Chong Vang v. Colvin (934 F. Supp. 2d 1054, 2013)

ORDER ADOPTING REPORT AND RECOMMENDATION

PATRICK J. SCHILTZ, District Judge.

This matter is before the Court on plaintiff Chong Vang’s objection to the February 11, 2013 Report and Recommendation (“R & R”) of Magistrate Judge Janie S. Mayeron. Judge Mayeron recommends granting defendant’s motion for summary judgment and denying Vang’s motion for summary judgment. The Court has conducted a de novo review. See 28 U.S.C. § 636(b)(1); Fed.R.Civ.P. 72(b). Based on that review, the Court adopts Judge Mayeron’s R & R. Only two issues merit comment:

First, Vang objects that the Administrative Law Judge (“ALJ”) gave insufficient weight to the opinion of her treating psychotherapist, Dr. Jonathan Hoistad. A treating doctor’s opinion “is afforded less deference when the medical evidence in the record as a whole contradicts the opinion itself.” Haggard v. Apfel, 175 F.3d 591, 595 (8th Cir.1999). As explained in the R & R, Hoistad’s conclusions about the severity of Vang’s depression and the scope of her work limitations are often undercut by other evidence in the record, including Hoistad’s own treatment notes. Under those circumstances, it was reasonable for the ALJ to give only limited weight to Hoistad’s opinions.

Second, Vang argues that both the ALJ and the R & R placed undue weight on the opinion of Dr. Karen Butler, who did not treat or examine Vang. But Butler’s opinions were not the sole basis for any of the ALJ’s findings; the R & R describes other evidence in the record supporting each of those findings.

This is a close case. Reasonable ALJs could disagree about whether Vang is disabled, and reasonable judges could disagree about whether the ALJ’s decision in this case is supported by substantial evidence on the record as a whole. Having closely examined the record and Judge Mayeron’s careful and thorough R & R, the Court concludes that the ALJ’s decision “ ‘falls within the available zone of choice.’ ” Buckner v. Astrue, 646 F.3d 549, 556 (8th Cir.2011) (quoting Bradley v. Astrue, 528 F.3d 1113, 1115 (8th Cir.2008)).

ORDER

Based on the foregoing, and on all of the files, records, and proceedings herein, the Court ADOPTS the R & R [ECF No. 15]. Accordingly, IT IS HEREBY ORDERED THAT:

1. Plaintiff Chong Vang’s motion for summary judgment [ECF No. 9], is DENIED.

2. Defendant’s motion for summary judgment [ECF No. 12] is GRANTED.

3. Plaintiffs complaint [ECF No. 1] is DISMISSED WITH PREJUDICE AND ON THE MERITS.

LET JUDGMENT BE ENTERED ACCORDINGLY.

REPORT AND RECOMMENDATION

JANIE S. MAYERON, United States Magistrate Judge.

The above matter is before the undersigned United States Magistrate Judge on plaintiffs Motion for Summary Judgment [Docket No. 9] and defendant’s Motion for Summary Judgment [Docket No. 12]. This matter has been referred to the undersigned Magistrate Judge for a Report and Recommendation by the District Court pursuant to 28 U.S.C. § 636(b)(1)(B) and Local Rule 72.1(c).

For the reasons discussed below, it is recommended that plaintiffs Motion for Summary Judgment be DENIED and that defendant’s Motion for Summary Judgment be GRANTED.

I. PROCEDURAL BACKGROUND

On May 23, 2007, plaintiff Chong Vang (“Vang”) filed applications for disability insurance benefits and supplemental security income, alleging disability since November 18, 2005, due to her shoulder, arm, neck, back and depression. Tr. 107-18, 137. Vang’s applications were denied initially and upon reconsideration. Tr. 53-62, 68-73. At Vang’s request, an administrative hearing was held on January 15, 2010, before Administrative Law Judge Roger Thomas. Tr. 10-19, 20. Vang was represented by an attorney during the hearing. Tr. 20. Testimony was taken at the hearing from Vang, a medical expert Dr. Andrew Steiner, M.D. (“ME”) and vocational expert L. David Russell (“VE”). Tr. 20. The ALJ issued a decision on August 24, 2010, finding that Vang was not disabled under sections 216(i) and 223(d) of the Social Security Act. Tr. 10-19. Vang filed a request for review of the ALJ’s decision with the Appeals Council, the Appeals Council denied Vang’s request for review and upheld the ALJ’s decision denying disability insurance benefits to Vang (Tr. 1-4), making the ALJ’s findings the final decision of defendant. See 42 U.S.C. § 405(g).

Vang has sought review of the ALJ’s decision by filing a Complaint with this Court pursuant to 42 U.S.C. § 405(g) and 42 U.S.C. § 1383(c)(3). [Docket No. 1]. The parties now appear before the Court on plaintiffs Motion for Summary Judgment [Docket No. 9] and defendant’s Motion for Summary Judgment [Docket No. 12].

II. PROCESS FOR REVIEW

Congress has prescribed the standards by which Social Security disability benefits may be awarded. “The Social Security program provides benefits to people who are aged, blind, or who suffer from a physical or mental disability.” Locher v. Sullivan, 968 F.2d 725, 727 (8th Cir.1992); 42 U.S.C. § 1382(a). The Social Security Administration shall find a person disabled if the claimant “is unable to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment.” 42 U.S.C. § 1382c(a)(3)(A). The claimant’s impairments must be “of such severity that [the claimant] is not only unable to do his previous work but cannot, considering his age, education, and work experience, engage in any other kind of substantial gainful work which exists in the national economy.” 42 U.S.C. § 1382c(a)(3)(B). The impairment must last for a continuous period of at least twelve months or be expected to result in death. 42 U.S.C. § 1382c(a)(3)(A); see also 20 C.F.R. §§ 404.1509, 416.909.

A. Administrative Law Judge Hearing’s Five-Step Analysis

If a claimant’s initial application for benefits is denied, he or she may request reconsideration of the decision. 20 C.F.R. §§ 404.907-09, 416.1407-09. A claimant who is dissatisfied with the reconsidered decision may obtain administrative review by an ALJ. 42 U.S.C. §§ 405(b)(1), 1383(c)(1); 20 C.F.R. §§ 404.929, 416.1429. To determine the existence and extent of a claimant’s disability, the ALJ must follow a five-step sequential analysis, requiring the ALJ to make a series of factual findings regarding the claimant’s work history, impairment, residual functional capacity, past work, age, education and work experience. See 20 C.F.R. §§ 404.1520, 416.920; see also Locher, 968 F.2d at 727. The Eighth Circuit described this five-step process as follows:

The Commissioner of Social Security must evaluate: (1) whether the claimant is presently engaged in a substantial gainful activity; (2) whether the claimant has a severe impairment that significantly limits the claimant’s physical or mental ability to perform basic work activities; (3) whether the claimant has an impairment that meets or equals a presumptively disabling impairment listed in the regulations; (4) whether the claimant has the residual functional capacity to perform his or her past relevant work; and (5) if the claimant cannot perform the past work, the burden shifts to the Commissioner to prove that there are other jobs in the national economy that the claimant can perform.

