John Anthony Martinez v. Commissioner of Social Security

E.D. California

John Anthony Martinez v. Commissioner of Social Security

DecidedApril 2, 2026

Docket1:24-cv-01257

StatusUnknown

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1 2 3 4 5 6 7 8 UNITED STATES DISTRICT COURT 9 FOR THE EASTERN DISTRICT OF CALIFORNIA 10 11 JOHN ANTHONY MARTINEZ, Case No. 1:24-cv-01257-HBK 12 Plaintiff, ORDER AFFIRMING THE DECISION OF THE COMMISSIONER OF SOCIAL 13 v. SECURITY1 14 COMMISSIONER OF SOCIAL (Docs. 12, 15) SECURITY, 15 16 Defendant. 17 18 19 John Anthony Martinez (“Plaintiff”) seeks judicial review of a final decision of the 20 Commissioner of Social Security (“Commissioner” or “Defendant”) denying his application for 21 supplemental security income and child’s insurance benefits under the Social Security Act. (Doc. 22 1). The matter is currently before the undersigned on the parties’ briefs, which were submitted 23 without oral argument. (Docs. 12, 15). For the reasons set forth more fully below, the Court 24 affirms the Commissioner’s decision. 25 I. JURISDICTION 26 Plaintiff protectively filed for supplemental security income and child’s insurance benefits 27 1 Both parties have consented to the jurisdiction of a magistrate judge, in accordance with 28 U.S.C. 28 §636(c)(1). (Doc. 8). 1 on October 20, 2021, alleging a disability onset date of January 2, 2021 in both applications. (AR 2 257-266, 269-75). Benefits were denied initially (AR 64-109, 159-64, 184-89) and upon 3 reconsideration (AR 110-154, 168-74). Plaintiff appeared for a telephonic hearing before an 4 administrative law judge (“ALJ”) on December 21, 2023. (AR 33-63). Plaintiff testified at the 5 hearing and was represented by counsel. (Id.). The ALJ denied benefits (AR 12-32) and the 6 Appeals Council denied review (AR 1-6). The matter is before the Court under 42 U.S.C. § 7 405(g) and 42 U.S.C. § 1383(c)(3). 8 II. BACKGROUND 9 The facts of the case are set forth in the administrative hearing and transcripts, the ALJ’s 10 decision, and the briefs of Plaintiff and Commissioner. Only the most pertinent facts are 11 summarized here. 12 Plaintiff was 20 years old at the time of the hearing. (See AR 35). He graduated from 13 high school and was enrolled in special education classes. (AR 42-43). He testified that he tried 14 to enroll in college classes but had a “hard time figuring out how to do it online.” (AR 43). He 15 lives with his parents and his nephews. (AR 41). He has no past work history. (AR 44). 16 Plaintiff testified that he is prevented from working because he has a hard time comprehending 17 and focusing on tasks, and because of his fine motor skills, inability to walk “far,” getting 18 distracted, and forgetting instructions from his supervisor. (AR 44-48). He wears an orthotic on 19 his left foot but does not use an assistive device. (AR 45). He reported that if he walks for long 20 periods of time he starts “hurting,” and he cannot comfortably walk a city block. (AR 49-50). 21 Plaintiff testified that he has not had seizures “recently,” and he gets migraines and stress-induced 22 headaches. (AR 50-51). He has anxiety that gets worse being in public, has a hard time 23 concentrating on “things he doesn’t like” but can concentrate for a long time on things he does 24 “like,” and has trouble with fine motor skills like writing and typing. (AR 51-52). 25 III. STANDARD OF REVIEW 26 A district court’s review of a final decision of the Commissioner of Social Security is 27 governed by 42 U.S.C. § 405(g). The scope of review under § 405(g) is limited; the 28 Commissioner’s decision will be disturbed “only if it is not supported by substantial evidence or 1 is based on legal error.” Hill v. Astrue, 698 F.3d 1153, 1158 (9th Cir. 2012). “Substantial 2 evidence” means “relevant evidence that a reasonable mind might accept as adequate to support a 3 conclusion.” Id. at 1159 (quotation and citation omitted). Stated differently, substantial evidence 4 equates to “more than a mere scintilla[,] but less than a preponderance.” Id. (quotation and 5 citation omitted). In determining whether the standard has been satisfied, a reviewing court must 6 consider the entire record as a whole rather than searching for supporting evidence in isolation. 7 Id. 8 In reviewing a denial of benefits, a district court may not substitute its judgment for that of 9 the Commissioner. “The court will uphold the ALJ's conclusion when the evidence is susceptible 10 to more than one rational interpretation.” Tommasetti v. Astrue, 533 F.3d 1035, 1038 (9th Cir. 11 2008). Further, a district court will not reverse an ALJ’s decision on account of an error that is 12 harmless. Id. An error is harmless where it is “inconsequential to the [ALJ’s] ultimate 13 nondisability determination.” Id. (quotation and citation omitted). The party appealing the ALJ’s 14 decision generally bears the burden of establishing that it was harmed. Shinseki v. Sanders, 556 15 U.S. 396, 409-10 (2009). 16 IV. SEQUENTIAL EVALUATION PROCESS 17 A claimant must satisfy two conditions to be considered “disabled” within the meaning of 18 the Social Security Act. First, the claimant must be “unable to engage in any substantial gainful 19 activity by reason of any medically determinable physical or mental impairment which can be 20 expected to result in death or which has lasted or can be expected to last for a continuous period 21 of not less than twelve months.” 42 U.S.C. §§ 423(d)(1)(A), 1382c(a)(3)(A). Second, the 22 claimant’s impairment must be “of such severity that he is not only unable to do his previous 23 work[,] but cannot, considering his age, education, and work experience, engage in any other kind 24 of substantial gainful work which exists in the national economy.” 42 U.S.C. §§ 423(d)(2)(A), 25 1382c(a)(3)(B). 26 The Commissioner has established a five-step sequential analysis to determine whether a 27 claimant satisfies the above criteria. See 20 C.F.R. §§ 404.1520(a)(4)(i)-(v), 416.920(a)(4)(i)-(v). 28 At step one, the Commissioner considers the claimant’s work activity. 20 C.F.R. §§ 1 404.1520(a)(4)(i), 416.920(a)(4)(i). If the claimant is engaged in “substantial gainful activity,” 2 the Commissioner must find that the claimant is not disabled. 20 C.F.R. §§ 404.1520(b), 3 416.920(b). 4 If the claimant is not engaged in substantial gainful activity, the analysis proceeds to step 5 two. At this step, the Commissioner considers the severity of the claimant’s impairment. 20 6 C.F.R. §§ 404.1520(a)(4)(ii), 416.920(a)(4)(ii). If the claimant suffers from “any impairment or 7 combination of impairments which significantly limits [his or her] physical or mental ability to do 8 basic work activities,” the analysis proceeds to step three. 20 C.F.R. §§ 404.1520(c), 416.920(c).

