In the 

United States Court of Appeals 

For the Seventh Circuit ____________________ 

No. 15-1727 

KYLE D. ALAURA, 

Plaintiff-Appellant, 

v. 

CAROLYN W. COLVIN, Acting Commissioner of Social 

Security, 

Defendant-Appellee. 

____________________ 

Appeal from the United States District Court for the 

Northern District of Indiana, Fort Wayne Division. 

No. 1:13-CV-287-PPS — Philip P. Simon, Chief Judge. 

____________________ 

ARGUED AUGUST 4, 2015 — DECIDED AUGUST 18, 2015 

____________________ 

Before POSNER, KANNE, and HAMILTON, Circuit Judges. 

POSNER, Circuit Judge. In September 2010, a 22-year-old 

man named Alaura, the plaintiff in this social security disability case, was struck in the back of his head by an assailant 

wielding a bar stool as a weapon. The blow shattered his 

skull, necessitating emergency surgery to remove a portion 

of his brain and place a metal plate in his skull. During this 
2 No. 15-1727 

craniotomy Alaura had a seizure, for which he was medicated. He remained hospitalized for eight days. 

Two months after the surgery Alaura went to see Jeffrey 

Kachmann, the neurosurgeon who had operated on him, 

complaining of headaches, dizziness, and confusion. Dr. 

Kachmann thought that Alaura was improving, but needed 

further tests before it could be determined whether he could 

return to work. 

A month later Alaura was examined by a neurologist, 

Thomas Banas, who diagnosed Alaura with post-traumatic 

headaches and a cognitive impairment caused by the injury 

to his brain. At about the same time Dr. Kachmann decided 

that Alaura, who was continuing to take anti-seizure medication and for whom Dr. Banas had prescribed pain medication in addition, was not to return to work until March 2011. 

In January 2011 Alaura complained to Dr. Kachmann of 

daily headaches and was found to be suffering from occipital neuralgia. That is an injury to or inflammation of nerves 

that run from the spinal cord at the base of the neck up 

through the scalp. It causes piercing or throbbing pain in the 

neck, the back of the head, and the front of the head behind 

the eyes. Kachmann prescribed a nerve block to lessen the 

pain. 

The next month brought a lessening of pain, though the 

pain returned the month after that, and Dr. Banas prescribed 

another nerve block plus an antidepressant drug commonly 

used to treat chronic pain conditions, including persistent 

headaches. A year later (March 2012), Alaura visited a family 

practitioner, a Dr. Ted Crisman, telling him he could no 

longer afford Dr. Kachmann or Dr. Banas. He said he was 
No. 15-1727 3 

having daily headaches, and Dr. Crisman prescribed an antidepressant. Alaura also complained that he was having 

“absence-type” seizures several times a week—brief lapses 

of consciousness in which he would blank out or zone out 

for a couple of minutes. Around the same time he was visiting a chiropractor for back and neck pain, and received some 

relief from the chiropractor’s ministrations. 

His headaches continued, however. He reported to a 

neurologist named John Collins (who examined him nine 

days before and three weeks after his hearing before the administrative law judge assigned to his case, and whose report was available to her when she wrote her opinion), and a 

pain specialist named William Hedrick, that although his 

headaches had been improving he was still experiencing 

persistent headaches several times a week that were interfering with his normal activities. The doctors diagnosed Alaura 

with chronic daily headaches, left occipital neuralgia, atypical spells with suspected seizure activity, myofascial pain—

pressure on sensitive points in the muscles—in his neck, dizziness, and a mood disorder. They also concluded that 

Alaura’s staring spells, during which he would experience 

disorientation, confusion and lethargy, were consistent with 

complex partial seizure activity. “Patients experiencing a 

complex partial seizure may stare blankly into space, or experience automatisms (non-purposeful, repetitive movements).” Johns Hopkins Medicine, “Neurology and Neurosurgery: Complex Partial Seizures,” www.hopkinsmedicine.

org/neurology_neurosurgery/centers_clinics/epilepsy/seizur

es/types/complex-partial-seizures.html (visited August 17, 

2015, as were the other websites cited in this opinion). The 

doctors prescribed two more nerve blocks, seizure and mi-
4 No. 15-1727 

graine medication, and additional antidepressants for pain 

and depression. 

The administrative law judge mentioned none of this. 

