In the

United States Court of Appeals

For the Seventh Circuit

No. 11-3232

VIRGIL M. SHAUGER,

Plaintiff-Appellant,

v.

MICHAEL J. ASTRUE, Commissioner of

Social Security,

Defendant-Appellee.

Appeal from the United States District Court

for the Western District of Wisconsin. 

No. 3:11-cv-00129-bbc—Barbara B. Crabb, Judge.

ARGUED FEBRUARY 29, 2012—DECIDED MARCH 22, 2012

Before BAUER, ROVNER and WOOD, Circuit Judges. 

BAUER, Circuit Judge. Virgil M. Shauger, a 50-year-old

former welder who suffers from a nerve disorder that

impairs his vision, challenges the denial of his application for Social Security disability benefits. An Administrative Law Judge (“ALJ”) disbelieved Shauger’s testimony about the severity of headaches caused by his

condition, and on that basis found him not disabled.
2 No. 11-3232

Because this adverse credibility determination is not

supported by substantial evidence, we return the case

to the agency for further proceedings.

I. BACKGROUND

Shauger operated a welding company in Milwaukee,

Wisconsin, from 1989 to 2004. He was forced to sell his

business in April 2004 after the symptoms of his disorder had worsened. Shauger was living in Florida in

2007 when he applied for disability insurance benefits,

alleging onset in April 2004. Medical records of his

vision problems date back to late 1988 when, at age 27,

he first sought treatment for symptoms including

double vision, eye strain, and facial numbness. Shauger

had experienced similar symptoms six months earlier,

but that initial bout had cleared after a few days and so

he did not think more about it. After a battery of tests,

Shauger was diagnosed in 1988 with abducens nerve

palsy of the left eye. This disorder, commonly known as

sixth nerve palsy, describes a paralysis of the muscle

controlling lateral eye movements. See DORLAND’S ILLUSTRATED MEDICAL DICTIONARY 1365 (32d ed. 2012).

The treatment for sixth nerve palsy depends on

the cause. Several causes are common among adults,

including head trauma, infection, diabetes, brain

aneurism, multiple sclerosis, and tumors. See

Loyola University Chicago Stritch School of Medicine,

Sixth Nerve Palsy, http://www.stritch.luc.edu/depts/

ophtha/adult_strabismus/sixth_nerve_palsy.htm (last

visited Mar. 19, 2012); U.S. National Library of Medicine,
No. 11-3232 3

M e d lin e P l u s, C r a n i a l M o n o n e u r o p a t h y VI,

http://www.nlm.nih.gov/medlineplus/ency/article/

000690.htm (last visited Mar. 19, 2012). Symptoms of

sixth nerve palsy often include double vision, headaches, and pain around the eye. See The University

of California-Irvine Gavin Herbert Eye Institute,

N euro - O p h tha l m o l ogy , http://www . eye .uc i. edu/

neuroophthalmology.html#AbducensNerve (last visited

Mar. 19, 2012); U.S. National Library of Medicine, Medline

Plus, Cranial Mononeuropathy VI, http://www.nlm.nih.gov/

medlineplus/ency/article/000690.htm (last visited Mar. 19,

2012). Because the treatment varies by etiology, physicians

typically start by giving patients a barrage of tests to

determine the cause of the palsy. See U.S. National Library

of Medicine, Medline Plus, Cranial Mononeuropathy

VI, http://www.nlm.nih.gov/medlineplus/ency/article/

000690.htm (last visited Mar. 19, 2012). Some cases of sixth

nerve palsy go away on their own, and others may

persist. Id.

Shauger speculates that his palsy stems from head

trauma suffered in 1988 when he fell 13 or 14 feet on a

welding job, and landed on the left side of his face on

the concrete. His first symptoms surfaced after this accident. In 1988 and 1989, his doctors ran several clinical

tests to determine the cause of his palsy, including an

MRI and an angiography. No specific cause ever was

found. Shauger continued working and did not seek

treatment again until 1996, after his vision problems

had worsened and he started experiencing headaches.

