Cepeda v. Commissioner of Social Security Administration

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IN THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF ARIZONA
Carol Cepeda,
Plaintiff,
v.
Commissioner of Social Security
Administration,
Defendant.
No. CV-25-04689-PHX-JJT (ASB)
REPORT AND RECOMMENDATION
TO THE HONORABLE JOHN J. TUCHI, UNITED STATES DISTRICT JUDGE:
Plaintiff Carol Cepeda seeks judicial review and reversal of the final decision of the
Commissioner of the Social Security Administration denying Plaintiff’s application for
Social Security Disability Insurance. For the reasons set forth below, undersigned
recommends the Court affirm the Commissioner’s final decision.
I. BACKGROUND
On October 28, 2022, Plaintiff filed an application for Social Security Disability
Insurance (“SSDI”) benefits under Title II of the Social Security Act based on a disability
beginning October 24, 2022. (AR 17.)1 Plaintiff’s application was initially denied by the
Social Security Administration (“SSA”) on September 7, 2023, and upon reconsideration
on August 8, 2024. (Id.) Plaintiff then filed a request for a hearing, which Plaintiff agreed
to be held telephonically. (Id.) On December 4, 2024, a telephonic hearing was held before
Administrative Law Judge (“ALJ”) Dante M. Alegre. (Id.) The ALJ issued a written
1 Administrative Record.
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unfavorable decision on February 27, 2025. (AR 17-34.) Following Plaintiff’s request for
reconsideration, the SSA affirmed the denial of the application on November 24, 2025.
(AR 1-5.)
The ALJ considered a period from October 24, 2022 through the date the decision,
February 25, 2025. (AR 18.) The ALJ found that Plaintiff had acquired sufficient quarters
of coverage to remain insured only through December 31, 2028, but ruled Plaintiff was not
entitled to SSDI because she was not disabled under the Social Security Act from October
24, 2022 through the date of the decision. (AR 17-34.) That decision became final on
November 24, 2025, when the Appeals Council denied Plaintiff’s request for review. (AR
1-5.)
Having exhausted the administrative review process, Plaintiff sought judicial review
of the Commissioner’s decision by filing a Complaint (Doc. 1) under 42 U.S.C. § 405(g).
The Court has subject matter jurisdiction pursuant to that statute. On March 10, 2026,
Plaintiff filed an Opening Brief, seeking the Court to remand the case without a rehearing
and grant Plaintiff the “credit-as-true” standard. (Doc. 13.) On April 8, 2026, Defendant,
Commissioner of Social Security, filed an Answering Brief (Doc. 14), and on April 27,
2026, Plaintiff filed a Reply Brief (Doc. 17).
II. STANDARD OF REVIEW
This Court reviews only those issues raised by the party challenging the ALJ’s
decision. See Lewis v. Apfel, 236 F.3d 503, 517 n.13 (9th Cir. 2001). In reviewing the
decision of the ALJ, the Court will not overturn the ALJ’s decision “unless it is either not
supported by substantial evidence or is based upon legal error.” Luther v. Berryhill, 891
F.3d 872, 875 (9th Cir. 2018) (citing Matney ex rel. Matney v. Sullivan, 981 F.2d 1016,
1019 (9th Cir. 1992)). “Substantial” evidence means “more than a mere scintilla,” but it is
“less than a preponderance.” Orn v. Astrue, 495 F.3d 625, 630 (9th Cir. 2007) (internal
citation omitted). That is, “substantial evidence” is “such relevant evidence as a reasonable
mind might accept as adequate to support a conclusion.” Burch v. Barnhart, 400 F.3d 676,
679 (9th Cir. 2005) (internal quotation marks and citation omitted). In determining whether
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substantial evidence supports the ALJ’s decision, the Court considers “the administrative
record as a whole, weighing both the evidence that supports and the evidence that detracts”
from the ALJ’s conclusions. Reddick v. Chater, 157 F.3d 715, 720 (9th Cir. 1998) (citation
omitted). “If the evidence can reasonably support either affirming or reversing the
Secretary’s conclusion, the court may not substitute its judgment for that of the Secretary.”
Id. at 720-21 (citing Flaten v. Sec’y of Health & Hum. Servs., 44 F.3d 1453, 1457 (9th Cir.
1995)). The “court must consider the entire record as a whole and may not affirm simply
by isolating a specific quantum of supporting evidence.” Robbins v. Soc. Sec. Admin., 466
F.3d 880, 882 (9th Cir. 2006) (internal quotations and citations omitted). The Court reviews
“only the reasons provided by the ALJ in the disability determination and may not affirm
the ALJ on a ground upon which he did not rely.” Orn, 495 F.3d at 630 (citing Connett v.
Barnhart, 340 F.3d 871, 874 (9th Cir. 2003)).
III. ANALYSIS
To be eligible for Social Security disability benefits, a claimant must show an
“inability to engage in any substantial gainful activity by reason of any medically
determinable physical or mental impairment which can be expected to result in death or
which has lasted or can be expected to last for a continuous period of not less than 12
months.” 42 U.S.C. § 423(d)(1)(a); see also Tackett v. Apfel, 180 F.3d 1094, 1098 (9th Cir.
1999). A five-step procedure is used to determine whether a claimant is “disabled” and
thus eligible for SSA benefits:
In step one, the Secretary determines whether a claimant is
currently engaged in substantial gainful activity. If so, the
claimant is not disabled. In step two, the Secretary determines
whether the claimant has a “medically severe impairment or
combination of impairments,” as defined in 20 C.F.R. §
404.1520(c). If the answer is no, the claimant is not disabled.
If the answer is yes, the Secretary proceeds to step three and
determines whether the impairment meets or equals a “listed”
impairment that the Secretary has acknowledged to be so
severe as to preclude substantial gainful activity. If this
requirement is met, the claimant is conclusively presumed
disabled; if not, the Secretary proceeds to step four. At step
four, the Secretary determines whether the claimant can
perform “past relevant work.” If the claimant can perform such
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work, she is not disabled. If the claimant meets the burden of
establishing an inability to perform prior work, the Secretary
must show, at step five, that the claimant can perform other
substantial gainful work that exists in the national economy.
Reddick, 157 F.3d at 721 (citing 20 C.F.R. § 404.1520). “The recent changes to the Social
Security regulations2 did not affect the familiar ‘five-step sequential evaluation process.’”