She said only that the doctors’ “physical examination findings were usually within normal limits, except for tenderness over his scalp, neck, and shoulders, as well as sharpened Romberg.” She did not explain the significance of 

“usually,” the significance of “tenderness over his scalp, 

neck, and shoulders,” or what she meant by “sharpened 

Romberg.” There is a Sharpened Romberg Test—a test of 

balance; we don’t know what she meant by saying that 

Alaura had a “sharpened Romberg.” That he had taken such 

a test and passed? Taken it and it had revealed a balance 

problem? 

The administrative law judge noted that an EEG (electroencephalogram) of Alaura taken around the same time was 

normal, yet she did not mention that the accompanying exam notes repeated the diagnoses by Drs. Collins and 

Hedrick of pain, seizures, dizziness, and mental-health problems such as depression. 

Both Alaura and his mother (he lives in her home) testified at the hearing before the administrative law judge. They 

were the only witnesses, unless the vocational expert, whom 

we discuss later, should be considered a witness. Alaura testified to a variety of ailments. A partial list would include 

constant headache, severe headaches a couple of times a 

week that make him sick and are exacerbated by bright 

lights (“photophobia”) and force him to go to bed, nausea 

from headaches, an occasional loss of feeling in one arm, 

mood swings, hearing loss, neck pain, a weakness in his 

right leg that sometimes causes him to fall, tremors in his 
No. 15-1727 5 

hands, dizziness in standing, anxiety, nightmares, and difficulty gripping objects. He testified that he can play video 

games only for five minutes at a time because the light from 

the screen bothers him (i.e., his play is inhibited by his photophobia), that he can’t mow the lawn because the jarring 

motion of the lawnmower makes him sick, and that five or 

ten minutes after sitting down he falls asleep. 

His mother added that at times he stares blankly into 

space (consistent with his diagnosis of complex partial seizures), that he has trouble finishing projects, that he can’t 

drive, that she’s reluctant to leave him alone in the house, 

that he leaves stove burners on, has dizzy spells, and cannot 

walk far and that she has to remind him to take his medications, brush his teeth, and take out the garbage. These lists, 

the mother’s and the son’s, of the son’s ailments and deficiencies are only partial. 

On the basis of the testimony and medical records, the 

administrative law judge determined that Alaura indeed 

suffers from multiple severe impairments—traumatic brain 

injury, seizure disorder, neuropathic pain (chronic pain 

caused by injury to the nervous system), headaches, occipital 

neuralgia, insomnia, cognitive disorder caused by his brain 

injury, adjustment disorder (a tendency to go to pieces under stress), anxiety disorder, and mood disorder. Nevertheless she concluded that Alaura is not totally disabled—that 

he can perform light work that involves no concentrated exposure to bright lights or jarring movements, no having to 

climb ropes (are there any rope-climbing jobs anymore?) or 

ladders or work on scaffolds, no commercial driving, and no 

more than superficial interaction with members of the public. Asked what jobs he can do given these limitations, a vo-
6 No. 15-1727 

cational expert testified that he would be able to work as a 

retail marker, hand packager, or addresser. A retail marker 

does such things as placing price tickets on articles of merchandise; a hand packager does packaging by hand and performs related tasks such as sealing and weighing containers 

and inspecting materials at various stages of the packaging 

process; an addresser addresses envelopes and other items 

by either hand or typewriter. 

The grounds on which the administrative law judge concluded that Alaura’s long list of impairments did not disable 

him from light work (which is not, with the exception of the 

addresser, sedentary work—the marker and the packager 

are bound to spend a lot of time standing) are that nerve 

blocks and other medications had reduced the severity of his 

impairments, that he went for significant periods of time 

(aggregating to eight months since his brain surgery) without taking medications or seeing doctors, that he was on 

Medicaid yet hadn’t sought treatment at low-cost or free 

clinics, and that he could prepare soup and sandwiches for 

himself, do laundry, send text messages on a cellphone, feed 

his two cats and change their litter, count change, handle 

bank accounts (whatever that means), play video games 

(though apparently only for five minutes at a time), take his 

medications with only occasional reminders by his mother to 

do so, and get along with other people. How being able to 

feed cats, make a sandwich, etc., prepare one for full-time 

employment as a retail marker, hand packager, or addresser 

was left unexplained. Handling bank accounts certainly 

sounds like an activity that prepares one for gainful employment, but the meaning of the phrase was not explained. 
No. 15-1727 7 

The administrative law judge noted that Alaura has not 

had further brain surgery, or been hospitalized, and that a 

physical examination in 2011 had yielded findings “essentially within normal limits, except for numbness in his scalp, 

tenderness over his occipital ridge, swaying with closed 

eyes, and a slow, deliberate gait.” Except? These don’t sound 

like trivial obstacles to being able to hold full-time employment. 

