The opinion
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7 UNITED STATES DISTRICT COURT
8 CENTRAL DISTRICT OF CALIFORNIA
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11 ANTHONY T.,
No. 5:25-cv-02365-AYP
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Plaintiff,
MEMORANDUM OPINION AND
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ORDER
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FRANK BISIGNANO,
15 Commissioner of Social Security,
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Defendant.
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18 Plaintiff Anthony T.1 seeks review of the Commissioner’s denial of his
19 application for disability insurance benefits (“DIB”) under Title II of the Social
20 Security Act. (Dkt. No. 1.) The parties consented to proceed before the
21 magistrate judge and thereafter filed briefs addressing the disputed issues.
22 (Dkt. Nos. 9, 12, 15, 17, 19.) The Court took the matter under submission
23 without oral argument. For the reasons discussed below, the Court finds that
24 the Commissioner’s decision should be affirmed.
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1 Plaintiff’s name is partially redacted in accordance with Federal Rule of
27 Civil Procedure 5.2(c)(2)(B) and the recommendation of the Committee on
Court Administration and Case Management of the Judicial Conference of the
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United States.
1 I. BACKGROUND
2 On April 21, 2020, Plaintiff filed an application for DIB, alleging disability
3 beginning January 20, 2013, due to autoimmune hemolytic anemia.
4 (Administrative Record (“AR”) 16.) The application was denied initially and
5 upon reconsideration. (AR 16, 115, 124.) Plaintiff, who was then represented
6 by counsel, appeared and testified at a hearing before an administrative law
7 judge (“ALJ”) on July 29, 2021. (AR 65-79.) A vocational expert (“VE”) also
8 testified. (AR 79-80.)
9 On August 19, 2021, the ALJ issued a decision denying benefits. (AR
10 3586-3605.) At the outset, the ALJ noted that Plaintiff had previously received
11 an unfavorable DIB decision dated April 20, 2018, which became final after the
12 Appeals Council denied review. (AR 3589-90.) The ALJ therefore considered
13 whether Plaintiff had demonstrated “changed circumstances” sufficient to rebut
14 the presumption of continuing nondisability under Chavez v. Bowen, 844 F.2d
15 691, 693 (9th Cir. 1988). Although Plaintiff testified that his anemia had
16 worsened, the ALJ found no new and material evidence establishing changed
17 circumstances. (AR 3595.) Accordingly, the ALJ concluded that Plaintiff had
18 not rebutted the Chavez presumption, adopted the findings from the prior April
19 20, 2018 decision, and found that Plaintiff was not disabled during the period
20 from April 21, 2018, through September 30, 2018, the date last insured. (AR
21 3596.)
22 Plaintiff thereafter filed an action in this Court. (AR 3530-61.) The Court
23 found that the ALJ had failed to adequately evaluate Plaintiff’s testimony that
24 changes in his treatment regimen resulted in increased fatigue and other
25 treatment-related side effects, which could constitute changed circumstances
26 sufficient to rebut the presumption of continuing nondisability under Chavez.
27 The Court therefore reversed and remanded for further administrative
28 proceedings. (AR 3562-81.)
1 Following remand, a different ALJ held a second administrative hearing
2 on November 15, 2024, at which Plaintiff appeared pro se and testified. (AR
3 3498-3529.) On March 21, 2025, the ALJ issued another unfavorable decision.
4 (AR 3474-97.) In that decision, the ALJ declined to apply the Chavez
5 presumption and instead evaluated Plaintiff’s claim from the alleged onset date
6 through the date last insured. (AR 3477-78.)
7 Following the five-step sequential evaluation process applicable to
8 disability determinations,2 the ALJ found that Plaintiff had one “severe”
9 impairment: anemia. (AR 3480.) The ALJ determined that Plaintiff retained
10 the residual functional capacity (“RFC”) to perform light work, except that he
11 could have no more than moderate exposure to temperature extremes, no
12 interaction with the general public, and only occasional interactions with others.
