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Jer Vang v. Michael J. Astrue

February 9, 2012


The opinion of the court was delivered by: Sheila K. Oberto United States Magistrate Judge


(Doc. 1)


Plaintiff Jer Vang ("Plaintiff") seeks judicial review of a final decision of the Commissioner of Social Security (the "Commissioner" or "Defendant") denying her application for Supplemental Security Income ("SSI") pursuant to Title XVI of the Social Security Act (the "Act"). 42 U.S.C. § 1383(c)(3). The matter is currently before the Court on the parties' briefs, which were submitted, without oral argument, to the Honorable Sheila K. Oberto, United States Magistrate Judge.


Plaintiff was born in 1964 in Laos, is a permanent United States resident, has no formal education, and has never worked. (Administrative Record ("AR") 119, 133-35, 219, 223.) On January 31, 2007, Plaintiff filed an application for SSI, alleging disability beginning on June 30, 2006, due to schizophrenia, paranoid and other functional psychotic disorders, and affective mood disorder. (AR 58, 119-32.)

A. Medical Evidence

Plaintiff was seen at Kings Winery Medical Clinic ("Kings Winery") from February 8, 2006, through January 12, 2007, for a variety of medical ailments, including chest pain, stomach ache, headache, leg pain, and recovery from miscarriage.*fn1 (AR 261-66.) On January 12, 2007, Plaintiff stated that she was very depressed, had suicidal ideations, and was "think[ing] about killing [her]self [with] a knife or gun." (AR 261.) Plaintiff indicated that she "feels scared," "sees people sometimes," "hears voices," and "hears babies crying." (AR 261.) She was referred to Maximo Parayno, M.D. (AR 261, 268.)

From January 14 through January 19, 2007, Plaintiff was admitted to Fresno County Psychiatric Health Facility after making a "suicide attempt . . . with a knife cut to her ankle." (AR 230-31, see also AR 215-52.) Plaintiff was diagnosed with "[m]ajor depressive disorder recurrent with psychotic features with delusions." (AR 215.) The hospital records indicate that Plaintiff had no prior history of psychiatric hospitalizations but that she had "overdosed" the prior year. (AR 216.) Plaintiff's hospitalization was "uneventful," and she was "offered individual, milieu, group therapy and pharmacological intervention." (AR 217.) Plaintiff's history indicated that she had experienced depression since she had been a teenager in a Thailand Refugee Camp and had severe depression since she had been in an automobile accident in 1991, which caused her to be unconscious for three days and required her to use a wheelchair for four months and a cane for over a year. (AR 218-19, 223.) Plaintiff reported "visual hallucinations of faces 'getting bigger and bigger' and [chasing] after her as well as hearing 'babies crying'" and that she "fantasiz[ed] about killing herself by various methods." (AR 230.) The hospital notes indicate that Plaintiff's daughter stated she was "afraid" that Plaintiff would be successful in her suicide attempts and that she did not believe that Plaintiff had been "med[ication]-adherent." (AR 231.) Plaintiff was discharged with medications of Prozac, Klonopin, and Seroquel; discharge recommendations included a dietary plan and orders to follow-up with Dr. Parayno.*fn2

Plaintiff was seen for counseling at Fresno County Mental Health Department ("Fresno Mental Health") from January 17, 2007, through March 9, 2007. (AR 204-10, 409.) Plaintiff reported that she was sad, depressed, had no concentration, and had no interest in daily activities. (AR 209, 210.) The counselor noted that Plaintiff's answers were relevant to the questions asked, her physical movement was slow but that she walked without a cane, she had a flat affect, and her mood was angry and depressed. (AR 208.) Plaintiff participated in group counseling and became more "involved" with the group discussion as her counseling progressed. (AR 204-05.)

Plaintiff was seen at Kings Winery from January 29, 2007, through April 2, 2007, for a variety of medical issues, including depression, medication refills, chronic chest pain, and stomach pain. (AR 327-30.)

