Leaver v. Commissioner of Social Security Administration

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IN THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF ARIZONA
Kandee Leaver,
Plaintiff,
v.
Commissioner of Social Security
Administration,
Defendant.
No. CV-25-00427-TUC-AMM (JR)
REPORT & RECOMMENDATION
Plaintiff Kandee Leaver (“Leaver” or “Plaintiff”), pursuant to 42 U.S.C. §§ 405(g)
and 1383(c)(3), seeks judicial review of a final decision by the Commissioner of the Social
Security Administration (the “Commissioner”). (Doc. 1.) This matter, on referral to the
undersigned United States Magistrate Judge for Report and Recommendation, is ripe for
decision. (Docs. 12, 14, 16, 19, 20.) Leaver seeks remand for reconsideration of the
evidence and of her maximum residual functional capacity. (Doc. 16 at 19.) As set forth
below, the undersigned recommends that the district court dismiss the complaint.
BACKGROUND
Procedural Background
Plaintiff filed concurrent Title II and Title XVI applications for disability benefits
on November 9, 2022, alleging an onset date of January 1, 2020. (AR 19.) Her claims were
denied initially on April 28, 2023, and upon reconsideration on March 8, 2024. (Id.) On
October 8, 2024, Plaintiff appeared telephonically for a hearing before ALJ Charles Davis
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(the “ALJ”). (Id.) The ALJ issued an unfavorable decision on November 7, 2024, finding
that Plaintiff retained the residual functional capacity (“RFC”) to perform light work as
defined in 20 C.F.R. 404.1567(b) and 416.967(b). (AR 16, 25.) On January 6, 2025,
Plaintiff filed a Request for Review to the Appeals Council. (AR 9.) On July 10, 2025, the
Appeals Council denied review rendering the ALJ’s decision the final decision of the
Commissioner for purposes of judicial review under 42 U.S.C. § 405(g). (AR 1.)
Relevant Factual Background1
Ms. Leaver was born in 1991 and was 33 years old at the time of her hearing, or a
younger person in the eyes of the Administration. Her threshold is less than sedentary under
the medical vocational rules. See AR 248; 20 C.F.R. §404 part P, App. 2. She has
completed one year of college. (AR 229.) She has no past relevant work.
Plaintiff’s primary physical complaints are chronic low back pain, chronic bilateral
shoulder pain, obesity, PTSD, major depressive disorder, and generalized anxiety disorder.
Ms. Leaver has consistently been followed by her primary care provider, Doctor Parag
Patel, at New Era Family Practice (AR 391-546, 750-866, 941-1075) and later at Optima
with Aric Ray, FNP (AR 1772-1820). These providers have managed and coordinated her
care, including management of referrals and medications.
Ms. Leaver was treated at Desert Sky Spine and Sport Medicine by Maureen By,
NP and Doctor Thomas Coury for chronic low back pain with radicular symptoms (AR
349-375, 1663-1666) and Sun Pain Management and Spine Specialists by Mandy Neblett,
NP (AR 925-932) for lumbar back pain, pelvic pain, cervical neck pain, and polyarthralgia.
Additionally, she has participated in physical therapy for both her chronic lumbar pain and
bilateral shoulder pain. (AR 338-347 (lumbar); 1770-1771 (lumbar); 1869-1922 (bilateral
shoulders); 1925-1987 (lumbar).)
Her primary treatment for mental health has been at Intermountain Centers or
Community Partners where she is treated for Bipolar II disorder, anxiety and PTSD. (AR
877-890, 1076-1559.) She was also evaluated at Charlie Health where she was assessed
1 The factual background is primarily taken from Plaintiff’s opening brief to which no
objection has been made.
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with a major depressive disorder, generalized anxiety disorder, and PTSD. (AR 1701-
1769.)
Written Statements and Hearing Testimony
In written statements, Ms. Leaver endorsed difficulty sitting for more than fifteen
minutes at a time, difficulty standing longer than ten minutes at a time, difficulty lifting
significant weight, experiencing chronic stabbing/aching pain in her spine, needing help
getting dressed and showering, and needing security bars and a step stool to toilet. (AR
280-281, 285.) She also endorses problems interacting with strangers, trouble with
authority figures, and a history of verbal altercations that resulted in job loss as well as
trouble handling stress and changes in her routine. (AR 284-285.)
