United States District Court, N.D. Illinois, Eastern Division
MEMORANDUM OPINION AND ORDER
B. KIM UNITED STATES MAGISTRATE JUDGE
Moore filed applications for Disability Insurance Benefits
(“DIB”) and Supplemental Security Income
(“SSI”) benefits alleging that she is disabled by
myasthenia gravis. After the Commissioner of the Social
Security Administration denied her applications, Moore filed
this suit seeking judicial review. See 42 U.S.C.
§ 405(g). Before the court is Moore's motion for
summary judgment. For the following reasons, the motion is
denied and the Commissioner's final decision is affirmed:
filed her concurrent DIB and SSI applications on January 4,
2012, alleging a disability caused by myasthenia gravis
(“MG”) since November 24, 2011. (Administrative
Record (“A.R.”) 162-74.) Her claims were denied
initially on February 24, 2012, and on reconsideration on
September 13, 2012. (Id. at 81-84.) Moore requested
and was granted a hearing before an Administrative Law Judge
(“ALJ”) which took place on September 4, 2013.
(Id. at 29-80.) On November 27, 2013, the ALJ issued
a decision finding that Moore is not disabled and thus not
entitled to DIB or SSI. (Id. at 8-24.) When the
Appeals Council declined review, (id. at 1-3), the ALJ's
decision became the final decision of the Commissioner,
see Schomas v. Colvin, 732 F.3d 702, 707 (7th Cir.
2013). Moore filed this action seeking judicial review,
(R.1); see 42 U.S.C. § 405(g), and the parties
consented to this court's jurisdiction, (R.5);
see 28 U.S.C. § 636(c).
was 27 years old and working as a mail carrier for the U.S.
Postal Service in November 2011, when she alleges that
symptoms stemming from MG forced her to stop working.
Myasthenia gravis is a “disease characterized by
progressive weakness and exhaustibility of voluntary muscles
without atrophy or sensory disturbance and caused by an
autoimmune attack on acetylcholine receptors at the
neuromuscular junction.” Merriam-Webster Dictionary,
(last visited Sept. 29, 2016). At her hearing before the ALJ,
Moore presented documentary and testimonial evidence in
support of her claim that her MG symptoms render her
records indicate that since August 2009 Moore has been a
patient at Rush University Medical Center, where Dr. Megan
Shanks has been treating her for MG. (A.R. 300.) On October
26, 2009, Moore underwent a pulmonary test which resulted in
a finding that she had respiratory muscle weakness consistent
with MG. (Id. at 310.) That same day Moore reported
to Dr. Shanks that the effects of the prednisone she had been
prescribed wore off within an hour. (Id. at 310.)
After a physical examination, Dr. Shanks noted mostly normal
results other than some issues with voice quality and
diplopia. (Id.) Dr. Shanks informed Moore of the
dangers of taking certain MG medications while pregnant.
(Id. at 301.)
March 2010, after a flare up of MG symptoms, Dr. Shanks
increased Moore's prednisone prescription. (Id.
at 294.) During a follow-up visit two months later, Dr.
Shanks again increased her prednisone dose because the
previous increase had not helped her symptoms. (Id.
at 291.) Throughout 2010, Moore visited Dr. Shanks with
fluctuating reports of her condition. While she reported
“less severe” symptoms at times, she also
reported flare-ups involving double vision and speech
slurring. (Id. at 286, 290.)
November 11, 2010, Dr. Shanks prepared a note for Moore's
manager informing him that Moore's medical condition
continued to warrant work restrictions. (Id. at
285.) She limited Moore to walking from two hours to two and
a half hours per day with breaks for rest as needed.
(Id.) Dr. Shanks noted that Moore may continue to
work up to eight hours or more per work day if tolerated.
(Id.) However, despite medical management, Moore
continued to weaken easily, could not climb more than a
flight of stairs, and walked very slowly to avoid severe
weakness. (Id. at 329.)
became pregnant in the late spring of 2011. (Id. at
246.) That July Dr. Shanks added prescriptions to Moore's
medication plan but Moore never filled them because of her
pregnancy. (Id.) During her pregnancy, Moore
reported an improvement in her double vision but continued to
have nasal speech, generalized weakness, and a diminished
ability to swallow. (Id.) During a follow-up visit
in October 2011, Moore reported worsening limb fatigue as she
was no longer able to walk at a normal pace and required rest
after one flight of stairs. (Id. at 259.) Dr. Shanks
noted that at that time Moore “no longer has 2 ½
hours walking at work, only an hour within a 7 hour schedule
with postal delivery.” (Id.) By November 2011
Moore had stopped work. (Id. at 270.) Two months
later Moore suffered severe MG symptoms but only slightly
worse than her baseline. (Id. at 345.) Moore
reported that the prednisone was ineffective but Dr. Shanks
continued to limit her Cellcept intake because of her
August 2, 2012, during a post-pregnancy follow-up
appointment, Moore continued to report shortness of breath
and fatigue. (Id. at 397.) In her notes from that
visit Dr. Shanks expressed concerns that Moore had medication
“compliance issues in the past with questionable
reporting and [was] frequently 30 min[utes] late for her 30
min[ute] appointment.” (Id.) Dr. Shanks noted
Although [Moore] continues to state that she takes her
prednisone as prescribed, I discovered after her
[appointment] today that her pharmacy fill pattern
indicate[s] that she does not take her medications as
prescribed, and takes much less prednisone than she was
given. I would conclude given that she initially responded to
prednisone, that she probably didn't take it much during
2009 when I kept increasing the dose, and she may have taken
some in late 2010 and early 2011 resulting in some
improvement (although she was not filling the Cellcept Rx
between 7/2010 through 1/2010 as prescribed). This is
reassuring in that the prednisone is likely still effective
if she actually takes it. I will not prescribe a steroid
sparing agent as she is too unreliable.
(Id. at 399-400.) After a March 2013 visit, Dr.
Shanks wrote that Moore's mother was angry with her
because Moore was denied Social Security benefits and
Moore's mother attributed the denial to Dr. Shanks's
comments that Moore did not take her medication.
(Id. at 396.) Dr. Shanks noted in her report that
while MG is an incurable disease, and that it is possible
Moore may ...