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1 2 3 4 5 6 7 8 UNITED STATES DISTRICT COURT 9 FOR THE EASTERN DISTRICT OF CALIFORNIA 10 11 JOHN ANTHONY MARTINEZ, Case No. 1:24-cv-01257-HBK 12 Plaintiff, ORDER AFFIRMING THE DECISION OF THE COMMISSIONER OF SOCIAL 13 v. SECURITY1 14 COMMISSIONER OF SOCIAL (Docs. 12, 15) SECURITY, 15 16 Defendant. 17 18 19 John Anthony Martinez (“Plaintiff”) seeks judicial review of a final decision of the 20 Commissioner of Social Security (“Commissioner” or “Defendant”) denying his application for 21 supplemental security income and child’s insurance benefits under the Social Security Act. (Doc. 22 1). The matter is currently before the undersigned on the parties’ briefs, which were submitted 23 without oral argument. (Docs. 12, 15). For the reasons set forth more fully below, the Court 24 affirms the Commissioner’s decision. 25 I. JURISDICTION 26 Plaintiff protectively filed for supplemental security income and child’s insurance benefits 27 1 Both parties have consented to the jurisdiction of a magistrate judge, in accordance with 28 U.S.C. 28 §636(c)(1). (Doc. 8). 1 on October 20, 2021, alleging a disability onset date of January 2, 2021 in both applications. (AR 2 257-266, 269-75). Benefits were denied initially (AR 64-109, 159-64, 184-89) and upon 3 reconsideration (AR 110-154, 168-74). Plaintiff appeared for a telephonic hearing before an 4 administrative law judge (“ALJ”) on December 21, 2023. (AR 33-63). Plaintiff testified at the 5 hearing and was represented by counsel. (Id.). The ALJ denied benefits (AR 12-32) and the 6 Appeals Council denied review (AR 1-6). The matter is before the Court under 42 U.S.C. § 7 405(g) and 42 U.S.C. § 1383(c)(3). 8 II. BACKGROUND 9 The facts of the case are set forth in the administrative hearing and transcripts, the ALJ’s 10 decision, and the briefs of Plaintiff and Commissioner. Only the most pertinent facts are 11 summarized here. 12 Plaintiff was 20 years old at the time of the hearing. (See AR 35). He graduated from 13 high school and was enrolled in special education classes. (AR 42-43). He testified that he tried 14 to enroll in college classes but had a “hard time figuring out how to do it online.” (AR 43). He 15 lives with his parents and his nephews. (AR 41). He has no past work history. (AR 44). 16 Plaintiff testified that he is prevented from working because he has a hard time comprehending 17 and focusing on tasks, and because of his fine motor skills, inability to walk “far,” getting 18 distracted, and forgetting instructions from his supervisor. (AR 44-48). He wears an orthotic on 19 his left foot but does not use an assistive device. (AR 45). He reported that if he walks for long 20 periods of time he starts “hurting,” and he cannot comfortably walk a city block. (AR 49-50). 21 Plaintiff testified that he has not had seizures “recently,” and he gets migraines and stress-induced 22 headaches. (AR 50-51). He has anxiety that gets worse being in public, has a hard time 23 concentrating on “things he doesn’t like” but can concentrate for a long time on things he does 24 “like,” and has trouble with fine motor skills like writing and typing. (AR 51-52). 25 III. STANDARD OF REVIEW 26 A district court’s review of a final decision of the Commissioner of Social Security is 27 governed by 42 U.S.C. § 405(g). The scope of review under § 405(g) is limited; the 28 Commissioner’s decision will be disturbed “only if it is not supported by substantial evidence or 1 is based on legal error.” Hill v. Astrue, 698 F.3d 1153, 1158 (9th Cir. 2012). “Substantial 2 evidence” means “relevant evidence that a reasonable mind might accept as adequate to support a 3 conclusion.” Id. at 1159 (quotation and citation omitted). Stated differently, substantial evidence 4 equates to “more than a mere scintilla[,] but less than a preponderance.” Id. (quotation and 5 citation omitted). In determining whether the standard has been satisfied, a reviewing court must 6 consider the entire record as a whole rather than searching for supporting evidence in isolation. 7 Id. 8 In reviewing a denial of benefits, a district court may not substitute its judgment for that of 9 the Commissioner. “The court will uphold the ALJ's conclusion when the evidence is susceptible 10 to more than one rational interpretation.” Tommasetti v. Astrue, 533 F.3d 1035, 1038 (9th Cir. 11 2008). Further, a district court will not reverse an ALJ’s decision on account of an error that is 12 harmless. Id. An error is harmless where it is “inconsequential to the [ALJ’s] ultimate 13 nondisability determination.” Id. (quotation and citation omitted). The party appealing the ALJ’s 14 decision generally bears the burden of establishing that it was harmed. Shinseki v. Sanders, 556 15 U.S. 396, 409-10 (2009). 16 IV. SEQUENTIAL EVALUATION PROCESS 17 A claimant must satisfy two conditions to be considered “disabled” within the meaning of 18 the Social Security Act. First, the claimant must be “unable to engage in any substantial gainful 19 activity by reason of any medically determinable physical or mental impairment which can be 20 expected to result in death or which has lasted or can be expected to last for a continuous period 21 of not less than twelve months.” 42 U.S.C. §§ 423(d)(1)(A), 1382c(a)(3)(A). Second, the 22 claimant’s impairment must be “of such severity that he is not only unable to do his previous 23 work[,] but cannot, considering his age, education, and work experience, engage in any other kind 24 of substantial gainful work which exists in the national economy.” 