At hearing, Leaver described emotional dysregulation and feeling “constantly on
edge” and that it’s “really hard for [her] to interact with humans.” (AR 49.) She
acknowledged “difficulty maintaining patience with other people,” explaining she “already
had a big temper,” and struggles “to calm [herself] down.” (AR 49.) She regularly isolates
herself at home because of stress and anxiety over these issues. (AR 49.) She testified, “I
don’t like confrontation at all” and that she must “always kind of keep [her] guard up”
because she “constantly senses [she’s] being lied to” (AR 50.) She also described rapid
mood fluctuations: “It’s every hour I’m having to fluctuate between super sad or emotional
overwhelmed… it’s almost every single day, multiple times a day” (AR 53-54.) She
reported difficulty maintaining motivation stating: “Why am I doing this? Why am I
bothering? … the only reason I keep going is thinking about my daughter.” (AR 54. She
said she cries a lot, in part because she feels insignificant and inferior to everyone else.
(AR 52.)
Regarding her physical abilities, she stated she can lift “almost 10 pounds,” but
“after about two minutes [her] arms give out.” (AR 46.) She experiences constant pain and
having to “constantly pay attention to every little movement” to avoid “electrical fire pains”
down to her toes. (AR 50-51.) She also testified that her medication makes her feel
constantly sleepy. (AR 47.)
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She said she avoids driving and she testified that she struggles to do household
chores because of pain and fatigue. (AR 47-48.) She tries to keep up with dishes or laundry
but also said “by the time I finish one thing I’m in pain and have to sit down.” (AR 48.)
Even light household work—cleaning, vacuuming, or picking things up—causes pain in
her back and legs, forcing her to stop frequently. (AR 48-49.) She uses a microwave to
cook simple things because standing over the stove makes her back tighten up and she asks
her daughter to help carry groceries and laundry baskets because she has difficulty lifting.
(AR 49-50.)
Finally, she testified to experiencing bad days a few times per week during which
she has difficulty doing basic activities like standing, walking, or even getting out of bed.
(AR 48-49.) On these days she stays mostly on her bed or on the couch. Id. If she tries to
push through her bad days, it makes her pain worse, and she pays for it the next day with
spikes in pain and fatigue. (AR 49-50.) Although not prescribed, she also testified to
needing a cane for balance on bad days because her pain makes her feel unsteady. (AR 47.)
Summary of the ALJ’s Decision
For the purposes of the Social Security Act, a claimant is disabled if she is unable
“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). To determine whether a claimant meets this definition, the ALJ employs a
five-step sequential evaluation. 20 C.F.R. § 404.1520(a); 20 C.F.R. § 416.920(a). The ALJ
considers: (1) whether the claimant is engaged in “substantial gainful activity”; (2) whether
the claimant has a “severe, medically determinable physical or mental impairment ... or a
combination of impairments that is severe” and that has lasted for more than 12 months;
(3) whether such impairment “meets or equals” one of the listings in the regulations; (4)
whether the claimant can still do his or her “past relevant work” given their residual
functional capacity (“RFC”); and (5) whether the claimant “can make an adjustment to
other work.” 20 C.F.R. § 404.1520(a)(4)(i)-(v); 20 C.F.R. § 416.920(a)(4)(i)-(v). The
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burden of proof is on the claimant at steps one through four but shifts to the Commissioner
at step five. Bray v. Comm'r of Soc. Sec. Admin., 554 F.3d 1219, 1222 (9th Cir. 2009).
Here, the ALJ applied the five-step sequential framework to determine that Plaintiff
is not disabled. (AR 21-32.) At step one, the ALJ determined Plaintiff has not engaged in
substantial gainful activity since January 1, 2020, the alleged onset date. (AR 21.) At step
two, the ALJ determined Plaintiff has the severe impairments of major depressive disorder,
generalized anxiety disorder, post-traumatic stress disorder (PTSD), degenerative disc
disease and obesity. (AR 22.) At step three, the ALJ determined Plaintiff does not have an
impairment or combination of impairments that meets or medically equals the severity of
one of the impairments listed in the regulations. (AR 23.) After step three but before step
four, the ALJ determined Plaintiff’s RFC as follows:
After careful consideration of the entire record, the
undersigned finds that the claimant has the residual functional
capacity to perform light work as defined in 20 CFR
404.1567(b) and 416.967(b) except: Claimant can perform
simple routine tasks, in work that does not involve a production
rate pace; work that does not involve direct public contact as
part of specified work duties; and work that involves only
occasional ongoing interaction with coworkers and
supervisors.