Woods v. Kijakazi, 32 F.4th 785, 787 n.1 (9th Cir. 2022) (citing 20 C.F.R. §
404.1520(a)(1)).
On February 27, 2025, the ALJ ruled Plaintiff was “not disabled” as defined in
sections 216(i) and 223(d) of the Social Security Act, and therefore not entitled to SSDI.
(AR 34.) In the decision, the ALJ found that Plaintiff did not engage in substantial gainful
activity during the period from her alleged onset date of October 24, 2022, through the
decision date. (AR 19.) The ALJ found that Plaintiff’s earnings in 2022 could be attributed
to months before Plaintiff’s alleged disability onset, and that Plaintiff’s 2023 earnings did
not exceed the threshold amounts considered indicative of substantial gainful employment.
(AR 19-20.) The ALJ next determined that Plaintiff had the following “severe”
impairments under the regulations: cervical degenerative disc disease (“DDD”), status-post
(s/p) surgical fusion; and obesity. (AR 20.) The ALJ concluded that the “severe”
impairments, whether considered singly or in combination, did not meet or medically equal
a listed impairment under 20 C.F.R. Part 404, Subpart P, Appendix 1 (20 C.F.R. §§
404.1520(d), 404.1525 and 404.1526). (AR 23.)
Next, the ALJ considered Plaintiff’s residual functional capacity (“RFC”).3 (AR 24-
2 Different regulations apply, depending on whether a claim was filed before, on, or
after March 27, 2017. 20 C.F.R. § 404.1520. In the case at bar, Plaintiff’s claim was filed
in 2022. Thus, the newer regulations apply.
3 A claimant’s residual functional capacity assessment is a determination of what the
claimant can still do despite his or her limitations. See 20 C.F.R. § 404.1545(a). In
determining a claimant’s residual functional capacity, an ALJ must assess all the evidence
to determine what capacity the claimant has for work despite his or her impairments,
including medical records, and the claimant’s and others’ descriptions of limitation. See id.
The ALJ considers a claimant’s ability to meet physical and mental demands, sensory
requirements, and other functions. See 20 C.F.R. § 404.1545(b-d). In evaluating whether a
claimant satisfies the disability criteria, the Commissioner must evaluate the claimant’s
“ability to work on a sustained basis.” 20 C.F.R. § 404.1512(a).
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32.) The ALJ determined Plaintiff has the RFC to perform light work as defined in 20
C.F.R. 404.1567(b), such that Plaintiff can lift and/or carry twenty pounds occasionally
and ten pounds frequently, stand and/or walk six hours in an eight-hour workday, and sit
six hours in an eight-hour workday. (AR 24.) The ALJ found that Plaintiff is capable of
occasional climbing of ramps or stairs but never climbing of ladders, ropes, or scaffolds;
frequent balancing, stooping, and crouching; and occasional kneeling but never crawling.
(Id.) The ALJ further found that Plaintiff is capable of occasional overhead reaching with
both arms; frequently reaching laterally and to the front with both arms; and frequently
handling with both arms. (Id.)
The ALJ determined that Plaintiff is capable of performing past relevant work as an
Accounting Clerk and Office Manager, both as generally performed in the national
economy, and as actually performed by Plaintiff in the past. (AR 32.) The ALJ concluded
that work as an Accounting Clerk or Office Manager does not require the performance of
work-related activities precluded by Plaintiff’s RFC. (Id.) At Plaintiff’s hearing, the
vocational expert testified that a person possessing the same RFC would be able to perform
Plaintiff’s past relevant work. (AR 33.) The ALJ concluded that Plaintiff had not been
under a disability, as defined in the Social Security Act, from October 24, 2022, through
the date of the ALJ’s decision, under 20 C.F.R. 404.1520(f). (AR 34.)
Plaintiff argues that the ALJ erred as a matter of law, and the decision should be
reversed and remanded for calculation of benefits. Plaintiff presents three issues for review:
1. Whether the ALJ failed to provide clear and convincing reasons to reject
the symptom testimony.
2. Whether the ALJ failed to give reasons based on consistency and
supportability to reject the upper extremity limitations of Joy PA and Dr.
William Stevens.
3. Whether the case should be reversed or remanded.
(Doc. 13 at 1.)
In response, Defendant disputes Plaintiff’s argument and contends Plaintiff failed
to show how the ALJ committed harmful legal error. (Doc. 14.)
//
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A. Plaintiff’s Symptom Testimony (Step Four Findings)
Plaintiff first argues that the ALJ erred when rejecting Plaintiff’s symptom
testimony by failing to provide clear and convincing reasons to reject Plaintiff’s testimony.
(Doc. 13 at 5.) Specifically, Plaintiff asserts that none of the ALJ’s citations to evidence
undermining Plaintiff’s upper reaching limitations were “evidence of ‘good upper
extremity function’ as the ALJ states. To the contrary, the citations are consistent with
occasional reaching limitations.” (Id. at 6.) Plaintiff continues that, despite major surgery
which helped some of symptoms, “she continued to complain of and have exam findings
that support severe, chronic upper extremity pain, arm weakness, decreased range of
motion, and her most recent MRI shower post-surgical changes.” (Id.) Plaintiff argues that
the ALJ does not meaningfully discuss this testimony. (See id.) Plaintiff contends that this
was not harmless error because “this is significant and relevant testing that shows [Plaintiff]
has objective evidence supporting her subjective complaints.” (Id. at 7.) Defendant argues
in Response that the ALJ reasonably considered Plaintiff’s subjective complaints about
spinal impairment and provided rational and well-supported findings. (Doc. 14 at 5-9.)
Defendant further avers that “[e]ven if part of the ALJ’s consideration was faulty, the ALJ’s
overall consideration of Plaintiff’s subjective complaints was supported by the ALJ’s other
valid reasoning.” (Id. at 9) (citing Carmickle v. Comm’r Soc. Sec. Admin., 533 F.3d 1155,
1162-63 (9th Cir. 2008)).
