United States District Court, N.D. Illinois, Eastern Division
JERRY T. GRANGER JR., Plaintiff,
NANCY A. BERRYHILL, Acting Commissioner of Social Security,  Defendant.
MEMORANDUM OPINION AND ORDER
M. Rowland Magistrate Judge.
Jerry T. Granger Jr. filed this action seeking reversal of
the final decision of the Commissioner of Social Security
denying his applications for Disability Insurance Benefits
(DIB) and Supplemental Security Income (SSI) under Titles II
and XVI of the Social Security Act (SSA). 42 U.S.C.
§§ 405(g), 423 et seq. The parties have
consented to the jurisdiction of the United States Magistrate
Judge, pursuant to 28 U.S.C. § 636(c), and Plaintiff has
filed a request to reverse the Administrative Law Judge's
(ALJ's) decision and remand for additional proceedings.
For the reasons stated below, the case is remanded for
further proceedings consistent with this Opinion.
THE SEQUENTIAL EVALUATION PROCESS
recover DIB or SSI, a claimant must establish that he or she
is disabled within the meaning of the Act. York v.
Massanari, 155 F.Supp.2d 973, 976-77 (N.D. Ill.
2001). A person is disabled if he or she is
unable to perform “any substantial gainful activity by
reason of any medically determinable physical or mental
impairment which can be expected to result in death or which
has lasted or can be expected to last for a continuous period
of not less than 12 months.” 20 C.F.R. §§
404.1505(a), 416.905(a). In determining whether a claimant
suffers from a disability, the Commissioner conducts a
standard five-step inquiry:
1. Is the claimant presently unemployed?
2. Does the claimant have a severe medically determinable
physical or mental impairment that interferes with basic
work-related activities and is expected to last at least 12
3. Does the impairment meet or equal one of a list of
specific impairments enumerated in the regulations?
4. Is the claimant unable to perform his or her former
5. Is the claimant unable to perform any other work?
20 C.F.R. §§ 404.1509, 404.1520, 416.909, 416.920;
see Clifford v. Apfel, 227 F.3d 863, 868 (7th Cir.
2000). “An affirmative answer leads either to the next
step, or, on Steps 3 and 5, to a finding that the claimant is
disabled. A negative answer at any point, other than Step 3,
ends the inquiry and leads to a determination that a claimant
is not disabled.” Zalewski v. Heckler, 760
F.2d 160, 162 n.2 (7th Cir. 1985). “The burden of proof
is on the claimant through step four; only at step five does
the burden shift to the Commissioner.”
Clifford, 227 F.3d at 868.
applied for DIB and SSI on December 29, 2011, alleging that
he became disabled on April 20, 2010, because of
Guillain-Barré syndrome (GBS) and chronic inflammatory
demyelinating polyneuropathy (CIDP). (R. at 96, 106, 118, 129).
The applications were denied initially and on
reconsideration, after which Plaintiff filed a timely request
for a hearing. (Id. at 116-17, 140-41, 165-67). On
October 23, 2013, Plaintiff, represented by counsel,
testified at a hearing before an ALJ. (Id. at
50-95). The ALJ also heard testimony from Ashok Jilhewar,
M.D., a medical expert (ME), Michael Cremerius, Ph.D., a
psychological expert, and Brian Harmon, a vocational expert
denied Plaintiff's request for benefits on April 25,
2014. (R. at 14-45). Applying the five-step sequential
evaluation process, the ALJ found, at step one, that there is
conflicting evidence whether Plaintiff had engaged in
substantial gainful activity since April 20, 2010, his
alleged onset date. (Id. at 20-22). However, after
evaluating the evidence, including Plaintiff's testimony,
the ALJ determined that there is no evidence that Plaintiff
worked after December 2011. (Id. at 21). At step
two, the ALJ found that Plaintiff's GBS and hepatitis B
infection are severe impairments. (Id. at 22-26). At
step three, the ALJ determined that Plaintiff does not have
an impairment or combination of impairments that meet or
medically equals the severity of any of the listings
enumerated in the regulations. (Id. at 26- 27).
then assessed Plaintiff's residual functional capacity
(RFC) and determined that Plaintiff can perform
a full range of sedentary work. (R. at 27-43). At step four,
the ALJ found that Plaintiff is unable to perform any past
relevant work. (Id. at 43). Based on Plaintiff's
RFC, age, education, and the VE's testimony, the ALJ
determined at step five that there are semi-skilled and
unskilled jobs that exist in significant numbers in the
national economy that Plaintiff can perform, including
personnel clerk, telephone solicitor, receptionist,
surveillance system monitor, bonder, and charge account
clerk. (Id. at 44). Accordingly, the ALJ concluded
that Plaintiff is not suffering from a disability, as defined
by the Act. (Id.).
