FILED NOT FOR PUBLICATION DEC 17 2025 MOLLY C. DWYER, CLERK UNITED STATES COURT OF APPEALS U.S. COURT OF APPEALS
FOR THE NINTH CIRCUIT
ALEXANDRA D. PETERSON, No. 25-528
Plaintiff - Appellant, D.C. No. 1:24-cv-03106-TOR v. * FRANK BISIGNANO, Commissioner of MEMORANDUM Social Security,
Defendant - Appellee.
Appeal from the United States District Court for the Eastern District of Washington Thomas O. Rice, District Judge, Presiding
Argued and Submitted November 19, 2025 Seattle, Washington
Before: McKEOWN, W. FLETCHER, and DESAI, Circuit Judges.
Alexandra Peterson (“Peterson”) appeals the district court’s order affirming
an Administrative Law Judge’s (“ALJ”) denial of her application for Social
Security disability insurance benefits.
We have jurisdiction pursuant to 28 U.S.C. § 1291 and review the district
court’s order affirming the denial of benefits de novo. Kitchen v. Kijakazi, 82
F.4th 732, 735, 738 (9th Cir. 2023). We “will disturb the denial of benefits only if
* This disposition is not appropriate for publication and is not precedent except as provided by Ninth Circuit Rule 36-3. the decision contains legal error or is not supported by substantial evidence.” Id. at
738 (internal quotations omitted). We hold that the ALJ erred by (1) improperly
evaluating the medical opinion evidence and (2) improperly discounting Peterson’s
subjective testimony about her symptom severity. We therefore reverse and
remand for further proceedings consistent with this disposition.
1. Medical Opinion Evidence
The ALJ erred when discounting the medical opinions of Doctor of
Chiropractic (“DC”) Briggs and Advanced Registered Nurse Practitioner
(“ARNP”) Hardison. The operative Social Security Regulations (“SSR”) do not
consider chiropractors or ARNPs “acceptable medical source[s],” so ALJs may
discount their opinions by providing “reasons germane to each witness.” 20 C.F.R.
§ 416.902(a); Britton v. Colvin, 787 F.3d 1011, 1013 (9th Cir. 2015) (internal
quotations omitted). However, when “evaluating whether a claimant’s [RFC]
renders them disabled because of fibromyalgia,” ALJs must construe the medical
evidence “in light of fibromyalgia’s unique symptoms and diagnostic methods.”
Revels v. Berryhill, 874 F.3d 648, 662 (9th Cir. 2017). Although the ALJ
recognized that Peterson’s severe impairments include fibromyalgia, he failed to
construe Briggs’ and Hardison’s opinions in light of fibromyalgia’s unique
characteristics.
2 25-528 Briggs estimated that Peterson’s symptoms would cause her to miss three
days of work per month. Hardison concluded that Peterson would miss four or
more days of work per month. The ALJ gave these opinions “little weight”
because they were inconsistent with evidence indicating that Peterson had “no
degenerative changes; no soft tissue abnormalities; no fractures or dislocations;
normal deep tendon reflexes; strong and equal bilateral muscle strength . . . normal
sensation to touch, pin and vibration,” and “normal gait.” This conclusion reflects
a “fundamental misunderstanding of fibromyalgia.” Id. at 662.
Fibromyalgia patients experience chronic pain, but their reflexes, muscle
strength, joints, and musculoskeletal exams appear normal. See id. at 656.
Fibromyalgia is instead diagnosed “entirely on the basis of patients’ reports of pain
and other symptoms.” Benecke v. Barnhart, 379 F.3d 587, 590 (9th Cir. 2004).
Thus, the ALJ erred by “effectively requir[ing] objective evidence for a disease
that eludes such measurement.” Id. at 594 (internal quotations omitted).
The ALJ also erred by discounting Briggs’ and Hardison’s opinions without
addressing the length of their treatment history. When determining how much
weight to afford a medical opinion, ALJs are “required to consider” the “[l]ength
of the treatment relationship and the frequency of examination” and the “[n]ature
and extent of the treatment relationship.” Ghanim v. Colvin, 763 F.3d 1154, 1161
(9th Cir. 2014); 20 C.F.R. § 404.1527(c)(2). These considerations are especially
3 25-528 important when evaluating fibromyalgia patients because their symptoms “can wax
and wane.” SSR 12-2p, at *6. For this reason, the SSR directs ALJs assessing
fibromyalgia patients to “consider a longitudinal record whenever possible.” Id.
From 2016 to 2018, Briggs treated Peterson approximately seventy-five
times. Yet, the ALJ found Briggs’ opinion “not persuasive” because it was
“inconsistent” with the findings of Dr. Drenguis, a non-treating physician who
evaluated Peterson once.
Hardison treated Peterson between 2014 and 2018, during which time she
specifically addressed Peterson’s chronic pain and fibromyalgia. The ALJ
discounted her opinion because it conflicted with ARNP Sigler’s opinion.