13 (AR 3481.) At step four, the ALJ found that Plaintiff had no past relevant work.
14 (AR 3484.) At step five, relying on the VE’s testimony, the ALJ found that
15 Plaintiff could perform other jobs existing in significant numbers in the national
16 economy, including marker, routing clerk, and assembler. (AR 3485.) As a
17 result, the ALJ concluded that Plaintiff was not disabled from January 20, 2013,
18 the alleged onset date, through September 30, 2018, the date last insured. (AR
19 3486.)
20 On April 29, 2025, Plaintiff submitted written exceptions to the ALJ’s
21 decision. (AR 3468.) The Appeals Council considered Plaintiff’s written
22 exceptions but declined to assume jurisdiction. (AR 3468-73.) Plaintiff,
23 proceeding pro se, then filed this action.
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2 The ALJ determines disability using a five-step sequential evaluation
26 process, which examines whether (1) the claimant engaged in substantial
gainful activity, (2) the claimant has a severe impairment, (3) the impairment
27 meets or equals a listed impairment, (4) the claimant is able to do past
relevant work, and (5) the claimant is able to do any other work. 20 C.F.R. §
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404.1520(a)(4).
1 II. STANDARD OF REVIEW
2 Under 42 U.S.C. § 405(g), this Court reviews the Commissioner’s decision
3 to determine whether it is supported by substantial evidence and whether the
4 proper legal standards were applied. Moncada v. Chater, 60 F.3d 521, 523 (9th
5 Cir. 1995). “Substantial evidence” is “more than a mere scintilla” and means
6 only “such relevant evidence as a reasonable mind might accept as adequate to
7 support a conclusion.” Biestek v. Berryhill, 587 U.S. 97, 103 (2019) (citations
8 omitted). In determining whether substantial evidence supports the ALJ’s
9 findings, the Court must review the administrative record as a whole, weighing
10 both the evidence that supports and the evidence that detracts from the ALJ’s
11 conclusion. Ahearn v. Saul, 988 F.3d 1111, 1115-16 (9th Cir. 2021). When the
12 evidence can rationally be interpreted in more than one way, the Court must
13 uphold the Commissioner’s decision. Id.; Attmore v. Colvin, 827 F.3d 872, 875
14 (9th Cir. 2016).
15 III. DISCUSSION
16 Plaintiff appears to argue that: (1) the ALJ failed to comply with the
17 Court’s remand order and improperly discounted his allegations regarding
18 fatigue and other treatment-related side effects; (2) the ALJ improperly
19 evaluated the medical opinion evidence; and (3) the ALJ’s step-five finding is
20 unsupported by substantial evidence because the RFC failed to account for
21 limitations arising from Plaintiff’s treatment regimen.3 (Dkt. No. 15 at 3-20.)
22 As discussed below, the Court finds that none of these arguments warrants
23 remand.
24 A. The ALJ Properly Evaluated Plaintiff’s Subjective Symptom
25 Allegations
26 Plaintiff contends that the ALJ failed to give legally sufficient reasons for
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3 Because Plaintiff is proceeding pro se, the Court construes his filing
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liberally. See Hebbe v. Pliler, 627 F.3d 338, 342 (9th Cir. 2010).
1 rejecting his subjective symptom allegations.
2 When a claimant produces objective medical evidence of an underlying
3 impairment that could reasonably be expected to produce the alleged symptoms,
4 and there is no affirmative evidence of malingering, an ALJ may reject the
5 claimant’s testimony regarding the severity of those symptoms only by
6 providing specific, clear and convincing reasons supported by substantial
7 evidence. Treichler v. Comm’r of Soc. Sec. Admin., 775 F.3d 1090, 1102 (9th Cir.
8 2014). General findings are insufficient; rather, the ALJ must specifically
9 identify the testimony being discounted and explain what evidence undermines
10 it. See Brown-Hunter v. Colvin, 806 F.3d 487, 493-94 (9th Cir. 2015). Although
11 an ALJ need not discuss every piece of evidence or draft a “line-by-line exegesis”
12 of the record, the Court must be able to follow the ALJ’s reasoning and
13 determine that the claimant’s testimony was not arbitrarily discredited.
