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Moore v. Colvin

United States District Court, N.D. Illinois, Eastern Division

October 6, 2016

CAROLYN W. COLVIN, Acting Commissioner, Social Security Administration, Defendant.



         Ayesha 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:

         Procedural History

         Moore 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).


         Moore 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 disabled.

         A. Medical Evidence

         Medical 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.)

         In 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.)

         On 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.)

         Moore 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 pregnancy. (Id.)

         On 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 that:

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 ...

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