The reasons given for concluding that Alaura is capable 

of full-time gainful employment despite the administrative 

law judge’s long list of his severe (her term) impairments are 

thin. True, he was better in May 2012, the date of his hearing 

before the administrative law judge, than he had been when 

he had his skull broken and a chunk of his brain removed. 

But how much better is unclear because at the time of the 

hearing more than a year had elapsed since Alaura had been 

examined by Drs. Kachmann and Banas, who appear 

(Kachmann especially) to have analyzed Alaura’s brainrelated impairments more thoroughly than any other doctors. 

Above all, the administrative law judge made no effort to 

consider the combined effects on Alaura’s ability to work of 

all his impairments and limitations. An administrative law 

judge is unlikely to be capable of assessing the interaction 

within and overall effect of such a collection of impairments; 

she is not a doctor. But she has access to the stable of medical 

consultants used by the Social Security Administration to 

evaluate applicants for disability benefits. Why didn’t she 

ask a reputable neurologist and a reputable pain specialist, 

experts comparable to Kachmann and Banas, to examine 

Alaura and Alaura’s medical records and offer an opinion on 
8 No. 15-1727 

his ability to do various forms of light work on a full-time 

basis? Kachmann and Banas had last seen Alaura in January 

and March 2011, respectively, more than a year before 

Alaura’s administrative hearing; and the administrative law 

judge didn’t issue her opinion until August 2012, roughly a 

year and a half after Alaura’s last visits to them. 

Not that they were the only doctors who examined 

Alaura and gave evidence. He was examined by Dr. Gautham Gadiraju in March 2011, but Gadiraju’s field is internal 

medicine rather than neurology and so, unsurprisingly, 

there is virtually nothing in his report about Alaura’s neurological symptoms. The administrative law judge rejected, 

moreover, without explanation, Dr. Gadiraju’s opinion that 

Alaura can sit for only thirty minutes at a stretch and walk 

only six blocks at a time. 

Alaura was later seen, as we noted, by a neurologist and 

a pain management specialist, Drs. Collins and Hedrick, but 

remember that virtually all that the administrative law judge 

said about their findings was that physically Alaura seemed 

to be in pretty good shape and in particular that he had no 

significant hearing loss. Yet these doctors reported that 

Alaura has chronic daily headaches, occipital neuralgia, 

atypical spells with suspected seizure activity, myofascial 

pain in his neck, dizziness, a mood disorder, and staring 

spells in which he experiences disorientation, confusion and 

lethargy consistent with complex partial seizure activity—all

unremarked on by the administrative law judge. 

There is probably some exaggeration in Alaura’s and his 

mother’s description of his physical and mental situation; for 

all we know, there is gross exaggeration. But the administrative law judge’s scattershot analysis leaves us with no confi-
No. 15-1727 9 

dence that Alaura’s fitness for full-time gainful employment 

as of the hearing date was responsibly determined; and so 

the case must be returned to the Social Security Administration for reconsideration of his application for benefits. 

We need to say something about the vocational expert’s 

conclusion that (in the words of the administrative law 

judge) “the claimant is capable of making a successful adjustment to other work [that is, other than his pre-braininjury employment as a warehouse worker, landscape laborer, and forklift driver] that exists in significant numbers in 

the national economy.” The vocational expert said that there 

are 500 retail-marker jobs in Alaura’s region, 7000 in the 

state, and 300,000 in the nation; 100 hand-packager jobs in 

the region, 2000 in the state, and 80,000 in the nation; and 

100 addresser jobs in the region, 1500 in the state, and 

200,000 in the nation. Why local and state statistics are included is unclear, since if there is a significant number of 

jobs that the applicant for benefits can perform anywhere in 

the United States he is deemed not disabled, Browning v. 

Colvin, 766 F.3d 702, 708 (7th Cir. 2014), although this surely 

exaggerates the mobility of a person with as many acknowledged severe impairments as Alaura. 