(AR 26.) At step four, the ALJ determined Plaintiff has no past relevant work history. (AR
31.) At step five, the ALJ determined there are jobs that exist in significant numbers in the
national economy that the claimant can perform including: “Assembler, Small Products,”
“Inspector,” and “Marker.” (AR 31.) Therefore, the ALJ ruled that Plaintiff has not been
under a disability, as defined in the Social Security Act, from January 1, 2020, through the
date of his decision, November 7, 2024. (AR 32.)
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). “Substantial” evidence means “more than a mere scintilla,”
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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 citation omitted). In determining whether
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). “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. The
“court must consider the entire record as a whole and may not affirm simply by isolating a
specific quantum of supporting evidence.” Orn, 495 F.3d at 630 (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.” Id.
ISSUES ON REVIEW
Plaintiff raises two issues for review. (Doc. 16 at 3.) First, Plaintiff claims the ALJ
committed harmful error by failing to articulate clear and convincing reasons to discount
her symptom testimony. (Id.) Second, Plaintiff claims the ALJ committed harmful error
by improperly analyzing supportive opinion evidence. (Id.)
ANALYSIS
I. The ALJ articulated clear and convincing reasons to discount Plaintiff’s
subjective symptom testimony.
Where a claimant has provided objective medical evidence of an impairment that
could reasonably produce the alleged symptoms, the ALJ evaluates the intensity and
persistence of the symptoms. See SSR 16-3p, 2016 WL 1119029. The ALJ is required to
evaluate whether a claimant’s statements about her symptoms are consistent with the
objective medical evidence and the other evidence in the record. See 20 C.F.R. pt.
404.1529(c)(2), (3); SSR 16-3p, 2016 WL 1119029. The ALJ must make specific findings
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about a claimant’s allegations, properly supported by the record and sufficiently specific
to ensure a reviewing court that the claimant’s subjective testimony was not arbitrarily
discredited. See Thomas v. Barnhart, 278 F.3d 947, 958 (9th Cir. 2002) (citing Bunnell v.
Sullivan, 947 F.2d 341, 345-46 (9th Cir. 1991) (en banc)). Unless there is affirmative
evidence that a claimant is malingering, an ALJ’s reasons for discounting the claimant’s
testimony regarding the severity of his symptoms must be “clear and convincing.” Reddick
157 F.3d at 722. “If the ALJ's . . . finding is supported by substantial evidence, [a court]
may not engage in second-guessing.” Kelly L. K. v. Saul, 2021 WL 3269981, at *6 (C.D.
Cal. July 30, 2021) (citation omitted).
A. Physical Impairments
As to Plaintiff’s physical impairments, the ALJ found Plaintiff’s testimony
somewhat persuasive:
The undersigned considered all of the claimant’s medically
determinable impairments, including those that are not severe,
when assessing the claimant’s residual functional capacity.
Based on the foregoing, the undersigned finds the claimant has
the above residual functional capacity assessment, which is
supported by the totality of the medical evidence and objective
findings, as well as the subjective allegations of the claimant.
The claimant alleged that due to a combination of mental
impairments along with her pain complaints, which exacerbate
her psychiatric conditions, she cannot perform any work. She
further testified at hearing that she has not tried to work
anywhere since 2019 however the notations in the file call into
question the veracity of her statements. As detailed above, she
was noted to be doing side jobs, described as painting and
cleaning. At one point she reported to her provider that she was
a health and wellness coach. She reported that she had been
applying for work but had not been able to find a job due to her
criminal history, not due to any physical or mental barrier. As
well, she participated in physical therapy for her back and
shoulder with improvement in symptoms, to include full and
painless range of motion in her shoulder. Claimant also
testified to being unable to hold onto things due to weakness
however during evaluation by a neurologist, her examination
was unremarkable. She had 5/5 strength in all extremities, no
evidence of atrophy, normal sensation, and normal gait/station.