Shauger had tried several types of glasses, but the headaches persisted. A neurologist confirmed the previous
4 No. 11-3232

diagnosis of left sixth nerve palsy (he described Shauger’s

affliction as “rather remarkable”), but further testing

again failed to identify the root cause. An ocular examination in 1998 showed that Shauger’s palsy was marked

by hypertropia and diplopia. Hypertropia is a misalignment of the eye, and diplopia is double vision.

DORLAND’S ILLUSTRATED MEDICAL DICTIONARY 525, 898

(32d ed. 2012). In July 2007, a month before he applied

for disability benefits, Shauger consulted an optometrist

who concluded that he still suffered from double vision

and prescribed glasses. The Commissioner of Social

Security contends that this doctor prescribed prism

glasses, which can help correct double vision by shifting

the image entering the affected eye and allowing for

coordinated vision with less lateral movement in

that eye. American Optometric Association, Strabismus,

http://www.aoa.org/x4700.xml (last visited Mar. 19,

2012). The eyeglasses prescription is indecipherable,

though Shauger has not disputed the Commissioner’s

interpretation.

After Shauger filed his disability claim in August 2007,

several other doctors evaluated his condition. Dr. Martha

Pollock, an internist, examined Shauger in October at

the request of the Florida Department of Health and

confirmed the diagnosis of left sixth nerve palsy. Two

other doctors then reviewed Shauger’s medical records

for the state agency. The first, an ophthalmologist,

opined that prism glasses should minimize or eliminate

Shauger’s double vision in all gazes except directly to

the left. Even so, the ophthalmologist advised Shauger

should avoid concentrated exposure to hazardous condi-
No. 11-3232 5

tions no matter how successful prism glasses might be.

The second doctor, an OB/GYN, opined that Shauger,

due to his balance difficulties, always should avoid ladders, ropes, and scaffolds and only rarely should climb

ramps or stairs. This consultant also recommended

that Shauger avoid even moderate exposure to

hazardous machinery.

The agency denied Shauger’s disability claim initially

and on reconsideration, and he received a hearing

before an ALJ in July 2009. Shauger testified that he

last worked in 2004 when he was forced to sell his company because of his impaired vision. At the time of the

hearing, Shauger still suffered from double vision, and

he explained that he must turn his head to the left in

order to focus his eyes. Looking straight ahead, he said,

causes eye strain and burning, watery eyes. Headaches

set in after 15 minutes of trying to focus, so he cannot

read or watch TV for more than brief periods. He testified

that most days he suffers two or three severe headaches

lasting 30 to 45 minutes each, which force him to lie

down and shut his eyes with a cool compress on his

forehead. Shauger explained that he relied on ibuprofen

and eye drops but did not take any prescription medications. He testified that several times he had tried

covering the affected eye with a patch but he saw no

improvement in his balance or depth perception. When

asked by his attorney whether he continued to see eye

specialists and neurologists, Shauger answered that he

did not because he had been told there was nothing

more they could do.
6 No. 11-3232

The ALJ also solicited testimony from an internist and

a vocational expert. Dr. Sami Nafoosi had reviewed

Shauger’s medical records and listened while he

testified but did not examine Shauger. He asserted that

Shauger’s disorder does not meet or equal a listing

but does prevent him from taking jobs requiring depth

perception, especially positions requiring exposure to

heights, heavy machinery, or open water. Dr. Nafoosi’s

direct testimony spans less than two pages of the

hearing transcript, and he did not even mention

Shauger’s complaints of disabling headaches. When crossexamined about that subject, Dr. Nafoosi conceded

that sixth nerve palsy “could result in headache” but

asserted, without explanation, that Shauger’s headaches would not be severe enough to require unscheduled breaks during the course of the workday or “further

limit him.” The ALJ asked no follow-up questions. The

vocational expert acknowledged that Shauger cannot

perform his past work of welding but suggested that

a person of Shauger’s age, education, work experience,

and limitations is qualified for available jobs including “dining room attendant,” “kitchen helper,” and

“laundry worker.” The vocational expert conceded,

though, that Shauger is unemployable if his headaches

require unscheduled, 30-minute breaks two or three

times daily. He also conceded that there could be a significant erosion of potential job options if Shauger

has difficulty working in small, narrow places like

a kitchen.