42 U.S.C. §§ 423(d)(2)(A), 25 1382c(a)(3)(B). 26 The Commissioner has established a five-step sequential analysis to determine whether a 27 claimant satisfies the above criteria. See 20 C.F.R. §§ 404.1520(a)(4)(i)-(v), 416.920(a)(4)(i)-(v). 28 At step one, the Commissioner considers the claimant’s work activity. 20 C.F.R. §§ 1 404.1520(a)(4)(i), 416.920(a)(4)(i). If the claimant is engaged in “substantial gainful activity,” 2 the Commissioner must find that the claimant is not disabled. 20 C.F.R. §§ 404.1520(b), 3 416.920(b). 4 If the claimant is not engaged in substantial gainful activity, the analysis proceeds to step 5 two. At this step, the Commissioner considers the severity of the claimant’s impairment. 20 6 C.F.R. §§ 404.1520(a)(4)(ii), 416.920(a)(4)(ii). If the claimant suffers from “any impairment or 7 combination of impairments which significantly limits [his or her] physical or mental ability to do 8 basic work activities,” the analysis proceeds to step three. 20 C.F.R. §§ 404.1520(c), 416.920(c). 9 If the claimant’s impairment does not satisfy this severity threshold, however, the Commissioner 10 must find that the claimant is not disabled. 20 C.F.R. §§ 404.1520(c), 416.920(c). 11 At step three, the Commissioner compares the claimant’s impairment to severe 12 impairments recognized by the Commissioner to be so severe as to preclude a person from 13 engaging in substantial gainful activity. 20 C.F.R. §§ 404.1520(a)(4)(iii), 416.920(a)(4)(iii). If 14 the impairment is as severe or more severe than one of the enumerated impairments, the 15 Commissioner must find the claimant disabled and award benefits. 20 C.F.R. §§ 404.1520(d), 16 416.920(d). 17 If the severity of the claimant’s impairment does not meet or exceed the severity of the 18 enumerated impairments, the Commissioner must pause to assess the claimant’s “residual 19 functional capacity.” Residual functional capacity (RFC), defined generally as the claimant’s 20 ability to perform physical and mental work activities on a sustained basis despite his or her 21 limitations, 20 C.F.R. §§ 404.1545(a)(1), 416.945(a)(1), is relevant to both the fourth and fifth 22 steps of the analysis. 23 At step four, the Commissioner considers whether, in view of the claimant’s RFC, the 24 claimant is capable of performing work that he or she has performed in the past (past relevant 25 work). 20 C.F.R. §§ 404.1520(a)(4)(iv), 416.920(a)(4)(iv). If the claimant is capable of 26 performing past relevant work, the Commissioner must find that the claimant is not disabled. 20 27 C.F.R. §§ 404.1520(f), 416.920(f). If the claimant is incapable of performing such work, the 28 analysis proceeds to step five. 1 At step five, the Commissioner considers whether, in view of the claimant’s RFC, the 2 claimant is capable of performing other work in the national economy. 20 C.F.R. §§ 3 404.1520(a)(4)(v), 416.920(a)(4)(v). In making this determination, the Commissioner must also 4 consider vocational factors such as the claimant’s age, education, and past work experience. 20 5 C.F.R. §§ 404.1520(a)(4)(v), 416.920(a)(4)(v). If the claimant is capable of adjusting to other 6 work, the Commissioner must find that the claimant is not disabled. 20 C.F.R. §§ 7 404.1520(g)(1), 416.920(g)(1). If the claimant is not capable of adjusting to other work, analysis 8 concludes with a finding that the claimant is disabled and is therefore entitled to benefits. 20 9 C.F.R. §§ 404.1520(g)(1), 416.920(g)(1). 10 The claimant bears the burden of proof at steps one through four. Tackett v. Apfel, 180 11 F.3d 1094, 1098 (9th Cir. 1999). If the analysis proceeds to step five, the burden shifts to the 12 Commissioner to establish that (1) the claimant is capable of performing other work; and (2) such 13 work “exists in significant numbers in the national economy.” 20 C.F.R. §§ 404.1560(c)(2), 14 416.960(c)(2); Beltran v. Astrue, 700 F.3d 386, 389 (9th Cir. 2012). 15 V. ALJ’S FINDINGS 16 At step one, the ALJ found that Plaintiff has not engaged in substantial gainful activity 17 since January 2, 2021, the alleged onset date. (AR 17). At step two, the ALJ found that Plaintiff 18 has the following severe impairments: cerebral palsy, anxiety disorder, and borderline intellectual 19 functioning. (AR 18). At step three, the ALJ found that Plaintiff does not have an impairment or 20 combination of impairments that meets or medically equals the severity of a listed impairment. 21 (AR 18). The ALJ then found that Plaintiff has the RFC to 22 perform light work as defined in 20 CFR 404.1567(b) and 416.967(b) except the claimant can occasionally operate foot controls with the 23 bilateral lower extremities. The claimant can occasionally balance, stoop, crouch, and crawl. The claimant can occasionally climb ramps 24 and stairs and never climb ladders, ropes, or scaffolds. The claimant can never work in an area that has concentrated exposure to extreme 25 heat or cold. The claimant can never work in hazardous environments, such as at unprotected heights or around moving 26 mechanical parts. The [claimant] can understand, remember, and carry out simple instructions in the workplace, can work in a low 27 stress job, defined as making only occasional decisions and tolerating only occasional changes in the work setting and can perform 28 repetitive work, but not work requiring a specific production rate, 1 such as assembly line work. The claimant can have no more than occasional interaction with supervisors, coworkers, and the general 2 public with respect to performing work related duties. 