1. Legal Standard
There is a two-step analysis for assessing a claimant’s symptom testimony. “First,
the ALJ must determine whether the claimant has presented objective medical evidence of
an underlying impairment ‘which could reasonably be expected to produce the pain or other
symptoms alleged.’” Lingenfelter v. Astrue, 504 F.3d 1028, 1036 (9th Cir. 2007) (quoting
Bunnell v. Sullivan, 947 F.2d 341, 344 (9th Cir. 1991)). Then, if “there is no evidence of
malingering, the ALJ can reject the claimant’s testimony about the severity of her
symptoms only by offering specific, clear and convincing reasons for doing so.” Garrison
v. Colvin, 759 F.3d 995, 1014-1015 (9th Cir. 2014) (internal citations omitted). Conclusory
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or general statements about the plaintiff’s symptom testimony do not meet the clear and
convincing standard. Brown-Hunter v. Colvin, 806 F.3d 487, 493 (9th Cir. 2015). To meet
the standard, the ALJ must identify which statements or parts of the plaintiff’s testimony
are not credible and explain why. Id. at 493-494. “Providing a summary of medical
evidence in support of a residual functional capacity finding is not the same as providing
clear and convincing reasons for finding the claimant’s symptom testimony not credible.”
Id. at 494.
Moreover, “an ALJ may not ‘reject a claimant’s subjective complaints based solely
on a lack of medical evidence to fully corroborate the alleged severity of pain.’ This means
that an ALJ cannot effectively render a claimant’s subjective symptom testimony
superfluous by demanding positive objective medical evidence ‘fully corroborat[ing]’
every allegation within the subjective testimony.” Smartt v. Kijakazi, 53 F.4th 489, 495
(9th Cir. 2022) (quoting Burch, 400 F.3d at 681). Clear and convincing reasons may be
found by an ALJ by identifying inconsistencies in the objective medical evidence and in
Plaintiff’s conduct. See id. at 496-498. Essentially, “the clear and convincing standard
requires an ALJ to show his work.” Id. at 499.
2. Plaintiff’s Testimony
Plaintiff testified about her upper extremity pain at the hearing before the ALJ. (AR
47-81.) Plaintiff stated that her pain has been chronic and has always been there, but at the
onset point in October 2022 she could no longer bear the pain. (AR 47-48.) She testified
that she started to feel numbness down her arms and “tingling radiating pain down [her]
right arm.” (AR 48.) She further asserted that she started to lose grip and mobility. (Id.)
Plaintiff testified that she was born with spina bifida, scoliosis, and without three vertebrae,
which limited her neck mobility. (Id.) Plaintiff stated that her arms tend to lock, and
therefore that she needs assistance with tasks like showering. (AR 54.) Plaintiff testified
that she tries to do chores, like the dishes or sweeping, but she can no longer see downward
or crouch down, and must rest between tasks. (AR 54-55.) Plaintiff testified that she can
no longer make meals for herself, do laundry, grocery shop, go for long walks or drive.
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(AR 55-58.)
Plaintiff stated that even during her prior employment, she was never able to lift a
heavy box or carry something without pain. (AR 59-60.) Plaintiff testified that when
working with computer monitors in her prior job, she would have considerable pain due to
sitting for long periods of time and her “neck became stiffer and stiffer with time, and the
pain and the numbness would progressively become worse . . . it was affecting how [she]
was able to [] look down for a period of time . . . because now [her] arm and going down
to [her] hand was becoming numb.” (AR 60-61.) Plaintiff then discussed how the surgery
she received did not change her neck mobility and that she has “no neck motion.” (AR 62.)
Plaintiff also testified to the headaches and migraines she experiences while sleeping and
due to the permanent pinched nerves in her neck. (AR 64.) According to Plaintiff’s
testimony, she cannot sit in an upright position for longer than ten minutes without
experiencing tingling, numbness, and radiating pain from her neck down to her shoulder,
bicep, forearm, and hand. (Id.) She stated that she feels this pain, numbness, or tingling
about ten hours of the day, on and off, throughout the day. (AR 66.) She also testified,
regarding her mobility, that she cannot pick up her arms or reach without hurting herself.
(AR 67.) Plaintiff testified that she is almost always in some degree of pain because of her
neck condition, and on a scale of one to ten, one being the lowest and ten being the highest,
her pain is “nine to ten” throughout the day. (AR 68.)
The ALJ discredited Plaintiff’s symptom testimony by stating:
After careful consideration of the evidence, the undersigned
finds that, although the claimant’s medically determinable
impairments can reasonably be expected to have caused some
of the claimant’s alleged symptoms during the period at issue;
the claimant’s further statements concerning the intensity,
persistence and limiting effects of these symptoms are less than
fully consistent with the evidence, for the reasons explained
throughout this decision.
(AR 36.)
In reaching that conclusion, the ALJ found inconsistencies in the testimony and
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evidence provided. The ALJ first found that although Plaintiff alleged inability to move
her neck and disabling difficulty using her shoulders, the medical records following her
surgery demonstrate “no use of cane or walker, normal hand function, and normal gait,
despite some restrictions of shoulder function.” (AR 25.) The ALJ further cited treatment
records from 2023 to 2024, “where examinations administered to [Plaintiff] during this
time typically revealed some or no tenderness of the neck, normal gait, full grip strength,
and full strength of both arms.” (Id.) (citing AR 942-978; 979-1078; 1108-1121; 1163-
1189; 1192-1204). The ALJ further found that Plaintiff’s alleged inability to walk, lift more
than five pounds, and regular use of an assistive device for ambulation failed to yield
significant evidentiary support. (AR 25.) The ALJ cited to select gait assessments in the
record which have been “most frequently [] unremarkable” (AR 995, 1012, 1022, 1106,
1115, 1138, 1144, 1170, 1260), and that “the record otherwise fails to demonstrate
[Plaintiff’s] regular use of assistive device during the period at issue.” (AR 25.) The ALJ
further detailed Plaintiff’s motor strength and sensation of the upper extremities being
assessed as normal, though some examinations have demonstrated decreased strength or
grip, and frequently demonstrated normal, painless range of motion of bilateral shoulders,
elbows, wrists, and digits. (Id.) (citing AR 995-996, 1012, 1022, 1026-1027, 1038, 1043-
1044, 1115, 1144, 1151, 1156, 1247). The ALJ also identified that in a physical
consultative examination on May 30, 2023, Plaintiff had 4/5 strength of bilateral upper
extremities, normal grip strength, and normal muscle bulk, sensation, and reflexes. (AR
26) (citing AR 924-929). In the examination, Plaintiff showed normal fine motor skills of
the upper extremities, where she could pick up small coins, screw a nut onto a bolt, and
write her name without notable manipulative dysfunction. (Id.) The ALJ concluded that
while Plaintiff experienced significant limitations, the limitations did not exceed those
reflected in the RFC. (AR 26.)
