Brown v. Commissioner Social Security Administration

Filing 21

Opinion and Order. Signed on 09/05/2017 by Judge Robert E. Jones. (rs)

IN THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF OREGON

DIANNA LYNN BROWN,

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Plaintiff,

6: 16-CV-00047-JO

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NANCY A. BERRYHILL, Acting Commissioner
of Social Security,
Defendant.

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OPINION AND ORDER

JONES, J.,
Plaintiff Dianna Brown appeals the Commissioner's decision denying her concunent
applications for disability insurance benefits and supplemental security income under Titles II and
XVI of the Social Security Act. The court has jurisdiction under 42 U.S.C. § 405(g). I AFFIRM the
Commissioner's decision.
PRIOR PROCEEDINGS
Brown alleged disability beginning in March 2001, due to post traumatic stress disorder
(PTSD), depression, anxiety, bipolar disorder, and chronic joint pain from aiihritis. Admin. R. 225,
275. At the administrative hearing she amended the alleged onset of disability to October 2, 2010,
the date she last worked. Admin. R. 49. Brown satisfied the insured status requirements under the
Act through December 31, 2015, and must establish that she was disabled on or before that date to
prevail on her Title II claim. Tidwell v. Apfel, 161 F.3d 599, 601 (9th Cir. 1998).

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OPINION AND ORDER

The ALJ applied the sequential disability determination process described in 20 C.F.R.
sections 404.1520 and 416.920. See Bowen v. Yuckert, 482 U.S. 137, 140 (1987). The ALJ found
Brown's ability to perform basic work activities adversely affected by osteomihritis of the knees,
bipolar disorder with depression, personality disorder, PTSD, and a history of alcohol abuse. Admin.
R. 18. The ALJ found that, despite these impairments, Brown retained the residual functional
capacity ("RFC") to perform a range of work at the medium level of exertion, with limited postural
activities, such as crawling, kneeling, stooping, climbing and so fmih, and no more than occasional
interactions with supervisors, coworkers, and the general public. Admin. R. 20-36.
The vocational expert ("VE") testified that a person having Brown's age, education, work
experience, and RFC could perform the activities required in unskilled occupations such as motel
cleaner, hand packager, price marker, and industrial cleaner, which, in combination, represent
hundreds of thousands of jobs in the national economy. Admin. R. 37-38, 72-73. The ALJ
concluded that Brown was not disabled within the meaning of the Social Security Act. Admin. R.
38.
STANDARD OF REVIEW

The district cou1i must affirm the Commissioner's decision if it is based on proper legal
standards and the findings of fact are supported by substantial evidence in the record as a whole.
Tommasetti v. Astrue, 533 F.3d 1035, 1038 (9th Cir. 2008). Substantial evidence is relevant

evidence that a reasonable person might accept as adequate to suppmi a conclusion. Richardson v.
Perales, 402 U.S. 389, 401 (1971). Substantial evidence may be less than a preponderance of the

evidence. Robbins v. Soc. Sec. Adm in., 466 F.3d 880, 882 (9th Cir. 2006). Under this standard, the
cou1i must consider the record as a whole, and uphold the Commissioner's factual findings that are
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OPINION AND ORDER

supported by inferences reasonably drawn from the evidence even if another interpretation is also
rational. Robbins, 466 F.3d at 882; Batson v. Comm 'r ofSoc. Sec. Adm in., 359 F.3d 1190, 1193 (9th
Cir. 2004); Andrews v. Sha/ala, 53 F.3d 1035, 1039-40 (9th Cir. 1995).
ASSIGNMENTS OF ERROR

The plaintiff bears the burden of showing that the ALJ erred and that any error was harmful.
lvfcLeod v. Astrue, 640 F.3d 881, 886-87 (9th Cir. 2011). Brown contends the ALJ failed to fully
develop the record regarding her mental impairments. She contends the ALJ improperly discredited
her subjective statements about her symptoms and discounted the global assessment of functioning
("GAF") scores assigned by mental health providers. Brown argues that these errors led the ALJ to
elicit testimony from the VE based on hypothetical assumptions that did not accurately reflect all of
her functional limitations and to erroneously conclude that she is not disabled.
DISCUSSION

I.

