(SS) Regina Rines v. Commissioner of Social Security

• Court: District Court, E.D. California
• Decided: February 27, 2025
• Docket: 1:21-cv-01113
• Status: Unknown

Opinion

1 2 3 4 5 6 7 8 UNITED STATES DISTRICT COURT 9 EASTERN DISTRICT OF CALIFORNIA 10 11 REGINA RINES, Case No. 1:21-cv-01113-CDB (SS)

12 Plaintiff, ORDER DENYING PLAINTIFF’S MOTION FOR SUMMARY JUDGMENT 13 v. AND AFFIRMING DECISION OF COMMISSIONER OF SOCIAL 14 COMMISSIONER OF SOCIAL SECURITY, SECURITY1

15 Defendant. (Docs. 14, 17)

17 18 Plaintiff Regina Rines (“Plaintiff”) seeks judicial review of a final decision of the 19 Commissioner of Social Security (“Commissioner” or “Defendant”) denying her application for 20 disability insurance benefits under the Social Security Act. (Doc. 1). The matter is currently 21 before the Court on the parties’ briefs, which were submitted without oral argument. (Docs. 14, 22 17). Upon review of the Administrative Record (“AR”) and the parties’ briefs, the Court finds 23 and rules as follows. 24 I. BACKGROUND 25 A. Administrative Proceedings and ALJ’s Decision 26 On July 25, 2018, Plaintiff filed a Title II application for disability insurance benefits and 27 1 Following the parties’ filing of notices indicating their consent to the jurisdiction of a U.S. magistrate judge for all purposes, this action was reassigned on January 5, 2022, pursuant to 28 U.S.C. § 1 Title XVI application for supplemental security income. (AR 20, 263-278). Plaintiff’s 2 application was denied and, after reconsideration, was denied again. (AR 91-172). On April 7, 3 2020, the assigned Administrative Law Judge (“ALJ), Matilda Surh, held a hearing; Plaintiff and 4 her counsel attended, as well as vocational expert Sandra Trost. (AR 41-90). The ALJ issued her 5 decision on May 11, 2020, finding Plaintiff not disabled. (AR 34). On September 18, 2020, the 6 Appeals Council found no basis for changing the ALJ’s decision. (AR 5-10). 7 In her decision, the ALJ found the date of onset of the alleged disability to be March 1, 8 2013. (AR 20). The ALJ engaged in the five-step sequential evaluation process set forth by the 9 Social Security Administration. 20 C.F.R. §§ 404.1520(a), 416.920(a). At step one, the ALJ 10 found Plaintiff had not engaged in substantial gainful activity since March 1, 2013, the alleged 11 onset date. At step two, the ALJ determined that Plaintiff had “the following severe impairments: 12 anxiety; depression; osteoarthritis of the bilateral hips; and degenerative joint disease of the 13 lumbar spine.” She also found that Plaintiff had the following non-severe impairments: obesity, 14 gastric bypass issues, hypertension, hypothyroidism, polycystic ovarian disease, benign pituitary 15 tumor, Barrett’s esophagus, gastroesophageal reflux disease, asthma, and kidney stones. (AR 23- 16 24). 17 At step three, she found that Plaintiff did not have an impairment, or combination of 18 impairments, that met or medically exceeds the severity of one of the listed impairments in 20 19 C.F.R. Part 404, Subpart P, Appendix 1. Regarding Plaintiff’s mental impairments, she 20 conducted an evaluation using the “paragraph B” and “paragraph C” criteria, finding that 21 Plaintiff’s mental impairments do not cause at least two “marked” limitations or one “extreme” 22 limitation, and that Plaintiff does not have only marginal adjustment to adapt to changes in daily 23 life and has not been hospitalized for psychiatric treatment. (AR 24-27). 24 The ALJ determined Plaintiff’s residual functional capacity (“RFC”) as follows: “she can 25 lift and carry 20 pounds occasionally and 10 pounds frequently. She can stand and walk for 6 26 hours in an 8-hour workday and sit for 6 hours in an 8-hour workday. She can only occasionally 27 climb ramps, stairs, ladders, ropes, and scaffolds. She is limited to no more than frequent 1 She is limited to only non-complex, routine tasks. She is also limited to only occasional public 2 contact.” (AR 27). 3 The ALJ then considered Plaintiff’s symptom testimony, finding “that the [Plaintiff’s] 4 medically determinable impairments could reasonably be expected to cause the alleged 5 symptoms; however, the [Plaintiff’s] statements concerning the intensity, persistence and limiting 6 effects of these symptoms are not entirely consistent with the medical evidence and other 7 evidence in the record.” The ALJ noted that “[x]-rays of the claimant’s hips have shown 8 moderately severe degenerative changes on the right side but only mild degenerative changes on 9 the left side.” She found that “overall, the medical records documented little evidence of 10 persistent functional difficulties, such as diminished ranges of motion or decreased strength … 11 She allegedly uses a cane everywhere at all times, but the medical records documented little 12 objective evidence of constant usage of a cane. In fact, treatment notes dated July 29, 2019 and 13 September 9, 2019 mentioned that she was not using any assistive device for ambulation.” (AR 14 28) (citing Ex. 21F). 15 The ALJ stated that Plaintiff’s “gait was sometimes noted to be antalgic, but she often had 16 a normal gait … In addition, the treatment records reflect that injections and medications are 17 effective in reducing her pain and improving her functioning.” (AR 28) (citing Exs. 3F, 4F, 6F, 18 7F, 9F, 10F, 16F, 18F, 21F, 22F, and 25F). She also found little evidence of any surgical 19 intervention being recommended for her hip disorder. Id. 20 Regarding Plaintiff’s back, the ALJ found that “x-rays of her lumbar spine taken in June 21 2017 revealed only mild degenerative changes … and an electrodiagnostic study of her lower 22 extremities done in June 2019 found no evidence of lumbar radiculopathy … She also generally 23 exhibited normal motor and sensory function.” (AR 28). 24 The ALJ noted that “treatment records reflect that injections and medications are effective 25 in reducing her pain and improving her functioning. Moreover, there is little evidence that any 26 surgical intervention has been recommended for her back disorder … With respect to the 27 claimant’s mental impairments, the medical records reflect that her mental functioning was 1 generally exhibited normal mood and affect, pleasant or friendly attitude, cooperative behavior, 2 good eye contact, normal judgment, intact thought process, and normal attention span and 3 concentration.” (AR 28). 4 The ALJ found that Plaintiff pursued little mental health treatment after 2014, but 5 acknowledged Plaintiff testified at the hearing that she would start mental health treatment again 6 in May 2020. (AR 29). The ALJ concluded:

7 “This large treatment gap is inconsistent with the alleged severity of her mental 8 symptoms. She allegedly tried to obtain treatment from 2015 through early 2020, but there is no definitive evidence that she had difficulty obtaining specialized 9 mental health treatment as necessary during this 5-year period. In addition, despite the allegations of frequent panic attacks, she has not been hospitalized for 10 psychiatric treatment since March 1, 2013. Moreover, according to the hearing testimony, her psychotropic medications generally help calm her down.” (AR 28) 11 (citing Ex. 8F). 12 13 The ALJ found that Plaintiff’s daily activities were:

