opinions unpersuasive. See AR 30. The ALJ 10 pointed out that his medical source statement was not supported by any medical findings, see AR 11 30 (stating that the opinions were not “supported with an explanation”); rather, the statement 12 simply referred to, e.g., “[patient] reported pain” in support of the limitations stated. See AR 13 1162-63 (medical source statement from Mr. Ebert, dated 4/22/2021). 14 The ALJ also found Mr. Ebert’s opinions inconsistent with the medical records from other 15 medical sources. For example, although there were some references to slow and guarded 16 movements and observed use of a cane or walker, see, e.g., AR 1838 (medical record from Dr. 17 Alvord, dated 5/14/2022) (observing that A.K. “walks with a cane with a compensated gait”); AR 18 1811 (medical record from Mr. Arroyo (chiropractor), dated 2/7/2022) (noting that A.K. used a 19 walker and that her movements were slow and guarded); AR 1311 (medical record from Dr. 20 Gould, dated 12/2/2021) (requesting “Standard 2-Wheel Walker”); AR 1922 (medical record from 21 Mr. Arroyo (chiropractor), dated 3/22/2021) (noting that A.K. used a walker and that her 22 movements were slow and guarded), there were other instances in which A.K. did not use an 23 assistive device and where her gait was described as essentially normal. See, e.g., AR 1857 24 (medical record from Mr. Arroyo (chiropractor), dated 9/14/2022) (commenting that A.K. was 25 “[n]o longer using cane” and her movements were “[u]nremarkable”); AR 1740 (medical record 26 from Dr. Bowerman (consulting examiner), dated 5/14/2022) (observing that A.K. “did not use a 27 cane or other assistive device to aid in walking”); AR 1003 (medical record from Mr. Ebert, dated 1 “otherwise unremarkable”); AR 763 (medical record from Dr. Kuntz, dated 12/27/2020) (stating 2 that A.K. was “[a]mbulatory without antalgic gait”); AR 867 (medical record from Mr. Ebert, 3 dated 5/1/2020) (in evaluating musculoskeletal condition, stating “[v]isual overview of all four 4 extremities is normal”); AR 773 (medical record from Dr. Calderon, dated 5/26/2019) (stating that 5 S.K. had full range of motion for all major joints and “[n]ormal gait”); cf. AR 1282 (medical 6 record from Dr. Griffin (consulting examiner), dated 9/10/2021) (stating that A.K. “came in with a 7 Rollator device which she states that she bought herself because the primary care provider stated 8 that Medicare would never pay for it”; “[d]escription of ambulation with the device was normal”). 9 Moreover, as indicated above, medical records indicated that A.K.’s physical deterioration related 10 to her back and knees was mild. See also AR 31 (ALJ decision) (noting that “[i]maging . . . 11 revealed only mild degenerative changes”). Thus, the ALJ concluded that the “use of an assistive 12 device, given the inconsistencies in records, along with [A.K.’s] generally normal strength, is not 13 medically necessary.” AR 31. 14 A.K. challenges the ALJ’s assessments of Dr. Allen and Mr. Ebert, putting particular 15 emphasis on her use of an “assistive device[] throughout the adjudicated period.” Op. Br. at 20. 16 She criticizes the ALJ for not including the assistive device as part of her physical RFC. But as 17 noted above, there were instances in the record where A.K. was noted to be walking without such 18 a device and even Mr. Ebert admitted that the use of a device was self-prescribed (although he also 19 characterized the device as medically necessary for improved stability). Another treating provider 20 (Dr. Gould) did go on to prescribe a standard 2-wheel walker for A.K, see AR 1311 (medical 21 record from Dr. Gould, dated 12/2/2021), but notably he also did not consider the walker overly 22 limiting as reflected by his express statement that he did not see anything that qualified her for 23 disability. See AR 1312. And imaging did not suggest anything more than mild degenerative 24 changes. See, e.g., AR 1214 (MRI of lumbar spine on 4/13/2021) (noting “[m]ild multilevel 25 degenerative changes . . . without definite evidence of significant central stenosis or focal nerve 26 root impingement”); AR 1124 (MRI of right knee on 3/5/2021) (finding “[n]ormal MRI 27 examination” – e.g., “visualized bony structures show normal signal intensity[;] [t]he articular 1 (x-ray of bilateral knees on 6/23/2020) (finding “[m]ild joint space narrowing” in both knees; 2 stating “[m]ild degenerative disease”); AR 828 (x-ray of left knee on 6/19/2020) (finding “[n]o 3 acute fracture or dislocation[;] [j]oint spaces are maintained”). 4 Ultimately, another ALJ could well have reached an opinion different from the ALJ in the 5 case at bar, but that does not mean that the ALJ’s opinion here is not supported by substantial 6 evidence. If the evidence supports “more than one rational interpretation,” a court must uphold 7 the ALJ’s decision. Burch, 400 F.3d at 680-81; see also Blanchard v. Bisignano, No. 24-4359, 8 2025 U.S. App. LEXIS 24853, at *4 (9th Cir. Sept. 25, 2025) (“Substantial evidence supports the 9 ALJ’s consideration of the medical opinions. Where conflicting evidence is susceptible to more 10 than one rational interpretation, it is the ALJ’s conclusion that must be upheld.”); Kunish v. 11 O’Malley, No. 23-2844, 2024 U.S. App. LEXIS 27405, at *1-2 (“The ALJ ‘is responsible for 12 determining credibility, resolving conflicts in medical testimony, and for resolving ambiguities.’ 13 And if the evidence ‘is susceptible to more than one rational interpretation, it is the ALJ’s 14 conclusion that must be upheld.’”). Because the ALJ’s evaluation of Dr. Allen and Mr. Ebert is 15 supported by substantial evidence, the Court finds no error here. See Blanchard, 2025 U.S. App. 16 LEXIS 24853, at *4-5 (acknowledging that several doctors “came to varying conclusions” on 17 plaintiff’s condition but concluding that ALJ’s finding was supported by substantial evidence: “the 18 ALJ weighed [the] competing opinions, determining which opinions were most consistent with the 19 overall record,” and ALJ discounted three medical sources favorable to plaintiff because they 20 “were less thorough, lacked citations to evidence from the relevant time frame, and conflicted with 21 the rest of the record”). 22 / / / 23 / / / 24 / / / 25 / / / 26 / / / 27 / / / 1 Til. CONCLUSION 2 For the foregoing reasons, the Court denies A.K.’s request for relief. The Court instructs 3 || the Clerk of the Court to enter a final judgment in accordance with this decision and close the file 4 || in the case. 5 This order disposes of Docket Nos. 12-13. 6 7 IT IS SO ORDERED. 8 9 Dated: March 2, 2026 10 1] EDWARD M. CHEN 12 United States District Judge 13 14
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