In mid-April 2007, Dr. Parayno completed a medical source statement mental assessment. (AR 267-68.) Dr. Parayno found that Plaintiff had poor memory and would have difficulty understanding or carrying out detailed or complex instructions, but did not express an opinion as to Plaintiff's ability to understand and remember very short and simple instructions. (AR 267.) Dr. Parayno indicated that Plaintiff's ability to interact with the public, co-workers, and supervisors was poor, as was Plaintiff's ability to adapt to changes in the workplace, her awareness of normal hazards, and her ability to use public transportation or travel to unfamiliar places. (AR 268.) Dr. Parayno stated that Plaintiff had "psychotic symptoms [and] thoughts." (AR 267.)

In April 2007, Plaintiff continued her counseling at Fresno Mental Health. (AR 314-19.) On April 13, 2007, Plaintiff "participated in [the] group discussion more than she did before" and "displayed less sadness." (AR 318.) Plaintiff said, however, that she was "feeling sad, depressed, and helpless" and that she "depend[ed] on her children and her husband every day." (AR 317.) Plaintiff was encouraged to meet with Dr. Parayno and to "take [her] medication as prescribed."

(AR 317.) On April 26, 2007, Plaintiff indicated that her only social activity was her therapy sessions and that she only felt "less depressed" during that time as she was "with her peers." (AR 315.) On April 27, 2007, Plaintiff was "involved moderately in [the] group discussion" and stated that "her medical problems caused marital problems" and "limited [her] daily activities and socialization." (AR 314.)

On April 28, 2007, Plaintiff was examined by Ekram Michiel, M.D., for a psychiatric evaluation. (AR 269-71.) Plaintiff indicated that she was experiencing auditory and visual hallucinations, and that she would "wake up with bad dreams, screaming." (AR 269.) Plaintiff stated that her symptoms started ten years previously when she had been in a motor vehicle accident. (AR 269.) Dr. Michiel noted that Plaintiff's past psychiatric history included group therapy and care from a psychiatrist, including medication, but indicated that Plaintiff had "[n]o past psychiatric hospitalizations." (AR 269.) Plaintiff informed Dr. Michiel that she was "able to take care of her personal hygiene" but could "not do any more" and did "not go out." (AR 270.) Dr. Michiel performed a mental status examination and found that Plaintiff's attitude and behavior were "normal," her mood "depressed," and her "[a]ffect was restricted [and] sad." (AR 270-71.) Dr. Michiel found that Plaintiff's thought process was "goal-directed" and her "[t]hought content was not delusional" but that she stated that she was "fearful around people." (AR 271.) Dr. Michiel stated that although Plaintiff "[a]dmits to auditory and visual hallucinations," there was "no evidence during the interview of any response to internal stimuli." (AR 271.) Dr. Michiel opined that Plaintiff was "able to maintain attention and concentration and to carry out simple job instructions," "able to relate and interact with co-workers, supervisors, and the general public," but would be "unable to carry out an extensive variety of technical and/or complex instructions." (AR 271.) On May 14, 2007, S.V. Reddy, M.D., reviewed Plaintiff's records and affirmed Dr. Michiel's findings. (AR 278-81.)

Plaintiff continued to be seen at Fresno Mental Health through May and June 2007. (AR 305-13.) Her counselors indicated that she was alert and oriented with appropriate grooming and hygiene. (AR 309-13.) Plaintiff continued to feel depressed and stated that she suffered from "helpless and hopeless feelings."

On May 21, 2007, G. K. Ikawa, M.D., reviewed Plaintiff's medical records and performed a mental residual functional capacity ("RFC") assessment.*fn3 (AR 282-84.) Dr. Ikawa indicated that Plaintiff was "moderately limited in her ability to understand, remember, and carry out detailed instructions but not significantly limited in any other area. (AR 282-84.) Dr. Ikawa opined that Plaintiff was "able to sustain" simple repetitive tasks and was "able to relate and adapt." (AR 284.)

