In the

United States Court of Appeals

For the Seventh Circuit ____________

No. 05-1507

SANDRA K. SIMS,

Plaintiff-Appellant,

v.

JO ANNE B. BARNHART,

Defendant-Appellee.

____________

Appeal from the United States District Court

for the Southern District of Indiana, Indianapolis Division.

No. 1:04-cv-536-LJM—Larry J. McKinney, Chief Judge.

____________

ARGUED JANUARY 25, 2006—DECIDED MARCH 22, 2006

____________

Before POSNER, MANION, and WOOD, Circuit Judges.

POSNER, Circuit Judge. Sandra Sims was turned down by

an administrative law judge for social security disability

benefits sought by her on the ground that she is severely

impaired by somatoform disorder. She appeals from the

district court’s rejection of her challenge to the administrative law judge’s decision. That decision is exceptionally

thorough and in trying to pick it apart Sims’s lawyer shows

a lack of awareness of the limitations of “substantial evidence” review, especially in a case such as this in

which the claimant alleges a somatoform disorder. We

confine this opinion to the difficult proof issues raised by
2 No. 05-1507

such an allegation, disposing of Sims’s other grounds in an

unpublished order issued today.

The term “somatoform disorder” refers to what used to be

called “psychosomatic” illness: one has physical symptoms,

but there is no physical cause. This is a well-attested

phenomenon. E.g., White v. Barnhart, 415 F.3d 654, 656 n. 1

(7th Cir. 2005); Carradine v. Barnhart, 360 F.3d 751, 753-54

(7th Cir. 2004); Vaughn v. Nissan Motor Corp. in U.S.A., Inc.,

77 F.3d 736, 737 (4th Cir. 1996). The problem in the disability

context is proof (and it is a problem for the reviewing court

as well as for the administrative law judge), though it is a

problem only when the severity of the symptoms that are

claimed to be disabling is in dispute. If you are disabled,

you are entitled to disability benefits even if no cause for

your disability can be assigned. E.g., Carradine v. Barnhart,

supra, 360 F.3d at 753; Foote v. Chater, 67 F.3d 1553, 1561

(11th Cir. 1995); Easter v. Bowen, 867 F.2d 1128, 1130 (8th Cir.

1989). The problem of proof arises when the symptoms are

reported by the claimant but not verified by medical

experts. The classic example is pain. Its existence cannot be

verified, and since a person can experience intense, disabling pain even though no physical cause can be found,

there is great difficulty in determining whether the person

really is experiencing the pain that he reports. In such a

case, the administrative law judge must of necessity base

decision on the credibility of the claimant’s testimony.

Credibility determinations can rarely be disturbed by a

reviewing court, lacking as it does the opportunity to

observe the claimant testifying. Only if the trier of fact

grounds his credibility finding in an observation or argument that is unreasonable or unsupported, as in Zurawski v.

Halter, 245 F.3d 881, 887-88 (7th Cir. 2001), can the finding

be reversed. E.g., Pelkey v. Barnhart, 433 F.3d 575, 578 (8th
No. 05-1507 3

Cir. 2006); Thomas v. Barnhart, 278 F.3d 947, 958-59 (9th Cir.

2002).

Sims’s case depends critically on her contention, for which

specialists have found no organic basis, that she has tunnel

vision. (Her other claimed disabilities have no possible

merit, as explained in our accompanying, unpublished

order.) It is possible to have severe vision problems that

have no organic cause; the medical literature on somatoform

disorder identifies vision problems— including tunnel

vision—as being among the somatoform symptoms. E.g.,

Deborah N. Black et al., “Conversion Hysteria: Lessons from

Functional Imaging,” 16 J. Neuropsychiatry & Clinical

Neurosciences 246 (2004); Hirofumi Ohkubo, “Visual Field in

Hysteria—Reliability of Visual Field by Goldmann

Perimetry,” 71 Documenta Ophthalmologica 61 (1988). And, to

repeat, if a claimant’s symptoms are severe enough to be

disabling, the fact that they have no organic cause is

irrelevant. Sims might have been able to show this. One of

the medical reports states that her field of vision is only 5

degrees. A normal field of vision is 180 to 200 degrees, Jill

Sardegna & T. Otis Paul, Encyclopedia of Blindness and Vision

Impairment 241 (1991); Richard E. Simmons & Donald A.

Keller, One Pair for a Lifetime 18 (1979), and a field of vision

below 10 degrees is disabling per se under the “grid” that

the Social Security Administration uses to streamline

disability determinations. 20 C.F.R. pt. 404, subpt. P, app. 1,

§ 2.03A. But Sims has abandoned that route, and can obtain

benefits only by demonstrating that she indeed has a

disabling somatoform disorder.

She was given several tests and the results of all of them

(not just the one we mentioned) indicated that she indeed

has tunnel vision. But just as with the test for impaired

peripheral vision that one has to pass to obtain a driver’s
4 No. 05-1507

license, the tests for tunnel vision are valid only if the

patient cooperates. Joseph C. Thompson et al., “Field of

Dreamers and Dreamed-Up Fields: Functional and Fake

Perimetry,” 103 Ophthalmology 117, 123 (1996). So there is

always a risk that the patient is a malingerer. Id.; S.

Beatty, “Psychogenic Medicine: Non-Organic Visual Loss,”

75 Postgrad. Med. J. 201, 204 (1999); Neil R. Miller & James R.

Keane, “Neuro-Ophthalmologic Manifestations of

Nonorganic Disease,” in Walsh and Hoyt’s Clinical NeuroOphthalmology 1765, 1766 (1988); Roger G. Kathol et al.,

“Functional Visual Loss: I. A True Psychiatric Disorder?,” 13

Psychological Med. 307, 309-11 (1983). And therefore

the results of the tests administered to Sims were not

decisive on whether she really has a disabling somatoform disorder. In such a case, the administrative law judge

is entitled to require additional evidence. Cf. White v.

Barnhart, 415 F.3d 654, 658 (7th Cir. 2005); Sims v. Barnhart,

309 F.3d 424, 431 (7th Cir. 2002).

Where might such evidence be found? The type of

somatoform disorder that produces symptoms such as

tunnel vision (the type that used to be called “hysteria” and

now is called “conversion disorder,” Black et al., supra;

see also Kathol et al., supra, at 308) need not also produce

symptoms that a psychiatric examination would reveal,

the way suicidal ideation might evidence depression or

agoraphobia anxiety or paranoid delusions schizophrenia.

But the article by Black and his associates indicates that

brain scans may be able to distinguish real from feigned

symptoms of conversion disorder (apparently, organic brain

disease is present in a majority of cases of conversion disorder, Susan Dufel, “Conversion Disorder,” Apr. 15,

2005, http:www.emedicine.com/emerg/topic112.htm.), and

Sims had not had a brain scan. In addition, the symptoms of

conversion disorder are often precipitated by stress, id.;
No. 05-1507 5

American Psychiatric Association, Diagnostic and Statistical

Manual of Mental Disorders, Text Revision (DSM-IV-TR) 498

(4th ed. 2000), and a psychiatric examination might determine whether the claimant was experiencing or had recently

experienced stress. No such inquiry was conducted either.

As a result of Sims’s failure to produce evidence beyond the

results of the vision tests, the administrative law judge was

entitled to reject her claim to be totally disabled as a consequence of somatoform disorder.

AFFIRMED.

A true Copy:

Teste:

 _____________________________

Clerk of the United States Court of 

Appeals for the Seventh Circuit 

USCA-02-C-0072—3-22-06