However, ARNP Sigler saw Peterson only three times, two of which were
ten-minute video appointments, and none of which addressed her fibromyalgia.
In discounting Briggs’ and Hardison’s opinions, the ALJ failed to
acknowledge that they had longer, more frequent, and more extensive treatment
relationships with Peterson than Dr. Drenguis or ARNP Sigler. The ALJ’s failure
to address these factors “alone constitutes reversible legal error.” Trevizo v.
Berryhill, 871 F.3d 664, 676 (9th Cir. 2017); see also 20 C.F.R. § 404.1527(f)(1)
(“[I]t may be appropriate to give more weight to the opinion of a medical source
who is not an acceptable medical source if he or she has seen the individual more
often . . . .”).
4 25-528 2. Symptom Severity Testimony
The ALJ also erred in discounting Peterson’s testimony about her physical
and mental health symptoms. An ALJ “can reject the claimant’s testimony about
the severity of her symptoms only by offering specific, clear and convincing
reasons for doing so.” Garrison v. Colvin, 759 F.3d 995, 1014–15 (9th Cir. 2014)
(internal quotations omitted). This “clear and convincing standard is the most
demanding required in Social Security cases.” Moore v. Comm’r of Soc. Sec.
Admin., 278 F.3d 920, 924 (9th Cir. 2002).
The ALJ discounted Peterson’s testimony about her physical symptoms
because (1) it conflicted with “objective findings” suggesting that she had normal
muscle tone, normal gait, good range of motion, etc., and (2) her reports of pain
were supposedly inconsistent. On the first point, the ALJ once again erred by
requiring objective evidence of Peterson’s fibromyalgia. Benecke, 379 F.3d at 594.
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FILED NOT FOR PUBLICATION DEC 17 2025 MOLLY C. DWYER, CLERK UNITED STATES COURT OF APPEALS U.S. COURT OF APPEALS
FOR THE NINTH CIRCUIT
ALEXANDRA D. PETERSON, No. 25-528
Plaintiff - Appellant, D.C. No. 1:24-cv-03106-TOR v. * FRANK BISIGNANO, Commissioner of MEMORANDUM Social Security,
Defendant - Appellee.
Appeal from the United States District Court for the Eastern District of Washington Thomas O. Rice, District Judge, Presiding
Argued and Submitted November 19, 2025 Seattle, Washington
Before: McKEOWN, W. FLETCHER, and DESAI, Circuit Judges.
Alexandra Peterson (“Peterson”) appeals the district court’s order affirming
an Administrative Law Judge’s (“ALJ”) denial of her application for Social
Security disability insurance benefits.
We have jurisdiction pursuant to 28 U.S.C. § 1291 and review the district
court’s order affirming the denial of benefits de novo. Kitchen v. Kijakazi, 82
F.4th 732, 735, 738 (9th Cir. 2023). We “will disturb the denial of benefits only if
* This disposition is not appropriate for publication and is not precedent except as provided by Ninth Circuit Rule 36-3. the decision contains legal error or is not supported by substantial evidence.” Id. at
738 (internal quotations omitted). We hold that the ALJ erred by (1) improperly
evaluating the medical opinion evidence and (2) improperly discounting Peterson’s
subjective testimony about her symptom severity. We therefore reverse and
remand for further proceedings consistent with this disposition.
1. Medical Opinion Evidence
The ALJ erred when discounting the medical opinions of Doctor of
Chiropractic (“DC”) Briggs and Advanced Registered Nurse Practitioner
(“ARNP”) Hardison. The operative Social Security Regulations (“SSR”) do not
consider chiropractors or ARNPs “acceptable medical source[s],” so ALJs may
discount their opinions by providing “reasons germane to each witness.” 20 C.F.R.
§ 416.902(a); Britton v. Colvin, 787 F.3d 1011, 1013 (9th Cir. 2015) (internal
quotations omitted). However, when “evaluating whether a claimant’s [RFC]
renders them disabled because of fibromyalgia,” ALJs must construe the medical
evidence “in light of fibromyalgia’s unique symptoms and diagnostic methods.”
Revels v. Berryhill, 874 F.3d 648, 662 (9th Cir. 2017). Although the ALJ
recognized that Peterson’s severe impairments include fibromyalgia, he failed to
construe Briggs’ and Hardison’s opinions in light of fibromyalgia’s unique
characteristics.
2 25-528 Briggs estimated that Peterson’s symptoms would cause her to miss three
days of work per month. Hardison concluded that Peterson would miss four or
more days of work per month. The ALJ gave these opinions “little weight”
because they were inconsistent with evidence indicating that Peterson had “no
degenerative changes; no soft tissue abnormalities; no fractures or dislocations;
normal deep tendon reflexes; strong and equal bilateral muscle strength . . . normal
sensation to touch, pin and vibration,” and “normal gait.” This conclusion reflects
a “fundamental misunderstanding of fibromyalgia.” Id. at 662.