14 “not limited to the extent one would expect, given the complaints of disabling 15 symptoms and limitations. Despite her physical and mental impairments, she is essentially independent in personal care. She is able to prepare simple meals, do 16 laundry, wash dishes, do light cleaning, use a computer, manage her own finances, crochet, sew, and make crafts. She spends time with others daily. She 17 can get along with authority figures adequately. She can go to a grocery store on a regular basis. She is able to pay attention most of the time and finish what she 18 starts. She can follow written and spoken instructions adequately. She has not 19 alleged any significant side effects from the use of medications.” (AR 29) (citing Exs. 5E, 8F, 9E, 10E). 20 21 The ALJ found the opinions of the state agency medical consultants’ persuasive because 22 they were from highly qualified physicians, familiar with Social Security programs, and 23 “consistent with the general absence of positive clinical signs concerning the claimant’s hips in 24 the treatment records … The opinions are also supported by the lumbar spine x-rays, which 25 showed only mild findings, and the electrodiagnostic study, which was normal … Moreover, the 26 opinions are consistent with the well-documented effectiveness of injections and pain 27 medications” as well as Plaintiff’s activities of daily living. “However, the opinions somewhat 1 the claimant’s subjective complaints.” (AR 30). 2 The ALJ found the mental consultative examination persuasive, finding a “moderately 3 limited ability to deal with usual work stress and a mildly to moderately limited ability to perform 4 work activities on a consistent basis, react to changes in work environment, and complete a 5 normal workday or workweek” but “an adequate ability to perform at least simple tasks, maintain 6 regular attendance, work without special or additional supervision, accept instructions from 7 supervisors, and interact with coworkers and the public. (AR 30-31) (citing Ex. 8F). 8 As to Plaintiff’s primary care physician, Mitchell Cohen, the ALJ found the opinions in 9 his records unpersuasive because they are “inconsistent with the general absence of positive 10 clinical signs concerning the claimant’s hips in the treatment records … contradicted by the 11 lumbar spine x-rays, which showed only mild findings, and the electrodiagnostic study, which 12 was normal … contradicted by the claimant’s generally normal motor and sensory function and 13 her often normal gait … contradicted by the generally adequate mental functioning that the 14 claimant exhibited during the adjudicative period … inconsistent with the effectiveness of 15 injections, pain medications, and psychotropic medications …inconsistent with the claimant’s 16 generally adequate daily living activities and social activities … which indicate some physical 17 and mental capacity.” (AR 31). 18 At step four, the ALJ found that Plaintiff was unable to perform any past relevant work. 19 Finally, at step five, she found that, per testimony of the vocational expert, Plaintiff could perform 20 jobs that exist in significant numbers in the national economy, such as silver wrapper, marker, 21 and office helper. (AR 32-33). 22 B. Medical Record and Hearing Testimony 23 The relevant hearing testimony and medical record were reviewed by the Court and will 24 be referenced below as necessary to this Court’s decision. 25 II. 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 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 4 evidence equates to “more than a mere scintilla[,] but less than a preponderance.” (Id.) (quotation 5 and citation omitted). “It is such relevant evidence as a reasonable mind might accept as adequate 6 to support a conclusion.” Healy v. Astrue, 379 Fed. Appx. 643, 645 (9th Cir. 2010). In 7 determining whether the standard has been satisfied, a reviewing court must consider the entire 8 record as a whole rather than searching for supporting evidence in isolation. (Id.). 9 The court will review only the reasons provided by the ALJ in the disability determination 10 and may not affirm the ALJ on a ground upon which she did not rely. Social Security Act § 205, 11 42 U.S.C. § 405(g). In reviewing a denial of benefits, a district court may not substitute its 12 judgment for that of the Commissioner. “The court will uphold the ALJ’s conclusion when the 13 evidence is susceptible to more than one rational interpretation.” Tommasetti v. Astrue, 533 F.3d 14 1035, 1038 (9th Cir. 2008). Further, a district court will not reverse an ALJ’s decision on account 15 of an error that is harmless. (Id.). An error is harmless where it is “inconsequential to the 16 [ALJ’s] ultimate nondisability determination.” (Id). (quotation and citation omitted). The party 17 appealing the ALJ’s decision generally bears the burden of establishing that it was 18 harmed. Shinseki v. Sanders, 556 U.S. 396, 409-10 (2009). 19 A claimant must satisfy two conditions to be considered “disabled” and eligible for 20 benefits within the meaning of the Social Security Act. First, the claimant must be “unable to 21 engage in any substantial gainful activity by reason of any medically determinable physical or 22 mental impairment which can be expected to result in death or which has lasted or can be 23 expected to last for a continuous period of not less than twelve months.” 42 U.S.C. § 24 1382c(a)(3)(A). Second, the claimant’s impairment must be “of such severity that he is not only 25 unable to do his previous work[,] but cannot, considering his age, education, and work 26 experience, engage in any other kind of substantial gainful work which exists in the national 27 economy.” 42 U.S.C. § 1382c(a)(3)(B). 1 claimant satisfies the above criteria. See 20 C.F.R. § 416.920(a)(4)(i)-(v). At step one, the 2 Commissioner considers the claimant’s work activity. 20 C.F.R. § 416.920(a)(4)(i). If the 3 claimant is engaged in “substantial gainful activity,” the Commissioner must find that the 4 claimant is not disabled. 20 C.F.R. § 416.920(b). 5 If the claimant is not engaged in substantial gainful activity, the analysis proceeds to step 6 two. At this step, the Commissioner considers the severity of the claimant’s impairment. 20 7 C.F.R. § 416.920(a)(4)(ii). If the claimant suffers from “any impairment or combination of 8 impairments which significantly limits [his or her] physical or mental ability to do basic work 9 activities,” the analysis proceeds to step three. 20 C.F.R. § 416.920(c). If the claimant’s 10 impairment does not satisfy this severity threshold, however, the Commissioner must find that the 11 claimant is not disabled. (Id.). 