Dixon v. Barnhart, 353 F.3d 602, 605 (8th Cir.2003).

B. Appeals Council Review

If the claimant is dissatisfied with the ALJ’s decision, he or she may request review by the Appeals Council, though review is not automatic. 20 C.F.R. §§ 404.967-404.982, 416.1467-1482. The decision of the Appeals Council (or of the ALJ, if the request for review is denied) is final and binding upon the claimant unless the matter is appealed to Federal District Court within sixty days after notice of the Appeals Council’s action. 42 U.S.C. §§ 405(g), 1383(c)(3); 20 C.F.R. §§ 404.981, 416.1481.

C. Judicial Review

Judicial review of the administrative decision generally proceeds by considering the decision of the ALJ at each of the five steps. The Court is required to review the administrative record as a whole and to consider:

1. The credibility findings made by the ALJ. '

2. The plaintiffs vocational factors.

3. The medical evidence from treating and consulting physicians.

4. The plaintiffs subjective complaints relating to exertional and non-exertional activities and impairments.

5. Any corroboration by third parties of plaintiffs impairments.

6. The testimony of vocational experts, when required, which is based upon a proper hypothetical question which sets forth plaintiffs impairment.

Cruse v. Bowen, 867 F.2d 1183, 1185 (8th Cir.1989) (citing Brand v. Secretary of HEW, 623 F.2d 523, 527 (8th Cir.1980)).

The review by this Court is limited to a determination of whether the decision of the ALJ is supported by substantial evidence in the record as a whole. 42 U.S.C. § 405(g); Bradley v. Astrue, 528 F.3d 1113, 1115 (8th Cir.2008); Johnston v. Apfel, 210 F.3d 870, 874 (8th Cir.2000); Clark v. Chater, 75 F.3d 414, 416 (8th Cir.1996). “We may reverse and remand findings of the Commissioner only when such findings are not supported by substantial evidence on the record as a whole.” Buckner v. Apfel, 213 F.3d 1006, 1012 (8th Cir.2000) (citation omitted).

Substantial evidence is “such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.” Richardson v. Perales, 402 U.S. 389, 401, 91 S.Ct. 1420, 28 L.Ed.2d 842 (1971) (quoting Consolidated Edison Co. v. NLRB, 305 U.S. 197, 229, 59 S.Ct. 206, 83 L.Ed. 126 (1938)); see also Culbertson v. Shalala, 30 F.3d 934, 939 (8th Cir.1994). “Substantial evidence is less than a preponderance, but is enough that a reasonable mind would find it adequate to support the Commissioner’s conclusion.” Buckner, 213 F.3d at 1012 (quoting Prosch v. Apfel, 201 F.3d 1010, 1012 (8th Cir.2000)); see also Slusser v. Astrue, 557 F.3d 923, 925 (8th Cir.2009) (citing Gonzales v. Barnhart, 465 F.3d 890, 894 (8th Cir.2006)) (same); Cox v. Apfel, 160 F.3d 1203, 1206-07 (8th Cir.1998) (same).

In reviewing the record for substantial evidence, the Court may not substitute its own judgment or findings of fact for that of the ALJ. Hilkemeyer v. Barnhart, 380 F.3d 441, 445 (8th Cir.2004); Woolf v. Shalala, 3 F.3d 1210, 1213 (8th Cir.1993). The possibility that the Court could draw two inconsistent conclusions from the same record does not prevent a particular finding from being supported by substantial evidence. Culbertson, 30 F.3d at 939. The Court should not reverse the Commissioner’s finding merely because evidence may exist to support the opposite conclusion. Buckner, 213 F.3d at 1011; Mitchell v. Shalala, 25 F.3d 712, 714 (8th Cir.1994); see also Woolf, 3 F.3d at 1213 (the ALJ’s determination must be affirmed, even if substantial evidence would support the opposite finding). Instead, the Court must consider “the weight of the evidence in the record and apply a balancing test to evidence which is contradictory.” Gavin v. Heckler, 811 F.2d 1195, 1199 (8th Cir.1987); see also Heino v. Astrue, 578 F.3d 873, 878 (8th Cir.2009) (quoting Jackson v. Bowen, 873 F.2d 1111, 1113 (8th Cir.1989)) (same).

The claimant bears the burden of proving his or her entitlement to disability insurance benefits under the Social Security Act. See 20 C.F.R §§ 404.1512(a), 416.912(a); Thomas v. Sullivan, 928 F.2d 255, 260 (8th Cir.1991). Once the claimant has demonstrated he or she cannot perform prior work due to a disability, the burden of proof then shifts to the Commissioner to show that the claimant can engage in some other substantial, gainful activity. See Goff v. Barnhart, 421 F.3d 785, 790 (8th Cir.2005); Eichelberger v. Barnhart, 390 F.3d 584, 591 (8th Cir.2004); Martonik v. Heckler, 773 F.2d 236, 239 (8th Cir.1985).

III. DECISION UNDER REVIEW

A. The ALJ’s Findings of Fact

The ALJ concluded that Vang was not entitled to disability insurance benefits under sections 216(i) and 223(d) of the Social Security Act, or supplemental security income under section 1614(a)(3)(A) of the Social Security Act. Tr. 19. The ALJ made the following findings:

1. The claimant meets the insured status requirements of the Social Secu: rity Act through December 31, 2010.

2. The claimant has not engaged in substantial gainful activity since November 18, 2005, the alleged onset date (20 CFR 404.1571 et seq., and 416.971 et seq.).

3. The claimant has the following severe impairments: a right shoulder and arm disorder with related pain, rotator cuff tendinitis, obesity, asthma, and a major depressive disorder (20 CFR 404.1520(c) and 416.920(c)).

4. The claimant does 'not have an impairment or combination of impairments that meets or medically equals one of the listed impairments in 20 CFR Part 404, Subpart P, Appendix 1 (20 CFR 404.1520(d), 404.1525, 404.1526, 416.920(d), 416.925 and 416.926).

5. The claimant has the residual functional capacity to perform light work as defined in 20 CFR 404.1567(b) and 416.967(b) with these additional restrictions: she is limited to simple, unskilled, visually demonstrated tasks; she cannot meet the demands of rapid-paced or high production goals; she can tolerate no contact with the public; she can tolerate no more than brief and superficial contact with co-workers and supervisors; she can perform no right overhead work; she can perform no power gripping with her left upper extremity; she cannot tolerate exposure to high concentrations of air pollutants.