(23F/14). Similarly when examined during a consultative
examination other than reduced range of motion in the lumbar
and cervical spine, there was only normal findings. (11F).
However giving her testimony some persuasive value as there
is objective evidence of orthopedic complaints with waxing
and waning symptoms, the undersigned finds it reasonable to
limit her to light work activity.
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(AR 29.) Here, the ALJ found Plaintiff’s medically determinable impairments could
reasonably be expected to cause the alleged symptoms, but Plaintiff’s “statements
concerning the intensity, persistence and limiting effects of these symptoms are not entirely
consistent with the medical evidence and other evidence in the record.” (AR 26.) The Court
finds that the ALJ’s findings as to Plaintiff’s testimony regarding the extent of her physical
impairments is supported by substantial evidence.
First, there may be affirmative evidence in the record of malingering. As pointed
out by the ALJ, the Plaintiff testified that she has “not tried to work since 2019.” (AR 29.)
However, this is contradicted by statements in the record made by Plaintiff that she was
doing part-time work (AR 1433, 1450), that she was working as a “health and wellness
coach,” (AR 1910-11), and that she applied and was denied from jobs not because of her
ability to perform those jobs but because of her criminal history (AR 1118, 1374). (See AR
29.) “In assessing the claimant's credibility, the ALJ may use “ordinary techniques of
credibility evaluation,” such as considering the claimant's reputation for truthfulness and
any inconsistent statements in her testimony.” Tonapetyan v. Halter, 242 F.3d 1144, 1148
(9th Cir. 2001). Further, “Contradiction with the medical record is a sufficient basis for
rejecting the claimant’s subjective testimony.” Carmickle v. Comm’r, Soc. Sec. Admin.,
533 F.3d 1155, 1161 (9th Cir. 2008).
While Plaintiff’s subjective testimony could have been discounted for those reasons
alone, the ALJ still provided multiple other clear and convincing reasons why he gave
Plaintiff’s testimony regarding her alleged physical disabilities “some persuasive value.”
(AR 22-23, 25-30.) When an ALJ provides multiple reasons for discounting a claimant’s
statements, the Court can affirm even if the ALJ erred as to one or more reasons, so long
as valid reasons remain. Carmickle, 533 F.3d at 1162.
Here, the ALJ determined that Plaintiff’s symptoms were previously relieved
through treatment and cited numerous medical records and exam results which contradicted
Plaintiff’s specific plaintiff complaints. (See AR 29.) “[E]vidence of medical treatment
successfully relieving symptoms can undermine a claim of disability,” and an ALJ may
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discount a claimant’s reported symptoms if they sufficiently improved with treatment.
Wellington v. Berryhill, 878 F.3d 867, 876 (9th Cir. 2017); see also 20 C.F.R. §§
404.1529(c)(3), 416.913(c)(3).
Plaintiff argues that the ALJ did not explain why such “waxing and waning of
symptoms” is inconsistent with her subjective testimony. (Doc. 16 at 15.) However, the
ALJ specifically accepted that portion of her testimony stating: “However giving her
testimony some persuasive value as there is objective evidence of orthopedic complaints
with waxing and waning symptoms, the undersigned finds it reasonable to limit her to light
work activity.” (AR 29.) Accordingly, the Court finds no evidence supporting the argument
that the ALJ discounted Plaintiff’s testimony specifically related to her “waxing and
waning” symptoms. Under the substantial evidence standard of review, the Court must
affirm the ALJ’s finding if supported by substantial evidence in the record, regardless of
whether other rational interpretations exist. Burch, 400 F.3d at 680-81.
