United States District Court, N.D. Illinois, Eastern Division
MEMORANDUM OPINION AND ORDER 
I. Schenkier, United States Magistrate Judge
Michelle G., moves for reversal and remand of the final
decision of the Acting Commissioner of Social Security
("Commissioner") denying her applications for
disability insurance benefits ("DIB") and
supplemental security income ("SSI") (doc. # 13).
The Commissioner has filed a cross motion, asking the Court
to affirm (doc. #21). The matter is now fully briefed. For
the following reasons, we deny plaintiffs motion to remand
and grant the Commissioner's motion to affirm.
February 29, 2012, at age 53, Ms. G. applied for DIB and SSI
(R. 458-67), alleging an onset date of January 1, 2007, which
Ms. G. later amended to May 30, 2008 (R.
56-57). Her date last insured was March 31, 2011
(R. 18). Ms. G.'s applications were denied
initially and on reconsideration, and she sought and received
a hearing before an Administrative Law Judge
("ALJ") on October 15, 2014, at which she testified
along with medical and vocational experts (R. 99). On January
22, 2015, the ALJ issued a decision denying Ms. G.'s
applications for benefits (R. 216-48), but the Appeals
Council granted Ms. G.'s request for review and remanded
the case to the ALJ (R. 250-52). On October 17, 2016, the ALJ
held another hearing (R. 53), and on November 21, 2016, the
ALJ issued a decision again denying Ms. G.'s claims for
DIB and SSI benefits (R. 17-41). Lhis time, the Appeals
Council denied Ms. G.'s request for review of the
ALJ's decision, making the ALJ's ruling the final
decision of the Commissioner (R. 1-3). See Shauger v.
Astrue, 675 F.3d 690, 695 (7th Cir. 2012).
2003, Ms. G. reported to her internist, Steven Gallo, M.D.,
that she was having trouble swallowing and would sometimes
choke or cough (R. 866). At that time, Ms. G. was diagnosed
with thyroid nodules (R. 865).
Gallo also opined that Ms. G. had myasthenia gravis (R. 865),
a condition characterized by weakness and rapid fatigue of
muscles, which can lead to difficulties with chewing,
swallowing, limb weakness and drooping eyelids (ptosis),
among other symptoms. Dr. Gallo prescribed Mestinon
(Id.), which enhances the communication between
nerves and muscles. Ms. G. testified that she stopped working
as a mail clerk in 2006 because her muscles would get stiff
and sore after sitting or standing for long periods of time
(R. 135), and she has not worked since then (R. 20).
also received regular treatment from neurologist, Alan G.
Shepard, M.D., to monitor her epilepsy, a condition she had
had since childhood (R. 1108). Ms. G. had been seizure-free
on Depakote and phenobarbital since 1982 (R. 856). In
December 2005, however, Ms. G. reported blacking out and
being confused for a few minutes (R. 909). Dr. Shepard
described this as an "episode of syncope" (fainting
or sudden, temporary loss of consciousness) that could have
been a seizure, and he increased her dose of phenobarbital
(Id.). Dr. Gallo noted that Ms. G.'s last
seizure in 1982 was of a similar type (R. 856).
2006 through 2009, Dr. Shepard reported that Ms. G. was
seizure-free and her myasthenia gravis was stable on
Depakote, phenobarbital and Mestinon (R.
910-11). However, in a disability report dated
March 13, 2008, Ms. G. reported that she had seizures
"often" (R. 537), and her mother, brother, and a
friend, Paul Hlepas, submitted seizure description forms to
the Bureau of Disability Determination Services
("DDS") in April 2008 stating that Ms. G. had more
than one seizure per month, and they had each witnessed her
having a seizure - on September 27, November 27, and December
23, 2007, respectively - which were characterized by wild and
erratic movements (R. 552-54).
2010, Dr. Shepard referred Ms. G. to neurologist Senda
Ajroud-Driss, M.D., to treat her myasthenia gravis (R. 922).
On May 5, 2010, Ms. G. reported to Dr. Ajroud-Driss that she
had muscle stiffness and weakness in her thighs, hands,
shoulders, and throat, which were alleviated with rest and
Mestinon (R. 922-23). She also reported that her hand muscles
locked up with repetitive movement, and she had intermittent
swallowing and speech problems, numbness and tingling in her
feet, and double or blurred vision (R. 923-24). On
examination, Dr. Ajroud-Driss found Ms. G. had mild bilateral
limitation of her lateral gaze, mild bilateral ptosis, mild
lower facial/lip weakness, mild deltoid weakness bilaterally,
and decreased deep tendon reflexes (R. 924-25). However, Dr.
Ajroud-Driss stated that she could not confirm the myasthenia
diagnosis in the absence of an EMG and blood and spirometry
tests (measuring lung function) (R. 920-21, 925).
April 2011, Ms. G.'s brother, Mr. Hlepas, and an
unidentified neighbor again submitted seizure description
forms to DDS, this time stating that Ms. G. had less than one
seizure per month, characterized by her whole body shaking or
twitching of her hands and feet (R. 611-13). Mr. Hlepas and
her brother stated they last witnessed a seizure in 2010, and
the neighbor allegedly witnessed one in January 2011
(Id.). On June 2, 2011, Ms. G. reported to DDS
internal medicine consultative examiner, Alexander Panagos,
M.D., that she had three seizures per year; they lasted for
five minutes and were not "full blown" tonic-clonic
seizures (R. 933). She also reported weakness with repetitive
movements and droopy eyelids (Id.). Dr. Panagos
found Ms. G.'s examination was within normal limits but
showed mildly impaired deep tendon reflexes (R. 934-35). On
August 5, 2011, Dr. Shepard noted that Ms. G. had "no
definite seizures, possibly some little ones" (R. 951).