Appeals Council denied Plaintiff's request for review on
October 19, 2015. (R. at 1-5). Plaintiff now seeks judicial
review of the ALJ's decision, which stands as the final
decision of the Commissioner. Villano v. Astrue, 556
F.3d 558, 561-62 (7th Cir. 2009).
STANDARD OF REVIEW
review of the Commissioner's final decision is authorized
by § 405(g) of the SSA. In reviewing this decision, the
Court may not engage in its own analysis of whether the
plaintiff is severely impaired as defined by the Social
Security Regulations. Young v. Barnhart, 362 F.3d
995, 1001 (7th Cir. 2004). Nor may it “reweigh
evidence, resolve conflicts in the record, decide questions
of credibility, or, in general, substitute [its] own judgment
for that of the Commissioner.” Id. The
Court's task is “limited to determining whether the
ALJ's factual findings are supported by substantial
evidence.” Id. (citing § 405(g)).
Evidence is considered substantial “if a reasonable
person would accept it as adequate to support a
conclusion.” Indoranto v. Barnhart, 374 F.3d
470, 473 (7th Cir. 2004); see Moore v. Colvin, 743
F.3d 1118, 1120-21 (7th Cir. 2014) (“We will uphold the
ALJ's decision if it is supported by substantial
evidence, that is, such relevant evidence as a reasonable
mind might accept as adequate to support a
conclusion.”) (citation omitted). “Substantial
evidence must be more than a scintilla but may be less than a
preponderance.” Skinner v. Astrue, 478 F.3d
836, 841 (7th Cir. 2007). “In addition to relying on
substantial evidence, the ALJ must also explain his analysis
of the evidence with enough detail and clarity to permit
meaningful appellate review.” Briscoe ex rel.
Taylor v. Barn-hart, 425 F.3d 345, 351 (7th Cir. 2005).
this Court accords great deference to the ALJ's
determination, it “must do more than merely rubber
stamp the ALJ's decision.” Scott v.
Barnhart, 297 F.3d 589, 593 (7th Cir. 2002) (citation
omitted). “This deferential standard of review is
weighted in favor of upholding the ALJ's decision, but it
does not mean that we scour the record for supportive
evidence or rack our brains for reasons to uphold the
ALJ's decision. Rather, the ALJ must identify the
relevant evidence and build a ‘logical bridge'
between that evidence and the ultimate determination.”
Moon v. Colvin, 763 F.3d 718, 721 (7th Cir. 2014).
Where the Commissioner's decision “lacks
evidentiary support or is so poorly articulated as to prevent
meaningful review, the case must be remanded.”
Steele v. Barnhart, 290 F.3d 936, 940 (7th Cir.
RELEVANT MEDICAL EVIDENCE
was diagnosed with hepatitis B with liver fibrosis in 2009
and began therapy thereafter. (R. at 416). On April 21, 2010
Plaintiff was hospitalized at Loyola University Medical
Center with a one-week history of progressive weakness that
started in his lower extremities and progressed to his upper
extremities with pares-thesias of his toes and fingers.
(Id. at 505). On admission, Plaintiff showed 4/5
upper extremity strength and 3/5 lower extremity strength.
(Id.). Plaintiff was unable to walk but had normal
cognition and cranial nerves. (Id.). On April 22,
2010, Matthew McCoyd, M.D., performed an electromyography
(EMG) which was abnormal and revealed evidence of a
non-length-dependent axonal neuropathy affecting motor
fibers. (Id. at 866). Plaintiff was diagnosed with
GBS and acute hepatitis B and received five days of
intravenous immunoglobulin therapy (IVIG). (Id. at
was discharged on April 26, 2010, and transferred to
inpatient rehabilitation. (R. at 499). Upon discharge,
Plaintiff demonstrated improved strength in his upper and
lower extremities and some return of muscle stretch reflexes
in his upper and lower extremities. (Id. at 501).