Next, Plaintiff argues that the ALJ improperly relied on Plaintiff’s travel to Ohio to
discount her symptom testimony. (Doc. 16 at 14.) Here, the record reflects, and the ALJ
properly determined that there was no evidence that the symptoms complained about by
Plaintiff have lasted for a continuous period of 12 months. (See AR 29.) As explained
above, substantial evidence supports the ALJ’s determination that Plaintiff improved with
conservative treatment. However, Plaintiff began to complain of severe symptoms in July
2024 which were not improving with treatment. (See AR 28-29.) This time period directly
corresponds with Plaintiff’s travel to Ohio in May to June of 2024, during which her
treatment for both her physical and mental symptoms was terminated. (See AR 28-29
(“During a June 14, 2024 she confirmed she was residing in Ohio thus her services would
be terminated. [] Claimant became verbally belligerent with the office staff.”)) Logically,
Plaintiff’s symptoms got worse after treatment was discontinued. See Silva v. Comm’r
Soc. Sec. Admin., 2018 WL 3342898, at *6 (July 9, 2018) (citing Tommasetti v. Astrue,
533 F.3d 1035, 1039 (9th Cir. 2008)) (affirming that a claimant’s poorly explained failure
to pursue beneficial and recommended treatment is a valid reason for discounting her pain
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complaints). Given that July 2024 was only three months prior to the hearing, the ALJ’s
determination is correct, and there is no evidence that the Plaintiff’s newly complained
about treatment-resistant symptoms would last longer than a period of 12 months.
Accordingly, the undersigned finds that to the extent the ALJ discounted Plaintiff’s
subjective symptom testimony as to any physical disability beginning January 1, 2020, the
ALJ’s findings were supported by clear and convincing evidence.
B. Mental Impairments
As to Plaintiff’s mental impairments, the ALJ found:
As it relates to her psychiatric conditions, there are notations
in the file of increased symptoms such as crying spells, anxiety
and preference not to leave the house and isolate – generally
accompanied by notations that the increase in symptoms were
associated with relationship issues. However there are also
notations that the claimant is doing well, going out hiking,
taking care of rescue animals, keeping “very active,” as well as
working as a health and wellness coach. She reported her
medications were helpful in reducing her symptoms. Although
claimant testified to having dizzy spells and being drowsy due
to her medications, she routinely denied having medication
side effects. (10F; 15F). More recently in July 2024 she began
to report constant crying and increased symptoms, however the
evidence does not support that the more severe symptoms
lasted for at least a continuous period of 12 months, and the
evidence is insufficient to find that they are expected to last at
this more severe level for at least a continuous period of 12
months. A claimant’s statements alone may not be the sole
basis for conclusions regarding disability; objective medical
evidence must support a claim. See 20 C.F.R. 404.1512; Cf. 20
C.F.R. 404.1508. The burden of proof to establish evidence
showing disability rests with the claimant. Here, the claimant
has failed to point to the clinical evidence or other evidence
that supports her alleged complaints. Such is particularly
significant considering the extreme nature of the limitations
alleged. The residual functional capacity set forth above
addresses the claimant’s symptoms to the degree supported by
the evidence as a whole.
(AR 29-30 (emphasis in original).)
Here, Plaintiff does not point to any objective medical evidence in the record which
supports the severity of her subjective mental symptoms. Much like her physical
impairments, the ALJ determined with substantial evidence that her mental impairments
were improving with treatment. See Wellington, 878 F.3d at 876; see also 20 C.F.R. §§
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404.1529(c)(3), 416.913(c)(3). Again, her symptoms deteriorated drastically after her
treatment was terminated when she moved to Ohio, which as explained above, the Plaintiff
cannot show that such newly complained-about treatment-resistant symptoms in July 2024
would last for a period longer than 12 months given the October 2024 hearing date. See
supra I.A; see also Kealoha v. Comm’r Soc. Sec. Admin, 2024 WL 638559, at *3 (D. Ariz.
Feb. 15, 2024) (citing Tommasetti, 533 F.3d at 1039) (holding that a limited degree of
mental health treatment is an appropriate reason to discount a claimant’s psychological
complaints.)
Further, Plaintiff relies on the testimony itself as proof of such symptoms, (Doc. 16
at 14-15.) This is improper. As correctly recited by the ALJ, it is the claimant who is
“responsible for providing the evidence used to make the RFC determination” and for
ultimately proving she is disabled. Gray v. Comm'r. of Soc. Sec. Admin., 365 Fed.Appx.
60, 63 (9th Cir. 2010); 20 C.F.R. §§ 404.1545(a)(3), 416.945(a)(3); 42 U.S.C. § 423(d)(5)
(“An individual shall not be considered to be under a disability unless he furnishes such
medical and other evidence of the existence thereof as the Commissioner of Social Security
may require.”); 20 C.F.R. § 404.1512 (“In general, you have to prove to us that you are
blind or disabled. You must inform us about or submit all evidence known to you that
relates to whether or not you are blind or disabled.”). Here, the Plaintiff does not point to
any objective medical evidence in the record to support her symptom testimony. However,
the ALJ points to multiple medical reports indicating that Plaintiff’s symptoms improved
greatly with the treatment. (See AR 29-30.)