3 (AR 20). At step four, the ALJ found that Plaintiff has no past relevant work. (AR 26). At step 4 five, the ALJ found that considering Plaintiff’s age, education, work experience, and RFC, there 5 are jobs that exist in significant numbers in the national economy that Plaintiff can perform, 6 including collator operator, merchandise marker, and photocopying machine operator. (AR 26- 7 27). On that basis, the ALJ concluded that Plaintiff has not been under a disability, as defined in 8 the Social Security Act, from January 2, 2021, through the date of the decision. (AR 27). 9 VI. ISSUES 10 Plaintiff seeks judicial review of the Commissioner’s final decision denying him 11 supplemental security income benefits under Title XVI of the Social Security Act and child’s 12 disability benefits under Title II of the Social Security Act. (Doc. No. 1). Plaintiff raises the 13 following issue for this Court’s review: whether the physical and mental RFC is supported by 14 substantial evidence in light of the ALJ’s consideration of the medical opinion of Merveen Appu, 15 M.D. (Doc. 12 at 7-26). 16 VII. DISCUSSION 17 A. Medical Opinions 18 A claimant’s RFC is “the most [the claimant] can still do despite [his or her] limitations.” 19 20 C.F.R. § 404.1545(a); 20 C.F.R. § 416.945(a). The RFC assessment is an administrative 20 finding based on all relevant evidence in the record, not just medical evidence. Bayliss v. 21 Barnhart, 427 F.3d 1211, 1217 (9th Cir. 2005). In determining the RFC, the ALJ must consider 22 all limitations, severe and non-severe, that are credible and supported by substantial evidence in 23 the record. (Id.) (RFC determination will be affirmed if supported by substantial evidence). 24 However, an ALJ’s RFC findings need only be consistent with relevant assessed limitations and 25 not identical to them. Turner v. Comm'r of Soc. Sec., 613 F.3d 1217, 1222-23 (9th Cir. 2010). 26 Ultimately, a claimant’s RFC is a matter for the ALJ to determine. See Vertigan v. Halter, 260 27 F.3d 1044, 1049 (9th Cir. 2001) (“It is clear that it is the responsibility of the ALJ ... to determine 28 residual functional capacity.”). 1 Plaintiff argues the ALJ erred in considering the treating medical opinions of Merveen 2 Appu, M.D., addressing Plaintiff’s physical and mental limitations. (Doc. 12 at 7-26). For claims 3 filed on or after March 27, 2017, new regulations apply that change the framework for how an 4 ALJ must evaluate medical opinion evidence. Revisions to Rules Regarding the Evaluation of 5 Medical Evidence, 2017 WL 168819, 82 Fed. Reg. 5844-01 (Jan. 18, 2017); 20 C.F.R. §§ 6 404.1520c, 416.920c. The new regulations provide that the ALJ will no longer “give any specific 7 evidentiary weight…to any medical opinion(s)…” Revisions to Rules, 2017 WL 168819, 82 Fed. 8 Reg. 5844, at 5867-68; see 20 C.F.R. §§ 404.1520c(a), 416.920c(a). Instead, an ALJ must 9 consider and evaluate the persuasiveness of all medical opinions or prior administrative medical 10 findings from medical sources. 20 C.F.R. §§ 404.1520c(a) and (b), 416.920c(a) and (b). The 11 factors for evaluating the persuasiveness of medical opinions and prior administrative medical 12 findings include supportability, consistency, relationship with the claimant (including length of 13 the treatment, frequency of examinations, purpose of the treatment, extent of the treatment, and 14 the existence of an examination), specialization, and “other factors that tend to support or 15 contradict a medical opinion or prior administrative medical finding” (including, but not limited 16 to, “evidence showing a medical source has familiarity with the other evidence in the claim or an 17 understanding of our disability program’s policies and evidentiary requirements”). 20 C.F.R. §§ 18 404.1520c(c)(1)-(5), 416.920c(c)(1)-(5). 19 Supportability and consistency are the most important factors, and therefore the ALJ is 20 required to explain how both factors were considered. 20 C.F.R. §§ 404.1520c(b)(2), 21 416.920c(b)(2). Supportability and consistency are explained in the regulations: 22 (1) Supportability. The more relevant the objective medical evidence and supporting explanations presented by a medical source are to 23 support his or her medical opinion(s) or prior administrative medical finding(s), the more persuasive the medical opinions or prior 24 administrative medical finding(s) will be. 25 (2) Consistency. The more consistent a medical opinion(s) or prior administrative medical finding(s) is with the evidence from other 26 medical sources and nonmedical sources in the claim, the more persuasive the medical opinion(s) or prior administrative medical 27 finding(s) will be. 28 20 C.F.R. §§ 404.1520c(c)(1)-(2), 416.920c(c)(1)-(2). The ALJ may, but is not required to, 1 explain how the other factors were considered. 20 C.F.R. §§ 404.1520c(b)(2), 416.920c(b)(2). 2 However, when two or more medical opinions or prior administrative findings “about the same 3 issue are both equally well-supported ... and consistent with the record ... but are not exactly the 4 same,” the ALJ is required to explain how “the other most persuasive factors in paragraphs (c)(3) 5 through (c)(5)” were considered. 