Plaintiff remained at the inpatient rehabilitation facility
through May 20, 2010. (Id. at 503). Plaintiff was
then discharged to home with instructions to follow up with
his primary care provider, a neurologist, and a hepatologist
for his hepatitis B with transaminitis. (Id.).
4, 2010, Plaintiff was examined by Claus J. Fimmel, M.D. (R.
at 420- 21, 721-29). At that time, Plaintiff had marked
residual paralysis and could not walk. (Id. at 420,
725). Dr. Fimmel noted that a liver biopsy would be useful in
assessing the extent and possible chronicity of
Plaintiff's hepatitis B infection, but Plaintiff was
unwilling to undergo a diagnostic liver biopsy. (Id.
at 421, 725-26). Dr. Fimmel recommended starting Plaintiff on
Entecavir (antiviral) once his repeat vi-rological studies
were back. (Id. at 421, 726).
was seen by Michael J. Schneck, M.D., on June 24, 2010,
complaining of worsening double vision, left arm weakness,
and difficulty ambulating with worsening symptoms over the
past several days. (R. at 420). Dr. Schneck readmitted
Plaintiff to Loyola University Medical Center hospital for a
repeat lumbar puncture, EMG, rehab assessment, and possible
pheresis/IVIG or steroids depending on the findings of a
diagnostic workup. (Id.). Upon readmission,
Plaintiff had marked motor weakness, areflexia (below normal
or absent reflexes), and bilateral facial muscle weakness.
(R. at 437). An EMG showed marked deterioration compared to
the April 22, 2010 EMG. (Id.). The June 24, 2010 EMG
continued to show evidence of demyelination but was
accompanied by significant axonal injury, worse distally in
the limbs and involving sensory as well as motor axons.
(Id.). A liver biopsy showed severe autoimmune
inflammation. (Id. at 437, 491). Plaintiff started
Entecavir and prednisone (steroid) 80 mg daily.
(Id.). Plaintiff also received five days of IVIG.
(Id.). Dr. Danilo Vitorovic, M.D., stated that
Plaintiff's clinical picture was most consistent with
CIDP. (Id.). Plaintiff was discharged to the
Rehabilitation Institute of Chicago (RIC) on July 2, 2010.
(Id. at 440). Upon discharge, Plaintiff's
medical condition was “fair.” (Id. at
437). Plaintiff had severe bilateral left extremity weakness
with pain as well as left upper extremity weakness, but his
left upper extremity weakness was improving. (Id.).
July 2 and August 12, 2010, Plaintiff participated in
physical therapy, occupational therapy, and rehabilitation at
the RIC. (R. at 594-711). Upon admission, Plaintiff was
unable to ambulate. (Id. at 705). Prior to
discharge, Plaintiff was able to ambulate 400 feet and climb
20 stairs. (Id.). In terms of transfers, Plaintiff
was “total assist” upon admission and became
“modified independent” prior to discharge.
Plaintiff's follow-up visit on July 23, 2010, with Dr.
McCoyd, Plaintiff reported some recent improvement in his
symptoms but he was not back to his pre-April baseline. (R.
at 416). Plaintiff's motor examination showed left
deltoid and biceps weakness at 4/5. (Id. at 417).
His upper and lower extremity reflexes were absent.
(Id.). Plaintiff's gait and station were normal.
(Id.). Dr. McCoyd stated that the clinical and
electrophysiologic picture seemed most consistent with a
diagnosis of CIDP. (Id.). Dr. McCoyd recommended
continued treatment with maintenance on oral steroids at
Plaintiff's current dose (80 mg per day) and monthly IVIG
therapy. (Id. at 418-19).
follow-up on August 18, 2010, with Dr. Fimmel, Plaintiff was
walking with a walker but no other assistance. (R. at 409,
734). He was able to move around freely with full or
near-full use of his upper and lower extremities.
(Id.). Plaintiff reported that he was about to
finish his formal outpatient physical therapy and was eager
to return to work. (Id.). Plaintiff's physical
examination was normal. (Id. at 411, 735). Dr.