Accordingly, the undersigned finds the ALJ did not err when discounting Plaintiff’s
subjective symptom testimony as to any mental disability beginning January 1, 2020.
II. The ALJ’s analysis of statements made by Dr. Belton is supported by
substantial evidence as a matter of law.
Plaintiff asserts the ALJ erred as to his findings of Dr. Belton’s analysis of Plaintiff’s
limitations because the ALJ did not address the “supportability and consistency” factors as
required by the Social Security regulations. (Doc. 16 at 16-19.) Defendant argues that the
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statements of Dr. Belton do not constitute “medical opinion evidence” as a matter of law
because they do not assign any specific limitations to Plaintiff. (Doc. 19 at 10 (citing Ford
v. Saul, 950 F.3d 1141, 1156 (9th Cir. 2020).)
The ALJ analyzed Dr. Belton’s opinion as follows:
The undersigned has considered the opinion of Consultative
Examiner Dr. Maryanne Belton and finds it generally
persuasive insofar as the claimant does have severe mental
impairments that would reasonably result in limitations.
However, her narrative findings are not persuasive as they
contained terms that are not vocationally defined and are
hypothetical, speculative and do not represent the most the
claimant can do despite her limitations (20 CFR 404.1545 and
416.945). For example, Dr. Belton noted when claimant’s
“emotional symptoms activate, she will have difficulty” in
understanding and remembering. In regard to sustained
concentration and persistence, Dr. Belton indicated again that
when claimant’s emotional dysregulation activates, she will
experience “diminished” capacity to pay attention to “novel”
situations, neither diminished nor novel were defined. Turning
to social interactions and adaption, Dr. Belton again noted the
claimant may struggle. (12F). The undersigned has outlined
vocationally defined and more accurate limitations that are
generally consistent with Dr. Belton’s finding of impairment
in each domain.
(AR 30-31.)
Under the revised 2017 SSA regulations, when reviewing an ALJ's decision to reject
a medical source's opinion, a court must determine whether the ALJ “considered the
supportability and consistency factors” and, if so, whether substantial evidence supports
the ALJ's decisions concerning those factors. Woods v. Kijakazi, 32 F.4th 785, 792 (9th Cir.
2022). Yet, these requirements apply only to the ALJ's evaluation of medical opinions, and
not all medical source statements qualify as opinions. Windish v. Comm'r of Soc. Sec.
Admin., 2023 WL 6568185, *7 (D. Ariz. Oct. 10, 2023) (citing Hale v. Kijakazi, 2022 WL
14654959, *6 (D. Mont. Oct. 25,2022) (“An ALJ must discuss statements by a medical
source that qualify as ‘medical opinions’ ... [but] is not required to address statements by a
medical source that do not qualify as medical opinions.”) (citations omitted)). The 2017
SSA regulations define a “medical opinion” as:
A medical opinion is a statement from a medical source about
what you can still do despite your impairment(s) and whether
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you have one or more impairment-related limitations or
restrictions in the following abilities: ... (i) Your ability to
perform physical demands of work activities, such as sitting,
standing, walking, lifting, carrying, pushing, pulling, or other
physical functions (including manipulative or postural
functions, such as reaching, handling, stooping, or crouching);
(ii) Your ability to perform mental demands of work activities,
such as understanding; remembering; maintaining
concentration, persistence, or pace; carrying out instructions;
or responding appropriately to supervision, co-workers, or
work pressures in a work setting; (iii) Your ability to perform
other demands of work, such as seeing, hearing, or using other
senses; and (iv) Your ability to adapt to environmental
conditions, such as temperature extremes or fumes.
Id. (quoting 20 C.F.R. § 404.1513(a)(2)).
In this case, Dr. Belton made statements regarding four areas of Plaintiff’s mental
functioning: understanding and memory; sustained concentration and persistence; social
interaction; and adapting to change. (AR 906-07.) For “understanding and memory,” Dr.