One month after the hearing, Shauger initiated a consultation with Dr. Maxim Gorelik, an ophthalmologist.
No. 11-3232 7

Dr. Gorelik echoed the prior diagnosis of left sixth

nerve palsy, and stated that double vision and depth

perception prevent Shauger from safely working in an

environment that requires hand-eye coordination.

Dr. Gorelik also opined that prism glasses might

provide some relief. Shauger’s lawyer forwarded

Dr. Gorelik’s report to the ALJ. 

In January 2010 the ALJ rejected Shauger’s disability

claim, concluding that he could transition from welding

to other work. Applying the required five-step analysis,

see 20 C.F.R. § 404.1520(a)(4), the ALJ determined that

(1) Shauger had not engaged in substantial gainful

activity from his alleged onset in 2004 through his date

last insured in 2007, (2) his left sixth nerve palsy constitutes a severe impairment, (3) this impairment does

not meet or equal a listed impairment, (4) Shauger

could not perform his past relevant work of welding

through the date last insured, and (5) there exist jobs in

the economy he still could perform. The ALJ said little

about Shauger’s headaches. She wrote that Shauger

“complains of headaches” but reasoned that they must

be “non-severe” because he was not using prescription

drugs and—so the ALJ thought—had never sought

medical care for them. The ALJ did not acknowledge

Shauger’s testimony about the severity and frequency

of his headaches, his response to those headaches, or

the effect the headaches have on his daily activities. She

opined that he had the residual functional capacity to

perform a full range of work at all exertional levels

through the date last insured and gave the “greatest

weight” to the opinion of Dr. Nafoosi. The ALJ asserted
8 No. 11-3232

that Shauger’s “statements concerning the intensity,

persistence, and limiting effects” of his symptoms were

“not credible to the extent they are inconsistent with

the above residual functional capacity assessment.”

She cited what she characterized as a “sparse and sporadic” treatment history for sixth nerve palsy and his

purported failure to “ever” seek treatment for headaches. The ALJ also discredited Shauger’s testimony

that doctors had said nothing else could be done for

his condition. His testimony, the ALJ reasoned, was

contradicted by Dr. Gorelik’s opinion that Shauger

might benefit from prism glasses. Shauger challenged

the ALJ’s decision in the district court, lost, and

now appeals.

II. DISCUSSION

On appeal, Shauger argues that the ALJ erred in

finding him not credible. Because the Appeals Council

denied review, we evaluate the ALJ’s decision as the

final word of the Commissioner. See Scott v. Astrue, 647

F.3d 734, 739 (7th Cir. 2011). Our review is confined

to the rationales offered by the ALJ, see SEC v. Chenery

Corp., 318 U.S. 80, 93-95 (1943); Steele v. Barnhart, 290

F.3d 936, 941 (7th Cir. 2002), and asks whether the

ALJ’s decision is supported by substantial evidence,

42 U.S.C. § 405(g); O’Connor-Spinner v. Astrue, 627 F.3d

614, 618 (7th Cir. 2010). We give an ALJ’s credibility

determination special, but not unlimited, deference.

Jones v. Astrue, 623 F.3d 1155, 1160 (7th Cir. 2010); Villano

v. Astrue, 556 F.3d 558, 562 (7th Cir. 2009). The ALJ must
No. 11-3232 9

consider a number of factors imposed by regulation,

see 20 C.F.R. § 404.1529(c); S.S.R. 96-7p, 1996 WL 374186,

and must support credibility findings with evidence in

the record, Villano, 556 F.3d at 562.

Shauger begins by correctly noting that the ALJ’s

initial explanation for disbelieving his testimony—that

his “statements concerning the intensity, persistence,

and limiting effects” of his symptoms were “not credible

to the extent they are inconsistent with” the judge’s

assessment of his residual functional capacity—is meaningless boilerplate seen frequently in decisions from

ALJs. We have criticized this template as unhelpful,

Bjornson v. Astrue, No. 11-2242, 2012 WL 280736, at *4

(7th Cir. Jan. 31, 2012); Parker v. Astrue, 597 F.3d 920, 921-

22 (7th Cir. 2010), and explained that it backwardly

“implies that the ability to work is determined first and

is then used to determine the claimant’s credibility,”

Bjornson, 2012 WL 280736, at *5. Credibility findings

must have support in the record, and hackneyed

language seen universally in ALJ decisions adds nothing. See Punzio v. Astrue, 630 F.3d 704, 709 (7th Cir. 2011);

Parker, 597 F.3d at 921-22.