6. The claimant is capable of performing past relevant work as a assembly worker. This work does not require the performance of work-related activities precluded by the claimant’s residual functional capacity (20 CFR 404.1565 and 416.965).

7. The claimant has not been under a disability, as defined in the Social Security Act, from November 18, 2005 through the date of this decision (20 CFR 404.1520(1) and 416.920(1)).

Tr. 12-18.

B. The ALJ’s Application of the, Five-Step Process

The ALJ made the following determinations under the five-step procedure. At step one, the ALJ found that Yang had not .engaged in substantial gainful activity since November 18, 2005. Tr. 12. At the second step, the ALJ found that Vang had severe impairments of a right shoulder and arm disorder with related pain, rotator cuff tendinitis, obesity, asthma, and a major depressive disorder. Id.

At the third step of the evaluation, the ALJ determined that Vang did not have impairment or combination of impairments that met or equaled the relevant criteria of any impairment listed in 20 C.F.R. Part 404, Subpart P, Appendix 1. Tr. 13. Specifically, the ALJ found that neither Vang’s physical nor mental impairments met or equaled any of the listings. Id. The ALJ relied and, placed significant weight on the opinion of clinical psychologist Dr. Karen Butler, Ph.D., to make this finding as to Vang’s mental impairments. Id.

In determining that Vang’s mental impairment did not meet or medically equal the criteria of Listing 12.04 for affective disorders, pursuant to “paragraph B” of Listing 12.04, the ALJ considered whether Vang’s impairments resulted in at least two of the following: marked restriction of activities of daily living; marked difficulties in maintaining social functioning; marked difficulties in maintaining concentration, persistence or pace; or repeated episodes of decompensation, each of extended duration. Tr. 13-14.

With regard to activities of daily living, the ALJ relied on Dr. Butler’s conclusion that Vang had no more than a moderate limitation in this area. Tr. 14. The ALJ also relied on Vang’s statements made during an consulting examination by psychologist Dr. Mark Schuler, Ph.D. in March 2007, that her day began at 6 a.m. when she helped her children prepare for school, she.cooked for the family, and she swept, vacuumed, went grocery shopping two to three times a week, drove and visited with family and friends. Id. (citing Tr. 283).

Based on the opinion of Dr. Butler, the ALJ found moderate difficulties in social functioning. Tr. 14. The ALJ also premised this determination on the fact that the record showed that Vang got along well with her children, examining psychologist Dr. Robert Barron, Ph.D., found her responses to be logical and goal directed, and she was able to shop on a regular basis, all of which suggested that she was able to go out in the public and tolerate at least superficial interactions with others. Id. (citing Tr. 329).

With respect to her ability to maintain concentration, persistence or pace, again based on Dr. Butler’s opinion, the ALJ found that Vang had a moderate limitation in this area. Tr. 14. The ALJ acknowledged that Vang stated to Dr. Schuler that she had memory problems, (Tr. 14 (citing Tr. 287)), but noted that during her mental status examination by Dr. Schuler, Vang displayed no difficulty in performing a simple focused attention tasks. Tr. 14 (citing Tr. 285). As for any evidence of decompensation, stating that the record reflected no extended psychiatric hospitalizations and no evidence that Vang was required to leave a work-like setting due to psychologically-based symptoms or an inability to leave home, the ALJ determined that Vang suffered no episodes of decompensation. Tr. 14. Thus, he concluded that Vang did not satisfy the “B criteria” of Listings 12.04. Id.

The ALJ also found, based on the opinion of Dr. Butler, no evidence of the “C criteria” of the Listings. Tr. 14-15.

In support of his determination of Vang’s residual functional capacity (“RFC”) at the fourth step of the evaluation process, the ALJ gave considerable weight to the testimony of independent medical expert, Dr. Steiner, that Vang was limited to a light level RFC as to her physical limitations. Tr. 15. As for Vang’s mental impairments, based on Dr. Butler’s considerable experience assessing work-related limitations for individuals and strong understanding of the medical record, the ALJ placed significant weight on her opinion that Vang could perform simple, unskilled work that is visually demonstrated, could not work at a rapid pace or meet high production goals, and should have no public contact and only brief and superficial with co-workers. Id. The ALJ also gave significant weight to the opinions of the state agency physicians, Dr. James M. Alsdurf, Ph.D. and Dr. R. Owen Nelsen, Ph.D., that Vang was able to concentrate on, understand, remember and carry out routine, repetitive, three-to-four-step tasks and instructions, and she was able to tolerate brief and superficial contact with co-workers and the public, as they were consistent with each other and the record as a whole. Id. (citing Tr. 339-64, 467-72).

Additionally, the ALJ placed significant weight on examining psychologist Dr. Barron’s opinion that Vang was capable of communicating, comprehending, and retaining simple directions in an entry-level employment situation. As for Dr. Barron’s statement that “it would appear doubtful that she would be capable of withstanding work-related stresses, performing routine and repetitive activities with reasonable persistence and pace, or meeting production requirements in an entry-level employment situation,” the ALJ did not interpret this statement to mean that Vang was unable to tolerate stress, meet production requirements or perform with reasonable pace. Tr. 16 (citing Tr. 331). The ALJ noted that Dr. Barron’s opinion was based in part on the report of Dr. Schuler, a report which Dr. Barron had discredited. Tr. 16.

The ALJ found that the record did not support the March 2007 opinion by Dr. Schuler that Vang would experience problems maintaining a competitive rate of work while performing tasks that require any type of visual scanning or processing, and that her depression would interfere with a consistent rate of work performance. Id. In making this finding, the ALJ stated that Dr. Barron had found that Dr. Schuler’s report was probably an underestimate of her cognitive abilities. Id. (citing Tr. 326-32). Further, the ALJ relied on Vang’s activity level and her ability to be responsible for young children to show that she was functioning at a higher level than that described by Dr. Schuler. Id.

The ALJ gave limited weight to the opinions set forth in a mental impairment questionnaire prepared by Vang’s treating psychotherapists, Dr. Jonathan Hoistad, Ph.D., and Xullvong Moua, M.A., on December 3, 2009, in which they opined that Vang could tolerate no stress; would miss more than three days of work per month; had a poor or no . ability to maintain attention for two-hour segments; poor or no ability to complete a normal work day or work week without interruptions from psychologically-based symptoms; poor or no ability to accept instructions and respond appropriately to supervisors; marked restriction of activities of daily living; and marked difficulties in maintaining concentration, persistence, or pace. Tr. 16-17 (citing Tr. 639-44). The ALJ also indicated that certified nurse practitioner Carol Thersleff, who was Vang’s therapist from June 15, 2009 through at least November 23, 2009, filled out the same form and set forth similar limitations. Tr. 17. The ALJ found the record did not support the extreme limitations given by Dr. Hoistad, Moua and Thersleff based on Vang’s ability to raise her young children and perform housework during the long period of time she was estranged from her husband and the only adult in the household. Tr. 17. The ALJ also noted that while Dr. Hoistad and Moua stated Vang’s level of functioning was poor in the mental impairment questionnaire, in their medical reports they stated her level of functioning was fair on some occasions, and on other occasions indicated it was poor. Tr. 16-17 (citing Tr. 384-437, 623^4).