Fibromyalgia patients experience chronic pain, but their reflexes, muscle
strength, joints, and musculoskeletal exams appear normal. See id. at 656.
Fibromyalgia is instead diagnosed “entirely on the basis of patients’ reports of pain
and other symptoms.” Benecke v. Barnhart, 379 F.3d 587, 590 (9th Cir. 2004).
Thus, the ALJ erred by “effectively requir[ing] objective evidence for a disease
that eludes such measurement.” Id. at 594 (internal quotations omitted).
The ALJ also erred by discounting Briggs’ and Hardison’s opinions without
addressing the length of their treatment history. When determining how much
weight to afford a medical opinion, ALJs are “required to consider” the “[l]ength
of the treatment relationship and the frequency of examination” and the “[n]ature
and extent of the treatment relationship.” Ghanim v. Colvin, 763 F.3d 1154, 1161
(9th Cir. 2014); 20 C.F.R. § 404.1527(c)(2). These considerations are especially
3 25-528 important when evaluating fibromyalgia patients because their symptoms “can wax
and wane.” SSR 12-2p, at *6. For this reason, the SSR directs ALJs assessing
fibromyalgia patients to “consider a longitudinal record whenever possible.” Id.
From 2016 to 2018, Briggs treated Peterson approximately seventy-five
times. Yet, the ALJ found Briggs’ opinion “not persuasive” because it was
“inconsistent” with the findings of Dr. Drenguis, a non-treating physician who
evaluated Peterson once.
Hardison treated Peterson between 2014 and 2018, during which time she
specifically addressed Peterson’s chronic pain and fibromyalgia. The ALJ
discounted her opinion because it conflicted with ARNP Sigler’s opinion.
However, ARNP Sigler saw Peterson only three times, two of which were
ten-minute video appointments, and none of which addressed her fibromyalgia.
In discounting Briggs’ and Hardison’s opinions, the ALJ failed to
acknowledge that they had longer, more frequent, and more extensive treatment
relationships with Peterson than Dr. Drenguis or ARNP Sigler. The ALJ’s failure
to address these factors “alone constitutes reversible legal error.” Trevizo v.
Berryhill, 871 F.3d 664, 676 (9th Cir. 2017); see also 20 C.F.R. § 404.1527(f)(1)
(“[I]t may be appropriate to give more weight to the opinion of a medical source
who is not an acceptable medical source if he or she has seen the individual more
often . . . .”).
4 25-528 2. Symptom Severity Testimony
The ALJ also erred in discounting Peterson’s testimony about her physical
and mental health symptoms. An ALJ “can reject the claimant’s testimony about
the severity of her symptoms only by offering specific, clear and convincing
reasons for doing so.” Garrison v. Colvin, 759 F.3d 995, 1014–15 (9th Cir. 2014)
(internal quotations omitted). This “clear and convincing standard is the most
demanding required in Social Security cases.” Moore v. Comm’r of Soc. Sec.
Admin., 278 F.3d 920, 924 (9th Cir. 2002).
The ALJ discounted Peterson’s testimony about her physical symptoms
because (1) it conflicted with “objective findings” suggesting that she had normal
muscle tone, normal gait, good range of motion, etc., and (2) her reports of pain
were supposedly inconsistent. On the first point, the ALJ once again erred by
requiring objective evidence of Peterson’s fibromyalgia. Benecke, 379 F.3d at 594.
On the second point, the ALJ erred by mischaracterizing the record. Although
hundreds of medical records addressed Peterson’s pain symptoms, the ALJ held
that her reports of pain were inconsistent. However, the few appointments the ALJ
identified in which Peterson did not discuss her pain focused on COVID-19
symptoms and contraception. It is reasonable that a patient visiting a provider for
COVID-19 or birth control would not discuss her unrelated chronic-pain
symptoms. Because the ALJ’s conclusion rested on a misunderstanding of
5 25-528 fibromyalgia and misstatement of the record, we hold that he did not provide “clear
and convincing reasons” for discounting Peterson’s physical symptom testimony.
Garrison, 759 F.3d at 1015.
The ALJ also erred by discounting Peterson’s mental health testimony on the
grounds that she was “resistan[t] to taking medication for her mental health
issues.” Throughout her treatment history, Peterson took several different
medications to manage her mental health symptoms. The record shows that she
discontinued these prescriptions because they were ineffective, poorly tolerated, or
prohibitively expensive. In 2019, a treating physician agreed that psychotropic
medication was “unlikely to be helpful.” Thus, the record does not support the
conclusion that Peterson was “resistan[t] to taking medication” to the degree that
she was “treatment resistant.”
For the above reasons, we REVERSE the decision of the district court with
directions to REMAND this case to the Social Security Commissioner for further
proceedings consistent with this disposition.
6 25-528