20 C.F.R. §§ 404.1520c(b)(3), 416.920c(b)(3). 6 The Ninth Circuit has additionally held that the new regulatory framework displaces the 7 longstanding case law requiring an ALJ to provide “specific and legitimate” or “clear and 8 convincing” reasons for rejecting a treating or examining doctor’s opinion. Woods v. Kijakazi, 32 9 F.4th 785, 787 (9th Cir. 2022). Nonetheless, in rejecting an examining or treating doctor’s 10 opinion as unsupported or inconsistent, an ALJ must still provide an explanation supported by 11 substantial evidence. Id. at 792. This means that the ALJ “must ‘articulate ... how persuasive’ 12 [he or she] finds ‘all of the medical opinions’ from each doctor or other source ... and ‘explain 13 how [he or she] considered the supportability and consistency factors’ in reaching these findings.” 14 Id. (citing 20 C.F.R. §§ 404.1520c(b), 404.1520(b)(2)). 15 1. Physical Medical Source Statement 16 In January 2023, Dr. Merveen Appu completed a physical medical source statement 17 opining that Plaintiff can walk no city blocks without rest or severe pain; he can sit, stand, and 18 walk for less than 2 hours total in in an 8-hour working day; he needs a job that permits shifting 19 positions at will from sitting, standing, or walking; he “must” walk every 30 minutes for 10 20 minutes at a time during an 8-hour working day; he will need to take unscheduled breaks 3-4 21 times during a working day for 20 minutes before returning to work; he must use a cane or other 22 hand-held assistive device for standing and walking; he can never twist, stoop, crouch/squat, 23 claim stairs, and climb ladders; he has significant limitations with reaching, handling, or 24 fingering; he is likely to be “off task” for 25% or more of a typical workday; he is incapable of 25 tolerating even “low stress” work; he is likely to absent about four days per month as a result of 26 the impairments or treatment; and he will need to take unscheduled breaks 3 times during a 27 working day for 10-15 minutes before returning to work. (AR 582-85). The ALJ found Dr. 28 Appu’s opinion as to Plaintiff’s physical limitations unpersuasive. (AR 24). 1 As an initial matter, to the extent Plaintiff argues the supportability analysis was not 2 supported by substantial evidence, this argument is unavailing. The ALJ specifically found the 3 opinion “was supported with reference to [Plaintiff’s] subjective complaints, his diagnoses, 4 clinical findings, and [his] treatment.” (AR 24 (emphasis added)). Thus, the Court is unable to 5 discern, nor does Plaintiff articulate, any harmful error in the ALJ’s consideration of the 6 supportability of Dr. Appu’s opinion as to Plaintiff’s physical limitations. See Woods, 32 F.4th at 7 793-94, n.4 (noting the ALJ found the opinion was supported and affirming the ALJ’s rejection of 8 a medical opinion based on the inconsistency factor alone). However, as to consistency, the ALJ 9 found that “while the longitudinal record is generally consistent with exertional, postural, and 10 environmental limitations, it is not consistent with the degree of limitation opined, nor is it 11 consistent with the unscheduled breaks, additional absences, time off task, or need for shifting 12 positions that were opined by Dr. [Appu]. As discussed [earlier in the decision, Plaintiff’s] 13 normal and abnormal physical examination findings; his conservative treatment during the period 14 at issue; his subjective complaints; and his activities of daily living are consistent with a 15 limitation to work at the light exertional level with the [noted] postural and environmental 16 limitations and limitations on [his] ability to operate foot controls.” (AR 24-25 (citing 306-13, 17 314-25, 527-28, 537-49, 560-66, 567-73, 602-04, 632, 638, 664)). 18 In considering the consistency factor, “[t]he more consistent a medical opinion(s) or prior 19 administrative medical finding(s) is with the evidence from other medical sources and 20 nonmedical sources in the claim, the more persuasive the medical opinion(s) or prior 21 administrative medical finding(s) will be.” 20 C.F.R. § 416.920c(c)(2). Plaintiff argues (1) the 22 ALJ’s reliance on a string cite, including general cites to “entire exhibits,” in support of his 23 finding “does not constitute the requisite specificity required when discussing the supportability 24 of Dr. Appu’s opinion with his own evidence of record and the consistency of Dr. Appu’s opinion 25 with the record as a whole”; and (2) the ALJ “glosses over by harmfully and erroneously failing 26 to discuss” evidence in Dr. Appu’s own examination notes and the record as a whole including 27 “seizure-like events,” “spastic quadriplegia” of the right leg, decreased muscle bulk with 28 increased tone, reduced hamstring reflexes, right knee contracture, paresthesia and numbness, 1 “hip hike” gait, crouching gait, abnormal gait, a need to wear ankle foot orthosis (AFO) on the 2 right lower extremity, leg length discrepancy, reduced deep tendon reflexes, and the inability to 3 perform a “strait leg raise.” 