On May 24, 2007, Plaintiff informed Fresno Mental Health that she was having transportation problems and that it was difficult for her to attend her weekly counseling; she did not know how to drive and was thus dependent upon someone to bring her to the therapy session. (AR 307.) Plaintiff indicated that she was "feeling sad, depressed and helpless." (AR 307.) She attended sessions again on June 14 and June 28, 2007, and again indicated that she had transportation difficulties and could not attend regularly. (AR 305-06.) Plaintiff stated that she was "depressed and sad," had "no motivation," and "no interest[] in daily activities." (AR 305.)

Between June 7, 2007, and November 6, 2007, Plaintiff was seen at Kings Winery and was medically managed by Dr. Parayno. (AR 320-27, 349-54.) Plaintiff was also seen at Fresno Mental Health from August 30, 2007, through October 26, 2007. (AR 406-08.) Plaintiff indicated that she was sad, depressed, and felt helpless; she was encouraged to continue her support meetings since she was "stable and being able to maintain her current functioning level." (AR 406-08.)

On September 19, 2007, E.E. Wong, M.D., performed a case analysis, reviewed the medical records and affirmed the mental RFC assessment of Dr. Ikawa. (AR 331-33.)

On November 16, 2007, Plaintiff was involuntarily admitted to Fresno Mental Health as being a danger to herself. (AR 391-96.) Plaintiff's daughter had contacted the Fresno County Sheriff and advised that Plaintiff stated "she wanted to kill herself." (AR 396.) Plaintiff "was found hiding in the bushes about [a half] mile" from her home with "a bottle of pills that contained three unknown types of pills" and a "bottle of water." (AR 396.) Plaintiff's daughter reported that Plaintiff had "tried to kill herself before by overdosing." (AR 396.)

On November 17, 2007, a crisis assessment was performed at Fresno Mental Health regarding Plaintiff's involuntary hospital admission. (AR 401-03.) Plaintiff indicated that she did not know why she was admitted and did not remember the previous day. (AR 401.) Plaintiff indicated that she did remember "crying" the prior day and stated that "she [was] sad because of her multiple health problems. She believes that since she can't read, write, drive, or do anything around the house, she has no worth to her family." (AR 401.) The assessment determined that Plaintiff indicated that if she was released on that day, "she expects that she will attempt to overdose"; thus, continued "[h]ospitalization [was] required for safety and stabilization." (AR 403.) Plaintiff was, however, ultimately discharged on that date. (AR 391.)

On November 21, 2007, Plaintiff returned to Fresno Mental Health. (AR 390.) Her "[m]ood was depressed." (AR 390.) She "signed a no harm contract," indicating that she would not "harm herself or others." (AR 390.) The notes stated that Plaintiff remained under the care of Dr. Parayno. (AR 390.) Plaintiff was taking Seroquel and Paxil and her social worker "[e]xplained the importance and benefit for taking pyschotropic medications as prescribed."*fn4 (AR 390.) Plaintiff was seen again on November 29 and 30, 2007, and indicated that she was "sad, depressed, helpless, angry and agitated." (AR 388-89.) Plaintiff reported that she was scheduled to see Dr. Parayno within a few days. (AR 388.)

On December 7, 2007, Dr. Parayno assessed Plaintiff's mental functioning and indicated that Plaintiff had a depressive disorder which resulted in marked limitations in activities of daily living, social functioning, and maintaining concentration, persistence, and pace; Plaintiff also experienced "one or two" episodes of decompression, but not for an extended duration. (AR 334, 336.) Dr. Parayno indicated that Plaintiff's ability to work was impaired or poor at all levels, including her ability to relate and interact with supervisors and co-workers, work with the public, and carry out simple one-or two-step as well as complex instructions. (AR 338.) Dr. Parayno opined that Plaintiff was "unable to handle [the] pressure [and] stress of a full days['] work." (AR 338.)