Development of the Record

Brown contends the ALJ failed to fully develop the record because he denied her request for
a consultative psychological evaluation. Admin. R. 49, 302. An ALJ has a duty to assist the
claimant in developing the record. Delorme v. Sullivan, 924 F.2d 841, 849 (9th Cir. 1991). The
ALJ did so in case, by obtaining medical records, written statements, and testimony from the health
care providers and third paiiywitnessesBrown identified. See Bowen v. Yuckert, 482 U.S. 137, 140
n. 5 (1987) (The claimant is in the best position to provide info1mation about his medical condition
and identify sources of such information). An ALJ's duty to develop the record further is triggered
only when the ALJ finds it is necessary to resolve an ambiguity or when the record is inadequate to

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OPINION AND ORDER

allow for proper evaluation of the claim. Tonapetyan v. Halter, 242 F.3d 1144, 1150 (9th Cir. 2001 );
kfayes v. kfassanari, 276 F.3d 453, 459-60 (9th Cir. 2001).

Brown contends the record is ambiguous regarding her mental impairments because there
were a variety of provisional diagnoses by different health care providers, including possible mood
disorders, such as major depression and cyclothymic disorder, anxiety, and personality disorder.
Admin. R. 444, 474, 758. The ALJ did not find an ambiguity or inadequacy here that would require
further development of the record. lvfayes, 276 F.3d at 459-60; Tonapetyan, 242 F.3d at 1150. The
ALJ reviewed the treatment records and considered the expert opinion of the state agency
psychological consultant. He found that the record supported diagnoses of bipolar disorder with
depression, personality disorder, and PTSD. Admin. R. 18.
Even if the provisional diagnoses suggested a lack of unanimity regarding the most
appropriate diagnostic impression, the record as a whole made both the nature and severity of
Brown's functional limitations from mental impainnents reasonably clear. The treatment records
show that Brown's primary functional limitations were social difficulties, including distrust of others
and aggression in response to situations in which she felt she had been treated with disrespect.
Admin. R. 18-20, 24-29, 32, 109-112, 377, 380, 381, 385, 387, 396, 409, 742, 743, 748, 749, 754,
875, 878, 883. The ALJ found that Brown's reported activities provided a basis to reasonably
estimate the degree of her limitations. Brown was capable of social interactions such as attending
church, being involved in her church community, living in a donnitory setting, daily grocery
shopping, visiting neighbors and friends, and using public transportation, among other activities.
Admin. R. 21, 24-27, 29-30, 36, 241-243, 286-287.

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OPINION AND ORDER

In sunnnary, the ALJ determined that the case record, including Brown's treatment records,
repo1ied activities, and other relevant matters, provided sufficient evidence to fully evaluate the
nature and severity of her functional limitations from mental impairments. Accordingly, he found
an additional consultative evaluation unnecessmy. Admin. R. 15. The ALJ accommodated Brown's
reported social difficulties by limiting her RFC to work involving only occasional interactions with
others. Admin. R. 20. Brown did not allege additional functional limitations that a consultative
evaluation would support. She merely suggested that a consultative evaluation might produce some
evidence of disability. Such speculation does not trigger the ALJ's duty to develop the record
further. 1vfayes, 276 F.3d at 461.

II.

Evaluation of Subjective Symptoms
In her application papers, Brown said she last worked in October 2010 when she was fired

for reasons umelated to disability. She said PTSD, depression, anxiety and arthritis limited her
ability to work. Admin. R. 225. She could walk about one block and then would need to rest for
15 minutes. She had difficulty with memmy and concentration, but could pay attention "as long as
needed" and could follow clear instructions. Adm in. R. 24 3. Brown said she got along with
authority figures, as long as they did not have a bad attitude. She could handle stress pretty well, but
had difficulty with changes in routine. Admin. R. 244. In a later report, Brown said she could not
stand or sit without pain in her joints and muscles. She did not like to have people near her. Brown
said she had difficulty concentrating and problematic mood swings. Admin. R. 283. Inconsistently
with her earlier function report, Brown said she did not get along well with authority figures and had
difficulty handling stress. Admin. R. 288-289.