Shauger principally argues that the ALJ could not

discredit his testimony based on a perception of unexplained gaps in his treatment history. Although a

history of sporadic treatment or the failure to follow a

treatment plan can undermine a claimant’s credibility,

an ALJ must first explore the claimant’s reasons for

the lack of medical care before drawing a negative inference. S.S.R. 96-7p, 1996 WL 374186, at *7; Moss v. Astrue,
10 No. 11-3232

555 F.3d 556, 562 (7th Cir. 2009); Craft v. Astrue, 539 F.3d

668, 679 (7th Cir. 2008). An ALJ may need to “question

the individual at the administrative proceeding in order

to determine whether there are good reasons the

individual does not seek medical treatment or does not

pursue treatment in a consistent manner.” S.S.R. 96-7p,

1996 WL 374186, at *7. The claimant’s “good reasons”

may include an inability to afford treatment, ineffectiveness of further treatment, or intolerable side effects. Id.

at *8. Here, the ALJ made no effort to question Shauger

about the perceived gaps in his treatment history

between 1988 and 2009.

More importantly, the reason for the “gaps” is obvious.

Shauger suffers from a condition that, by definition,

may wax and wane. See U.S. National Library of Medicine, Medline Plus, Cranial Mononeuropathy VI,

http://www.nlm.nih.gov/medlineplus/ency/article/

000690.htm (last visited Mar. 19, 2012). Shauger has not

claimed that his condition was disabling before 2004.

After he was diagnosed in 1988, he submitted to a full

regimen of diagnostic tests, but the underlying cause

was never discovered. He continued working and

dealt with his impairment. It was not until 1996 that

Shauger’s impairment became more pronounced. As

noted in his medical records, Shauger had “remained

about stable” for eight years but now suffered from “a

rather remarkable left sixth palsy” that was precipitating

headaches. Again Shauger had a battery of tests, including an angiogram and a Tensilon test with their

associated risks, and again no cause was determined.

Even so, he pressed on with his job, treated his head-
No. 11-3232 11

aches with over-the-counter medications, and tried to

live a normal life. It was not until 2004 that, by his

account, Shauger no longer could cope, and only then

did he apply for disability.

On the ALJ’s logic, a person suffering from an impairment that has not become disabling must act and seek

treatment as if the condition is disabling or else run the

risk that any future assertion that the impairment has

worsened will be viewed as a lie. We have recognized

that even persons who are disabled sometimes cope

with their impairments and continue working long

after they might have been entitled to benefits. See Gentle

v. Barnhart, 430 F.3d 865, 867 (7th Cir. 2005); Hawkins v.

First Union Corp. Long-Term Disability Plan, 326 F.3d 914,

918 (7th Cir. 2003). Shauger emphasizes this point particularly with his purported lack of treatment history

for his headaches. Not only did the ALJ fail to seek an

explanation for the perceived lack of treatment, but

her analysis rests on a misreading of the administrative

record. In discrediting Shauger’s testimony about the

severity of his headaches, the ALJ asserts that “there is

no indication from the medical evidence of record that

the claimant ever sought treatment for headaches.” To

the contrary, Shauger’s medical records leave no room

for doubt that he initiated the second round of neurological testing in 1996 because he had serious headaches

stemming from his left sixth nerve palsy.

Shauger further disputes the ALJ’s conclusion that

he undermined his credibility by testifying that doctors

could do nothing else for his condition. This statement
12 No. 11-3232

is false, the ALJ surmised, because “in the 2009 treatment note, his doctor recommended a special type of

glasses to help with his malpositioning.” Shauger

correctly points out that it was July 2009 when he

testified that his treatment options had been exhausted,

and not until August 2009 that he consulted with

Dr. Gorelik, who recommended prism glasses. The ALJ

received Dr. Gorelik’s report after the hearing. When

issuing her decision in January 2010, the ALJ apparently

overlooked the timing of Shauger’s consultation with

Dr. Gorelik and thus, in effect, labeled Shauger’s hearing

testimony as false because he did not anticipate the

result of a medical visit that would not occur until the

following month. The Commissioner argues that this

miscue should not matter because Shauger had been

prescribed the same type of glasses in July 2007, but the

ALJ did not mention the 2007 prescription, and the

agency may not bolster the ruling with evidence the

ALJ did not rely on. See Chenery, 318 U.S. at 93-95;

Campbell v. Astrue, 627 F.3d 299, 307 (7th Cir. 2010).