The ALJ also discussed Plaintiff’s MRI in January 2022, prior to Plaintiff’s anterior
cervical discectomy and fusion. (AR 26.) The ALJ examined Plaintiff’s post-surgical MRI
in November 2022, where the MRI “continued to reveal significant cervical spine problems
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“including multiple congenital segmentation anomalies; annual tear/fissure at C3-4; and
disc desiccation at non-fused cervical levels.” (Id.) The ALJ then discussed Plaintiff’s
additional December 2022 surgical intervention and post-surgical evaluations. (Id.)
According to the ALJ, “upon initial postoperative follow-up of December 12, 2022,
[Plaintiff] again reported controlled pain, as well as improvement of parethesias in the left
upper and lower extremities.” (Id.) The ALJ also discussed Plaintiff’s follow up specialized
orthopedic visit on March 6, 2023, where Plaintiff reported “minimal pain beyond some
tinges in the trapezius muscles” and “associated x-ray imaging showed stable fusion and
acceptable hardware placement.” (Id.) The ALJ detailed Plaintiff’s subsequent follow-up
appointments throughout 2023 and 2024, and discussed how Plaintiff’s December 2024
MRI showed “stable postsurgical changes relating to both of the claimant’s historical
cervical spine surgeries; but ongoing cervical kyphosis with moderate DDD at most
cervical spine levels and moderate-severe neural foraminal stenosis at multiple levels.”
(AR 27.)
The ALJ found that Plaintiff’s obesity contributed to all of Plaintiff’s specified
exertional, postural, and manipulative limitations, “via exacerbation of pain and mobility
limitations initially stemming from her cervical DDD.” (AR 27.) The ALJ determined that
Plaintiff’s BMI scores above the obesity threshold “at least partially exacerbated”
Plaintiff’s limitations during the period at issue. (AR 27-28.) Finally, the ALJ discussed
Plaintiff’s self-reported use of assistive devices to move, such as a walker or cane. (AR
28.) The ALJ found that Plaintiff used a walker after her fusion surgery in March 2022, but
evaluations after her surgery “do not show any problems walking or that she was using an
assistive device.” (Id.) The ALJ discussed Plaintiff’s December 2022 appointment, where
Plaintiff was using a walker “but was independent of activities of daily living” and
“evaluations after that visit did not show difficulty with walking or the use of an assistive
device including a walker.” (Id.) The ALJ also identified that Plaintiff’s primary care visits
in December 2022 and early 2023 showed no indication of difficulty walking or using a
walker. (Id.) The ALJ further discussed Plaintiff’s examination in August 2023 where
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Plaintiff reported that she was walking an hour a day several days per week, and her
examination showed normal muscle tone and mass for all extremities, painless range of
motion, no joint swelling, no gross instability, normal spinal balance, and ambulated
normally. (Id.) In this appointment, there was no evidence of the use of a walker. (Id.)
3. Discussion
Plaintiff argues that the ALJ failed to give clear and convincing reasons to reject her
testimony. Undersigned disagrees. The ALJ first discussed Plaintiff’s testimony regarding
her inability to move her neck and difficulty reaching. (AR 25). The ALJ noted Plaintiff’s
testimony that she is unable to lift more than five pounds and has difficulty using her
shoulders and upper extremities for reaching and other manipulative activities. (Id.) The
ALJ found, however, that the record failed “to yield significant evidentiary support for
these allegations.” (Id.) The ALJ discussed how a physical consultative examination on
May 30, 2023 revealed the claimant to have 4/5 strength of bilateral upper extremities,
normal grip strength, and normal muscle bulk, sensation, reflexes, and fine motor skills of
the upper extremities. (Id.) Plaintiff could pick up small coins, screw a nut onto a bolt, and
write her name without notable manipulative dysfunction. (AR 26) (citing AR 924-929).
The ALJ also cited an orthopedic follow-up from August 2023 where Plaintiff had 5/5
strength of all extremities, outside of signs of decreased grip on the left. (AR 27) (citing
AR 996). The ALJ did not merely cite to only positive physical evaluations, nor did he
ignore the evaluations that recorded Plaintiff’s report of pain and decreased mobility. (See
AR 26) (citing to Plaintiff’s “10/10 pain” of the posterior neck and back as well as mildly
impaired strength and balance immediately following surgical intervention). The ALJ
extensively outlined the medical records and appointments indicating Plaintiff’s degree of
mobility, strength, and pain in the upper extremities, but ultimately concluded that
Plaintiff’s abilities based on her limitations were “limited to light work, subject to
additional postural and manipulative limitations as indicated above, throughout the period
at issue.” (AR 28.) This exhaustive discussion from the ALJ does not indicate the kind of
“conclusory or general statements” that the Ninth Circuit has found insufficient. See
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Brown-Hunter, 806 F.3d 487 at 493. Rather, the ALJ identified “specific, clear, and
convincing reasons supporting a finding that [Plaintiff’s] limitations were not as severe as
she claimed.” See Smartt, 53 F.4th at 499. The ALJ cited to specific aspects of the medical
record, across several appointments, contrasting Plaintiff’s testimony with the objective
medical evidence. See id. The ALJ thus did not err in rejecting Plaintiff’s testimony about
her upper extremity limitations and neck pain. See id. (“The standard isn’t whether our
court is convinced, but instead whether the ALJ’s rationale is clear enough that it has the
power to convince.”)
The ALJ also discussed Plaintiff’s mobility and gait, such that she is able to get
around without assistance. Plaintiff testified that she was unable to walk for more than
about 2-3 blocks or about 5-15 minutes, and regularly used an assistive device for
ambulation. (AR 25, 65.) The ALJ found this testimony unpersuasive because “the record
fail[ed] to yield significant evidentiary support for these allegations.” (AR 25.) The ALJ
cited to evidence in the record that gait assessments across many visits have been “most
frequently [] unremarkable.” (Id.) (citing AR 995, 1012, 1022, 1106, 1115, 1138, 1144,
1170, 1260). The ALJ did not merely focus on the positive gait assessments; the ALJ found
that Plaintiff used a walker after her fusion surgery in March 2022, but that “evaluations
after her surgery do not show any problems walking or that she was using an assistive
device.” (AR 28.) The ALJ also discussed Plaintiff’s December 2022 appointment, where
Plaintiff was using a walker “but was independent of activities of daily living” and
“evaluations after that visit did not show difficulty with walking or the use of an assistive
device including a walker.” (Id.) The ALJ also identified that Plaintiff’s primary care visits
in December 2022 and early 2023 showed no indication of difficulty walking or using a
walker. (Id.) The ALJ further discussed Plaintiff’s examination in August 2023 where there
was no evidence of the use of a walker. (Id.) Accordingly, the ALJ supported his
assessment regarding Plaintiff’s mobility and lack of dependence on a walker with specific
evidence from the record, over multiple years and appointments. Undersigned finds that
the ALJ adequately identified areas in the medical record that conflicted with Plaintiff’s
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testimony, and thus did not err in rejecting Plaintiff’s testimony about her mobility and
gait.