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OPINION AND ORDER

At the administrative hearing, Brown said that difficulty being around people and bad mood
swings kept her from doing any sort of work. Admin. R. 52. She sometimes experienced episodes
in which she felt really down and would not talk to anyone. If someone treated her with disrespect,
she would become ang1y and confront them. Admin. R. 58.
The ALJ found that Brown's medically dete1minable impairments could reasonably be
expected to produce some of the symptoms she alleged and he did not identify affirmative evidence
of malingering. Admin. R. 22. Under such circumstances, an ALJ must assess the credibility of the
claimant's statements about the severity of symptoms. Here, the ALJ did so and concluded that
Brown's statements suggesting that her symptoms were so persistent and intense that their limiting
effects precluded any sort of work were not entirely credible. Adm in. R. 22. As reflected in the RFC
assessment, the ALJ believed that Brown's aithritis limited her activities, and that her mental
impahments limited her ability to work in frequent contact with others. He discounted her
statements, only to the extent she claimed that her symptoms precluded her from work with limited
climbing, kneeling, stooping and so forth and with only occasional interactions with others at work.
Admin. R. 20.
An adverse credibility determination must include specific findings suppo1ted by substantial
evidence and clear and convincing reasons. Carmickle v. Comm 'r, Soc. Sec. Admin., 533 F.3d 1155,
1160 (9th Cir. 2008); Smolen v. Chafer, 80 F.3d 1273, 1281-82 (9th Cir. 1996). The findings must
be sufficiently specific to permit the reviewing comt to conclude that the ALJ did not arbitrarily
discredit the claimant's statements. Tomasetti v. Astrue, 533 F.3d at 1039.
In assessing credibility, an ALJ must consider all the evidence in the case record, including
the objective medical evidence, the claimant's treatment history, medical opinions, daily activities,

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work history, the observations of third parties with knowledge of the claimant's functional
limitations, and any other evidence that bears on the consistency and veracity of the claimant's
statements. Tommasetti, 533 F3d at 1039; Smolen, 80 F3d at 1284; SSR 16-3p, available at 2016
WL 1110029 (2016).
The ALJ' s decision demonstrates that he perfmmed a thorough review of all the evidence
relating to proper factors for evaluating the intensity, persistence and limiting effects of Brown's
symptoms. Admin. R. 20-36. He considered the objective medical evidence and Brown's treatment
history, and found that this evidence did not support the claim thather physical impairments preclude
her from work with the postural limitations in the RFC assessment. Admin. R. 22, 34. This finding
is supported by substantial evidence in the record.
As a baseline for her physical symptoms, the ALJ noted that before the alleged onset of
disability, Brown already complained of clu·onic pain in the lower extremities but diagnostic imaging
showed only early signs of mild, marginal osteoarthritis. Admin. R. 22, 677, 711-715. Notably, the
medical records do not indicate any change in her physical health at the alleged onset of disability
in October 2010. After the alleged onset of disability, Brown had a normal physical examination in
August 2011; she said she felt excellent and had no complaints of physical pain. Admin. R. 22, 383.
In February 2012, Brown said she had chronic back pain that was "not particularly

bothersome" with no lower extremity weakness or difficulty walking or climbing stairs. On physical
examination, Brown had a smooth, well coordinated gait, normal tandem gait, notmal heel to toe
walk, no difficulty rising from sitting, and no discomfort getting on and off the examination table.
Her physical examination was entirely benign, showing full ranges of motion without discomfort,
full muscle strength, and intact reflexes and sensation. Admin. R. 23, 369. In November 2012,
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OPINION AND ORDER

Brown sprained her right ankle but was able bear weight and ambulate without difficulty. She had
mild tenderness in her right knee, but retained full range of motion without effusion or signs oflaxity
in the ligaments. Admin. R. 23, 649-650, 750.
In February 2014, Brown saw an orthopedic specialist for increased pain in both knees.
Diagnostic imaging showed moderate osteoaiihritis without joint effusion or soft tissue swelling.
Physical examination revealed that Brown had full muscle strength without laxity in the ligaments.
Dr. Stephen Shah recommended steroid injections, which Brown declined. He then recommended
treatment with nonsteroidal anti-inflammatory drugs ("NSAIDS") and low impact exercise. Admin.