As for her subjective complaints, the ALJ noted that Vang’s medications were consistent for her established impairments and the record did not suggest that she failed to receive significant relief of symptoms with the use of medication. Tr. 17. The ALJ also noted that Vang was inconsistent her use of medication in that she alternated the medication that' she was supposed to be taking on a daily basis, (id. (citing Tr. 329-30)), and she understood that some of her problems could be reduced by taking her medication and she did have some control over her problems. Id. (citing Tr. 442).

The ALJ found that Vang made contradictory statements as to what she could do on a daily basis, observing that in March 2007, she told Dr. Schuler that she prepared all of the family’s meals, could perform household chores and visited friends weekly, but in August 2007, she stated to Dr. Barron that her husband prepared the meals, she did no household chores, and had no friends. Tr. 17 (citing 283, 328, 330).

In further development of the RFC, the ALJ considered Vang’s work history which showed that she stopped working in November 2005, the date that coincides with the date she alleges she first became disabled. Tr. 17. However, she told Dr. Schuler that she stopped working, not because of her disability, but because the third shift that she worked was discontinued and she did not return to work because she could not find childcare. Id. (citing Tr. 281). The ALJ also noted that Vang is a fulltime parent and as of March 2007, two of her children were not yet school aged and she babysat them on a daily basis.' Tr. 18.

The ALJ considered but did not place much weight on the written statements from Vang’s daughter and husband, given their relationship to Vang and their incentive to support her. Id. According the ALJ, Vang’s husband basically described Vang as an invalid, yet for an extended period of time, she was solely responsible for all of the activities he claimed he performed alone. Id. In addition, the ALJ observed that the husband and daughter’s statements about who did the cooking contradicted each other. Id.

Based on the RFC assigned to Vang and the VE’s testimony, the ALJ concluded that Vang was able to perform her past relevant work as an assembly worker. Id.

IV. THE RECORD

A. Background

Vang was 42-years-old when she filed her application for benefits in May 2007. She had nine children, five of which still lived at home (ranging from three to seventeen years old) at the time of the hearing before the ALJ. Tr. 27.

B. Functional Reports by Vang, Husband and Daughter

On June 13, 2007, Vang and her husband both filled out reports on Vang’s abilities to function. Tr. 149-156, 160-67. Vang’s husband indicated that he took care of Vang and the children, cooked, cleaned and did the shopping. Tr. 150. While Vang used to be able to do this work, she could no longer do so. Id. The children assisted Vang by giving her clothes to wear, giving her a bath, and helping her care for her nails. Id. Vang needed to be reminded to groom herself, to take her medications, and to go to medical appointments. Tr. 151, 153. Vang could not cook because she could not concentrate. Id. Vang travelled by riding in a car and using a medical rider, and she was afraid to go anywhere by herself because she felt she might get lost. Tr. 152. Vang shopped once a month for 30-40 minutes with her husband. Id. Vang’s husband stated that he paid the bills. Id. Vang could no longer attend family ceremonies; she was forgetful and could not finish tasks; she could only pay attention for less than 5 minutes at a time; she could not follow spoken instructions very well; she handled stress by being alone; and her condition worsened with changes in her routine. Tr. 154-55.

In her report, Vang indicated that she spent her day by waking up at 7:00 a.m.; she went to the couch to ruminate about things; she ate breakfast at 9:00 a.m., which was cooked by her husband; in the summer she went outside for 5-10 minutes; she ate dinner at 7:00 p.m.; and went to bed at 10:00 p.m. but did not fall asleep until 2:00 or 3:00 a.m. Tr. 160. Vang stated that her husband took care of her and the children. Tr. 161. Her children assisted her by giving her clothes to wear, giving her a bath, and helping her care for her nails. Id. Her family reminded her to take care of her personal needs and grooming; they took care of cooking since she forgets easily; she went to medical appointments using a medical rider; she went shopping once a month with her husband for clothing; and her husband took care of the bills. Tr. 162-63. Vang noted that she spent time with her family, went to the Hmong New Year celebration for 1 hour, went to her doctor’s appointment 2-3 times per week, no longer visited her relatives, and complained of a poor memory and concentration. Tr. 164-65. Vang claimed that she could only concentrate for about 5 minutes at a time, dealt with stress by being calm and alone, and changes in her routine caused her greater depression. Tr. 165-66.

Vang’s daughter submitted a functional report dated February 15, 2008. Tr. 182. The report contains virtually the same statements of Vang’s functional abilities as that set forth in her father and mother’s reports, except that the daughter represented that she, as opposed to her farther, did the cooking and cleaning, took care of her younger siblings, took her mother shopping, and paid the bills. Tr. 182-89.

C. Medical Records

1. Treatment Records

a. Treatment by Dr. Jonathan Hoistad and Xulivong Moua from 2006 through 2009

In March 2006, Vang presented to licensed psychologist, Dr. Jonathan Hoistad, complaining of being worried about family finances, shoulder problems, not being able to sleep at night, poor appetite and depression for the last five years. Tr. 434. Vang’s husband had moved out in 2003. Id. Vang was physically abused by her husband. Tr. 435. She was not able to engage in any social activities because she did not have the, time. Tr. 436.

Dr. Hoistad’s impression of Vang was that she was very depressed over her finances and taking care of her children. Id. Dr. Hoistad felt that .Vang’s prognosis was fair. Tr. 436. Regarding her mental status, he observed that she appeared casual, her mood was depressed, her affect was appropriate and her thought process was normal. Id. Dr. Hoistad diagnosed Vang with major depressive disorder, recurrent, moderate, and assigned her with a GAF of 45. Id. The treatment plan was to meet weekly with a therapist, practice coping skills, and coordinate as it relates to social security supplemental income. Tr. 437.