Plaintiff was seen at Fresno Mental Health between December 11, 2007, through October 24, 2008. (AR 362-86.) The treatment notes indicate that Plaintiff had "low stress and frustration tolerance" and had "difficult[ies]. . . manag[ing] her anger." (AR 386.) Plaintiff was "participating in [a] Hmong support group and receiving psychotropic medications" so as to "learn coping and problem[] solving skills to cope with daily stressors, to reduce depression, [and] to avoid suicide thoughts or attempts and hospitalization." (AR 386.) On January 10, 2008, Plaintiff indicated that she was taking her medication as prescribed and that she continued to see Dr. Parayno as scheduled. (AR 380.) Plaintiff was still feeling "helpless and hopeless" and had "no motivation for any daily activities." (AR 380.) On February 14, 2008, Plaintiff reported that she felt "handicapped" because she was dependent upon "her family for transportation and finance" and that she did "not receive appropriate attention from her family and her husband did not understand her anguish." (AR 379.) On February 28, 2008, the treatment notes indicated that Plaintiff "[a]ppear[ed] relaxed and less sad" and that she made "good eye contact and [was] involved in [the] group discussion." (AR 377.)

On April 17, 2008, Plaintiff continued her care at Fresno Mental Health and reported that she was not active "in daily chores and her energy decreased due to worry, depression, marital problems and medical condition." (AR 374.) Plaintiff indicated that "her husband put her down" due to an "automobile accident in the past 18 years" which caused her to be unable to "fulfill her roles in the family" and thus she "lost respect from her husband and children." (AR 374.) On May 1, 2008, Plaintiff indicated that she had "less verbal arguments with her husband because she is able to manage her feelings." (AR 372.) On May 15, 2008, Plaintiff stated that her relationship with her husband had become "amicable." (AR 371.) Plaintiff still felt "helpless" because she was "unable to fulfill her family roles." (AR 371.) On June 12, 2008, Plaintiff indicated that she was "content[]" with the "love and care that she received from her family." On June 26, 2008, Plaintiff appeared to be "in good spirit" and stated that she not longer had suicidal ideation "because she loves her family"; she was also "involved more in family activities and social life than she [had been] before." (AR 369.) Plaintiff's relationship with her husband remained "amicable" and Plaintiff was now "able to control her emotions and express[] feelings in an appropriate way." (AR 369.) On October 17, 2008, Plaintiff stated that she was "feeling less depressed and less tearful" than when she had first started therapy. (AR 363.)

On February 21, 2009, Dr. Parayno completed a mental medical report and assessment. (AR 413-17.) Dr. Parayno diagnosed Plaintiff with a recurrent, severe major depressive disorder with psychotic symptoms and indicated that her response to treatment and prognosis was "fair." (AR 413.) Dr. Parayno indicated that Plaintiff's ability to follow work rules, relate to co-workers, interact with supervisors, deal with work stress, and function independently was "fair" (defined as "limited but satisfactory"), while her ability to interact with the public and maintain attention and concentration was "poor" (defined as "seriously limited but not precluded"). (AR 414.) Plaintiff had a "fair" ability to carry out simple job instructions but a "poor" ability to carry out detailed as well as complex job instructions. (AR 415.) Dr. Parayno also opined that Plaintiff's ability to work was "impaired" in all categories and that her response to treatment and prognosis was "fair to poor." (AR 417.)

On March 19, 2009, psychologist Vang Leng Mouanoutoua, Ph.D., completed a mental medical report form and medical assessment. (AR 418-22.) Dr. Mouanoutoua opined that Plaintiff had a poor ability to follow work rules, relate to co-workers, deal with the public, interact with supervisors, and maintain attention and concentration, and had no ability to use judgment, deal with work stress, or function independently. (AR 419.) Dr. Mouanoutoua found that Plaintiff's ability to carry out simple instructions was "fair" but "limited" and needed "supervision/encouragement." (AR 420, 422.) Her ability to carry out technical or complex job instructions was "impossible," as was her ability to deal with the public and withstand the stress and pressures of a work day. (AR 422.) Dr. Mouanoutoua opined that Plaintiff had a "poor prognosis due to her responses to past [treatment]." (AR 422.)