Finally, Shauger challenges the ALJ’s evaluation of his

headaches, arguing that she failed to properly consider

the relevant evidence including his daily activities, the

timing and duration of his headaches, and the measures

taken to treat the headaches. See 20 C.F.R. § 404.1529(c);

S.S.R. 96-7p, 1996 WL 374186, at *3. We agree. The ALJ

ignored several of the factors listed in Social Security

Ruling 96-7p, including that Shauger testified that (1) he

could not read or look at a computer screen for more

than 10 to 15 minutes without getting a headache, (2) he

dealt with the pain by lying down with a cold compress

and closing his eyes for 30 to 45 minutes, (3) the head-
No. 11-3232 13

aches occurred at unscheduled times, two or three times

a day, (4) his wife handles all household accounts

because he cannot, and (5) he sought treatment for headaches as far back as 1996. See 20 C.F.R. § 404.1529(c); S.S.R.

96-7p, 1996 WL 374186, at *3. Without any discussion

of these relevant factors, the ALJ failed to build a

logical bridge between the evidence and her conclusion that Shauger’s testimony was not credible. See

Villano, 556 F.3d at 562.

In response to this argument, the Commissioner

asserts that the ALJ reasonably considered Dr. Nafoosi’s

representation that Shauger’s headaches had not been

severe. We reject this contention. The ALJ did not

mention this aspect of Dr. Nafoosi’s testimony despite

saying that she had given the greatest weight to his

opinion. Moreover, reliance on Dr. Nafoosi’s superficial

testimony in general, and this statement in particular,

would have been problematic. Dr. Nafoosi did not hint

that he had experience with patients afflicted with

sixth nerve palsy, nor did he say anything suggesting

knowledge of the severity of headaches typically

associated with this affliction. He had not personally

examined Shauger, and, like the ALJ, said nothing about

the extensive testing conducted in 1996 after Shauger

had complained about severe headaches. No factual

evidence in the record contradicts Shauger’s testimony

about the severity of his headaches, and Dr. Nafoosi

offered no medical reason for doubting Shauger’s statements. Instead, it seems to us that Dr. Nafoosi went

beyond the permissible bounds of a medical expert and

usurped the ALJ’s role by making his own credibility

assessment after observing Shauger testify. See Allen v.
14 No. 11-3232

Comm’r of Soc. Sec., 561 F.3d 646, 652 (6th Cir. 2009)

(“[C]redibility determinations with respect to subjective

complaints of pain rest with the ALJ.”); Hacker v. Barnhart,

459 F.3d 934, 936 (8th Cir. 2006) (“It [is] the ALJ’s task

to resolve conflicts in the evidence and issues of credibility.”); S.S.R. 96-7p, 1996 WL 374186, at *4 (“The adjudicator must then make a finding on the credibility of

the individual’s statements.”). Without any basis for

Dr. Nafoosi’s opinion, the ALJ had the duty to develop

a full and fair record. See Nelms v. Astrue, 553 F.3d 1093,

1098 (7th Cir. 2009). And yet the ALJ did not ask

Dr. Nafoosi any follow-up questions to determine

what medical explanation, if any, he had for his

skepticism about the severity of Shauger’s headaches.

See Bjornson, 2012 WL 280736, at *7-*8 (concluding that

it was impossible to discern basis for non-examining

doctor’s expressed skepticism about claimant’s complaints of pain); Campbell, 627 F.3d at 308-09 (concluding

that ALJ did not adequately explain reason for relying

on opinion of non-examining medical expert who

testified that claimant was still drinking daily when

records showed claimant was sober).

III. CONCLUSION

For the reasons stated herein, we REVERSE the

judgment of the district court and REMAND the case

with instructions that it be returned to the SSA for

further proceedings consistent with this opinion.

3-22-12