United States Court of Appeals 

For the Seventh Circuit 

Chicago, Illinois 60604 

Argued October 3, 2019 

Decided October 17, 2019 

Before 

DIANE P. WOOD, Chief Judge 

AMY C. BARRETT, Circuit Judge 

MICHAEL Y. SCUDDER, Circuit Judge

No. 19-1523 

WILSON BURGOS, 

 Plaintiff-Appellant, 

v. 

ANDREW M. SAUL, 

Commissioner of Social Security, 

 Defendant-Appellee.

 Appeal from the United States District 

Court for the Northern District of Illinois, 

Eastern Division. 

No. 1:17-cv-6167 

Michael T. Mason, 

Magistrate Judge.

O R D E R 

Wilson Burgos worked successfully for many years in warehouse jobs. Beginning 

in 2005, he underwent a series of surgeries to treat a kidney ailment and repair 

abdominal hernias. From there Burgos experienced worsening abdominal pain that 

limited his ability to work. He applied for disability benefits in 2014. An administrative 

law judge denied his application, concluding that Burgos could still perform light work 

with only a few limitations. The district court affirmed. We now vacate that judgment 

and remand for further proceedings. The ALJ erred by assigning too little weight to the 

opinions of Dr. James Boffa, the surgeon who performed Burgos’s many hernia 

surgeries. Because the ALJ did not adequately account for Dr. Boffa’s opinions, the 

denial of benefits was not supported by substantial evidence. 

NONPRECEDENTIAL DISPOSITION 

To be cited only in accordance with Fed. R. App. P. 32.1 
No. 19-1523 Page 2 

I 

A 

Burgos has a birth defect that partially blocks the flow of urine from his left 

kidney. The condition has required multiple surgeries, including a failed stent 

placement and a partial removal of his kidney in 2005. These surgeries resulted in 

Burgos being susceptible to hernias. 

Burgos first developed a hernia in his left abdomen in 2006. Between 2006 and 

2012, he had three surgeries to repair the hernia, at least two of which Dr. Boffa 

performed. Even after the surgeries, however, Burgos continued to experience 

abdominal pain. In February 2013, about a year after his final surgery, Dr. Boffa 

diagnosed Burgos with an incisional hernia—a hernia on scar tissue from a prior 

surgery. Five months later, Burgos experienced abdominal pain, which Dr. Boffa 

attributed to a condition known as eventration (the protrusion of abdominal contents 

through the abdominal wall) in the same location. 

Up until this point, Burgos continued to work in a warehouse. But in September 

2013, his employer moved out of town and laid him off. After the layoff, Burgos’s 

condition worsened. He experienced more severe abdominal pain, and in August 2014, 

Dr. Boffa again noted eventration and prescribed medication. The pain worsened over 

time, and by April 2015, Dr. Boffa confirmed that Burgos’s hernia had returned. 

Burgos’s kidney also began to deteriorate in 2015. A renal scan from March 2015 

revealed decreased blood flow and function in his left kidney. Based on these results, 

Dr. Boffa referred Burgos to Dr. Michael Young, the urologist who performed the earlier 

kidney surgeries, to assess the need for a kidney removal. A follow-up scan showed 

additional kidney deterioration, and when Dr. Young examined Burgos, he discovered 

a new blockage. Although Dr. Young did not recommend a kidney removal, Burgos 

nonetheless required three surgeries in 2016 to clear the urine flow from his left kidney. 

Following these surgeries, Burgos again experienced abdominal pain and again 

returned to Dr. Boffa. Dr. Boffa treated Burgos’s hernia by prescribing an abdominal 

binder and telling Burgos to wear the binder at all times. 

 
No. 19-1523 Page 3 

B 

Burgos applied for disability insurance benefits in 2014. He alleged a disability 

onset date of September 13, 2013, the day that he lost his job at the warehouse. He 

alleged that he was unable to work primarily because of pain from his kidney and 

hernia. 

An internist hired by the agency examined Burgos and found that he could walk 

50 feet without support and had a normal range of motion in most muscle groups. But 

the agency’s internist stopped short of giving an opinion on Burgos’s functional 

limitations. Two other state agency consultants reviewed Burgos’s medical records and, 

without examining him, opined that he could perform light work with only a few 

limitations. 

In May 2015, Burgos submitted a statement from Dr. Boffa that outlined his 

opinions about Burgos’s functional limitations. Dr. Boffa opined that because of “left 

abdominal wall strain [and] left kidney perfusion,” Burgos could lift no more than five 

pounds, stand or walk no more than one hour in an eight-hour workday, and sit no 

more than two hours during a standard workday. He also opined that Burgos needed to 

elevate his legs for 30 minutes every two hours throughout the day. 