Finally, the ALJ also noted that Plaintiff’s compliance with physical therapy after
her surgery was inconsistent. The ALJ discussed that “[f]ollowing surgery, the claimant
also underwent physical therapy beginning in June 2022 and reported associated
improvement with this intervention; where discharge notes of October 26, 2022, indicate
that, by the time of discharge on that date, the claimant had not been seen in physical
therapy for several months.” (AR 26.) While not explicitly stated, the record appears to
indicate that Plaintiff ceased her physical therapy, as the discharge note describes that none
of her goals were met, Plaintiff had not shown up to physical therapy “for several
months[,]” and the recommended treatment plan was “physical therapy.” (AR 547-549.)
An ALJ “may consider a claimant’s ‘failure to seek treatment or to follow a prescribed
course of treatment’ in discrediting her symptom testimony.” Davis v. Comm’r of Soc. Sec.
Admin., No. CV-24-02916, 2026 WL 874023, at *5 (D. Ariz. Mar. 31, 2026) (quoting
Molina v. Astrue, 674 F.3d 1104, 1112 (9th Cir. 2012)). The ALJ reasonably supported his
rejection of Plaintiff’s symptom testimony with inconsistent medical records and failure to
follow prescribed treatment. See Smartt, 53 F.4th at 499; Davis, 2026 WL 874023, at *5.
Accordingly, Plaintiff has not established that the ALJ failed to give clear and convincing
reasons to reject her testimony. Undersigned will recommend the Court find the ALJ did
not err in rejecting Plaintiff’s symptom testimony.
B. Medical Opinion Evidence (Step Four Findings)
Plaintiff argues that the ALJ committed materially harmful error when rejecting the
assessment from physicians Charles Clinton, M.D. (“Dr. Clinton”), Christine Joy, PA (“Joy
PA”), and William R. Stevens, M.D. (“Dr. Stevens”). (Doc. 13 at 7-11.) Specifically,
Plaintiff argues that the ALJ improperly dismissed Dr. Clinton’s examination regarding
Plaintiff’s limitation to require the use of a hand-held assistive device for ambulation. (Id.
at 8.) Plaintiff avers that “the ALJ fails to discuss the limitation entirely and gives no
analysis of supportability or consistency.” (Id.)
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Plaintiff further argues that the ALJ failed to give legal reasons to reject the opinion
of Joy PA. (Doc. 13 at 8.) Plaintiff argues that the ALJ cited to evidence and evaluations
from Joy PA that were unrelated to Plaintiff’s reaching limitations or were consistent with
reaching imitations, and yet the ALJ rejected Joy PA’s opinion. (Id. at 8-9.)
Plaintiff finally argues that the ALJ failed to give reasons based on supportability
and consistency to reject the opinion of Dr. Stevens. (Doc. 13 at 10.) Plaintiff argues that
“[t]he ALJ exclusively cites exams for varicose veins to show strong upper extremity
function” but “the treatment note for venous insufficiency has no information related to
upper extremities.” (Id. (citing AR 31, 1144).) Plaintiff alleges that the ALJ cited to
treatment notes which relate to Plaintiff’s recovery from a major surgery, rather than any
improvement in her chronic pain. (Id.) (“The notes of ‘improvement of the paresthesias in
the left upper extremity’ and ‘pain is controlled’ should be read in the context of recovering
from a major surgery.”) Plaintiff argues that the ALJ failed to give any persuasive reasons
to reject the upper extremity limitations identified by Dr. Stevens, and that this error was
harmful. (Id. at 10-11.)
Defendant argues in Response that the ALJ reasonably considered Joy PA and Dr.
Stevens’ opinions. (Doc. 14 at 9.) Defendant argues that the ALJ reasonably found Joy PA
and Dr. Stevens’ opinions conflicted with their own mostly normal examination findings.
(Id.) Defendant further argues that the ALJ rationally found Dr. Stevens’ opinions were
unpersuasive because they conflicted with Dr. Stevens’ examination findings of generally
good neurological functioning and normal gait without the use of an assistive device. (Id.
at 10.) Defendant continues that “[t]he ALJ also reasonably found Dr. Stevens’ opinions
were undermined by Dr. Stevens’ records of controlled pain, improved paresthesia, and
stable surgical hardware following spinal surgery.” (Id.) Defendant further argues that Joy
PA and Dr. Stevens’ opinions were inconsistent with examination findings from other
sources and the functional findings of state agency consultants. (Id. at 11-13.)
By way of Reply, Plaintiff again makes the argument that the ALJ failed to discuss
the limitation identified by Dr. Clinton to require use of a hand-held assistive device for
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ambulation. (Doc. 17 at 3.) Plaintiff again argues that the ALJ failed to give legal reasons
to reject the opinion of Joy PA, and disputes Defendant’s argument that this Court’s
decision in Cooper v. Comm’r Soc. Sec. Admin is comparable. (Id. at 3-4) (citing 2022 WL
16757504, at *5 (D. Ariz. Nov. 8, 2022). Plaintiff argues instead that the limitations in
Cooper were different as the claimant in that case was under fifty and thus the definition
of “disabling limitations” is different from this case, where Plaintiff was fifty-five at her
onset date. (Id. at 3-4) (citing 2022 WL 16757504, at *5). Plaintiff argues that “the normal
exam findings cited by the ALJ are unrelated to the medical limitations” and that “the ALJ
fails to give any analysis of how his findings build a logical bridge to his conclusion” to
reject Joy PA’s determination of the reaching limitation. (Id. at 4) (“None of the findings
noted by the ALJ specifically relate to reaching except the decreased upper extremity
strength which supports the limitation.”). Plaintiff further argues that Defendant incorrectly
cites to treatment notes of “full range of motion and normal strength throughout Plaintiff’s
extremities” arguing instead that the treatment notes relate to lower extremities “and there
is no specific information about the claimants’ upper extremities. (Id. at 4) (citing AR 1151,
1156). Plaintiff argues that Defendant “simply restates the ALJ’s findings” and cites to
evidence and exams that “are consistent with occasional reaching limitations that Joy PA
stated.” (Id. at 5-6.)