From March 14, 2006 through March 2008, Vang met with Dr. Hoistad and therapist Xulivong Moua, M.A., who worked with Dr. Hoistad, for psychotherapy sessions. The results of each session were set forth in progress notes signed both by Dr. Hoistad and Moua. Tr. 387-433, 487-509. Each progress note was made up of sections entitled: Current Issues/Complaints; Medications; Mental Status; Review of Symptoms; Objective; Assessment/Diagnosis, Level of Functioning; Progress Toward Treatment Goals; and Plan. Id. The section entitled “Mental Status” listed various dimensions including mood, affect, attention/eoncentration, thought processes, associations, memory and insight/judgment, and required the therapist to write in his or observations on that particular dimension. Id. The “Review of symptoms” section listed 36 different types of symptoms {e.g., sad/depressed, sleep disturbance, amdety/worry, inability to focus, concentration, etc.); as for any symptom the therapist believed applied, he or she would place a checkmark next to that sjmptom. Id. The section entitled “Level of Functioning” had boxes labeled poor, fair, average, good or excellent, and required the provider to check the applicable box. Id. The “Progress Toward Treatment Goals” section asked the therapist to check the applicable box indicating no progress, some improvement or .great improvement. Id.

From March 2006 through May 2007, issues and complaints identified by Vang included her husband rejoining the family in February 2006, but not working; struggling with finances and public assistance; arm pain; the health and well-being of her children; her pregnancy and upcoming birth of her child; her husband not participating with the family; being denied social security supplemental income; having to take care of the family and feeling like she was “wearing the pants in the home;” not being able to work because of the pain in her right arm; not being able to divorce her husband due to cultural issues; and being forgetful. Tr. 387-433. The stated objectives of these sessions during this time period were mental health support and to assist her to obtain financial support. See, e.g., Tr. 418, 420, 422, 427, 428, 430, 431. Dr. Hoistad opined during this time period that Vang’s level of functioning was poor and she showed no progress. Id. Vang was diagnosed with major depressive disorder, recurrent, moderate; and a pain disorder associated with both psychological factors and a medical condition. Tr. 387-433.

Starting in June 27, 2007, Dr. Hoistad reported that Vang was showing some improvement. Tr. 399. Vang told Dr. Hoistad that she wanted to go back to her work, but that her back pain was keeping her from doing so. Id. In August 2007, Dr. Hoistad noted that Vang’s level of functioning improved to fair and some improvement was seen with her depression. Tr. 395. On September 6, 2007, Vang reported to Dr. Hoistad that her depression was getting worse, despite Dr. Hoistad’s belief that Vang showed some improvement. ' Tr. 394. On December 5, 2007, Vang’s level of functioning was rated by Dr. Hoistad as fair, with some improvement with her depression. Tr. 392. Vang was stressed out with public assistance rules and regulations, as they wanted her to find work or go to school, and Vang felt that was very difficult for her to do given that she had two small children and her husband had run off. Id. On January 15, 2008, Vang reported to Dr. Hoistad that her husband had run off with another woman and that he had not come back for a few weeks. Tr. 389. Dr. Hoistad noted that Vang’s level of functioning was poor, with some improvement. Id. On January 29, 2008, Vang reported to Dr. Hoistad that she was having a flashback from the burglary of her house. Tr. 388. Vang indicated that she sometimes forgot to cook for her children. Id. Her husband had riot been at home for months. Id. Dr. Hoistad opined that Vang’s level of functioning was poor, with some improvement. Id.

In February 2008, Vang reported to Dr. Hoistad that she could not sleep and she had communication problems with her children and husband, resulting in a family fight, and she had health and financial problems. Tr. 387. Dr. Hoistad reported that Vang’s level of functioning was fair, with some improvement.

From February 2008 to November 2008, Vang reported issues and complaints to Dr. Hoistad, including problems communicating with her children who were being disobedient and having behavioral problems, problems with sleeping and headaches, wanting to help financially by obtaining SSI benefits, her husband’s affair, financial stresses, and chronic pain. Tr. 487-509. Dr. Hoistad indicated that Vang’s level of functioning during this period was primarily fair and showing some improvement. Id. Vang’s diagnosis was major depressive disorder, moderate. Id.

From November 24, 2008 through April 15, 2009, Vang reported to Dr. Hoistad that her children were getting into trouble; she was having problems with her husband (from whom she was separated); she had financial stress (including applying for SSI benefits and housing issues); she had arm pain, sleep problems, and fatigue; and she had been involved in a car accident. Tr. 582-605. Dr. Hoistad opined that Vang’s level of function ranged from fair to poor with some improvement. Id. Dr. Hoistad’s diagnosis for Vang was a major depressive disorder and the intervention prescribed for Vang was to work on her coping skills, group therapy and medications. Id.

From May 19, 2009 through November 24, 2009, Vang reported to Dr. Hoistad that she had no child support from her husband and financial stress; her children were having problems at school and getting into fights and arguments; she was trying to find a new house to live in; her daughter was having legal problems related to destruction of property; her daughter had run away from home; and she was suffering from mood swings and having feelings of hopelessness and helplessness. Tr. 576-80, 625-37. Dr. Hoistad opined that Vang’s level of functioning during this time was poor with no progress. Id. From October 2009 through November 2009, Dr. Hoistad diagnosed Vang with a major depressive disorder, moderate, severe depression without psychotic features, (Tr. 625-27), anxiety, and a learning disability. See, e.g., Tr. 625, 628, 633.

Throughout his work with Vang, Dr. Hoistad indicated under the Mental Status section that her mood was depressed; her affect was flat or appropriate; her attention/concentration was limited or poor; her thought processes were fair, limited or poor; and her associations and memory was fair, limited, poor or had no comment at all. Id. Tr. 387-433, 487-509. For symptoms, Dr. Hoistad checked one or more of the following: sad/depressed mood, sleep disturbance, loss of interest/enjoyment, hopeless/helplessness/worthless, anxiety/worry, mood swings, memory issues, irritability, excessive worry, fatigue, nightmares, flashbacks, inability to focus and concentration/foeus. Id.

On December 9, 2009, Dr. Hoistad and Moua filled out a mental impairment questionnaire for Vang, indicating they had seen her bi-monthly for a three-year period. Tr. 639-44. Their DSM-IV diagnosis for Vang was major depressive disorder, moderate, and they stated that Vang’s highest GAF score for the year was 46. Tr. 639. They identified the following symptoms for Vang: poor memory; sleep disturbance; mood disturbance; emotional lability; loss of interest; difficulty thinking or concentration; apprehensive expectation; time or place disorientation; flat affect; decreased energy; generalized persistent anxiety and hostility; and irritability. Id. They also noted that Vang had been depressed for over ten years and could sometimes get suicidal. Id. They opined that her fatigue moderately impaired her ability to work and she could handle no stress in an employment setting. Tr. 640.

Dr. Hoistad and Moua stated that the following clinical findings demonstrated the severity of Vang’s mental impairments and symptoms: poor ability to focus; poor short-term memory; irritable mood; sleep disturbances; feelings of hopelessness. Id. They indicated Vang’s response to treatment was fair, her prognosis was guarded, and her condition was expected to last at least 12 months. Id.