Belton stated:
Ms. Leaver can comprehend and follow through on simple task
directions. Yet, she struggled with multi-step procedures and
questions during the clinical interview. As such, it is offered
that when emotional symptoms activate and with her
capacity to self-regulate being poor, she will have difficulty
with understanding and completing a series of task instructions
provided.
(AR 906 (emphasis added).) For “sustained concentration and persistence,” Dr. Belton
stated: “When Ms. Leaver experiences symptoms of pain/physical complications, and her
emotional dysregulation activates, she will experience a diminished capacity to pay
attention to novel situations and events.” (AR 906 (emphasis added).) For “social
interaction,” Dr. Belton stated: “With symptoms of depression involving anhedonia,
sadness, and tearfulness, Ms. Leaver will struggle to respond quickly or efficiently to
supervisory requests. Also, her capacity to engage with the nuances involved in a social
situation or setting will reduce when she is dealing with emotional dysregulation.” (AR
906 (emphasis added).) For “adapting to change,” Dr. Belton stated: “With active
emotional symptoms, Ms. Leaver will struggle to navigate an unpredictable work scenario
and have difficulty with quickly implementing an action plan toward resolution.” (AR 907
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(emphasis added).) Dr. Belton did not discuss the frequency of Plaintiff’s emotional
dysregulation and only vaguely addresses Plaintiff’s limitations in conjunction with
heightened emotional episodes but importantly failed to opine on what Plaintiff “can still
do despite [her] impairment(s).” See 20 C.F.R. § 404.1513(a)(2).
In Ford, the Ninth Circuit determined that substantial evidence supported the ALJ's
determination that an examining physician did not provide “useful” statements regarding
the degree of the claimant's limitation because the physician's descriptions “failed to
specify [the claimant's] functional limits” as the examiner spoke only in general terms such
as “limited” or “fair.” Rupert B. v. Kijakazi, 2022 WL 1468386, at *9 (D. Mont. May 10,
2022) (quoting Ford, 950 F.3d at 1156.)
“Though the ALJ is required to review all evidence relevant to a claim…the ALJ is
not required to discuss all the objective medical evidence in a record (in contrast to being
generally required to assess each medical opinion).” Youngblood v. Berryhill, 734 F. App'x
496, 498 (9th Cir. 2018) (“[a]n ALJ does not err by not incorporating a physician's opinion
when the physician had not ‘assign[ed] any specific limitations on the claimant.’”) (quoting
Turner v. Comm'r of Soc. Sec., 613 F.3d 1217, 1223 (9th Cir. 2010)).
Accordingly, here, substantial evidence supports the ALJ’s determination that Dr.
Belton’s statements “were hypothetical, speculative and do not represent the most the
claimant can do despite her limitations” when crafting the RFC. (AR 30-31); see Ford, 950
F.3d at 1156 (finding ALJ could reasonably conclude that doctor's descriptions of
claimant's ability to work “were inadequate for determining RFC” where the doctor failed
to specify claimant's functional limits); see also Juarez v. Comm'r of Soc. Sec., 2026 WL
575540, at *6 (E.D. Cal. Mar. 2, 2026) (“Neither [record] opine[s] on what Plaintiff could
still do despite his impairments.).
Further, the ALJ here “outlined [in the RFC] vocationally defined and more accurate
limitations that are generally consistent with Dr. Belton’s finding of impairment in each
domain.” (AR 31.) While the Plaintiff may disagree with the ALJ’s RFC, the Court must
nevertheless uphold the ALJ's determination because it is a rational interpretation of the
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evidence. See Ford, 950 F.3d at 1159 (“Our review of an ALJ's fact-finding for substantial
evidence is deferential”); Thomas, 278 F.3d at 954.
Accordingly, the undersigned recommends the district court deny Plaintiff’s second
ground for relief.
RECOMMENDATION
For the foregoing reasons, it is RECOMMENDED that the district court DISMISS
the complaint with prejudice. Pursuant to Federal Rule of Civil Procedure 72(b)(2), any
party may serve and file written objections within fourteen days of being served with a
copy of the Report and Recommendation. A party may respond to the other party’s
objections within fourteen days. No reply brief shall be filed on objections unless leave is
granted by the district court. If objections are not timely filed, they may be deemed waived.
If objections are filed, the parties should use the following case number: 4:25-cv-427-
AMM.
Dated this 9th day of June, 2026.
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