14 Lambert v. Saul, 980 F.3d 1266, 1277 (9th Cir. 2020); Smartt v. Kijakazi, 53
15 F.4th 489, 499 (9th Cir. 2022) (clear and convincing standard requires ALJ to
16 “show his work”).
17 Here, Plaintiff alleged disability primarily due to autoimmune hemolytic
18 anemia. (AR 71, 3512.) He testified that he received Rituximab infusions when
19 his hemoglobin levels declined, following relapses that occurred approximately
20 every 12 to 18 months. (AR 3520-22.) Plaintiff stated that, as his hemoglobin
21 levels dropped, he would experience increasing symptoms, including profound
22 fatigue, concentration problems, and difficulty functioning. (AR 73, 75, 77-78,
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4 To the extent Plaintiff contends that the ALJ failed to comply with the
25 Court’s remand order, that argument lacks merit. The remand order directed
the ALJ to consider whether Plaintiff’s testimony regarding his changed
26 treatment regimen and alleged increased side effects established changed
circumstances sufficient to rebut the Chavez presumption. (AR 3562-81.) On
27 remand, the ALJ found changed circumstances, declined to apply Chavez, and
evaluated Plaintiff’s claim through the date last insured. (AR 3477-78.) Thus,
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the ALJ complied with the remand order.
1 3513-14.) He testified that these symptoms worsened in the weeks preceding
2 treatment and that he then required additional recovery time following the
3 infusions. (AR 75-76, 3513-14.) Plaintiff further testified that his treatment
4 regimen later changed to maintenance Rituximab infusions approximately
5 every two months. (AR 72, 74, 3518.) According to Plaintiff, this more frequent
6 treatment schedule caused increased side effects, including fatigue, headaches,
7 dizziness, and a lowered immune system, and he developed shingles. (AR 77,
8 3518-19.) Plaintiff maintained that these treatment-related side effects and
9 recovery periods prevented him from sustaining full-time employment. (AR
10 3522-23.)
11 In the decision, the ALJ discounted Plaintiff’s subjective symptom
12 testimony based on the medical and treatment evidence of record and Plaintiff’s
13 contemporaneous reports to medical providers. (AR 3481-84.) As discussed
14 below, these were specific, clear and convincing reasons, supported by
15 substantial evidence, for discounting Plaintiff’s subjective symptom allegations.
16 See Treichler, 775 F.3d at 1102.
17 First, the ALJ cited the medical and treatment evidence. (AR 3481-84.)
18 The objective medical evidence and the effectiveness of treatment are relevant
19 considerations in evaluating the intensity and persistence of a claimant’s
20 symptoms. See Social Security Ruling (“SSR”) 16-3p, 2017 WL 5180304, at *5-
21 8; see also Burch v. Barnhart, 400 F.3d 676, 681 (9th Cir. 2005). Here, the
22 treatment records reflect that Plaintiff experienced periodic relapses of his
23 autoimmune hemolytic anemia. (AR 3462.) His condition generally responded
24 well to Rituximab therapy, and he did not require blood transfusions. (AR 959.)
25 Plaintiff underwent two eight-infusion courses of Rituximab therapy, first from
26 December 2014 through January 2015 and again from July through August
27 2016. (AR 960.) Treatment records later noted that Plaintiff experienced
28 periods of remission lasting approximately 12 to 18 months following each
1 course of treatment. (AR 959-60.)
2 After Plaintiff experienced additional relapses in late 2017 and again in
3 spring 2018, his medical providers elected to begin maintenance Rituximab
4 therapy. (AR 2593, 2601.) The treating hematologist described this regimen as
5 a "maintenance/preventative" dosing schedule intended to minimize Plaintiff's
6 long-term Rituximab exposure. (AR 2593, 3088.) Subsequent treatment records
7 documented stable or normal blood counts, ECOG performance scores of 0,5 and
8 a favorable response to treatment. (AR 959, 764-65, 769-70, 774, 778-80.)