12 At step three, the Commissioner compares the claimant’s impairment to impairments 13 recognized by the Commissioner to be so severe as to preclude a person from engaging in 14 substantial gainful activity. 20 C.F.R. § 416.920(a)(4)(iii). If the impairment is as severe or more 15 severe than one of the enumerated impairments, the Commissioner must find the claimant 16 disabled and award benefits. 20 C.F.R. § 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. § 416.945(a)(1)), is relevant to both the fourth and fifth steps of the 22 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. § 416.920(a)(4)(iv). If the claimant is capable of performing past relevant 26 work, the Commissioner must find that the claimant is not disabled. 20 C.F.R. § 416.920(f). If 27 the claimant is incapable of performing such work, the analysis proceeds to step five. 1 claimant is capable of performing other work in the national economy. 20 C.F.R. § 2 416.920(a)(4)(v). In making this determination, the Commissioner must also consider vocational 3 factors such as the claimant’s age, education, and past work experience. (Id.). If the claimant is 4 capable of adjusting to other work, the Commissioner must find that the claimant is not 5 disabled. 20 C.F.R. § 416.920(g)(1). If the claimant is not capable of adjusting to other work, the 6 analysis concludes with a finding that the claimant is disabled and is therefore entitled to 7 benefits. (Id.). 8 The claimant bears the burden of proof at steps one through four above. Tackett v. Apfel, 9 180 F.3d 1094, 1098 (9th Cir. 1999). If the analysis proceeds to step five, the burden shifts to the 10 Commissioner to establish that (1) the claimant is capable of performing other work; and (2) such 11 work “exists in significant numbers in the national economy.” 20 C.F.R. § 416.960(c)(2); Beltran 12 v. Astrue, 700 F.3d 386, 389 (9th Cir. 2012). 13 III. ISSUES AND ANALYSIS 14 Plaintiff seeks judicial review of the Commissioner’s final decision denying her 15 application. (Doc. 1). Plaintiff raises the following issues: 16 1. The ALJ failed to provide specific and legitimate reasons for discounting the treating 17 medical source opinion of physician Mitchell Cohen (Doc. 14 at 2); and 18 2. The ALJ erred in finding that Plaintiff’s chronic kidney stones were a non-severe 19 impairment at step two of the analysis and the resulting RFC fails to include 20 limitations related to that impairment. Id. 21 A. Whether the ALJ Properly Discounted the Treating Medical Source Opinion of 22 Physician Mitchell Cohen 23 Plaintiff argues that the ALJ failed to provide “specific and legitimate reasons” for 24 discounting the treating medical source opinion of physician Mitchell Cohen. (Doc. 14 at 18-27). 25 As a preliminary matter, Plaintiff incorrectly advances the standard applicable to claims filed 26 before March 27, 2017 (“specific and legitimate reasons”). Because Plaintiff filed her application 27 for benefits after that date, Plaintiff’s claim for benefits is governed by the agency’s “new” 1 Woods v. Kijakazi, 32 F.4th 785, 790 (9th Cir. 2022) (noting the “specific and legitimate” 2 standard is “clearly irreconcilable with the 2017 regulations”). Plaintiff cites cases for the 3 proposition that the “specific and legitimate” standard still applies. (Doc. 14 at 23). These cases 4 predate Woods and are, therefore, not persuasive. 5 The new regulations set “supportability” and “consistency” as “the most important 6 factors” when determining the opinions’ persuasiveness. 20 C.F.R. § 404.1520c(b)(2). And 7 although the regulations eliminate the “physician hierarchy,” deference to specific medical 8 opinions, and assigning “weight” to a medical opinion, the ALJ must still “articulate how [they] 9 considered the medical opinions” and “how persuasive [they] find all of the medical opinions.” 10 20 C.F.R. § 404.1520c(a)–(b). Accordingly, under the new regulations, “the decision to discredit 11 any medical opinion, must simply be supported by substantial evidence.” Woods, 32 F.4th at 787. 12 In conjunction with this requirement, “[t]he agency must ‘articulate ... how persuasive’ it 13 finds ‘all of the medical opinions’ from each doctor or other source, and ‘explain how [it] 14 considered the supportability and consistency factors’ in reaching these findings.” Id. at 792 15 (citing 20 C.F.R. § 404.1520c(b)). See also 20 C.F.R. § 416.920c(b). “Supportability means the 16 extent to which a medical source supports the medical opinion by explaining the ‘relevant ... 17 objective medical evidence.’” Woods, 32 F.4th at 791–92 (quoting 20 C.F.R. § 404.1520c(c)(1)). 18 See also id. § 416.920c(c)(1). “Consistency means the extent to which a medical opinion is 19 ‘consistent ... with the evidence from other medical sources and nonmedical sources in the 20 claim.’” Id. at 792 (quoting 20 C.F.R. § 404.1520c(c)(2)). See also 20 C.F.R. § 416.920c(c)( 2). 21 The ALJ’s analysis of Dr. Cohen’s opinion is as follows: 22 Mitchell Cohen, D.O., the claimant’s own physician, stated that the claimant would frequently be unable to perform simple tasks, was limited to low-stress work, was 23 restricted to less than sedentary exertion, could perform very limited postural activities, and would be absent from work more than 4 days per month. I find that 24 this opinion is not persuasive because it is inconsistent with the general absence of positive clinical signs concerning the claimant’s hips in the treatment records. The 25 opinion is also contradicted by the lumbar spine x-rays, which showed only mild 26 findings, and the electrodiagnostic study, which was normal. In addition, the opinion is contradicted by the claimant’s generally normal motor and sensory 27 function and her often normal gait. Moreover, the opinion is contradicted by the generally adequate mental functioning that the claimant exhibited during the 1 with the effectiveness of injections, pain medications, and psychotropic medications. As mentioned above, she has received little specialized mental health 2 treatment since 2014 and has not been hospitalized for psychiatric treatment since March 1, 2013. Finally, the opinion is inconsistent with the claimant’s generally 3 adequate daily living activities and social activities as discussed above, which 4 indicate some physical and mental capacity. 5 (AR 31) (citations omitted). 6 First, Plaintiff argues that the ALJ “summarily found [Dr. Cohen’s] opinion was 7 inconsistent with the ‘general absence of positive clinical signs concerning the claimant’s hips in 8 the treatment records.’” (Doc. 14 at 23) (citing AR 31; internal citations omitted). Plaintiff states 9 that there are “multiple positive clinical findings in the record concerning [Plaintiff’s] bilateral 10 hips.” Id. Plaintiff provides that the ALJ’s inaccurate statements do not satisfy the relevant 11 standard to discount the opinion. Id. at 24. 