At a hearing before the ALJ, Burgos’s testimony largely tracked the limitations in 

Dr. Boffa’s statement from May 2015. Burgos stated that he elevates his legs two or 

three times a day for 30 minutes at a time to relieve his hernia pain. He added that after 

90 to 120 minutes of standing, he feels pain in his feet, hip, and side and needs to sit for 

10 to 15 minutes. But sitting in the same position for extended periods, Burgos 

explained, leads to abdominal pain. He further noted that he adheres to Dr. Boffa’s 

advice and wears an abdominal binder around the clock. 

The ALJ also heard testimony from a vocational expert. The vocational expert 

explained that a person with a medical need to elevate his legs every two hours would 

be unable to find employment. 

The ALJ concluded that Burgos’s congenital kidney defect and hernias 

constituted severe impairments. In doing so, though, she assigned only “little weight” 

to Dr. Boffa’s opinions, reasoning that he had a “limited treating relationship” with 

Burgos, failed to provide objective evidence for his opinions, and offered observations 

contradicted by other doctors and Burgos’s daily activities. The ALJ also discounted 
No. 19-1523 Page 4 

Burgos’s account of his limitations, finding the described limitations inconsistent with 

the remainder of the record. 

Relying instead on the opinions of the reviewing agency consultants, the ALJ 

concluded that Burgos could perform light work (for example, as a mail clerk) if 

allowed to wear the abdominal binder and to sit for five minutes every hour. She did 

not include an accommodation allowing Burgos to elevate his legs every two hours as 

part of her residual functional capacity determination. 

In the end, the ALJ determined that Burgos was not disabled and denied him 

benefits. The district court affirmed, and Burgos now appeals. 

II 

A 

We will uphold an ALJ’s final decision if supported by “substantial evidence.” 

See 42 U.S.C. § 405(g); Lanigan v. Berryhill, 865 F.3d 558, 563 (7th Cir. 2017). Substantial 

evidence means “such relevant evidence as a reasonable mind might accept as adequate 

to support a conclusion.” Biestek v. Berryhill, 139 S. Ct. 1148, 1154 (2019). Our role is not 

to “reweigh evidence, resolve conflicts, decide questions of credibility, or substitute 

[our] judgment for that of the Commissioner.” Burmester v. Berryhill, 920 F.3d 507, 510 

(7th Cir. 2019) (internal citations omitted). 

B 

Burgos contends that the ALJ erred by assigning little weight to Dr. Boffa’s 

statement. For claims filed before March 27, 2017, like Burgos’s here, a treating 

physician’s opinion is entitled to controlling weight if well-supported by medical 

findings and not inconsistent with other substantial evidence in the record. 20 C.F.R. 

§ 404.1527(c)(2); Larson v. Astrue, 615 F.3d 744, 749 (7th Cir. 2010). An ALJ must offer 

“good reasons” for declining to give controlling weight to the opinion of a treating 

physician. Larson, 615 F.3d at 749. 

The ALJ failed to adhere to this standard. Although the ALJ gave several reasons 

for discounting Dr. Boffa’s statement, none had substantial evidentiary support. 

First, the record does not support the ALJ’s finding that Dr. Boffa had a “limited 

treating relationship” with Burgos. To the contrary, Dr. Boffa had treated Burgos for 
No. 19-1523 Page 5 

more than six years and performed multiple surgeries. The record shows that he 

examined Burgos on eight separate occasions between the final hernia repair in 2012 

and rendering his opinion in May 2015. The ALJ did not explain why these regular 

visits were insufficient for Dr. Boffa to obtain “a longitudinal picture of [Burgos’s] 

impairment.” 20 C.F.R. § 404.1527(c)(2)(i). 

Second, and again contrary to the record, the ALJ determined that Dr. Boffa 

failed to provide objective evidence for his opinions. Yet Dr. Boffa’s treatment notes 

extensively document the causes of Burgos’s abdominal pain. He diagnosed an 

incisional hernia a year after Burgos’s last hernia repair and noted eventration in the 

same location less than two months before the alleged onset date of September 13, 2013. 

From that date forward, Dr. Boffa treated Burgos for recurring abdominal pain and 

prescribed medication. He continued to note eventration at the hernia repair site 

throughout 2014. And in 2015, he diagnosed Burgos with yet another hernia, noted 

decreased functioning in the left kidney, and ultimately referred Burgos for possible 

kidney removal. 