2 (Doc. 12 at 7-14 (AR 520 (noting spasms and seizures are “well 4 controlled” with medication), 528, 539, 543-47, 552-55, 564-65, 582-83 (Dr. Appu’s summary of 5 Plaintiff’s symptoms), 632-33, 638, 652-53, 664); see Reddick v. Chater, 157 F.3d 715, 725 (9th 6 Cir. 1998) (when considering the medical opinion evidence, the ALJ must do more than state a 7 conclusion; rather, the ALJ must “set forth his own interpretations and explain why they, rather 8 than the doctors’, are correct.”). Defendant argues the ALJ “reasonably found Dr. Appu’s 9 opinion not persuasive because it was not consistent with the extreme limitations, particularly 10 those regarding unscheduled breaks, additional absences, time off task, and the need to shift 11 position.” (Doc. 15 at 5-6). 12 While the Court would generally look unfavorably upon a string cite referencing multiple 13 pages without specific reference, as discussed below, each of the “entire exhibits, constituting 66 14 pages” cited by the ALJ in this instance offers relevant and easily discernable support from across 15 the longitudinal record for the ALJ’s findings. See Molina, 674 F.3d at 1121 (“Even when an 16 agency explains its decision with less than ideal clarity, we must uphold it if the agency’s path 17 may be reasonably discerned.”) (internal quotations and citations omitted). Moreover, the ALJ 18 directly references his discussion of the physical medical evidence earlier in the decision, 19 including evidence that could be considered more favorable to Plaintiff, cited in his opening brief, 20 documenting spasticity in the right lower extremity, a flat walk, abnormal gait, dystonia in the 21 bilateral lower extremities, axial hypotonia with appendicular hypertonicity, reduced strength in 22 the bilateral lower extremities, ability to move all extremities equally, normal strength and 23

24 2 The Court notes that Plaintiff does not specifically challenge the ALJ’s findings, as part of the medical opinion analysis, that the assessed RFC was consistent with Plaintiff’s activities of daily living and 25 conservative treatment during the relevant period; moreover, to the extent Plaintiff relies on his own self- reports and testimony as support for her argument, the ALJ properly discounted Plaintiff’s subjective 26 complaints, and Plaintiff does not challenge that finding in his opening brief. The Court may decline to consider issues not raised with specificity in Plaintiff’s opening brief. See Carmickle v. Comm’r of Soc. 27 Sec. Admin., 533 F.3d 1155, 1161 n.2 (9th Cir. 2008); see also Kim v. Kang, 154 F.3d 996, 1000 (9th Cir. 1998) (the Court may not consider on appeal issues not “specifically and distinctly argued” in the party’s 28 opening brief). 1 coordination in the extremities, normal coordination, average motor movement, and normal 2 neurological examination without tremor. (AR 21, 24-25, 527-28, 537-49 (noting ability to 3 perform daily activities mostly independently), 542 (normal asleep EEG results), 551-59 (2021 4 record noting “good long-term outcome” and Plaintiff is “doing well” after right lower extremity 5 surgery in 2015), 560-66, 569-73, 602-04 (2022 record noting gait pattern has “dramatically 6 improved” relative to preoperatively and maintained benefits of surgery), 632, 638, 664)). The 7 ALJ also noted at the January 2022 consultative examination Plaintiff was observed to ambulate 8 independently and “nothing atypical was observed in [his] gait or postural presentation,” he wore 9 a right ankle brace at times in the record, he received conservative treatment including medication 10 and physical therapy during the relevant period, and his spasms were well controlled in December 11 2020. (AR 21, 527-28, 551, 564-65, 569-73). Based on the foregoing, and regardless of 12 evidence that could be considered more favorable to Plaintiff, substantial evidence supports the 13 ALJ’s finding that Dr. Appu’s opinion as to Plaintiff’s physical limitations is not persuasive 14 because the severity of the opined limitations, particularly as to ability to walk a city block, 15 unscheduled breaks, additional absences, time off task, and need for shifting positions, are not 16 consistent with or supported by the “normal and abnormal physical examination findings.” (AR 17 24); 20 C.F.R. § 416.920c(c)(1)-(2); see also Burch v. Barnhart, 400 F.3d 676, 679 (9th Cir. 18 2005) (“Where the evidence is susceptible to more than one rational interpretation, it is the ALJ’s 19 conclusion that must be upheld.”). 20 After viewing the ALJ’s reasoning in light of the record as a whole, the Court concludes 21 that the ALJ’s finding that Dr. Appu’s opinion as to Plaintiff’s physical limitations is not 22 persuasive was supported by substantial evidence after proper consideration of the supportability 23 and consistency factors. 20 C.F.R. § 416.920c(c)(1)-(2); Woods, 32 F.4th at 792. The Court 24 finds no error in the ALJ’s consideration of the medical opinion evidence and the formulation of 25 the physical RFC. 26 2. Mental Health Residual Functional Assessment 27 Also in January 2023, Dr. Appu completed a mental residual capacity questionnaire 28 opining that Plaintiff is not precluded from interacting appropriately with the general public, 1 asking simple questions or requesting assistance, and getting along with coworkers or peers 2 without distracting them or exhibiting behavioral extremes; and he is precluded for 5% or more of 3 an 8-hour workday in his ability to carry out short and simple instructions, maintain attention and 4 concentration for extended periods of time, perform activities within a schedule, maintain regular 5 attendance, and be punctual and within customary tolerances, work in coordination with or in 6 proximity to others without being distracted by them, make simple work-related decisions, and 7 maintain socially appropriate behavior and adhere to basic standards of neatness and cleanliness. 