R. 24, 845-849. Brown returned for a second opinion regarding knee pain. Peter Patricelli, M.D.,
agreed with Dr. Shah that Brown's objective findings supported conservative treatment with
NSAIDs and Tylenol. Admin. R. 24, 83 5. In March 2014, Brown had another physical examination
for complaints of joint pain, and Mary Loeb, M.D. encouraged her to exercise and to avoid long
periods of sitting. Admin. R. 24, 831-832.
These relatively benign objective findings do not support the presence of debilitating arthritis
symptoms. Lingenfelter v. Astrue, 504 F.3d 1028, 1040 (9th Cir. 2007); Burch v. Barnhart, 400 F.3d
676, 681 (9th Cir. 2005). Likewise, the conservative treatment Brown received suggests her
symptoms were not so severe as to preclude any work activity. Parrav. Astrue, 481F3d742, 750-51
(9th Cir. 2007); 1'.Ieanal v. Apfel, 172 F3d 1111, 1114 (9th Cir. 1999).
Similai·ly, the ALJ considered the objective findings and treatment notes of the psychiatrists
and counselors who treated Brown for mental health issues. He concluded this evidence showed that
Brown functioned well when stable on medications. Admin. R. 24, 34-35. The longitudinal record
describes a pattern of generally moderate depression symptoms with exacerbations during periods

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OPINION AND ORDER

of medication adjustment and situational stressors, including financial difficulty, homelessness, and
her strained relationship with her father.
Brown established care with her counselor, Jordan Shin, in July 2009, the year before the
alleged onset of disability. She complained of stress, anxiety, and depression, and endorsed mild
symptoms on a depression invento1y.

She divulged a histo1y of substance abuse, including

marijuana, methamphetamine, and cocaine, and cmTent heavy alcohol use. Admin. R. 692-694. In
October 2009, Brown saw psychiatrist Alfredo Velez, M.D., for depression associated with
situational stressors. He noted that Brown appeared well and fully oriented with full affect, euthymic
mood, and logical thought processes and associations. Her cognition was intact. Brown had an
average fund of knowledge with good insight and judgment. Dr. Velez prescribed an antidepressant.
Admin. R. 682.
The records do not reflect any change in her mental health at the time her disability allegedly
began in October 2010. Ms. Shin said that Brown appeared to be functioning well, speaking freely
with appropriate affect, and remaining cheerful and relaxed, even when talking about potentially
distressing events. Admin. R. 24, 409, 411. In October 2010, Brown told Ms. Shin that she had
been fired from her job. Despite this potentially stressful situation, Ms. Shin said Brown appeared
to be coping and functioning well. Admin. R. 24, 405. In December 2010, Brown told Ms. Shin she
was minimally depressed and coping well with stress from the holidays, bad weather, being alone
and other stressors. Admin. R. 24, 396. In Janumy 2011, Ms. Shin observed that Brown continued
to function well and wanted to discontinue counseling with continued medication management.
Admin. R. 395. In July201 l, Brown told Ms. Shin that she had increased stress because her mother
was in the hospital. She appeared to be functioning well and coping with the stress. Admin. R. 24-

