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Lunzer v. Berryhill

United States District Court, D. Minnesota

April 16, 2018

Megan C. Lunzer, Plaintiff,
Nancy A. Berryhill, [1]Deputy Commissioner of Operations Defendant.



         Pursuant 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.

         I. BACKGROUND

         A. Procedural History

         Lunzer 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).

         Following 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.[2] Lunzer initiated the instant lawsuit on May 25, 2017. (Compl.)

         B. Factual Background

         The 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 conditions.

         1. Lunzer's Background and Testimony

         As of 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).

         At the 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).

         Lunzer 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).

         Lunzer 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).

         Lunzer 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.).

         2. Medical Evidence

         Lunzer 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.[3] (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.[4] (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.[5] (Id. at 959).

         On 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.[6] (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.”[7] (Id. at 686).

         On May 27, 2011, Lunzer had a loop recorder implanted.[8] (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.” (Id.).

         On July 16, 2012, Lunzer underwent a tilt table test.[9] 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 1121-22).

         On 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.).

         Starting December 20, 2012, Lunzer began seeing Joseph Pennington, MD (“Dr. Pennington”), a POTS specialist. (Id. at 1309). Dr. Pennington diagnosed her with dysautonomia.[10] (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).

         Lunzer 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.).

         Starting 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).

         3. State Medical Expert Opinion

         At 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 103-04).

         Dr. 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 severe problem.

(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 ...

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