## Facts

- Gina L. Britton applied for Disability Insurance Benefits in 2007, alleging disability from fibromyalgia, migraines, generalized dystonia, and other conditions.
- She reported significant functional limits, including limited driving, poor sleep, difficulty walking/standing/sitting for extended periods, and an inability to lift more than 5–10 pounds.
- At the administrative hearing, a medical expert (Dr. McBarron) testified that Britton “met” a fibromyalgia listing, but also testified she could perform light work; fibromyalgia is not itself a listed impairment.
- Dr. McBarron’s testimony about migraine frequency and effects relied heavily on Britton’s subjective reports.
- A vocational expert testified that, with limitations the ALJ adopted, Britton could perform past relevant work including phlebotomist, sales clerk, waitress, and sandwich maker.
- The ALJ’s residual functional capacity finding allowed light work with restrictions, including: up to 20 pounds carrying; sitting/standing/walking up to six hours in an eight-hour day; one day off per month; 5% off-task; no fast-paced settings; no exposure to moving machinery or heights; superficial public contact; and occasional coworker/supervisor interaction.
- The ALJ did not include additional migraine-related limits in all hypotheticals posed to the vocational expert.
- The ALJ denied benefits; the Appeals Council denied review; the district court affirmed.

## Issues

1. Whether the ALJ erred in giving little weight to the medical expert’s statement that Britton “met” or equaled a listing based on fibromyalgia.
2. Whether the ALJ properly discounted opinions from a nurse practitioner and other non-physician medical sources.
3. Whether the ALJ erred by omitting migraine-related limitations from vocational expert hypotheticals and the residual functional capacity finding.
4. Whether the Commissioner’s final decision was supported by substantial evidence and free of legal error.

## Decision

- The Ninth Circuit affirmed the district court’s judgment upholding the denial of benefits.
- The court held substantial evidence supported the ALJ’s non-disability determination and residual functional capacity assessment.
- The court approved the ALJ’s decision to accord little weight to the medical expert’s “listing” statement regarding fibromyalgia while crediting other supported portions of his testimony.
- The court held the ALJ gave germane reasons for discounting the nurse practitioner’s opinions.
- The court held the ALJ was not required to include additional migraine-related limitations in vocational hypotheticals absent substantial evidentiary support.

## Legal Principles

- Fibromyalgia is not a listed impairment; an opinion that a claimant “meets the listing for fibromyalgia” is legally flawed and may be discounted.
- An ALJ may discount a medical opinion that is brief, conclusory, or inadequately supported by clinical findings, and may credit only the supported portions of an opinion.
- Nurse practitioners (under the then-applicable rules) are “other sources”; their opinions may be discounted for reasons germane to the witness, including inconsistency with objective evidence and other credited opinions.
- Hypothetical questions to a vocational expert must include only limitations the ALJ finds supported by substantial evidence; the ALJ need not incorporate additional limits based primarily on subjective symptom reports.
- On judicial review, an ALJ’s findings are upheld when supported by substantial evidence and when the correct legal standards are applied.

## Conclusion

The Ninth Circuit upheld the denial of disability benefits because the ALJ reasonably evaluated the medical record, permissibly discounted unsupported opinions about fibromyalgia and other-source evidence, and could omit additional migraine-related restrictions from vocational hypotheticals where the record did not substantiate those added limitations.


Britton v. Colvin, 787 F.3d 1011 (9th Cir. 2015)