12 Second, Plaintiff argues that the ALJ failed to meet the relevant standard when finding 13 that Dr. Cohen’s opinion is contradicted by mild findings on lumbar spine x-rays, EMG results, 14 normal motor and sensory functions, and normal gait. Plaintiff argues that the ALJ failed to 15 discuss evidence in the record regarding positive clinical findings on physical exams and multiple 16 steroid injections to treat Plaintiff’s back pain. Id. Third, Plaintiff argues that the evidence in the 17 record does not support a conflict between Dr. Cohen’s opinion and the effectiveness of any pain 18 medications, injections, and psychotropic medications. Id. at 24-25. 19 Fourth, Plaintiff argues that Dr. Cohen’s opinion as to mental functioning was not based 20 solely on mental health impairments, but also on “pain or other symptoms” that are severe enough 21 to interfere with Plaintiff’s ability to sustain attention and concentration. Plaintiff provides that, 22 as such, the ALJ did not explain how allegedly adequate mental functioning and lack of mental 23 health treatment contradict an opinion based on chronic pain. Id. at 25-26. And finally, Plaintiff 24 argues that the ALJ did not explain how Plaintiff’s activities of daily living are inconsistent with 25 Dr. Cohen’s opinion, particularly in light of Ninth Circuit precedent that Plaintiff need not be 26 bed-ridden. Id. at 26. 27 Defendant argues that the ALJ’s opinion met the appropriate standard when analyzing Dr. 1 Dr. Cohen’s opinion limiting Plaintiff’s lifting of ten pounds of weight due to lower back pain in 2 light of spinal examinations that returned only mild findings. Defendant points out that the ALJ 3 considered steroid injections when determining a limitation to a light work RFC, finding the 4 treatment effective. Id. at 5. Defendant also argues that, when discounting Dr. Cohen’s less than 5 sedentary assessment, the ALJ properly cited to records reflecting Plaintiff’s physicians stated 6 that she did not use any assistive walking device. Id. at 5-6. 7 Lastly, Defendant argues that the ALJ properly discounted Dr. Cohen’s opinion as to 8 mental limitations, supported by a record that showed little evidence of treatment since 2014, no 9 hospitalizations, and largely normal activities of daily living. In that assessment, Defendant 10 asserts that the ALJ referenced in her decision earlier analyses where she noted normal mental 11 status exams, attention, concentration, and activities, also mentioning Plaintiff’s limited attention 12 at the consultative examination but noting Plaintiff was able to demonstrate adequate 13 concentration, calculations, and logical thought processes. Id. at 6. 14 Dr. Cohen’s opinion consists of four pages of a “Physical Residual Functional Capacity 15 Questionnaire” provided by the Social Security Administration. (AR 3519-3522). It asks for 16 Plaintiff’s diagnoses, prognoses, symptoms, clinical findings, and a range of limitations. It is 17 predominantly a “checkbox” form. Where Dr. Cohen was asked to identify clinical findings, 18 treatments, and responses, he wrote “see chart notes.” (AR 3519). 19 In her review and consideration of Dr. Cohen’s opinion, the ALJ references narrative and 20 analysis she provided earlier in her decision. Though the format of the ALJ’s deliberation is 21 somewhat cumbersome, her reasoning is reasonably discerned. See Molina v. Astrue, 674 F.3d 22 1104, 1121 (9th Cir. 2012) (“Even when an agency explains its decision with less than ideal 23 clarity, we must uphold it if the agency’s path may reasonably be discerned.”) (citations and 24 quotations omitted; superseded on other grounds). 25 i. Degenerative Changes in Plaintiff’s Hips 26 Addressing Dr. Cohen’s assessment, the ALJ found that “this opinion is not persuasive 27 because it is inconsistent with the general absence of positive clinical signs concerning the 1 17F, 18F, 21F). 2 Earlier in her decision, the ALJ discusses the evidence in the record regarding Plaintiff’s 3 hips: 4 X-rays of the claimant’s hips have shown moderately severe degenerative changes on the right side but only mild degenerative changes on the left side. During the 5 adjudicative period, she was sometimes noted to have tenderness and painful motion in the hips, but, overall, the medical records documented little evidence of 6 persistent functional difficulties, such as diminished ranges of motion or decreased 7 strength. She allegedly uses a cane everywhere at all times, but the medical records documented little objective evidence of constant usage of a cane. In fact, treatment 8 notes dated July 29, 2019 and September 9, 2019 mentioned that she was not using any assistive device for ambulation. Her gait was sometimes noted to be antalgic, 9 but she often had a normal gait. In addition, the treatment records reflect that injections and medications are effective in reducing her pain and improving her 10 functioning. Moreover, there is little evidence that any surgical intervention has 11 been recommended for her hip disorder. 12 (AR 28) (citations omitted). 13 Here, the ALJ reasonably analyzed and cited relevant treatment notes in evaluating Dr. 14 Cohen’s opinion and her findings are amply supported by the record. See (AR 616, 631-632, 639, 15 800-805, 856, 858, 980, 987, 1008, 1018, 1211, 1215-1217, 1256-1258, 2634-2635, 2638). For 16 example, on September 14, 2017, Plaintiff went to the emergency room for “bilateral hip pain 17 onset four days in duration.” (AR 800). She was given a prescription for Motrin and Ultram and 18 recommended to follow up with her primary care physician the following week. (AR 804). The 19 x-rays taken during that visit evidenced no fractures or dislocations but found arthritic spurs in 20 her joints. (AR 805). 21 On June 9, 2017, after a physical exam, Dr. Cohen noted that Plaintiff had “right hip pain 22 with int [sic] rotation.” He ordered an x-ray for her hip. (AR 1018). On July 10, 2017, Dr. 23 Cohen states that Plaintiff’s “right hip is still hurting her. She had her xrays [sic] done and a 24 referral was made for her right hip.” (AR 1008). On January 9, 2018, physician William Pistel 25 found “moderate osteoarthritis with the right hip being more suggestive of joint space narrowing, 26 osteophytic spur formation, and sclerosis.” He found Plaintiff to not be an “ideal surgical 27 candidate” due to her age and body mass index and recommended a referral for a hip injection, 1 “will get an injection in the hip. She is waiting for authorization. She will also be starting PT 2 next week.” (AR 991). On April 16, 2018, Plaintiff attended physical therapy, having already 3 received her injection. (AR 1231-1234). And on May 1, 2018, Dr. Cohen notes that Plaintiff 4 “had the injection in her hip and it has been helping her. She will be having injections in her 5 back.” (AR 980). 6 On June 19, 2018, the radiology provider noted degenerative changes in the hips as 7 “pronounced” for her age, with “right greater than left” and no “acute fracture” or dislocation. 