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25, 387. At a follow up medical appointment with a physician assistant, Brown had good eye
contact, coherent thought processes, and good insight. She was not withdrawn or agitated. Her
mental health symptoms appeared to be controlled by medications, despite situational stressors.
Admin. R. 25, 384-3 85. In September 2011, Brown had run out of her prescribed antidepressant and
appeared agitated and depressed in response to derogatory comments from her father. Admin. R.
25, 381. By the next month, after restarting her medications, she appeared to be functioning well
again, and she tenninated counseling. Admin. R. 25, 377.
At a medical check up in Februaiy 2012, Brown denied depression or panic attacks and said
her antidepressant medication was working to level her mood. She made good eye contact, had
coherent thought processes, and was not tearful or withdrawn. She spoke confidently and laughed
throughout the examination. Brown reported she was working as a dog groomer. The physician
assistant said her mental health issues were currently stable, but encouraged her to decrease her
alcohol consumption due to its potential adverse contribution to depression and anxiety. Brown
declined counseling. Admin. R. 26, 369. At another medication check in June 2012, Brown said
she had been abstaining from alcohol after getting a DUI. She said her mood had been level,
although she continued to have episodes of anxiety due to situational stress. She denied being
particularly depressed or tearful. The physician assistant observed that she appeared to be upbeat
and positive, without agitation, fidgeting, or symptoms of depression. Admin. R. 26, 365.
Brown had a brief period of significant difficulty in July 2012 when she took an intentional
overdose of prescription drugs after a family argument. The ALJ noted evidence that Brown was
evasive and manipulative concerning her drinking and drug use. Admin. R. 26, 466, 472, 474, 477.
After a medical hospitalization to treat physical effects of the overdose, including pneumonia, Brown
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OPINION AND ORDER

was admitted for inpatient psychiatric care on August 1, 2012. Admin. R. 26, 448. After a brief
hospital course in which she restarted her medications, Brown's mood rapidly improved and she was
able to pai1icipate in group sessions. Admin. R. 27, 446. When she was discharged on August 3,
2012, Brown was oriented and had full affect, euthymic mood, and logical thought processes. Her
judgment and insight were fair to good and she denied delusions and suicidal ideation. Admin. R.
447.
On August 20, 2012, Brown saw James Hylton, M.D. for a medication check. Dr. Hylton
observed that Brown was pleasant, ale11, and oriented, with a normal train of thought and a good
sense of humor. She was accompanied by a supportive friend who told Dr. Hylton that Brown was
"back to normal." Brown said she had a good support network and an action plan for coping with
stressful situations, should they arise. Admin. R. 27, 767-768.
In September 2012, at a post hospitalization follow up with Dr. Velez, Brown said she was
doing ve1y well and she appeared alert and oriented, with full affect and logical thought processes.
Her insight and judgment were good. Her mood was mildly ilTitable. Brown said she thought her
medication regimen was losing effectiveness and Dr. Velez agreed to staii different medications for
depression and anxiety. Admin. R. 758. In October 2012, Brown told Dr. Velez she was doing ve1y
well on the new medications, but wanted to increase the dosage of her antidepressant. She reported
that she was reading a lot of books, getting more involved in her church, and dealing with family
interactions in a positive way. Dr. Velez found her ale11 and oriented, with full affect and euthymic
mood. Her thought processes and associations were logical, her thought content was n01mal, and
her insight and judgment were fair to good. Admin. R. 27, 754.

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OPINION AND ORDER

On October 25, 2012, Brown's father took her to the emergency room after she made vague
references suggesting she might become suicidal again ifher father did not give her money. At the
hospital, Brown admitted she was not suicidal and had no suicidal ideation. She said she was
frustrated and ang1y because her father would not help her financially and she could not work
without derailing her application for disability benefits. Hospital staff observed that she was
cooperative and interactive with a bright affect. She was ale1i, oriented, calm, and cooperative. Her
speech and memo1y were within normal limits, thoughts were logical and coherent, and responses
were appropriate. Admin. R. 27-28, 507, 509. Brown admitted to her counselor that she felt she
had to manipulate men to get money, including implied threats of suicide to her father. Admin. R.
753. Brown resumed counseling with Ms. Shin, who said Brown spoke freely with appropriate
affect and appeared to be coping well with stressors. Admin. R. 28, 746, 748, 749, 752.
In Januaiy 2013, Brown told Dr. Hylton that her moods were cyclical and that she wanted
to tty a mood stabilizing medication. Dr. Hylton found her pleasant, ale1i, and in tune with her
condition with a good sense of humor. He added Lamictal to Brown's medication regimen. Admin.
R. 29, 744. In her sessions with Ms. Shin during the following months, Brown appeared to be
benefitting from the added medication, feeling better overall, laughing more, having good dreams,
and waking up happy. She was attending church regularly, thinking about volunteering to care for
elderly people, and wanted to start a dog grooming business. She was attending mandato1y meetings
of all alcohol treatment group and felt able to keep impulsiveness in check while abstaining from
alcohol. Ms. Shin noted that Brown was largely positive and appeared to be functioning well,
speaking freely with an appropriate affect. Admin. R. 29-30, 742, 743, 875, 878, 882, 883.