With regard to Vang’s mental abilities and aptitude to do good work, Dr. Hoistad and Moua opined that Vang had a good ability to work in coordination with others without being distracted, ask simple questions and ask for assistance, get along with coworkers and be aware of normal hazards and take appropriate precautions; a fair ability to remember work-like procedures, understand, remember and carry out short and simple instructions, maintain regular attendance and sustain an ordinary routine without supervision, make simple work-related decisions, respond appropriately to changes in a routine work setting, and deal with normal work stress; and poor or no ability to maintain attention for two-hour segments, complete a normal workday or week without interruptions from psychologically-based symptoms, perform at a consistent pace without a unreasonable number of rest periods, and accept instructions and criticism from supervisors. Tr. 641-42. Id. In support of those areas they rated as fair or poor, Dr. Hoistad and Moua explained that Vang was limited in these areas due to poor concentration, inability to focus, and her irritable mood. Tr. 642. They indicated that Vang’s condition would cause her to miss work more than three times a month. Tr. 641.

In the area of mental abilities and aptitudes needed to do particular types of jobs, Dr. Hoistad and Moua opined that Vang had a good ability to interact appropriately with the general public, maintain socially appropriate behavior, and adhere to basic standards of neatness; and a fair ability to travel in unfamiliar places and use public transportation. Id. Vang was limited in the areas of travel and use of public transportation due to her poor English and cultural issues. Id.

Dr. Hoistad and Moua checked that Vang had a marked limitation as to restrictions of daily living and in maintaining concentration, persistence or pace, a moderate limitation in the area of maintaining social functioning. Tr. 643. They noted that Vang had repeated episodes of decompensation in the form of sleeping for a few days with low energy, and indicated that Vang’s daughter was taking care of the family during these unspecified periods of decompensation. Id. Dr. Hoistad and Moua did not believe that Vang could manage benefits in her own best interest. Tr. 644.

b. June 2006 through April 2009 Treatment by Psychiatrist Dr. Roger A. Johnson

In June 2006, Vang saw psychiatrist Dr. Roger A. Johnson with complaints of depression for three years, insomnia, loss of interest, low appetite, lowered concentration and memory, feelings of helpless, and thoughts of death with no suicidal ideation. Tr. 310. She was given a prescription for the anti-depressant fluoxetine. Id. On June 19, 2006, Vang reported that she was doing a little better, but had complaints of insomnia. Tr. 444. Dr. Johnson diagnosed Vang with major depressive disorder in partial remission. Id. Dr. Johnson gave Vang Depakote ER. Id. On July 17, 2006, Vang reported that the Depakote did not help her, so it was discontinued and Vang was placed on Effexor and Prozac. Id. Vang reported no improvement during her July 20, 2006 through October 16, 2006 appointments, so she was provided with new prescriptions. Tr. 307. On July 20, 2006, she was diagnosed with recurrent major depressive disorder, severe; at her appointments September and October 2006, Vang was diagnosed with mild recurrent major depressive disorder. Tr. 307-OS. Vang reported improvement during the November 13, 2006 and December 13, 2006 appointments. Tr. 306. While she reported not being able to sleep at night, it was because she was sleeping during the day. Tr. 305-06. On January 15, 2007, Dr. Johnson diagnosed Vang with major depressive order, recurrent, in partial remission. Tr. 305. On February 15, 2007, Vang reported more depressive symptoms. Tr. 305. On March 20, 2007, Dr. Johnson noted that Vang had improved, and diagnosed Vang with major depressive order, recurrent, in partial remission. Id.

On May 21, 2007, Vang saw Dr. Johnson regarding her partially treated depression. Tr. 304. She was given Effexor XR. Id. On June 19, 2007, Dr. Johnson diagnosed Vang with major depressive order, recurrent, in partial remission. Tr. 444.

On August 16, 2007, Dr. Johnson reported that her medications were effective, but that she was not sleeping at night and was sleepy during the day. Tr. 441. Dr. Johnson recommended that Vang get some exercise and “do something.” Id. Vang was kept on the same medications. Id. She was diagnosed with major depressive order, recurrent, in partial remission. Id. On December 11, 2007, Dr. Johnson noted that Vang was off her medications and opined that she was suffering a major-depressive disorder, recurrent, moderate. Id. Dr. Johnson put Vang on Cymbalta. Id. On January 10, 2008, Dr. Johnson found that Vang had improved some, but that she still met the DSM-TV for a major depressive disordér, recurrent, mild, and added Lexapro to treat her depression. Tr. 440.

On February 8, 2008, Dr. Johnson noted that Vang had gotten better with the Lexapro, but then her husband left her alone with the kids and she was suffering from nightmares and anxiety. Id. Dr. Johnson prescribed Vang with Doxepin. Id. On March 11, 2008, Vang reported worrying excessively of being denied social security benefits. Tr. 573. Dr. Johnson placed Vang on Trazodone to help her sleep. Id. On April 10, 2008, Dr. Johnson reported that Vang had improved. Id. Vang told Dr. Johnson that legal aid was helping her with a social security appeal and the Trazodone had improved her sleep. Id. She still reported nightmares and some depressive symptoms. Id. Dr. Johnson had Vang try Clomipramine for her depression. Id. She was diagnosed with major depressive order, recurrent, in partial remission. Id.

On May 12, 2008, Dr. Johnson noted that Vang had worsened, she met the DSM-IV criteria for a major depressive disorder, recurrent, mild, and that medications were not probably going to help her with her condition. Tr. 572. He also noted that Vang could not work given her current mental condition and that she should appeal the social security rejection of benefits. Id. Dr. Johnson added Seroquel in order to treat Vang’s depression. Id. On June 9, 2008, Vang was a little improved and was able to sleep seven hours per night. Id. Dr. Johnson also found Vang to be generally inept, probably due to a dependent personality disorder. Id. On July 8, 2008, Dr. Johnson reported that Vang was still suffering from a major depressive order, moderate, and it appeared that her medication regimen was not helping bring her back to normal. Tr. 571. Dr. Johnson decided to have Vang try Strattera for her depression. Id.

On August 8, 2008 Dr. Johnson noted that Vang was still suffering from depression, reoccurring, moderate, and that Trazodone appeared to be the only medication that provided any relief for Vang, so she discontinued all other medications. Tr. 570-71. On September 4, 2008, Vang met the DSM-IV criteria for a major depressive disorder, recurrent, mild. Tr. 570. On October 6, 2008, Vang reported being off all medications, except for Trazodone, and that she had improved some, but was still depressed. Tr. 570. Vang appeared to have' improved a little. Id. On November 6, 2008, Dr. Johnson reported' that Vang appeared to be “quite a bit better.” Tr. 569. Vang was animated and talked spontaneously. Id. Vang still had stress issues, but showed no side effects to her medications. Id. She was diagnosed with major depressive order, recurrent, in partial remission. Id. On December 9, 2008, Vang reported that the Trazodone was making her nauseous, so she was switched to Seroquel. Id. On January 22, 2009, Vang was seen by Dr. Johnson who found her to have improved a little bit more, she reported that she slept fine and had no medication .side effects. Id. She was diagnosed with major depressive order, recurrent, in partial remission. Id.

