United States District Court, D. Minnesota
Megan C. Lunzer, Plaintiff,
Nancy A. Berryhill, Deputy Commissioner of Operations Defendant.
E. RAU, UNITED STATES MAGISTRATE JUDGE
to 42 U.S.C. § 405(g), Plaintiff Megan C. Lunzer
(“Lunzer”) seeks review of the Deputy
Commissioner of Operations of the Social Security
Administration's (the “Commissioner”) denial
of her application for disability insurance benefits
(“DIB”) and social security income
(“SSI”). See (Compl. for Judicial
Review, “Compl.”) [Doc. No. 1 ¶ 1]. The
parties filed cross-motions for summary judgment. (Pl.'s
Mot. for Summ. J.) [Doc. No. 12]; (Def.'s Mot. for Summ.
J.) [Doc. No. 14]. For the reasons set forth below, the Court
denies Lunzer's Motion for Summary Judgment and grants
the Deputy Commissioner's Motion for Summary Judgment.
filed for SSI and DIB on September 20, 2011, and July 11,
2012, respectively. (Admin. R.) [Doc. No. 11 at 306, 310].
She cited an alleged onset date (“AOD”) of
September 30, 2010. (Id. at 331). Lunzer claimed
disability due to depression, pectus excavatum, postural
orthostatic tachycardia syndrome (“POTS”),
inappropriate sinus tachycardia, syncope, blood pressure
issues, migraines, post-traumatic stress disorder
(“PTSD”), and several other conditions.
(Id. at 378). Lunzer's claims were denied
initially and upon reconsideration. (Id. at 194,
203). Following a hearing, the administrative law judge (the
“ALJ”) denied benefits to Lunzer on December 23,
2013. See (id. at 163-78). The Appeals
Council granted review of the ALJ's decision and remanded
the case to the ALJ for a new hearing. (Id. at
186-90). On remand, the ALJ had a hearing and again denied
benefits to Lunzer on October 30, 2015. See
(id. at 7-27).
this decision, the Appeals Council denied Lunzer's
request for review, rendering the ALJ's decision final.
(Id. at 1); 20 C.F.R. § 404.981. Lunzer initiated
the instant lawsuit on May 25, 2017. (Compl.)
Court has reviewed the entire administrative record, but
summarizes only the evidence necessary to provide context for
the issues before the Court. Specifically, Lunzer's
arguments are limited to issues arising from POTS, syncope,
and blood pressure, and consequently, the Court's review
of Lunzer's medical evidence is limited to these
Lunzer's Background and Testimony
her AOD, Lunzer was twenty-three years old, making her a
younger individual. (Admin. R. at 306); see 20
C.F.R.§ 404.1563(c). Lunzer completed high school and
college. (Admin. R. at 53-54). She has experience working as
a recreation supervisor, food court employee, and recreation
and programs assistant. (Id. at 367).
hearing before the ALJ, Lunzer testified as follows. She is
currently unemployed and the last place she worked for any
substantial period of time was as a guest services manager
for the city of Crystal. (Id. at 60-61). She worked
for Crystal as a part-time employee and was unable to work
full-time due to her symptoms. (Id.). She tried to
babysit, but could only work for “an hour to two
maximum” at a time. (Id. at 61, 95).
stated that she began experiencing symptoms in high school.
(Id. at 56). She testified that she was an athlete
in high school, but found that she was having trouble
breathing and experienced chest pain. (Id.). Since
then, her symptoms have gotten worse. (Id. at 58).
She experiences visual disturbances when she stands up, and
testified that she feels lightheadedness, fatigue, and
headaches daily. (Id. at 63-64). Lunzer is able to
do basic daily activities such as cook and clean, but states
that some days she is unable to be upright for more than
fifteen minutes. (Id. at 49).
experienced blood pooling in her legs; laying down alleviates
this issue, but compressive stockings did not help the
condition. (Id. at 49-50, 91). Lunzer has not driven
a vehicle for some time and feels unsafe driving.
(Id. at 67).
also testified that she had been diagnosed with a mood
disorder, PTSD, anxiety, and opioid dependence and remission.
(Id. at 93). Most of those conditions have improved.
(Id. at 54). She has continuing anxiety stemming
from the uncertainty of her diagnosis. (Id.). She
takes anxiety medication and feels that her symptoms improve
with the medication. (Id.).
visited a pediatric surgeon on July 1, 2010, with complaints
of shortness of breath with physical activity. (Id.
at 780). She experienced these symptoms throughout her
childhood and adolescent years. (Id.). A CT scan
demonstrated pectus excavatum with an index measured at 6.7
and marked displacement and compression of the
heart. (Id. at 781). Lunzer underwent
surgery to repair her pectus excavatum on July 7, 2010.
(Id. at 778). The surgeon assessed “possible
nerve injury secondary to surgery.” (Id. at
994). He prescribed her gabapentin to help with the
pain. (Id.). On January 15, 2011,
Lunzer recorded sinus tachycardia with a resting heart rate
at ninety-six beats per minute and blood pressure of 139/90.
(Id. at 958). She obtained a Holter monitor to
evaluate her heart rate. (Id. at 959).