The Commissioner takes issue with the manner and means through which 

Dr. Boffa conveyed his opinions. Dr. Boffa, the Commissioner insists, merely completed 

a pre-printed “checkbox form” and accompanied his findings with no narrative 

explanation. But “the mere absence of detailed treatment notes, without more, is 

‘insufficient grounds for disbelieving the evidence of a qualified professional.’” Brown v. 

Colvin, 845 F.3d 247, 253 (7th Cir. 2016) (quoting Herrmann v. Colvin, 772 F.3d 1110, 1111 

(7th Cir. 2014)). Dr. Boffa’s statement, no matter its format, reflects an expert medical 

opinion from the very surgeon who performed Burgos’s hernia repairs. And the basis 

for his opinions is far from unknown: he treated Burgos for years and the 

administrative record contains his treatment notes. Given the evidence that Dr. Boffa 

treated Burgos for a recurring, severely painful hernia that worsened after the alleged 

onset date, the ALJ needed to explain why Burgos’s worsening hernia and kidney 

condition did not provide an objective basis for Dr. Boffa’s opinions. See Spicher v. 

Berryhill, 898 F.3d 754, 757 (7th Cir. 2018) (“[A]n ALJ may not ignore evidence that 

undercuts her conclusion.”). 

The ALJ also erred by finding that Dr. Boffa’s statement was inconsistent with 

Burgos’s reported daily activities. The ALJ pointed to Burgos’s ability to drive a car, 

socialize, go to the grocery store, and perform household tasks like cleaning tables, 

sweeping, and folding laundry. Nowhere, however, did the ALJ explain why Burgos 

would be unable to perform these activities if he had the limitations Dr. Boffa proposed. 
No. 19-1523 Page 6 

The amount of time Burgos spends on chores (less than half an hour per week) and 

going to the grocery (once per week) is consistent with Dr. Boffa’s opinions. More 

generally, we have repeatedly underscored the necessity of the ALJ articulating why a 

claimant’s daily activities undermine a physician’s opinion and to avoid inferring an 

ability to do full-time work from a claimant’s occasional activities. See, e.g., Vanprooyen 

v. Berryhill, 864 F.3d 567, 571 (7th Cir. 2017); Clifford v. Apfel, 227 F.3d 863, 870 (7th Cir. 

2000). 

Finally, the ALJ noted what she saw as inconsistencies between Dr. Boffa’s 

opinions and the findings of Burgos’s other treating physicians. But the ALJ failed to 

account for each doctor’s specialty, as required by 20 C.F.R. § 404.1527(c)(5). And 

whereas Dr. Boffa provided specific opinions about Burgos’s physical limitations, the 

other treating physicians recorded only general observations about Burgos’s condition. 

A couple examples illustrate the point. The ALJ highlighted the “unremarkable 

musculoskeletal and neurological findings” of Burgos’s primary care provider. This 

observation, however, comes from a preliminary finding the primary care provider 

made while evaluating Burgos for diabetes, anxiety, and foot pain. That doctor neither 

evaluated Burgos’s physical abilities with any specificity, nor assessed Burgos for 

ailments related to his hernia or kidney—the ailments that formed the basis for 

Dr. Boffa’s opinions. 

The ALJ likewise noted how other doctors were able to treat Burgos successfully 

with physical therapy and cortisone shots. Those were treatments for arthritis, however, 

and have nothing to do with Burgos’s kidney or hernia. Similarly, the ALJ noted how 

Dr. Young recorded consistent renal functioning for ten years following Burgos’s 2005 

kidney operation. Dr. Young did not say anything, though, about how the pain from 

Burgos’s kidney disorder affected his abilities or aggravated the pain from his hernia. 

His findings are not inconsistent with Dr. Boffa’s opinions. 

All of these shortcomings lead us to conclude that the ALJ’s denial of benefits 

was not supported by substantial evidence. Dr. Boffa opined that Burgos needed to 

elevate his legs every two hours because of his abdominal pain, a limitation that the 

vocational expert testified would preclude full-time work. He also opined that Burgos 

could lift no more than five pounds, a limitation that conflicts with the agency’s 

definition of light work. See 20 C.F.R. § 404.1567(b) (stating that light work requires 

employee to lift up to 20 pounds, with frequent lifting of objects weighing ten pounds). 

And because Burgos is older than 50 and has only unskilled work experience, he would 
No. 19-1523 Page 7 

be disabled under the agency’s guidelines if limited to sedentary work. See 20 C.F.R. 

Part 404, Subpart P, App. 2 § 201.12. The ALJ failed to adequately account for these 

findings by Burgos’s treating physician. 

For these reasons, we VACATE the judgment and REMAND to the agency for 

further proceedings.