8 (AR 856). She continued to attend physical therapy appointments intermittently over the 9 following months (AR 1235-1240), but was discharged on July 26, 2018, because she 10 “cancelled/no-showed nine visits over the course of her care[,] [d]ischarge due to poor 11 attendance” (AR 1240). On September 5, 2018, physician Joshua Nicholson noted that Plaintiff 12 underwent a hip injection and she reported “97% improvement in her right hip pain. She is very 13 pleased with her functional improvement especially with walking” but still had “low back pain 14 and left hip pain” and expressed interest in obtaining a cane. (AR 1256). Dr. Nicholson further 15 noted “moderately severe degenerative changes on the right hip and mild degenerative changes of 16 the left hip.” (AR 1258). On February 3, 2020, Plaintiff again began attending physical therapy 17 and her functional performance was noted as “impaired.” (AR 2634-2635). On March 2, 2020, 18 Plaintiff was discharged “due to [one] no show [sic] and [two] same day cancels[,] [p]atient will 19 require new RX for future treatment.” (AR 2638). 20 On September 5, 2018, Dr. Nicholson noted Plaintiff had difficulty walking, favoring her 21 right hip. (AR 2661). On May 15, 2019, her gait was noted as normal by nurse practitioner 22 Michael They. (AR 2522). On September 9, 2019, nurse practitioner Amaechi Ozor noted that 23 Plaintiff’s gait was normal, with her not using any assistive device for ambulation (AR 2507); 24 Ozor made the same findings again on October 28, 2019 (AR 2511). 25 Some of the citations in the ALJ’s analysis refer to injections or medications reducing 26 lower back pain rather than hip pain, for example 16F/6 (AR 1720), 16F/10 (AR 1724), and 27 22F/66 (AR 2600). However, this is harmless error, as other citations, such as 6F/10 (AR 980) 1 Social Sec. Admin., 466 F.3d 880, 885 (9th Cir. 2006) (holding that error that is inconsequential 2 to the ultimate nondisability determination is harmless error). 3 Accordingly, the ALJ’s evaluation of Dr. Cohen’s opinion as to degenerative changes in 4 Plaintiff’s hips is supported by substantial evidence. See, e.g., Bob R. v. Comm’r of Soc. Sec., No. 5 C24-5558-BAT, 2025 WL 474259, at *4 (W.D. Wash. Feb. 12, 2025) (“even if the evidence is 6 susceptible to more than one rational interpretation, it is the ALJ’s conclusion that must be 7 upheld. Plaintiff has not demonstrated that the ALJ’s evaluation of Dr. Ruddell’s opinion was 8 unreasonable, unsupported by substantial evidence, or the result of harmful legal error.”) (internal 9 citations and quotations omitted) (citing Burch v. Barnhart, 400 F.3d 676, 679 (9th Cir. 2005)). 10 ii. Degenerative Changes in Plaintiff’s Lumbar Spine 11 As to limitations identified by Dr. Cohen, the ALJ found that “[t]he opinion is also 12 contradicted by the lumbar spine x-rays, which showed only mild findings, and the 13 electrodiagnostic study, which was normal. In addition, the opinion is contradicted by the 14 claimant’s generally normal motor and sensory function and her often normal gait.” (AR 31) 15 (citing Exs. 3F, 4F, 6F, 7F, 9F, 10F, 16F, 18F, 21F, 25F). 16 Earlier in her decision, the ALJ discusses the record evidence regarding Plaintiff’s lumbar 17 spine and motor and sensory functions: 18 During the adjudicative period, the claimant often had a diminished range of motion in the lumbar spine. However, x-rays of her lumbar spine taken in June 2017 19 revealed only mild degenerative changes. She complains of radicular symptoms, but an electrodiagnostic study of her lower extremities done in June 2019 found no 20 evidence of lumbar radiculopathy. She also generally exhibited normal motor and sensory function. She allegedly uses a cane everywhere at all times, but the medical 21 records documented little objective evidence of constant usage of a cane. In fact, 22 treatment notes dated July 29, 2019 and September 9, 2019 mentioned that she was not using any assistive device for ambulation. Her gait was sometimes noted to be 23 antalgic, but she often had a normal gait. In addition, the treatment records reflect that injections and medications are effective in reducing her pain and improving 24 her functioning. Moreover, there is little evidence that any surgical intervention 25 has been recommended for her back disorder. 26 (AR 28-29) (citations omitted). 27 Here as well, the ALJ adequately analyzed and cited relevant treatment notes in evaluating Dr. Cohen’s opinion and her findings are supported by the record. See (AR 1210-1211, 1217, 1 1248, 1266-1267, 1726, 1732-1734, 2507, 2511, 2519, 2530). For example, on April 10, 2017, 2 after a physical exam, Dr. Cohen noted that Plaintiff had lower back pain, for which she was 3 taking tramadol and cyclobenzaprine HCL. (AR 1024). On June 9, 2017, after another physical 4 exam, Dr. Cohen noted that Plaintiff had low back pain. He ordered an x-ray for her lower back. 5 (AR 1018). On June 28, 2017, physician John Martin noted “mild degenerative changes,” “mild 6 spurring,” “minimal mid lumbar levoscoliosis,” “no spondylolysis or spondylolisthesis,” and a 7 “normal statute and alignment” of Plaintiff’s lumbar vertebrae. (AR 1195). On January 9, 2018, 8 Dr. Pistel noted that Plaintiff had lower back pain and recommended injections and physical 9 therapy. (AR 1210-1211). 10 On April 6, 2018, Dr. Nicholson notes Plaintiff elected to proceed with injections for her 11 lower back pain. (AR 1229). On September 5, 2018, Dr. Nicholson found that Plaintiff’s “low 12 back pain is her worse pain … Pain is made better by changing positions[,] rest and medications.” 13 (AR 1716). Plaintiff was to continue her medication regime, with Tylenol and an increased dose 14 of tramadol, and undergo injections for her lower back pain. (AR 1718). On October 10, 2018, 15 during a consultative exam with a psychologist, she was noted as having normal motor activity. 16 (AR 1248). On October 11, 2018, Plaintiff had an injection for lower back pain. (AR 1266- 17 1267). She later reported “70% improvement.” (AR 1726). On February 14, 2019, Plaintiff had 18 another injection for lower back pain. (AR 1514, 1559). She later reported “80% improvement.” 19 (AR 1726). On May 2, 2019, Plaintiff had another injection for lower back pain (AR 2265), as 20 well as an additional injection on June 13, 2019 (AR 2519). On June 27, 2019, physician 21 Mahendra Nath noted that an electrodiagnostic exam found no “evidence of large fiber peripheral 22 polyneuropathy, lumbar radiculopathy, or any other nerve entrapment neuropathies.” (AR 2530). 23 The ALJ appears to have used the same string of citations relating to pain for the hips and 24 lower back, as some of the citations in the ALJ’s analysis refer to injections or medications 25 reducing hip pain rather than lower back pain, for example 6F/10 (AR 980) and 9F/6 (AR 1256). 