Asked at argument where the job figures we just quoted 

from the administrative law judge’s opinion came from, the 

Social Security Administration’s lawyer said she had no idea 

and added that the agency’s lawyers are forbidden to speak 

to vocational experts—which we find hard to believe, and 

which if true makes no sense at all. The administrative law 

judge said she’d “determined that the vocational expert’s 

testimony is consistent with the information contained in the 

Dictionary of Occupational Titles” (U.S. Department of La-
10 No. 15-1727 

bor, Dictionary of Occupational Titles (4th ed. 1991)), but she 

was wrong, because the DOT doesn’t contain statistics. Anyway the DOT has been superseded by the O*NET (Occupational Information Network)—a fact ignored by the Social Security Administration’s vocational experts and administrative law judges. 

We have recently expressed concern with the source and 

validity of the statistics that vocational experts trot out in social security disability hearings, Browning v. Colvin, supra, 

766 F.3d at 709; Herrmann v. Social Security Administration, 

772 F.3d 1110, 1112–14 (7th Cir. 2014), as have other courts, 

Brault v. Social Security Administration, 683 F.3d 443, 446–47 

(2d Cir. 2012) (per curiam); Guiton v. Colvin, 546 Fed. App’x 

137, 143–45 (4th Cir. 2013) (concurring opinion), and commentators: Jon C. Dubin, “Overcoming Gridlock: Campbell

After a Quarter-Century and Bureaucratically Rational GapFilling in Mass Justice Adjudication in the Social Security 

Administration’s Disability Programs,” 62 Administrative 

Law Review 937, 964–71 (2010); Peter J. Lemoine, “Crisis of 

Confidence: The Inadequacies of Vocational Evidence Presented at Social Security Disability Hearings (Part II),” Social 

Security Forum, Sept. 2012, p. 1. The problem appears to be 

that the only reliable statistics are census data for broad categories of jobs, rather than for jobs in the narrower categories that the applicant for benefits is capable of doing. Typically, it appears, the vocational expert simply divides the 

number of jobs in the broad category that includes the narrow category of jobs that the applicant can perform by the 

number of narrow categories in the broad category, Browning 

v. Colvin, supra, 766 F.3d at 709, thus assuming that each narrow category has the same number of jobs as each other narrow category—which is preposterous. A vocational expert’s 
No. 15-1727 11 

stated number of jobs in a narrow category seems likely, 

therefore, to be a fabrication. 

According to the DOT, an “addresser” is someone who 

“addresses by hand or typewriter, envelopes, cards, advertising literature, packages, and similar items for mailing. 

May sort mail.” “Addresser,” U.S. Department of Labor, Dictionary of Occupational Titles (4th ed. 1991), www.oal

j.dol.gov/public/dot/references/dot02a.htm. It’s hard to believe that, as the vocational expert testified in this case, there 

are 200,000 people in the United States for whom this is a 

full-time job. And does anyone use a typewriter anymore? 

Most addressing nowadays is either personal, as when one is 

sending a Christmas or get-well card, or automated, as in the 

case of business mailings, including mass mailings of advertisements or magazines. There is no indication that Alaura is 

capable of performing jobs typically found in automated 

mailing, such as bar-coding, pre-sorting, list management, 

variable data laser printing, folding, inserting, tabbing, 

warehousing, and shipping. See Automated Mailing Systems, Inc., www.automailsys.com/. And many of the jobs in 

the category “hand packager” are technical or demanding, 

Browning v. Colvin, supra, 766 F.3d at 710–12, and therefore 

likely, like most addresser jobs, to be beyond Alaura’s ability 

to perform. Even “retail marker” is a lot more complicated 

than it sounds; here is the DOT’s definition: “Marks and attaches price tickets to articles of merchandise to record price 

and identifying information: Marks selling price by hand on 

boxes containing merchandise, or on price tickets. Ties, 

glues, sews, or staples price ticket to each article. Presses 

lever or plunger of mechanism that pins, pastes, ties, or staples ticket to article. May record number and types of articles marked and pack them in boxes. May compare printed 
12 No. 15-1727 

price tickets with entries on purchase order to verify accuracy and notify supervisor of discrepancies. May print information on tickets, using ticket-printing machine.” 

www.occupationalinfo.org/20/209587034.html. 

The denial of the application for benefits, and the affirmation of that denial by the district court, were premature. 

The judgment is reversed with directions to remand the case 

to the Social Security Administration for further consideration of Alaura’s application for benefits. 

REVERSED AND REMANDED