From February 10, 2009 through April 10, 2009, Vang reported to Dr. Johnson that she had stress in her life, which she described as depression, she was not getting any better, and although all of the medications had been tried without effect, Vang did not want to go off of them. Tr. 568. Dr. Johnson did not believe that drugs were the answer. to treating her depression. Id. Vang was diagnosed with major depressive order, recurrent, unspecified during this time. Id.

c. Treatment by Certified -Nurse Practitioner Carol Thersleff from June 15, 2009 through November 23, 2009-

On June 15, 2009, Thersleff conducted a mental health intake assessment of Vang. Tr. 655-59. Vang was dressed casually and her speech was normal. Tr. 655. Her thoughts were logical, but she cried easily. Id. Vang reported her mood as being depressed and that her depression started in 2003, after her husband had assaulted her and dislocated her shoulder. Id. Vang stated that she had problems sleeping and only slept 2-3 hours per night. Id. Her appetite varied. Id. Vang had a decreased interest in pleasure and decreased energy. Tr. 656. Vang denied any psychomotor issues. Id. Vang felt hopeless, helpless, worthless and guilty. Id. Vang reported that she had a short temper and that she angered easily. Id. She complained that she never felt happy and believed that she would only be happy when she died. Id. Vang had suicidal ideations, but no history of suicidal attempts. Tr. 656, 658. Vang had no delusional behaviors, but she did have anxiety and panic attacks twice a week for 30 minutes, which she said were caused by thinking too much. Tr. 656-57. Vang had reoccurring negative thoughts, no obsessive or compulsive conduct, and reported memory problems. Tr. 657. Vang was separated from her husband and she lived with five of her children, the youngest of which was two years old. Tr. 658.

Thersleff believed that Vang was a medium risk and diagnosed her with major depressive affective disorder and severe psychosocial stressors. Tr. 659.

Vang continued to see Thersleff through November 23, 2009. Tr. 646-54. Thersleffs diagnosis for Vang during this period was major depressive disorder, recurrent, severe, with psychotic features ■ and chronic pain. Id. Thersleff noted that Vang’s behavior during these consultations was cooperative; her speech was logical, her appearance was mostly tired; she was orientated x3; her mood ranged from neutral to sad; her affect was appropriate; she had adequate insight and judgment; her thought process was logical and preoccupied (due to finances and pain); and she had occasional thoughts of suicide with no plan. Id During this time period, Vang reported that her appetite, activity and energy were low. Id She also had problems sleeping due to pain, but that was getting better. Tr. 646. Concerns raised during these sessions included that her daughter had run away, depression, back pain, liver pain, sleeping problems, and financial issues. See, e.g., Tr. 648, 649, 651.

On December 21, 2009, Thersleff filled out a mental impairment questionnaire for Vang. Tr. 661-66. Thersleffs DSM-IV diagnosis for Vang was major depressive disorder, recurrent, severe with psychotic features and with severe psychosocial stressors, chronic pain, and a GAF of 49. Tr. 661. In support, Thersleff listed the following symptoms: poor memory; sleep disturbance; mood disturbance; emotional lability; recurrent panic attacks; feelings of guilt and worthlessness; loss of interest; difficulty thinking or concentrating; motor tension; apprehensive expectation; suicidal ideation; decreased energy; intrusive recollections of a traumatic experience; persistent irrational fears; generalized persistent anxiety; somatization; and autonomic hyperactivity. Tr. 661. Thersleff also noted that Vang had witnessed her father’s death when she was six years old and had been assaulted and abandoned by her husband in 2003. Id

Thersleff opined that Vang’s fatigue moderately impaired her ability to work and she could only handle a low amount of stress in an employment setting. Tr. 662. This opinion was based on the fact that when Vang becomes anxious, she angers easily, panics and cannot think clearly, and Vang’s history of intrusive and traumatic memories. Id Thersleff also noted that when Vang first came to see her, she was on a number of medications, which she had been slowly tapering down. Id

Thersleffs prognosis was Vang’s condition was chronic and was likely to last at least 12 months. Id Thersleff believed that Vang’s condition would cause her to miss work more than three times a month. Tr. 663.

With regard to her mental abilities and aptitude to do unskilled work, Thersleff checked that Vang had a fair ability to remember and understand simple instructions, get along with co-workers, respond adequately to a change in routine, be aware of normal hazards and take appropriate precautions; a fair to poor ability to carry out very short and simple instructions, maintain attention for two-hour segments, work next to others without being unduly distracted, make simple work-related decisions, perform at a consistent pace without taking an unreasonable number of breaks and deal with normal work stress; and a poor ability to remember work-like procedures, maintain regular attendance, sustain an ordinary routine without special supervision, complete a normal work day or week without interruptions caused by her condition, ask for help, and accept instruction or take criticism from supervisors. Tr. 663-64. According to Thersleff, these limitations were due to Vang’s mental impairments. Tr. 664.

In the area of mental abilities and aptitudes needed to do particular types of jobs, Thersleff checked that Vang had a good ability to adhere to basic standards of neatness; a fair ability to interact appropriately with the general public and maintain socially appropriate behavior; a fair to poor ability to use public transportation; and no ability to travel in unfamiliar places. Tr. 664. Vang was limited in these areas due to being poorly acclimated to this country and her increased stress. Id.

Thersleff checked that Vang had marked limitations as to restrictions of daily living, maintaining social functioning, and maintaining concentration, persistence or pace. Tr. 665. Thersleff noted that her exam of Vang indicated that her depression had worsened in 2003 after her husband assaulted and left her. Tr. 666. Since then, Vang had experienced periods of exacerbation and remission of her depressive symptoms. Id. Thersleff also indicated that Vang had been compliant with her visits and medications. Id. Thersleff believed that Vang could manage benefits in her own best interest. Id.