9 Indeed, after maintenance therapy was initiated, later treatment records
10 reflected stable hemoglobin levels, continued remission, and no indication that
11 Rituximab needed to be restarted after it was eventually placed on hold. (AR
12 895-96, 2539, 2559.) Moreover, although Plaintiff developed shingles in 2018,
13 the record does not document recurrent infections, infection-related
14 hospitalizations, or other objective findings that would support Plaintiff’s claim
15 that treatment-related immune suppression prevented him from working. (AR
16 704-05, 708, 712.) Based on the foregoing, the ALJ reasonably concluded that
17 the medical and treatment evidence did not support Plaintiff’s allegations of
18 disabling symptoms.6
19 Second, the ALJ noted that Plaintiff’s allegations were inconsistent with
20 his contemporaneous reports to medical providers. (AR 3481-84.) An ALJ may
21 consider the consistency of a claimant’s own statements when evaluating the
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23 5 The Eastern Cooperative Oncology Group (“ECOG”) performance scale is
a measure of a patient’s functional status. An ECOG score of 0 indicates that
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the patient is fully active and able to carry on all pre-disease activities without
25 restriction. (AR 1269.)
26 6 To the extent Plaintiff argues that the ALJ improperly relied on evidence
predating the relevant period, that argument lacks merit. The ALJ
27 appropriately considered Plaintiff’s longitudinal treatment history to evaluate
the course of his autoimmune hemolytic anemia, the effectiveness of
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treatment, and the consistency of his allegations during the relevant period.
1 intensity, persistence, and limiting effects of symptoms. See SSR 16-3p, 2017
2 WL 5180304, at *5 (“we will compare statements an individual makes in
3 connection with the individual’s claim for disability benefits with any existing
4 statements the individual made under other circumstances”). Here, Plaintiff
5 testified that he experienced debilitating fatigue, headaches, dizziness,
6 prolonged recovery periods, and significant immune suppression following
7 Rituximab therapy. However, following treatment in 2015, Plaintiff repeatedly
8 told his providers that he had no symptoms, good energy, no new complaints,
9 and generally felt well. (AR 1264, 1423, 1917, 1923, 1930, 2344, 2333, 2341,
10 2355). During a 2016 relapse and subsequent treatment, Plaintiff stated that
11 he was “feeling pretty good” and experienced only occasional headaches. (AR
12 1857.) Thereafter, while in remission, treatment notes consistently reflected
13 good energy levels, no new complaints, and no symptoms related to infection.
14 (AR 705, 711, 715, 727, 738-39, 742, 2217.) Similarly, after transitioning to
15 maintenance Rituximab therapy, Plaintiff complained only of occasional fatigue
16 and denied any significant side effects. (AR 767, 769, 774, 778, 959.) The ALJ
17 reasonably found that these contemporaneous statements to his medical
18 providers were inconsistent with Plaintiff’s allegations of disabling symptoms
19 and treatment-related limitations.7
20 In sum, the ALJ provided specific, clear and convincing reasons for
21 discounting Plaintiff’s subjective symptom testimony, and remand is not
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25 7 Plaintiff argues that the ALJ improperly relied on Plaintiff’s reported
daily activities in evaluating his subjective symptom allegations. (Dkt. No. 15
26 at 11-12.) But even assuming that the ALJ erred in this respect, remand is
unwarranted because the ALJ provided other specific, clear and convincing
27 reasons supported by substantial evidence for discounting Plaintiff’s subjective
symptom allegations. See Carmickle v. Comm’r, Soc. Sec. Admin., 533 F.3d
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1155, 1162-63 (9th Cir. 2008).
1 warranted on this issue.