8 (AR 586-87). However, he is precluded for 15% or more of an 8-hour workday in his ability to 9 remember locations and work-like procedures, understand and remember very short and simple 10 instructions, understand and remember detailed instructions, carry out detailed instructions, 11 sustain an ordinary routine without special supervision, complete a normal workday and 12 workweek without interruptions from psychologically based symptoms, and perform at a 13 consistent pace without an unreasonable number and length of rest periods, respond appropriately 14 to changes in the work setting, be aware of normal hazards and take appropriate precautions, 15 travel in unfamiliar places or use public transportation, and set realistic goals or make plans 16 independently of others. (Id.). Dr. Appu estimated that Plaintiff would be absent from work for 17 five or more days per month as a result of his impairments, would be unable to complete an 8- 18 hour workday as a result of his impairments, and cannot manage benefit payments. (AR 588). 19 The ALJ found Dr. Appu’s opinion as to Plaintiff’s physical limitations unpersuasive. (AR 25). 20 First, Plaintiff argues that the ALJ erred in considering the supportability factor because 21 he failed to discuss the evidence cited by Dr. Appu in his opinion in support of the assessed 22 mental health limitations. (Doc. 12 at 18-19). However, as above, this argument is unavailing. 23 The ALJ specifically found Dr. Appu’s opinion “was supported with reference to [Plaintiff’s] 24 diagnoses, treatment, and subjective complaints.” (AR 25 (emphasis added)). Thus, the Court is 25 unable to discern, nor does Plaintiff articulate, any harmful error in the ALJ’s consideration of the 26 supportability of Dr. Appu’s opinion as to Plaintiff’s mental limitations. See Woods, 32 F.4th at 27 793-94, n.4 (noting the ALJ found the opinion was supported and affirming the ALJ’s rejection of 28 a medical opinion based on the inconsistency factor alone). 1 As to the consistency factor, Plaintiff asserts largely the same arguments he presented as 2 to Dr. Appu’s physical assessment, namely, (1) the ALJ’s reliance on the exact same string cites 3 to the “exact, same exhibits” as he did in rejecting Dr. Appu’s opinion regarding Plaintiff’s 4 physical limitations is harmful error, and, as above, “does not contain adequate consistency and 5 supportability analysis and thus does not constitute substantial evidence to reject Dr. Appu’s 6 psychological [mental residual functional capacity] limitations”; and (2) the ALJ “glosses over 7 and harmfully and erroneously fails to discuss” evidence cited by Dr. Appu in support of his 8 assessed mental health limitations and “the probative evidence as a whole supporting Dr. Appu’s 9 disabling limitations due to his reduced intellectual functioning, abnormal fund of knowledge and 10 learning disabilities in relation to the rejection of Dr. Appu’s psychological limitations and from 11 treating physicians.” (Doc. 12 at 16-26). 12 In support of these arguments, Plaintiff cites the narrative support offered by Dr. Appu in 13 the medical opinion explaining that Plaintiff has learning difficulties, is nervous and anxious, gets 14 frustrated when unable to answer questions, has difficulty carrying on a conversation and 15 expressing himself, and his fund of knowledge is abnormal. (Doc. 12 at 18-19 (citing AR 586- 16 88)). Plaintiff also argues the ALJ failed to “discuss in detail” medical evidence in the 17 longitudinal record including diagnosis of anxiety disorder and depressed mood; 2022 18 presentation with “severe social anxiety” and mildly to moderately impaired judgment and insight 19 on mental status examination in 2022 and 2023; agitated and anxious affect; “severe” test results 20 in the 2023 neuropsychological evaluation in language and non-language processing, verbal and 21 nonverbal reasoning, working memory, and attention; and reports by Plaintiff at treatment visits 22 that he felt down and depressed, once “grabbed a knife and intended to slit his wrists,” used a 23 rock to hit the door when he was locked in the bathroom because he had anxious thoughts about 24 being left behind, “doesn’t know how he feels,” “is tired of feeling hurt, scared, angry, feeling I 25 did something wrong,” felt lonely, and was anxious and depressed.3 (Doc. 12 at 22-26 (citing AR 26 3 Petitioner also argues the ALJ “fails to discuss in relation to his rejection of Dr. Appu’s MRFC 27 limitations his IEPs from 7th grade through 12th grade” documenting “severe academic discrepancies” compared to his peers and difficulties with daily living, and an “individual program plan” from 2020 28 documenting behavioral health concerns and lack of independence in daily self-care routines. (Doc. 12 at 1 563, 565, 641-43, 647-48 (noting diagnoses of learning difficulty, receptive and expressive 2 language disorder, attention deficit disorder, cognitive disorder, borderline intellectual disability, 3 and reading disorder), 673, 675, 677, 679, 681, 683, 685, 687, 689, 691, 695, 699-704). 4 Defendant argues the ALJ reasonably found Dr. Appu’s opinion not persuasive. (Doc. 15 at 6). 