Plaintiff finally argues again in her Reply that the ALJ failed to give reasons based
on supportability and consistency to reject the opinion of Dr. Stevens. (Doc. 17 at 6.)
Plaintiff argues that Defendant “attempts to use other medical opinions in the record to
show problems with consistency despite the ALJ rejection of those opinion[s].” (Id.)
Plaintiff argues that the ALJ rejected Dr. Stevens’ notes on the “persistent pain that is fairly
chronic that she lives with” and instead focuses on Dr. Stevens’ notes regarding Plaintiff’s
post-surgical recovery, which indicate decreased pain and improvement. (Id.) Plaintiff
argues that the ALJ erred by rejecting Dr. Stevens’ opinion and that “[t]he errors in
rejecting the reaching limitations are harmful because [Plaintiff’s] past work requires
frequent reaching and there are no jobs in significant numbers at light or sedentary that
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allow occasional reaching.” (Id.)
1. Legal Standard
The following factors are considered by an ALJ when reviewing such a medical
opinion, with the first and second factors being the most important4: (1) supportability, (2)
consistency, (3) relationship with the claimant (including length, purpose, and extent of the
treatment relationship, as well as frequency of examinations), (4) specialization of the
medical source, and (5) other factors such as the medical source’s familiarity with other
evidence in the claim. 20 C.F.R. § 404.1520c. “Supportability means the extent to which a
medical source supports the medical opinion by explaining the ‘relevant . . . objective
medical evidence.’” Woods, 32 F.4th at 791-92 (quoting 20 C.F.R. § 404.1520c(c)(1)).
“Consistency means the extent to which a medical opinion is ‘consistent . . . with the
evidence from other medical sources and nonmedical sources in the claim.’” Id. at 792
(quoting 20 C.F.R. § 404.1520c(c)(2)). Further, as the Ninth Circuit has recently
acknowledged, the relationship between the medical source and the claimant “is still
relevant when assessing the persuasiveness of the source’s opinion” under the new
regulatory paradigm. Woods, 32 F.4th at 792. Although the ALJ is not required to make
specific findings about the relationship factors under 20 C.F.R. § 404.1520c(c)(3)(i)-(v), a
discussion “may be appropriate when ‘two or more medical opinions . . . about the same
issue . . . are equally well-supported . . . and consistent with the record . . . but are not
exactly the same.’” Id. (quoting 20 C.F.R. § 404.1520c(b)(3)).
“[U]nder the new regulations, an ALJ cannot reject an examining or treating
doctor’s opinion as unsupported or inconsistent without providing an explanation
supported by substantial evidence.” Woods, 32 F.4th at 792 n.5. The ALJ is further required
to “articulate . . . how persuasive” he or she finds “all of the medical opinions” from each
medical source, but the ALJ need not address each individual opinion of a source. 20 C.F.R.
§ 404.1520c(b)(1). The ALJ must explain how he or she “considered the supportability and
consistency factors for a medical source’s medical opinions or prior administrative medical
4 20 C.F.R. § 404.1520c(a).
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findings.” 20 C.F.R. § 404.1520c(b)(2).
In Step Four of the analysis, the ALJ addressed the medical opinion evidence “in
accordance with the requirements of 20 C.F.R. 404.1520c(b)” (AR 28-29.) Plaintiff only
disputes the ALJ’s discussion of Dr. Clinton, Joy PA, and Dr. Stevens. (See Doc. 1.)
Accordingly, undersigned will address the ALJ’s discussion of each of these providers in
turn.
a. Dr. Clinton
The ALJ first discusses the medical opinion evidence from state medical consultant
Dr. Clinton. (AR 29.) Plaintiff only disputes the ALJ’s rejection of Dr. Clinton’s
assessment that Plaintiff requires use of a hand-held assistive device for ambulation, so
accordingly the Court will limit its discussion to only the arguments raised by Plaintiff.
(See Doc. 13 at 8); see Lewis, 236 F.3d at 517 n.13.
On August 4, 2024, Dr. Clinton performed a medical evaluation at the reassessment
level, reviewing Plaintiff’s medical records and testimony. (AR 100-103.) Dr. Clinton
found, inter alia, that Plaintiff could stand and/or walk for about four hours in an eight-
hour workday and “a medically required hand-held assistive device is necessary for
ambulation.” (AR 100.) The ALJ discussed Dr. Clinton’s examination and concluded:
[T]he contentions that the claimant can perform only 4 hours total
standing/walking per workday, and has any significant environmental
limitations unpersuasive, due to deficits of both support and consistency.
Deficits of support exist, given that Dr. Clinton reviewed much evidence
revealing no substantial limitations of gait (e.g., [995, 1012, 1022, 1106,
1115]. Deficits of consistency exist in relation to evidence not reviewed by
Dr. Clinton, including additional evidence of normal gait (e.g., [AR 1144,
1170, 1260], and subsequently received evidence of the claimant’s denial of
significant radicular symptoms, and her accompanying reports of only taking
her Gabapentin and muscle relaxers, occasionally. [AR 1261-1264].
(AR 29-30.)
Plaintiff argues that the ALJ “fails to discuss the limitation entirely and gives no
analysis of supportability or consistency.” (Doc. 13 at 8.) Undersigned disagrees. The ALJ
discussed Dr. Clinton’s findings regarding Plaintiff’s “environmental limitations” and
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finds the limitations unpersuasive based on the deficits of support (citing to areas in the
record where there is no substantial limitation of gait) and deficits of consistency (citing to
areas in the record of normal gait). (AR 29-30.) Furthermore, as Defendant argues, the ALJ
is not required “to parse and analyze medical opinions in this function-by-function
fashion.” See Joshua T. v. Comm’r, Soc. Sec. Admin., No. 3:24-CV-01480-YY, 2025 WL
1981027, at *5 (D. Or. July 17, 2025) (collecting cases); see also Bayliss v. Barnhart, 427
F.3d 1211, 1217 (9th Cir. 2005) (“Preparing a function-by-function analysis for medical
conditions or impairments that the ALJ found neither credible nor supported by the record
is unnecessary.”). The ALJ thus did not err in rejecting Dr. Clinton’s findings based on the
ALJ’s failure to specifically cite Dr. Clinton’s finding regarding an assistive device for
Plaintiff.