February 14, 2011, Lunzer was admitted to the emergency room
after reporting three separate episodes of syncope, the last
involving her hitting her head on a dresser. (Id. at
683). Her Holter monitor “demonstrated 48 to 171 beats
per minute.” (Id.). She was not wearing her
event monitor during her episodes of syncope. (Id.
at 683-84). The doctor stated, “[Lunzer's] syncope
is unlikely related to rapid heart rate, ” and that
“her symptoms of nausea, lightheadedness, [and]
sweating . . . correlate more with neurocardiogenic
syncope.” (Id. at 686).
27, 2011, Lunzer had a loop recorder implanted. (Id. at
569). Over the next several months, she reported extreme
depression and more frequent syncope events. See,
e.g., (id. at 1195-96, 1193-94, 1186-88,
1181-82, 1179-80, 1176-77, 1173-74, 1169-70, 1167-68,
1165-66) (showing Lunzer's distress stemming from
uncertainty in her medical diagnosis as well as syncope
events as frequent as three times per week). On July 10,
2012, Lunzer underwent a neurological exam and the
neurologist stated “I do not think [her syncope
events][are] necessarily due to a postural tachycardia
syndrome. . . because her spells may occur when she is not
standing.” (Id. at 1104). She opined that
Lunzer's condition was “a certain hemodynamic
instability with labile blood pressure and heart rate.”
16, 2012, Lunzer underwent a tilt table test. See
(id. at 1120-22). She presented with a baseline
sinus rhythm of sixty-six beats per minute and blood pressure
of 115/60. (Id. at 1120). Her upright tilt test
produced a sinus rhythm of sixty-three beats per minute with
a blood pressure of 77/47. (Id. at 1121). The
electrophysiologist stated that the tilt test was
“positive for signs of POTS during [Lunzer's]
passive tilt.” (Id.). Lunzer's event
recorder showed “no significant bradycardic or
arrhythmogenic episodes, ” and the electrophysiologist
found “no arrthymogenic evidence that would be causing
[Lunzer's] syncope. . . spells[.]” (Id. at
November 27, 2012, Lunzer's heart rate was measured and
found to range from “the 50s range to 198 beats per
minute even while she is sitting.” (Id. at
1430). Her blood pressure and heart rate fluctuate
“dramatically” with position change; lying down
her blood pressure was 135/79, and her pulse was 105 beats
per minute; standing the blood pressure was 101/77, and her
pulse was 152 beats per minute. (Id.).
December 20, 2012, Lunzer began seeing Joseph Pennington, MD
(“Dr. Pennington”), a POTS specialist.
(Id. at 1309). Dr. Pennington diagnosed her with
dysautonomia. (Id. at 1310, 1319). On
December 4, 2013, Lunzer had a pacemaker implanted.
(Id. at 1512). She reported that her symptoms
initially improved, but eventually worsened. See,
e.g., (id. at 1519, 1674, 1774, 1777, 1780,
1730, 1864) (showing that Lunzer eventually began to
experience venous congestion in the legs, reported severe
migraines, frequent syncope events, and became dizzy up to
twenty times per day).
saw several other treating physicians regularly. On February
27, 2012, Lunzer saw Mark Prebonich, MD (“Dr.
Prebonich”), for the first time. (Id. at
1089-93). On May 31, 2012, Dr. Prebonich completed a
disability recommendation questionnaire in which he opined
that Lunzer had been unable to work and earn money since June
1, 2010, and was currently bed- confined for three to five
days per week. (Id. at 1088). Dr. Prebonich noted
that Lunzer experienced dizziness and syncope that are
exacerbated by her dysautonomia. (Id.).
on January 9, 2013, Lunzer was treated by Eun Kim, MD
(“Dr. Kim”), a family physician. (Id. at
1330). Dr. Kim treated her for kidney stones and migraines.
(Id.). On October 2, 2013, Dr. Kim completed a
questionnaire in which he opined that Lunzer's conditions
made her incapable of performing any kind of work, and that
she would be unable to walk or sit for any amount of time.
(Id. at 1465-68). On February 27, 2014, Kathleen
Willey, MD (“Dr. Willey”), submitted a form
medical opinion stating that Lunzer's conditions will
last “[m]ore than 45 days” and that she will not
be able to perform “any employment in the foreseeable
future.” (Id. at 1664).
State Medical Expert Opinion
Lunzer's eligibility hearing, the ALJ called Andrew
Steiner, MD (“Dr. Steiner”), a medical expert in
the field of physical rehabilitation, to review the record
and testify. (Id. at 13, 100). Dr. Steiner stated
that he had no bias for or against Lunzer. (Id. at
101-02). He testified that Lunzer had abnormal aortic and
mitral valves, but an overall well-functioning cardiac
system. (Id. at 103). Steiner observed that the
readings from Lunzer's loop recorder were
“essentially unremarkable, ” and that the
readings taken by Dr. Pennington were “normal in
regards to pulse and blood pressure.” (Id. at
Steiner opined that he did not see sufficient evidence that
Lunzer's impairments met any Listing. He stated,
We don't have the kinds of heart changes, arrhythmias or
brady[cardia] or any other kinds of disturbance or blood
pressure changes that would be at a listings level of
documentation. This is mainly a record of reports of
lightheadedness or pre-syncope or syncope based [on] a
paucity of actual physical findings to support an ongoing
(Id. at 105). Based on these observations, Dr.
Steiner opined that Lunzer did not meet any of the
neurological or cardiovascular listings. (Id.). He
concluded that Lunzer was capable of performing ...