26 However, this again is harmless error, as other citations, such as 16F/6 (AR 1720), 16F/10 (AR 27 1724), and 22F/66 (AR 2600), evidence the injections specifically helping her lower back pain. 1 Accordingly, the ALJ’s evaluation of Dr. Cohen’s opinion as to degenerative changes in 2 Plaintiff’s lumbar spine is supported by substantial evidence. See Bob R., 2025 WL 474259, at 3 *4. 4 iii. Mental Functioning 5 Addressing Dr. Cohen’s assessment, the ALJ found that “the opinion is contradicted by 6 the generally adequate mental functioning that the claimant exhibited during the adjudicative 7 period, as discussed above … she has received little specialized mental health treatment since 8 2014 and has not been hospitalized for psychiatric treatment since March 1, 2013.” (AR 31) 9 (citing Exs. 6F, 8F). 10 Earlier in her decision, the ALJ discusses the record evidence regarding Plaintiff’s mental 11 functioning: 12 [T]he medical records reflect that her mental functioning was generally adequate throughout the adjudicative period. According to the treatment notes, she generally 13 exhibited normal mood and affect, pleasant or friendly attitude, cooperative 14 behavior, good eye contact, normal judgment, intact thought process, and normal attention span and concentration. At a mental consultative examination conducted 15 on October 10, 2018, she had limited attention, but she demonstrated appropriate attire, clean appearance, good grooming, polite attitude, cooperative behavior, 16 appropriate interaction, normal psychomotor activity, good eye contact, calm affect, normal speech, full orientation, intact intelligence, adequate concentration, 17 adequate fund of knowledge, adequate memory, adequate abstraction, intact simple 18 calculation skills, adequate judgment, intact insight, good mood, logical thought process, and unremarkable thought content. The evidence of record shows that the 19 claimant received little specialized mental health treatment, such as counseling and psychotherapy, after 2014. At the hearing, she testified that she was scheduled to 20 start specialized mental health treatment again in May 2020. This large treatment gap is inconsistent with the alleged severity of her mental symptoms. She allegedly 21 tried to obtain treatment from 2015 through early 2020, but there is no definitive 22 evidence that she had difficulty obtaining specialized mental health treatment as necessary during this 5-year period. In addition, despite the allegations of frequent 23 panic attacks, she has not been hospitalized for psychiatric treatment since March 1, 2013. Moreover, according to the hearing testimony, her psychotropic 24 medications generally help calm her down. I noticed that the claimant was able to respond to questions, interact appropriately, follow closely, and participate fully 25 during the telephonic hearing. While the hearing was short-lived and cannot be 26 considered a conclusive indicator of the claimant's overall level of mental problems on a day-to-day basis, the apparent lack of serious mental difficulties during the 27 hearing is somewhat inconsistent with the alleged severity of her symptoms. 1 As addressed by the undersigned above, the ALJ adequately analyzed and cited relevant 2 treatment notes in evaluating Dr. Cohen’s opinion and her findings are supported by the record. 3 See (AR 972-1081, 1121-1141, 1246-1249). For example, on October 10, 2018, Plaintiff 4 attended a consultative examination with psychologist Kelly T. Pham. (AR 1246-1249). She was 5 noted as taking sertraline and Risperdal, with no history of suicide or self-harm. (AR 1246). She 6 was further noted as being alert, oriented, and calm, having a cooperative attitude, good eye 7 contact, coherent speech, adequate concentration, adequation memory, adequate abstraction, 8 adequate judgment, intact calculations, logical thought content, and limited attention. (AR 1248). 9 A review of the record supports the ALJ’s conclusion that Plaintiff received little 10 specialized mental health treatment from the date of her disability. The record contains 11 psychiatric and behavioral health progress notes, dating from regular sessions between March 30, 12 2012 (prior to the date of onset of her disability), to December 31, 2014. (AR 1121-1141). These 13 notes, prepared by licensed clinical social worker Pete Thompson, state a diagnosis of post- 14 traumatic stress disorder and dysthymic disorder. They do not appear to evidence clinical 15 findings substantially different from the ALJ’s conclusions, nor do the sessions appear to 16 continue beyond the end of 2014. A record from Dr. Cohen, dated August 3, 2015, states that 17 Plaintiff has depression, bipolar disorder, and post-traumatic stress disorder and is taking Zoloft 18 (sertraline) and Risperdal. (AR 1078-1079). These medications continue throughout the period 19 of Dr. Cohen’s records but his records otherwise are largely devoid of any other mention of, or 20 treatments for, mental health concerns. (AR 972-1081). 21 Plaintiff argues that Dr. Cohen’s opinion as to mental functioning was not based solely on 22 mental health impairments, but also on “pain or other symptoms” that are severe enough to 23 interfere with Plaintiff’s ability to sustain attention and concentration. (Doc. 14 at 25-26; citing 24 AR 3520). Contrary to Plaintiff’s arguments, the ALJ addressed pain in her evaluation of Dr. 25 Cohen’s limitations, as noted in the discussion above relating to Plaintiff’s hips and lumbar spine. 26 Plaintiff cites to the case of McCrea v. Colvin2 for the proposition that the ALJ erred by failing to 27 explain how a normal mental status test detracted from a treating source’s opinion that attributed the 1 inability to sustain attention and concentration to chronic pain. (Doc. 14 at 26). However, the 2 opinion in the case largely is inapplicable here, or at least is unpersuasive, as it predates the adoption 3 of the new “substantial evidence” standard and thus applies the “specific and legitimate” standard in 4 evaluating the medical opinion. 5 Additionally, the facts of the McCrea case are distinguishable. When evaluating the 6 plaintiff’s foot and leg pain, the court held that the ALJ incorrectly noted the distance in which the 7 plaintiff walked to his Narcotics Anonymous meetings as 22 blocks when it was only seven blocks, 8 failed to consider that plaintiff was a recovering heroin addict and thus had a good reason for not 9 pursuing more aggressive pain medications beyond ibuprofen, improperly substituted his lay opinion 10 for that of a medical professional, and failed to base his rejection of the physician’s opinion on 11 physical limitations upon a holistic review of the medical evidence. McCrea, 2016 WL 884642, at 12 *7–8. It is upon this foundation that the court later concluded that the ALJ failed to explain how 13 findings of “appropriate thought content and thought process” detracted from the physician’s opinions 14 regarding attention and concentration, when such opinions were not explicitly linked to mental 15 impairments and, thus, may have been based on chronic pain. Id. at *8. Here, the ALJ has not 16 incorrectly stated facts upon which her analysis rests, nor improperly substituted her lay opinion for 17 that of a professional, nor failed to base her rejection of Dr. Cohen’s opinions on a holistic review of 18 the medical evidence. 