b. Joy PA
The ALJ then discusses Joy PA’s physical consultative examination. (AR 30.) Joy
PA opined that “[t]he claimant is able to complete self-care activities including meals,
hygiene, and light house work.” (AR 925.) Joy PA further opined, regarding Plaintiff’s gait
and station, that Plaintiff can stand, walk to the examination table, and get onto the
examination table; Plaintiff has a normal gait; Plaintiff can stoop without difficulty;
Plaintiff can lift each foot off the ground and stand without assistance; and Plaintiff
demonstrated normal balance. (AR 926.) Joy PA also found, inter alia, the Plaintiff’s
strength in the bilateral upper extremities was 4/5, that her grip strength is normal, and her
muscle bulk is normal. (Id.) Joy PA also evaluated Plaintiff’s fine motor skills, and found
that Plaintiff could pick up small coins with both hands without difficulty, screw a nut onto
a bolt with both hands without difficulty, and write on the medical chart without difficulty.
(AR 927.) Joy PA opined that Plaintiff has pain with palpation and movement of the
cervical spine, and her neck pain is increased with movement of her shoulders as well as
when bending forward at the waist. (AR 928.) Joy PA further noted that Plaintiff does not
use an assistive device, has no limitations in sitting, and can lift twenty pounds occasionally
and ten pounds frequently (AR 927-928.) Joy PA concluded in the medical opinion
submitted to the SSA that Plaintiff was limited to “2-6 hrs for stand/walk, no [assistive
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device]” and occasional reaching. (AR 87.) The ALJ found, regarding Joy PA’s medical
opinion, that Joy PA’s:
contentions that the claimant cannot perform 6 total hours of
standing/walking per 8-hour workday and has been limited to occasional
lateral and frontward reaching, as well as frequent fingering and feeling,
unpersuasive, due to deficits of both support and consistency. In addition,
[Joy PA’s] opinion that the claimant can reach, handle, finger & feel
occasionally is not persuasive. Deficits of support exist, given that [Joy PA’s]
own examination revealed the claimant to have normal gait and balance, 4/5
strength of the upper extremities, normal grip strength and sensation, and
strong fine motor skills. Deficits of consistency exist in comparison to
evidence generated by other medical sources, including additional evidence
of normal gait (e.g., [AR 995, 1012, 1022, 1106, 1115, 1144, 1170, 1260]);
and additional evidence of good upper extremity function (e.g., [AR 995-
996, 1115, 1144, 1151, 1156])
(AR 30.)
Plaintiff argues that “the ALJ failed to give legal reasons to reject the opinion of Joy
PA.” (Doc. 13 at 8.) Undersigned disagrees. The ALJ identified deficits of consistency in
the record regarding both gait and upper extremity function when discussing Joy PA’s
determination. (See AR 30.) While Plaintiff argues that “none of the findings noted by the
ALJ specifically relate to reaching except the decreased upper extremity strength which
supports the limitation[,]” this is not supported by the evidence in the record. (See Doc. 13
at 8.) The ALJ cited several medical sources in the record regarding the health of Plaintiff’s
upper extremities, for example an August 2023 appointment finding “normal muscle tone
and mass” in her upper extremities and 5/5 strength (AR 995-996), and in a May 2024
appointment where “there is no motor or sensory deficit in the upper or lower extremities
(AR 1115). Furthermore, the ALJ cited to the examination conducted by Joy PA in June
2023, whereby Joy PA found that Plaintiff was capable of many tasks including screwing
a nut onto a bolt with both hands and of “reaching occasionally.” (AR 928.)
While Plaintiff cites several areas in the record that may be “consistent with
reaching limitations[,]” Plaintiff fails to acknowledge the many citations in the record that
the ALJ cited which demonstrate inconsistencies with Joy PA’s opinion on Plaintiff’s
upper extremity range of motion. (See Doc. 13 at 9.) For example, the ALJ cites a follow
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up visit in February 2024, where Plaintiff had “full range of motion.” (AR 1144.) While
Plaintiff argues that this citation deals with “venous insufficiency” and “has no information
related to upper extremities[,]” the assessment with Plaintiff’s range of motion immediately
followed Plaintiff’s neuro exam, and thus implies that Plaintiff’s entire musculoskeletal
exam showed a “full range of motion” and “normal gait.” (Id.) Furthermore, this is not the
only evidence of Plaintiff’s range of motion and reaching capabilities that the ALJ cited to
in his decision. (See AR 30-31.) The ALJ cited to, for example, two office visits in 2022-
2023 whereby Plaintiff had “level, with expected painless range of motion” and “no joint
swelling” or “gross instability” in the shoulder. (AR 779, 791.) Thus, Plaintiff has failed to
demonstrate that the ALJ erred in rejecting Joy PA’s medical opinion. Undersigned finds
that the ALJ addressed both the supportability and consistency of the medical evidence in
the record and supported its conclusion regarding Joy PA’s medical opinion with evidence
from the record. See Woods, 32 F.4th at 791-92. While Plaintiff is correct that the ALJ
cited to evidence in the record also indicating upper extremity reaching limitations (see
Doc. 17) (citing AR 1106), the ALJ also cited to a plethora of evidence over a range of
years and medical providers that show a lack of limitations on Plaintiff’s upper extremity
strength, range of motion, and dexterity. (See AR 27-32.) The Court’s focus is on whether
the ALJ’s decision was free from legal error and supported by substantial evidence. See
Ford v. Saul, 950 F.3d 1141, 1154 (9th Cir. 2020) (“If the evidence is susceptible to more
than one rational interpretation, it is the ALJ’s conclusion that must be upheld.”) (internal
citations and quotation marks omitted). Accordingly, undersigned will recommend the
Court find the ALJ did not err in rejecting Joy PA’s medical opinion.
c. Dr. Stevens
Finally, the ALJ addressed the medical opinion evidence of Dr. Stevens. (AR 30-
31.) Dr. Stevens found the Plaintiff had identifiable impairments of complex congenital
cervical disease; cervical spinal stenosis; cervical spondylosis; and cervical radiculopathy.
(Id.) According to Dr. Stevens’ medical opinion, the claimant could only occasionally lift
less than five pounds, sit less than two hours per eight-hour workday, stand/walk two hours
per eight-hour workday, and could occasionally perform manipulative activities. (Id.) Dr.