5 As an initial matter, to the extent Plaintiff relies on his own self-reports and testimony as 6 support for her argument, the ALJ properly discounted Plaintiff’s subjective complaints, and 7 Plaintiff does not challenge that finding in his opening brief. See Carmickle v. Comm’r of Soc. 8 Sec. Admin., 533 F.3d 1155, 1161 n.2 (9th Cir. 2008) (court may decline to consider issues not 9 raised with specificity in plaintiff’s opening brief). Moreover, while the records cited by the ALJ 10 to support his rejection of Dr. Appu’s mental health opinion are comprised largely of same 11 records offered in support of his finding as the Dr. Appu’s physical opinion, the records are not 12 entirely identical; moreover, as above, the overall medical record is not extensive in this case, and 13 the cited records offers relevant support from across the relevant adjudicatory period. Finally, in 14 support of this finding, the ALJ directly references his discussion of the mental health evidence 15 earlier in the decision, which notably includes many of the same abnormal mental status 16 examination findings and Plaintiff’s subjective complaints cited by Plaintiff in his opening brief 17 as improperly “glossed over” by the ALJ. For example, the ALJ noted that Plaintiff complained 18 of social anxiety, anger, sleep issues, and that he was a “slow learner, and mental examination 19 during the relevant period showed immature speech and language for his age, frustrated behavior, 20 speaking in slow sentences, misuse of words, impaired concentration, difficulties in language 21 processing, impaired memory, poor judgment and insight, and depressed and anxious mood, and 22 had a full-scale IQ score of 77 which is borderline intellectual functioning range. (AR 22, 539 23 (immature language for his age), 563, 565 (referred for counseling), 570-73 (noting he received 24 special education services in school), 638, 642-43 (noting his scores place him within the 25

26 19-22). However, this evidence is all dated well before the alleged onset date of disability in January 2021 and is therefore of limited relevance in assessing Dr. Appu’s January 2023 opinion. See, e.g., Pacheco v. 27 Berryhill, 733 Fed. App’x 356, 360 (9th Cir. 2018) (citing Carmickle v. Comm'r, Soc. Sec. Admin., 533 F.3d 1155, 1165 (9th Cir. 2008) (“evidence that predates the alleged onset date of disability is of limited 28 relevance”). 1 intellectually impaired range, and his level of functioning), 661, 670, 673, 675, 677 (reporting 2 concerns about how he will survive when his parents are no longer around to support him), 679, 3 681 (reporting no one ever taught him basic listening skills), 683, 687, 695, 697. However, the 4 ALJ also cited normal mental status examination results indicating Plaintiff was alert and 5 oriented, interactive, cooperative, pleasant, exhibited appropriate mood and affect, had normal 6 eye contact, intact memory, normal attention and concentration, concrete thought processes and 7 normal psychomotor activities, was able to answer questions, and was able to “apply himself in a 8 consistent, persistent, effortful fashion to the meaningful engagement and completion of tasks 9 presented to him.” (AR 22, 538 (noting mild delays but able to perform daily activities mostly 10 independently), 539, 544 (noting good eye contact and appropriate speech and language for his 11 age), 548 (same), 561, 570-73 (noting no restrictions in daily activities or difficulties in 12 maintaining social relationships), 618, 625 (mood mostly good), 632, 638, 642, 652, 658, 661, 13 673, 675, 677, 679, 681, 683, 687, 693, 695 (good judgment for developmental level), 697. 14 Based on the foregoing, despite evidence that could be considered more favorable to 15 Plaintiff, substantial evidence supports the ALJ’s conclusion that Dr. Appu’s opinion as to 16 Plaintiff’s mental health limitations is not persuasive because the “degree” of the opined 17 limitations is not consistent with mental status examination findings across the longitudinal 18 record. (AR 25); 20 C.F.R. § 416.920c(c)(1)-(2); see Burch, 400 F.3d at 679. After viewing the 19 ALJ’s reasoning in light of the record as a whole, the Court concludes that the ALJ’s finding was 20 supported by substantial evidence after proper consideration of the supportability and consistency 21 factors. 20 C.F.R. § 416.920c(c)(1)-(2); Woods, 32 F.4th at 792. The Court finds no error in the 22 ALJ’s consideration of the medical opinion evidence and the formulation of the mental RFC. 23 VIII. CONCLUSION 24 A reviewing court should not substitute its assessment of the evidence for the ALJ’s. 25 Tackett, 180 F.3d at 1098. To the contrary, a reviewing court must defer to an ALJ’s assessment 26 as long as it is supported by substantial evidence. 42 U.S.C. § 405(g). As discussed in detail 27 above, the ALJ properly considered the medical opinions. After review, the Court finds the 28 ALJ’s decision is supported by substantial evidence and free of harmful legal error. ] Accordingly, it is ORDERED: 2 1. Plaintiff's Motion for Summary Judgment (Doc. 12) is DENIED. 3 2. Defendant’s Cross-Motion for Summary Judgment (Doc. 15) is GRANTED and the 4 decision of the Commissioner of Social Security is AFFIRMED for the reasons set 5 forth above. 6 3. The Clerk is directed to enter judgment in favor of the Commissioner of Social 7 Security, terminate any pending motions/deadlines, and close this case. 8 ” | Dated: _ April 2.2026 Wiha Th. Doareh Hack 10 HELENA M. BARCH-KUCHTA UNITED STATES MAGISTRATE JUDGE

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