Fimmel noted that Plaintiff had dramatically improved from a
neurological standpoint from July 2, 2010, when he was not
able to walk or provide any meaningful help to being
positioned on the examination table. (Id. at 412,
737). Dr. Fimmel further noted that Plaintiff had a
concomitant, marked improvement in his liver enzymes on
Entecavir and prednisone. (Id.). Dr. Fimmel
indicated that in hindsight, he suspected that
Plaintiff's “autoimmune-like” changes on his
liver biopsy may have been due to a flare up of his hepatitis
B reactivation. (Id.).Dr. Fim-mel recommended
discontinuing immunosuppression therapy and instead
continuing Entecavir monotherapy. (Id. at 412-13,
737). He directed Plaintiff to continue Entecavir
indefinitely, decrease prednisone from 80 mg to 40 mg per
day, and return in six weeks. (Id. at 413, 737-38).
September 10, 2010, Plaintiff had a follow-up visit with Dr.
McCoyd for weakness related to his inflammatory neuropathy.
(R. at 407-09). Plaintiff reported feeling 75% better
compared to April 2010, but he still had some pain in his
feet. (Id. at 408). On motor examination,
Plaintiff's strength was improved versus his previous
exam with mild weakness of right knee flexion and extension.
(Id.). Plaintiff's reflexes were 1 in the left
bicep. (Id.). Plaintiff's gait was slow but he
was able to walk without assistance. (Id.). He could
take a few steps on his tiptoes and heels. (Id.).
Dr. McCoyd planned to continue to slowly wean Plaintiff off
of steroids and maybe transition to Azathioprine
(immunosuppressant), continue IVIG treatment, continue
rehabilitation, and continue Neurontin (pain medication).
(Id. at 408-09). Dr. McCoyd opined that
Plaintiff's inflammatory neuropathy had led to symptoms
of muscle weakness which as an ongoing process that may have
relapses and remissions. (Id. at 870).
returned to Dr. Fimmel on September 29, 2010 for a follow-up
visit on his chronic hepatitis B infection. (R. at 402-07,
742-51). Dr. Fimmel noted that Plaintiff was improving on 50
mg of prednisone and 1 mg per day of Entecavir. (Id.
at 402, 743). Plaintiff was enrolled in daily rehabilitation
and was targeting a January 2011 possible return-to-work
date. (Id.). Plaintiff's physical exam was
normal with full range of motion, no atrophy, and normal
strength in his extremities. (Id. at 404, 744).
Plaintiff showed excellent virological response to Entecavir
with a decrease in viral load by at least six orders of
magnitude and near-normalization of liver enzymes.
(Id. at 407, 748). Plaintiff had improved
neurologically as well but was still on a fairly high dose of
prednisone. (Id.). Dr. Fimmel directed Plaintiff to
stay on Entecavir indefinitely and return in two to three
months to repeat labs. (Id.).
December 17, 2010, Plaintiff was examined by Dr. Fimmel at a
follow-up visit for his hepatitis B infection. (R. at
399-400, 752-60). Plaintiff stated that his overall strength
had returned to 75% of his normal baseline. (Id. at
399, 756). He reported difficulties concentrating and
increased fatigue at work and in class. (Id.).
Plaintiff had not resumed full-time work and was concerned
about his weight gain and moon face. (Id.). Dr.
Fimmel's impression was improved hepatitis B infection
and neurological status on Entecavir 1 mg per day and
prednisone 30 mg per day. (Id. at 400, 755). Dr.
Fimmel referred Plaintiff to neurology for a follow-up and a
decision regarding whether to start Plaintiff on
Azathioprine. (Id.). Plaintiff was directed to
follow-up with Dr. Fimmel in three months and continue
Entecavir indefinitely. (Id. at 400, 758).
January 3, 2011, Plaintiff returned to Dr. McCoyd for a
follow-up appointment. (R. at 396). Dr. McCoyd noted that
there had been gradual improvement in Plaintiff's
symptoms but he had not completely returned to his baseline.
(Id.). Plaintiff reported some residual back pain
and distal paresthesias. (Id.). Plaintiff had been
weaning off of prednisone and was currently taking 20 mg
daily. (Id. at 396-97). Plaintiff's general
physical examination was normal. (Id. at 398).
Plaintiff's motor examination was normal other than mild
distal weakness. (Id.).The reflex examination showed
ankle reflexes present, toes were downgoing, patellae and
upper extremity reflexes were relatively reduced.
(Id.). The Romberg test was negative.
(Id.). Plaintiff was able to walk under his own
power and stand on his tiptoes but had some difficulty
standing on his right heel. (Id.). Dr. McCoyd noted