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OPINION AND ORDER

In September 2013, Brown went to the emergency room rep01iing an increase in depression
due to situational stressors, including being told by her father to move out of his apaitment complex,
being kicked out of a shelter for intoxication, and worrying about her brother's recent hemt surgery.
Notably, Brown was not taking her prescribed medications. The emergency room doctor said she
appeared depressed, but not in imminent risk of harming herself. Her speech was clear, coherent,
and no1mal in rate, rhythm, and volume. Her thoughts were logical and linear. Emergency room
staff provided her prescription medications and discharged her in fair condition. Admin. R. 30, 799,
811, 815. Ms. Shin said Brown's distress was based on a combination of situational stressors and
medication withdrawal, and sent her to refill her prescriptions. Admin. R. 30, 868, 872. In October,
Brown showed marked improvement in her mental health after stabilizing on her medications.
Admin. R. 30, 865-866. In February and March 2014, Brown said she was doing well on her
medications and appeared to be coping adequately with stressors in her life. Admin. R. 31, 829, 850852. In April, however, Brown went to the emergency room repo1ting suicidal ideation and thoughts
of overdosing.

Medical staff related this exacerbation of symptoms to a recent change in

medications to which she had not stabilized. Admin. R. 31, 886-887.
These treatment records suppo1t the ALJ' s determination that Brown generally functioned
well while stabilized on medications. Impairments that are controlled by medications are not
disabling. Warre v. Comm 'r ofSoc. Sec. Admin., 439 F.3d 1001, 1006 (9th Cir. 2006). The episodes
of exacerbated symptoms that appear in the record coincide with noncompliance with treatment and
with periods of stabilization after changes in her medications. Admin. R. 20, 24, 34. The record also
supports the ALJ's view that Brown demonstrated a focus on obtaining disability benefits to solve
her financial strain, familial conflicts over support, and other situational stressors. Admin. R. 35.

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OPINION AND ORDER

Evidence of motivation to obtain financial benefits may support an adverse inference as to the
claimant's subjective statements about the limiting effects of symptoms. lY!atney v. Sullivan, 981
F.2d 1016, 1020 (9th Cir. 1992).
The ALJ properly considered the opinion evidence offered by the state agency medical
experts. Lloyd Wiggins, M.D., opined that Brown's physical impailments were not severe enough
to adversely impact her ability to work, and Sandra Lundblad, Psy.D., opined that Brown's mental
impairments caused no more than mild functional limitations in her ability to work. Admin. R. 31,
32, 109, 121. These opinions support the ALJ's determination regarding the limiting effects of
Brown's symptoms. Notably, the ALJ gave Brown the benefit of the doubt by finding her far more
limited than the experts opined. Admin. R. 31-32.
The ALJ also found that Brown engaged in activities that were not consistent with
debilitating symptoms. Admin. R. 35-36. This is a reasonable basis for finding a claimant less
impaired than she claimed. Orn v. Astrue, 495 F.3d 625, 639 (9th Cir. 2007). For example, Brown
engaged in social interactions such as involvement in her church comm1mity, living in a d01mitory
setting, daily groce1y shopping, visiting with neighbors and friends, and using public transportation,
among other activities. Admin. R. 21, 24-27, 29-30, 36, 241-243, 286-287. Brown also repo1ted
working as a caregiver and dog groomer after the alleged onset of disability. Admin. R. 36, 315,
368, 380-382. The ALJ found these activities inconsistent with Brown's subjective symptoms, such
as not being able to be around others or engage in physical activities. Admin. R. 35-36
The ALJ also considered Brown's work histo1y and noted that her alleged onset of disability
coincided with the date she was fired for taking unscheduled breaks. Admin. R. 22, 35, 51, 225.
When a claimant stops working for reasons umelated to disability, it may reasonably cast doubt on
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OPINION AND ORDER