19 Accordingly, the ALJ’s evaluation of Dr. Cohen’s opinion as to mental functioning is 20 supported by substantial evidence. See Her v. Comm’r of Soc. Sec., No. 1:24-CV-00906-EPG, 2025 21 WL 391819, at *4 (E.D. Cal. Feb. 4, 2025) (“While Plaintiff argues that other evidence could support 22 a different conclusion as to degree of her mental impairments and the persuasiveness of Dr. Thao’s 23 opinion, this at most amounts to another rational interpretation, meaning that the decision of the ALJ 24 must be upheld.”) (citations and quotations omitted). 25 iv. Daily Activities 26 Addressing limitations found by Dr. Cohen, the ALJ concluded that “the opinion is 27 inconsistent with the claimant’s generally adequate daily living activities and social activities as 1 8F). 2 Earlier in her decision, the ALJ discusses the evidence in the record regarding Plaintiff’s 3 daily activities: The claimant has described daily activities that are not limited to the extent one 4 would expect, given the complaints of disabling symptoms and limitations. Despite 5 her physical and mental impairments, she is essentially independent in personal care. She is able to prepare simple meals, do laundry, wash dishes, do light cleaning, 6 use a computer, manage her own finances, crochet, sew, and make crafts. She spends time with others daily. She can get along with authority figures adequately. 7 She can go to a grocery store on a regular basis. She is able to pay attention most 8 of the time and finish what she starts. She can follow written and spoken instructions adequately. She has not alleged any significant side effects from the 9 use of medications. 10 (AR 29) (citations omitted). 11 The ALJ cites to a function report completed by Plaintiff (AR 310-318) on August 13, 12 2018, as well as a consultative examination conducted by Dr. Pham on October 10, 2018 (AR 13 1246-1249). The ALJ found Dr. Cohen’s opinion was inconsistent with Plaintiff's reported 14 activities. (AR 31). An ALJ properly may consider a plaintiff’s reported activities in evaluating 15 the persuasiveness of medical opinions. See Leonard v. Comm’r of Soc. Sec., No. 1:21-cv-00627- 16 EPG, 2022 WL 4123990, at *4 (E.D. Cal. Sept. 9, 2022) (“when considered in conjunction with 17 the rest of the ALJ’s reasoning, the ALJ’s reliance on Plaintiff’s daily activities—caring for her 18 cat, preparing simple meals, cleaning, and sometimes administering her father's insulin, etc.—is a 19 reasonable basis to discount the severe limitations assessed [in a medical opinion]”). 20 Plaintiff argues that the ALJ did not explain how her daily activities are inconsistent with 21 Dr. Cohen’s opinion. She asserts that a “treating source opinion that a claimant is unable to work 22 full-time does not mean that a claimant must be bed-ridden and comatose.” (Doc. 14 at 26). If 23 the ALJ had solely relied on Plaintiff’s daily activities to reach her conclusion, Plaintiff’s 24 argument would be more persuasive. However, the ALJ’s analysis of Plaintiff’s daily activities is 25 simply one factor in her conclusion. As discussed in the subsections above, the ALJ evaluated 26 numerous other factors as well, such as extensive medical records relating to Plaintiff’s course of 27 treatment over the years, and her hips, lumbar spine, pain treatments, and medications. 1 supported by substantial evidence. 2 B. Whether the ALJ Erred in Finding That Plaintiff’s Chronic Kidney Stones Were 3 a Non-Severe Impairment at Step Two of the Analysis and Failed to Include 4 Limitations Related to That Impairment 5 As to Plaintiff’s kidney stones, the ALJ found: 6 The claimant has a long history of recurrent kidney stones, for which she underwent multiple shock wave lithotripsies. However, the vast majority of these episodes 7 occurred prior to March 1, 2013. There is little objective evidence that, since March 1, 2013, this condition has lasted or can be expected to last for a continuous period 8 of not less than 12 months. In addition, the record contains little evidence of significant, ongoing complications related to these conditions since March 1, 2013. 9 Because this condition causes no more than minimal limitations in the claimant’s 10 ability to perform basic work activities, I find that it is non-severe. 11 (AR 24) (citations omitted). 12 Plaintiff argues that the ALJ erred in finding that Plaintiff’s kidney stones did not meet the 13 duration requirement for a severe impairment. In support of her contention, Plaintiff cites to 14 records evidencing an admission to the hospital from January 21, 2020, to January 23, 2020, for 15 “right ureteral stone, right flank pain, hydronephrosis of the right kidney, and dehydration with 16 hyponatremia, morbid obesity, and acute pyelonephritis”, as well as “right hydronephrosis, right 17 ureteral stone, and left nephrolithiasis.” (Doc 14 at 27, citing AR 1913-1914, 1916). Plaintiff 18 underwent a “cystoscopy[] and right ureteral JJ stent insertion to treat proximal ureteral calculus.” 19 Id. (citing AR 1944-1945). 20 Plaintiff further argues that the ALJ failed to address related abdominal issues, namely 21 “diverticulosis, Barrett’s esophagus, hiatal hernia, and vomiting and diarrhea related to her gastric 22 bypass surgeries,” being treated for them in 2018 and 2019. Id. at 27-28 (citing AR 779-80, 796- 23 797, 1748-1749, 1754, 1763-1764). Plaintiff states that “[t]he ALJ’s error in finding Plaintiff’s 24 chronic kidney stones non-severe carries through the case as the ALJ then failed to assess 25 Plaintiff’s subjective complaints of chronic stomach pain, vomiting, and diarrhea” and the lack of 26 corresponding RFC limitations requires remand. Id. at 30. 27 “The plaintiff has the burden of establishing the severity of the impairment.” Cookson v. 1 2014). Applying the normal standard of review to the requirements of step two, the Court must 2 determine whether the ALJ supported with substantial evidence her finding that the medical 3 records clearly established that Plaintiff’s kidney stones did not constitute a medically severe 4 impairment. Yuckert v. Bowen, 841 F.2d 303, 306 (9th Cir. 1988). 5 The ALJ states that there is little evidence that Plaintiff’s conditions regarding kidney 6 stones can be expected to last for a continuous period not less than 12 months. She states that the 7 vast majority of Plaintiff’s recurrent kidney stones occurred prior to the date of onset of her 8 disability and that, since then, there is little evidence of “significant, ongoing complications” 9 related to kidney stones, resulting in it not causing more than minimal limitations to her ability to 10 perform basic work activities. (AR 24). 