December 28, 2011, Ms. G. followed up with Dr. Ajroud-Driss.
Dr. Ajroud Driss noted Ms. G. had two abnormal spirometry
tests and reported occasional leg pain, but her overnight
oximetry test (measuring blood oxygen levels) and
neurological evaluation were normal, which was not consistent
with active myasthenia gravis (R. 983-84). Dr. Ajroud-Driss
opined Ms. G.'s myasthenia gravis was in remission, and
she should continue the same dose of Mestinon (R. 980).
April 2012, Ms. G.'s brother, Mr. Hlepas, and an
unidentified friend submitted seizure description forms, this
time stating that Ms. G. had more than one seizure per week
(R. 681-83). Between the three of them, they alleged
witnessing Ms. G. having seizures on January 12, 15, 18, 20,
24, and 27, and February 1, 10, and 11, 2012 (Id.).
In addition, they described tonic-clonic or grand mal type
seizures, stating that Ms. G. lost consciousness for between
10 and 20 minutes, jerked and thrashed, and lost control of
her bladder and bowel movements (Id.).
3, 2012, Ms. G. told a DDS internal medicine consultative
examiner that she had a seizure one week prior (R. 973). The
examination was normal, and the examiner opined Ms. G. had a
history of grand mal seizure disorder and "well
controlled myasthenia gravis" (R. 974-75). On July 18,
2012, Dr. Ajroud-Driss again opined that Ms. G.'s
myasthenia gravis was in remission, despite mild ptosis on
the right, occasional double vision and swallowing
difficulties, and mildly limited deltoid and hip flexors and
deep tendon reflexes (R. 987).
September 2012, Ms. G.'s brother, Mr. Hlepas, and an
unidentified friend again filled out seizure description
forms (R. 704-06). They stated that Ms. G. had one or fewer
tonic-clonic type seizures per month, and that they witnessed
them on June 15, 2011, July 10 and 25, 2012, and August 15,
2012 (Id.). However, on December 6, 2012, Ms. G.
reported to Dr. Shepard that the last seizure she had had was
in April 2012 (R. 1076), and on January 9, 2013, Ms. G. told
Dr. Ajroud-Driss that she had a grand mal seizure in May 2012
(R. 1093-94). On April 27, 2013, Ms. G. reported blacking out
the previous day (R. 1020).
10, 2013, Ms. G. told Dr. Ajroud-Driss that she was having
more shortness of breath and fatigue with exertion, and on
examination, Ms. G. became fatigued after standing from a
seated position three times (R. 1100). Dr. Ajroud-Driss
opined that Ms. G.'s myasthenia gravis was "mildly
April 1, 2014, Ms. G. followed up with Dr. Shepard (R. 1074).
She reported having "a few episodes of flashing blue
lights" and an occasional "migraine aura," but
no new neurological issues (R. 1075). On examination, Ms. G.
had mild lower left extremity weakness, but otherwise no
significant changes (Id.), On May 19, 2014, Mahesh
Shah, M.D., performed an internal medicine consultative
examination for DDS (R. 1108). Ms. G. told Dr. Shah that she
had three to five tonic-clonic type seizures each year
(Id.). She also reported mild symptoms of myasthenia
gravis, including some vision problems from ptosis,
difficulty swallowing, and fatigue, but her symptoms were
"fairly well controlled with medications" (R.
1108-11). On examination, Ms. G. was rested, and Dr. Shah
reported that she exhibited full range of motion, normal gait
and grip, normal strength, intact nerves, and full strength
(R. 1110-11). However, Dr. Shah also wrote that "[o]nce
she starts doing any physical activities, she starts having
weakness of the muscle" (R. 1111). After the
examination, Dr. Shah completed a physical residual
functional capacity ("RFC") form, in which he
opined that Ms. G. could do light lifting and sit for six
hours, stand for four hours, and walk for one hour in an
eight-hour work day, limited to only occasionally climbing
ladders and scaffolds and being exposed to unprotected
heights in case of muscle weakness (R. 1112-16).
February and March 2015, Ms. G. sought treatment with
neurologist, Xabier Beristain, M.D. Ms. G. reported increased
fatiguability over the last year and occasional double vision
and trouble swallowing (R. 1332). Dr. Beristain observed Ms.
G. had droopy eyelids, but normal speech, full ocular
mobility and no facial weakness (R. 1334). He noted that a
blood test was suggestive of myasthenia gravis, and he
recommended Ms. G. continue taking Mestinon (Id.).
her mental health, in June 2012, Ms. G. reported having
increased stress due to personal upheaval, including taking
care of her elderly mother (R. 684). On July 19, 2012, Ms. G.
told Dr. Ajroud-Driss that she had attempted suicide by
taking some extra phenobarbital pills; she vomited them up
and did not seek medical treatment (R. 987). In October 2012,
Ms. G. began meeting with therapist Jennifer Borland; Ms. G.
reported having suicidal thoughts, but no intention to hurt
herself (R. 1009-12). On November 27, 2012, a DDS psychiatric
examination found Ms. ...