a subsequent claim that she cannot work due to a disabling medical condition. Bruton v. lvfassanari,
268 F.3d 824, 828 (9th Cir. 2001).
The ALJ atiiculated clear and convincing reasons for his evaluation of Brown's subjective
symptoms and his findings are suppotied by substantial evidence in the record. Carmickle, 533 F.3d
at 1160; Smolen v. Chafer, 80 F.3d at 1281-82. His findings are sufficiently specific to satisfy me
that he did not arbitrarily discredit Brown's subjective statements about the intensity, persistence and
limiting effects of her symptoms. Accordingly, I find no error in the ALJ's evaluation. Tommasetti,
533 F.3d at 1039; Carmickle, 533 F.3d at 1160.

III.

Global Assessment of Functioning
Brown contends the ALJ erred by failing to give sufficient weight to the GAF scores assigned

by mental health treatment providers. A GAF score reflects a clinician's judgment about the severity
of a patient's symptoms or the level of overall functioning at the time of the assessment. Admin. R.
32. Diagnostic and Statistical lvfanua/ oflvfental Disorders (4th ed. 1994) ("DSM IV") 33.
In July 2012, while Brown was hospitalized after overdosing on her medications, treatment

providers assigned GAF scores of15-20, 25, 29, and 30. Admin. R. 32, 478, 560, 569. At discharge
on August 3, 2012, however, Brown was assessed a GAF of 55, which indicates either moderate
symptoms or moderate difficulty in broad categories of function. Admin. R. 32. 446, 522. DSM N
34.
In September 2013, when Brown was not taking her prescribed medications and sought
urgent help from the emergency department, her GAF was assessed at 42 and 45. Admin. R. 32,
799, 825. Then in April 2014, when Brown visited the emergency department with increased

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OPINION AND ORDER

emotionality while trying to stabilize after a change in medications, her GAF was 35. Admin. R. 32,
887.
The ALJ did not reject these opinions, but gave the GAF scores little weight in assessing
Brown's general level of functioning while compliant with treatment and stabilized on her
medications. Admin. R. 32. The ALJ c01Tectly noted that the GAF scores reflected only Brown's
level of functioning during brief episodes of acute distress while she was not stabilized on
medications. The ALJ reasonably relied on the longitudinal treatment records and the evidence in
the record as a whole to provide a better assessment of her general functioning. Admin. R. 32. This
is a reasonable interpretation of the evidence in the record, and it will not be overturned. Robbins,
466 F.3d at 882; Batson, 359 F.3d at 1193; Andrews, 53 F.3d at 1039--40.

IV.

Other Contentions
Brown contends the ALJ erred by failing to include a limitation in her RFC indicating that

she must use a cane at work. The record reflects that, Brown used a cane briefly in April 2013 and
in February 2014, after twisting her knee. Admin. R. 23-24, 865, 873, 880. The ALJ did not find
that a cane was medically necessary for Brown to engage in work, and that is a rational interpretation
of the evidence in the record. Accordingly, it will not be ove1iurned. Robbins, 466 F.3d at 882;

Batson, 359 F.3d at 1193; Andrews, 53 F.3d at 1039--40.
Brown contends the ALJ elicited testimony from the VE with hypothetical assumptions that
did not include all of the limitations described in her subjective statements or limitations reflecting
her low GAF scores. The ALJ elicited testimony from the VE based on hypothetical questions that
accurately reflected his assessmentofBrown's RFC. Admin. R. 72. The VE testified that jobs exist
in the national economy that a person with the described RFC could perfo1m. Admin. R. 72-73.

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OPINION AND ORDER

Because I find no enor in the ALJ' s RFC assessment, the hypothetical limitations posed to the VE
were also free of enor, and the VE's testimony satisfied the Commissioner's bmden to show there
are jobs in the national economy that Brown could perform. Andrews v. Shala/a, 53 F.3d at 1043.
The ALJ was not required to include additional hypothetical limitations he found unsuppo1ied by
the record. Osenbrock v. Apfel, 240 F.3d 1157, 1163-65 (9th Cir. 2001).
CONCLUSION

For the foregoing reasons, the Commissioner's final decision is AFFIRJ\1ED.
s~

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OPINION AND ORDER