11 The record supports the ALJ’s findings. Plaintiff is correct in that records show a visit by 12 Plaintiff to the hospital regarding kidney stones in late January 2020, including as to all the 13 conclusions and procedures made by healthcare practitioners therefrom. In those records, 14 physician Dennis Gardner states that Plaintiff has a history of kidney stones and Plaintiff stated 15 that “this feels similar to previous from six years ago.” (AR 1923). On a return visit to the 16 hospital on February 1, 2020, physician Chi K. Poon notes that “mild right-sided hydronephrosis 17 is seen and has improved significantly from the prior examination.” (AR 2219). On April 27, 18 2019, Plaintiff visited the hospital for gastrointestinal issues; physician Erin Elizabeth Lensch 19 noted “nonobstructive nephrolithiasis” in her kidneys. (AR 1792, 1803). On August 27, 2019, 20 Plaintiff visited gastroenterologist Magdy S. Elsakr for a follow-up, who also noted a 21 nonobstructive nephrolithiasis and did not include kidney stones in his list of medical conditions, 22 and recorded that Plaintiff previously had kidney stones removed in September 2015. (AR 1765- 23 1766). 24 In one of the earliest relevant records, dated March 4, 2013, and prepared by physician 25 Joey C. Chang, Plaintiff is diagnosed with a “calyceal calculi 2 mm proximal right ureteral 26 calculus, mild left perinephric stranding and thickening of the left ureter.” (AR 2741). A record 27 from November 8, 2014, prepared by physician Arturo Soria states a diagnosis of kidney stones. 1 Fauconier notes bilateral nephrolithiasis and that Plaintiff “has passed multiple stones in the past 2 and is interested in attempting to pass this stone as well.” (AR 657). A record from January 15, 3 2015, references the November 8, 2014, diagnosis and notes that Plaintiff stated she passed 4 multiple kidney stones in the past and attempted to pass this one as well but had not yet, and thus 5 wished to proceed with endoscopic stone removal (AR 2713); a substantially similar record from 6 January 25, 2015, states the same, with a handwritten note mentioning that “Dr. Dewar will do 7 surgery. 2/20/15.” (AR 2687). A record prepared by physician C. R. Dewar notes a cystoscopy 8 and bilateral ureteroscopy performed on February 20, 2015. (AR 2692-2693). 9 A record from April 3, 2015, prepared by Dr. Fauconier documents a post-operation visit, 10 noting no residual ureteral calculi remaining, and proceeding with a metabolic stone evaluation. 11 (AR 647). A record from May 27, 2015, prepared by Dr. Fauconier reflects a recheck visit, 12 discussing clinical findings from a previous visit and directing continuation of stone prevention 13 measures, return appointment projected in six to eight months. (AR 646). A record from 14 September, 2015, prepared by physician Ricky Bassi notes nephrolithiasis and ureteral stone 15 under “[a]ctive [p]roblems” but does not discuss any further. (AR 615). A record signed by 16 physician Alexander Scott for service provided on January 22, 2016, found stable bilateral 17 nephrolithiasis. (AR 691). A record from January 29, 2016, noted a right-sided lithotripsy, 18 followed by a contralateral lithotripsy. (AR 637). A record from March 8, 2016, prepared by Dr. 19 Bassi notes nephrolithiasis and ureteral stone under “[a]ctive [p]roblems” but does not discuss 20 any further (AR 611); as does a record from June 8, 2016 (AR 607). 21 It appears from the record that Plaintiff did not have a severe kidney stone condition for at 22 least 12 consecutive months. The record shows significant gaps between treatments; Plaintiff did 23 not identify, and the Court cannot find, a continuous 12-month period where kidney stones caused 24 Plaintiff severe impairments. Though Plaintiff cites a more recent kidney stone treatment which 25 was not mentioned by the ALJ, the ALJ need not mention each visit to properly determine that 26 Plaintiff’s condition did not meet the duration requirement for a disability. See Wesley M. v. 27 Colvin, No. 4:24-CV-05044-ACE, 2024 WL 5126270, at *6 (E.D. Wash. Dec. 16, 2024) 1 history and correctly assessed the record reflected the plaintiff did not have a severe kidney stone 2 condition for at least 12 consecutive months; holding “the condition did not meet the durational 3 requirement for a severe medically determinable impairment.”) (citations omitted); see also Holt 4 v. Kijakazi, No. 3:23-CV-00162-LRH-CLB, 2024 WL 1420749, at *6 (D. Nev. Jan. 4, 2024), 5 report and recommendation adopted, No. 323CV00162LRHCLB, 2024 WL 1420600 (D. Nev. 6 Apr. 2, 2024) (“Although Holt testified that she has kidney stones ‘all the time,’ the medical 7 records first establish Holt has a kidney stone on February 25, 2021, but that her ‘initial stone 8 episode was years ago.’ On August 26, 2021, Holt was noted as developing sharp pains only two 9 days prior. From this evidence, it is entirely reasonable for the ALJ to conclude that Holt’s 10 kidney stones were non-severe because they did not cause continuous severe impairments for a 11 twelve-month period.”) (citations omitted). 12 Finally, it follows that, as to Plaintiff’s claim that the ALJ failed to assess Plaintiff’s 13 subjective pain complaints, vomiting, and diarrhea when determining that Plaintiff’s chronic kidney 14 stones were non-severe, as noted above, the record evidence does not establish a 12-month period 15 where such issues, in conjunction with kidney stones, resulted in severe impairments.3 16 * * * * * 17 In sum, the ALJ supported her discounting of Dr. Cohen’s medical opinion with 18 substantial evidence and properly found Plaintiff’s kidney stones to be a non-severe impairment. 19 20 Remainder of This Page Intentionally Left Blank

21 22 23

24 3 Although Plaintiff makes passing reference in her motion to the ALJ’s purported improper discounting of Plaintiff’s testimony (Doc. 14 at 29, 30), no argument is fully developed on this point and, 25 thus, the Court will not address the issue. See Martinez v. Comm’r of Soc. Sec., No. CIV S-08-1308- 26 CMK, 2010 WL 1286721, at *16 (E.D. Cal. Mar. 29, 2010); see also Najar v. Kijakazi, No. 2:21-CV- 01096-DJA, 2022 WL 1014960, at *4 (D. Nev. Apr. 4, 2022) (“Plaintiff also argues that to the extent the 27 Court finds the ‘frequent’ RFC determination to be supported by substantial evidence, the ALJ failed to encompass Dr. Rager’s opinion that Plaintiff would act inappropriately around others into the RFC … However, this argument is not fully developed, nor is it necessary for the Court to address, because 1 IV. CONCLUSION 2 Accordingly, IT IS HEREBY ORDERED that: 3 1. Plaintiff's motion for summary judgment (Doc. 14) is DENIED; 4 2. The ALJ’s decision is affirmed; and 5 3. The Clerk of the Court shall enter judgment in favor of Defendant, terminate any 6 deadlines, and close this case. 7 | ITIS ORDERED. | Dated: _ February 27, 2025 | hr 9 UNITED STATES MAGISTRATE JUDGE 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 IA