2 B. The ALJ Properly Evaluated the Medical Opinion Evidence
3 Plaintiff contends that the ALJ failed to properly evaluate the medical
4 opinion evidence. (Dkt. No. 15 at 9, 15-17.) This argument lacks merit. For
5 claims filed on or after March 27, 2017, an ALJ evaluates the persuasiveness of
6 medical opinions based primarily on their supportability and consistency. See
7 Woods v. Kijakazi, 32 F.4th 785, 791-92 (9th Cir. 2022). The ALJ’s evaluation
8 of the medical opinion evidence must be supported by substantial evidence. Id.
9 at 792.
10 First, Plaintiff appears to challenge the ALJ’s evaluation of the medical
11 source statement from his treating physician, Mark Carmichael, M.D. (Dkt. No.
12 15 at 9, 15.) This statement, however, did not identify any specific functional
13 limitations. (AR 3462-66.) Dr. Carmichael described Plaintiff’s prognosis as
14 good, responded “N/A” when asked to identify limitations, and identified no
15 additional limitations. (AR 3463-65.) The ALJ reasonably found that this
16 opinion did not support greater work-related limitations beyond those reflected
17 in the RFC. (AR 3483.)
18 Second, Plaintiff contends that the ALJ failed to account for the opinion
19 of Restituto Tibayan, M.D., his treating oncologist. (Dkt. No. 15 at 15-17.) Dr.
20 Tibayan’s brief letter likewise did not identify any specific functional limitations
21 arising from Plaintiff’s impairments. Rather, Dr. Tibayan generally referenced
22 fatigue, headaches, and COVID-related restrictions. (AR 2951.) Accordingly,
23 the letter provided limited insight into Plaintiff’s ability to perform work-related
24 activities during the relevant period.
25 Thus, Plaintiff has not shown that the ALJ erred in evaluating the
26 medical opinion evidence.
27 C. Substantial Evidence Supports the ALJ’s Step-Five Finding
28 Plaintiff also challenges the ALJ’s step-five finding, arguing that the RFC
1 should have included additional limitations arising from his maintenance
2 Rituximab treatment, including the need to isolate from others and miss several
3 days of work every six to eight weeks. Because those limitations were not
4 included in the RFC, Plaintiff likewise contends that the hypothetical question
5 posed to the VE was incomplete. (Dkt. No. 15 at 12-15.) This argument lacks
6 merit.
7 Plaintiff’s claim relies primarily on his own testimony regarding the
8 severity of his treatment-related symptoms and recovery periods. However, as
9 discussed above, the ALJ permissibly discounted Plaintiff’s subjective symptom
10 allegations based on the medical and treatment evidence and Plaintiff’s
11 contemporaneous reports to medical providers. Accordingly, the ALJ was not
12 required to include in the RFC, or the corresponding hypothetical question to
13 the VE, limitations derived solely from those allegations. See Bayliss v.
14 Barnhart, 427 F.3d 1211, 1216-17 (9th Cir. 2005) (the ALJ need include only
15 those “limitations that the ALJ found credible and supported by the substantial
16 evidence in the record”). Nor does the record otherwise support the limitations
17 Plaintiff proposes. No medical source opined that Plaintiff would require
18 periodic absences from work, isolation from coworkers, or other restrictions
19 beyond those incorporated into the RFC. To the contrary, treatment records
20 documented stable blood counts, remission, ECOG performance scores of 0, and
21 only occasional fatigue during maintenance therapy. Because the hypothetical
22 question posed to the VE included all of the limitations that the ALJ reasonably
23 found supported by the record, the ALJ was entitled to rely on the VE’s
24 testimony at step five. See Bayliss, 427 F.3d at 1216-17. Thus, remand is not
25 warranted.
26 IV. ORDER
27 For the foregoing reasons, IT IS ORDERED that the decision of the
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1 Commissioner is affirmed.
2 IT IS SO ORDERED.
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4 || DATED: July 6, 2026
5 ADC.
6 UNITED STATES MAGISTRATE JUDGE
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