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Vang v. Astrue

United States District Court, D. Minnesota

February 11, 2013

CHONG VANG, Plaintiff,
MICHAEL J. ASTRUE, Commissioner of Social Security, Defendant

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For Chong Vang, Plaintiff: Laura S Melnick, LEAD ATTORNEY, Southern Minnesota Regional Legal Services, Inc, St Paul, MN.

For Carolyn W. Colvin, Defendant: Ana H Voss, LEAD ATTORNEY, United States Attorney's Office, Minneapolis, MN.


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JANIE S. MAYERON, United States Magistrate Judge.


The above matter is before the undersigned United States Magistrate Judge on plaintiff's 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 plaintiff's Motion for Summary Judgment be DENIED and that defendant's Motion for Summary Judgment be GRANTED.


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

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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 plaintiff's Motion for Summary Judgment [Docket No. 9] and defendant's Motion for Summary Judgment [Docket No. 12].


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

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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 plaintiff's vocational factors.

3. The medical evidence from treating and consulting physicians.
4. The plaintiff's subjective complaints relating to exertional and non-exertional activities and impairments.
5. Any corroboration by third parties of plaintiff's impairments.
6. The testimony of vocational experts, when required, which is based upon a proper hypothetical question which sets forth plaintiff's 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.3d870, 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

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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).


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 Security 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(a)(1) and 416.920(a)(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

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step one, the ALJ found that Vang 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" [1] of the Listings. Tr. 14-15.

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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

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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, 623-44).

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 whet 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

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that Vang was able to perform her past relevant work as an assembly worker. Id.


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.

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C. Medical Records[2]

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. [3] 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. [4] 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/concentration, 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, anxiety/worry, inability to focus, concentration, etc.); as for any symptom the therapist believed applied, he or she would place a checkmark next to that symptom. Id. The section entitled " Level of Functioning" had boxes labeled poor, fair, average, good or excellent, and required the provider to

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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 not 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.

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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 ...

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