2. Consulting Records

a. March 15, 2007 Consultation with Dr. Mark Schuler

On March 15, 2007, Vang was referred to Dr. Schuler by a Social Security advocate with the Hmong American Partnership. Tr. 281. Vang complained to Dr. Schuler that she had a lot of stress and could not do anything. Id. Vang indicated that she was depressed, as her husband had remarried and she was unable to take care of her family. Id. Vang claimed that she had been suffering from depression since 2000 after she and her husband separated, she had never been treated for depression before her husband left, and was taking medication for her condition. Tr. 281-82, 287. Her husband returned to the family in 2005 but she continued to be depressed because she was never sure as to whether he would stay or leave. Tr. 282, 287

Vang received no formal education in Laos or Thailand. Tr. 281. She told Dr. Schuler that she had worked on an assembly line from July 1997 to November 2005. Id. She had worked the third shift, but when the shift was discontinued, she did not have anyone to provide childcare services and had not worked since then. Id. Vang considered her shoulder pain and headaches to be her biggest barriers to working. Id.

With regard to activities and skills of daily living, Vang told Dr. Schuler that her day begins at 6:00 a.m. when she got up to help her children prepare for school. Tr. 283. If she needed help, she would get assistance from the older children. Id. Vang bathed every day. Id. Vang indicated that she did the cooking for the family, was able to sweep and vacuum, made her bed two-three times a day (usually with help from her children), went grocery shopping three times a week, paid bills with the help of her husband or son, could buy a money order herself to pay the bills if no one was available, and knew how to drive a car. Id. Vang went to bed between 9:00 and 10:00 p.m., but did not fall asleep until midnight or 1:00 a.m. Id.

Regarding her interests, Vang indicated that she was usually at home babysitting her two youngest children. Id. She tried to keep her house clean while she was babysitting, watched some television, took walks outside when the weather was nice, visited her family twice a week, visited her friends once a week, and attended the Hmong New Year celebrations and Hmong funerals. Id.

With regard to her ability to relate, Vang told Dr. Schuler that she did not have any ongoing arguments with anyone. Id. Vang denied any current suicidal ideation, but stated that she had thoughts about harming herself when her husband initially left the family. ..Tr. 284, 287. Vang indicated she had sleep problems. Id.

Dr. Schuler observed that Vang’s affect was mildly liable and her mood was somewhat depressed. Tr. 284:

Dr. Schuler conducted.performance testing on Vang designed to measure her problem-solving, attention abilities, processing speed and motor efficiency, semantic fluency, and learning and memory. Tr. 284-87. With respect to problem-solving, Vang completed the TONI-3 which is a nonverbal intelligence test. Tr. 285. She produced a'test quotient of 65, a score that placed her below the 1st percentile compared to the general population. Id. However, Dr. Schuler concluded that these testing results, which measured her cognitive abilities, did not provide an accurate picture of her general cognitive abilities due to cultural disparities. Id. Rather, he believed that her level of functioning fell at least within the borderline region, if npt higher. Id.

On attention abilities, Dr. Schuler stated that Vang displayed no difficulty in performing a simple focused attention task, indicating that she repeated the names of three common objects twice consecutively after a single presentation. Tr. 285. However, on a spatial span subtest of WMS-III, Vang’s performance fell between the 1st and 12th percentiles when compared to several populations raised in this country with similar education. Tr. 285. Dr. Schuler indicated that her performance on this test reflected low average level of functioning, but as demands increased, he believed that her level of performance would decline because of her preoccupation with her concerns. Tr. 286.

On processing speed and motor efficiency, Vang was administered the visual scanning task that is part of the Cross Cultural Cognitive Examination. Tr. 286. Vang’s performance was very slow, falling below the criterion set by the exam. Id. However, on another test designed to measure fine motor dexterity and motor speed, her scores fell between the 8th and 55th percentile when compared to individuals raised in this country. Id. Taking into consideration both tests, Dr. Schuler stated that while Vang’s general motor speed appears unimpaired, she does have reduced or impaired processing efficiency. Id.

On semantic fluency, which is designed to test a person’s ability to rapidly produce as many words as possible in a designated category, Vang performed at or below the 1st percentile. Id. Dr. ■ Schuler felt that her slow response was associated with the decreased processing efficiency she showed on the visual scanning task. Id.

On learning and memory, Dr. Schuler indicated that Vang appeared to be able to acquire new information, but her performance reflected variability in learning style and an inefficient pattern of learning this information. Id.

Dr. Schuler opined that Vang’s performance on these various tests of cognitive functioning reflected a decline in functioning that was probably associated with her depression. Tr. 288. In support, Dr. Schuler noted that Vang , had a significant history of employment, before her depression, and that Vang marked her decline in cognitive functioning as beginning with her depression which she associated with her husband’s departure. Id. Specifically, Dr. Schuler stated that Vang displayed an impaired processing efficiency during testing that resulted in a slower rate of performance on tasks requiring cognitive processing, and that he believed that her depression, demoralization, and sense of helplessness interfered with her functioning. Id. Nevertheless, Dr. Schuler believed that Vang is able to learn new information. Id.

The diagnostic impression for Vang was major depressive disorder, recurrent, moderate; pain disorder associated with psychological factors; and pain disorder associated with psychological factors and medical conditions. Tr. ' 288-89. Dr. Schuler assigned Vang a GAF score of 45. Tr. 289.

Under the section of his report entitled “Considerations,” Dr. Schuler recommended that Vang continue with her medications and start support counseling. Tr. 289. In light of her display of decreased processing efficiency during the evaluation process, Dr. Schuler stated:

[I]n a work situation, it is likely that she would experience problems maintaining a competitive rate of work while performing tasks that required any type of visual scanning or processing. While her fine motor scores on testing are seen as a relative strength, it is felt that her depression would interfere with a consistent rate of work performance.

Id. Dr. Schuler also noted that should Vang reapply for Social Security benefits, he believed that “the basis for this application should be related to her decreased processing efficiency and decreased rate of work performance that is associated with her depression.” Tr. 289-90.

Finally, Dr. Schuler indicated that should Vang receive Social Security benefits, he believed that she would be able to reliably manage these funds. Tr. 290. In support, he stated that she had reported that she is able to buy groceries, she manages her household, and she pays monthly bills'when necessary. Id.

b. August 8, 2007 Psychological Evaluation by Dr. Robert C. Barron

On August 8, 2007, Vang was seen for a psychological evaluation by Dr. Barron, at the request of the state Disability Determination Services. Tr. 326-332. At this time, Vang indicated that she resided with her unemployed husband and six children ranging in age from one to 17 years of age, with two of the children being preschool age. Tr. 330.

When asked about the nature of her disability, Vang said she had chronic pain in her right arm since 2003 after her husband dislocated her shoulder. Tr. 329. She reported she had been depressed since 2003, after her husband left her to marry another woman. Id. As a result, she had to care for her children. Id. Vang’s husband returned in 2006, but they continued to have problems. Id. Vang’s husband had been physically abusive before he left and refused to support the family. Id. Vang was also depressed about her physical problems, her inability to work and financial difficulties. Id. Vang claimed that her appetite was diminished; she had difficulty sl