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Stevens opined that Plaintiff could perform less than two hours of sedentary or light work
daily, would be off-task 50% or more of each workday, and would be absent from work
three days per month. (Id.) The ALJ rejected Dr. Stevens’ assessment, finding:
Dr. Stevens’ contentions that the claimant cannot use her neck; requires a
cane/walker to ambulate; and cannot walk a block or climb stairs at
reasonable pace unpersuasive, due to deficits of both support and
consistency. Deficits of support exist, given that Dr. Steven’s own records
demonstrate normal gait and no use of assistive device (e.g., [AR 995,
1022]), as well as generally good neurological function (e.g., [AR 996, 1027,
1115]), and controlled pain (e.g., [AR 776]), with denial of substantial
radicular symptoms ([AR 1261-1264]), only occasional use of Gabapentin
and muscle relaxers (See [AR 1108-1121; 1261-1264]), reported
improvement of paresthesias ([AR 776]) and stable placement of surgical
hardware following the claimant’s second surgery ([AR 771]). Deficits of
consistency exist in relation to evidence generated by other medical sources,
to the extent this evidence also includes evidence of normal gait (e.g., [AR
1106, 1138, 1144, 1260]) and strong upper extremity function (e.g., [AR
1144, 1151, 1156]); as well as prior administrative medical findings
generally finding the claimant capable of a range of light work (See [AR 81-
91; 94-106]). The undersigned finds Dr. Stevens’ further contentions of
restriction to sedentary work; no balancing or crawling; occasional
balancing, stooping, and crouching; occasional handling, fingering, and
feeling; and work environments not involving concentrated exposure to
extreme cold/heat or even moderate exposure to wetness unpersuasive, due
to the same deficits of support and consistency identified above. Similarly,
Dr. Stevens’ contentions of inability to perform even 2 hours of sedentary or
light work, need for 50% off-task time per workday, and need for absence
from work at least 3 days per month are also unpersuasive, due to the same
deficits of support and consistency identified above.
(AR 30-31.)
Plaintiff argues that the ALJ failed to give reasons based on supportability and
consistency to reject the opinion of Dr. Stevens. (Doc. 13 at 10.) Plaintiff argues that “[t]he
ALJ exclusively cites exams for varicose veins to show strong upper extremity function.
(Id.) Plaintiff further argues that the notes of “improvement of the paresthesias in the left
upper extremity” and that “pain is controlled” should be read in the context of recovering
from a major surgery when Plaintiff was wearing a brace and taking morphine. (Id.)
Plaintiff thus relies on the argument that the ALJ erred because the citations accompanying
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the conclusion regarding “strong extremity function” were not sufficient to support such a
conclusion. (See id.) However, this argument fails because the ALJ’s decision is not
examined in such a precise and exacting way. See Whitaker v. Comm’r of Soc. Sec. Admin.,
No. CV-21-00117-PHX-DWL, 2022 WL 2800929, at *2 (D. Ariz. July 18, 2022) (finding
the ALJ did not commit legal error, despite citing to 57 pages of treatment records to
support a conclusion, because one page earlier the ALJ cited a specific page within the
record to support the conclusion and “[g]iven this background, the ALJ’s analytical path
may be reasonably discerned.”); see also Treichler v. Comm’r of Soc. Sec. Admin., 775
F.3d 1090, 1099 (9th Cir. 2014) (“An error is harmless . . . if the agency’s path may
reasonably be discerned, even if the agency explains its decision with less than ideal
clarity.”) (internal quotation marks and citations omitted).
Here, the ALJ supported his assessment of Plaintiff’s upper extremity mobility
extensively with evidence from the record throughout his decision, as discussed supra. (See
AR 24-32.) Plaintiff also disputes the ALJ’s rejection of Dr. Stevens’ medical opinion,
arguing that the ALJ’s citation where Plaintiff denied “substantial radicular complaints”
also contained Plaintiff’s testimony about “persistent” and “chronic” pain. (Doc. 13 at 10-
11.) However, the ALJ does not need to cite to every piece of medical testimony in the
record. See Smartt, 53 F.4th at 499. Rather, the ALJ must support its decision with
“substantial evidence” in that “a reasonable mind might accept as adequate to support a
conclusion.” See Orn, 495 F.3d at 630 (internal citations omitted). Here, the ALJ did that
by identifying places in the record, across many providers and appointments in the relevant
time period, where Plaintiff’s upper extremity evaluations5 were normal (see AR 29-32)
(citing AR 995, 1012, 1022, 1260). Accordingly, undersigned concludes the ALJ did not
err in rejecting Dr. Stevens’ medical opinion, as the ALJ properly “show[ed] his work.”
See Smartt, 53 F.4th at 499.
5 Plaintiff makes only passing reference to other reasons to reject Dr. Stevens
testimony in her Opening Brief and Reply. (See Doc. 13 at 10-11; Doc. 17 at 6.) Because
the Court need only examine the issues raised by Plaintiff in examining the ALJ decision,
undersigned addresses Dr. Stevens’ medical opinion evidence accordingly. See Lewis, 236
F.3d at 517 n.13.
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IV. CONCLUSION
Having found that the ALJ did not err in rejecting Plaintiff’s symptom testimony or
the medical opinion of Dr. Clinton, Joy PA, or Dr. Stevens, undersigned recommends that
the Court affirm the decision of the ALJ. Thus, the Court need not reach the third issue
presented by Plaintiff.
Based on the foregoing,
IT IS THEREFORE RECOMMENDED that the final decision of the
Commissioner of Social Security be AFFIRMED.
This recommendation is not an order that is immediately appealable to the Ninth
Circuit Court of Appeals. Any notice of appeal pursuant to Federal Rules of Appellate
Procedure, Fed. R. App. P. 4(a)(1), should not be filed until entry of the District Court’s
judgment. Pursuant to 28 U.S.C. § 636(b), any party may file and serve written objections
within fourteen (14) days after being served with a copy of this Report and
Recommendation. Pursuant to Rule 7.2(e)(3), Local Rules of Civil Procedure, objections
to the Report and Recommendation may not exceed ten (10) pages. If objections are not
timely filed, the party’s right to de novo review by the District Judge is waived. See United
States v. Reyna-Tapia, 328 F.3d 1114, 1121 (9th Cir. 2003).
Dated this 8th day of June, 2026.
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