B. Lay Testimony

On March 20, 2007, Plaintiff completed an adult function report. (AR 142-49.) Plaintiff indicated that she lived at home her family and that her daily activities consisted of "stay[ing at] home, sitting, [and] walking inside." (AR 142.) Plaintiff indicated that her illness affected her sleep because she would "see people who died before [who] want [her] to go with them." (AR 143.) Plaintiff stated that she needed assistance to dress, bathe, and care for her hair, and needed reminders every day to take care of her personal needs, grooming, and to take her medicine. (AR 143-44.) Plaintiff's husband prepared her meals and he and her children took care of all the household chores. (AR 144.) Plaintiff stated that she was unable to do house or yard work because she had "too much pain [in her] arms" as well as a "steady headache [and] dizziness." (AR 145.) Plaintiff was unable to go out without a caretaker and was unable to go shopping. (AR 145.) Plaintiff indicated that her only hobby was "sleep." (AR 146.) Plaintiff had no social activities and did not get along with authority figures. (AR 146-48.) Plaintiff noted that she used crutches and a cane "any time[]" she went out. (AR 148.) Plaintiff reported that she had "nightmares" and would see "ghosts" of her "friend who died 20 years" previously. (AR 149.) Plaintiff stated that because she had been in a "bad accident" and "died for a month" that she could not do any "cleaning, cooking, laundry, shopping, bathing, grooming" and was "total[ly] dependent" upon her daughter. (AR 149.)

On July 28, 2007, Plaintiff's daughter Chue Her completed a third-party function report. (AR 150-57.) Ms. Her indicated that Plaintiff's daily activities were to "walk[] around the house" and to "take [a] nap sometimes." (AR 150.) Ms. Her reported that Plaintiff needed assistance with her personal care due to "weakness" and "poor memory." (AR 151.) Plaintiff needed reminders to take her medicine, which needed to be "put in her mouth" until she was "forced to swallow." (AR 152.) Ms. Her stated that Plaintiff had no social activities and needed someone to accompany her "24 hours/every day." (AR 154.) Ms. Her indicated that Plaintiff had been in a "bad car accident" and was unconscious for a month; "after that she [had] severe depression." (AR 157.) Ms. Her stated that Plaintiff was "functioning like a 6 year[-old] child." (AR 157.)

C. Administrative Hearings

The Commissioner denied Plaintiff's applications initially and again on reconsideration; consequently, Plaintiff requested a hearing before an Administrative Law Judge ("ALJ"). (AR 80-84, 86-90, 93.) ALJ Sharon L. Madsen held a hearing on April 7, 2009, at which Plaintiff and vocational expert ("VE") Judith Najarian testified. (AR 26-45.)

1. Plaintiff's Testimony

Plaintiff testified through an interpreter that she was born in 1964 and became disabled as of June 30, 2006. (AR 28-30.) Plaintiff was married and had a total of twelve children (one had passed away); eight children still lived at home and the youngest one was in school. (AR 30.) Plaintiff stated that she did not have a driver's license and did not know how to drive a car; she also did not know how to take a bus. (AR 31.) Plaintiff testified that she was unable to dress herself, do household chores, cook, or shop and that her husband or children handled those activities. (AR 32.) Plaintiff would "lay on the sofa" during the day and was unable to engage in social activities such as attending church, temple, or Hmong celebrations due to her depression. (AR 33.)

Plaintiff stated that she was in pain "all the time. Constantly." (AR 33.) Medication would only provide temporary relief. (AR 34.) Plaintiff said that she walked with a cane because she had "pain" and "might fall down." (AR 36.) Plaintiff testified that she had been using a cane for "over one and a half years" and that a doctor had prescribed its use. (AR 36.)

Plaintiff testified that a symptom of her depression was that she would "hear someone calling" her "all the time." (AR 34-35.) She was unable to concentrate and had difficulties getting along with people. (AR 35.) Plaintiff indicated that prior to her depression, she would get along with people, attend social ...

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