How You Can Get Benefits for Postural Orthostatic Tachycardia Syndrome (POTS)

If you suffer from a dysfunction of the autonomic nervous system, which is dysautonomia, you may qualify for Social Security disability benefits. The autonomic nervous system oversees many of the body’s functions, including body temperature, heart rate, blood pressure, and digestion. There are several autonomic dysfunctions, including postural orthostatic tachycardia syndrome (POTS).

The Social Security Administration (SSA) oversees the Social Security Disability Insurance (SSDI) program, which pays monthly benefits to disabled workers. In order to be eligible for SSDI benefits, you have to have worked enough to earn sufficient credits and to have paid in an adequate amount of taxes to the SSDI. The disability process can be lengthy and complicated, so providing as much documentation and evidence as possible is imperative to proving your case.

Because dysautonomia disorders can essentially affect any body system, the symptoms experienced and their severity can vary significantly from patient to patient. Patients may experience fatigue, headaches, fainting, nerve and muscle pain, orthostatic hypotension (falling blood pressure when standing), anxiety, sleep disorders, sensory disorders, muscle and nerve pain, digestive disorders, and many other issues.

Is POTS a disability? Yes, POTS (Postural Orthostatic Tachycardia Syndrome) can be considered a disability by the Social Security Administration (SSA) if an applicant is able to meet the administration's definition of and criteria for disability outlined in their Blue Book.

What is POTS Disability?

POTS, or postural orthostatic tachycardia syndrome is one of several malfunctions of the autonomic nervous system. The autonomic nervous system is part of the body’s ability to control body functions through unconscious and automatic methods.

A dysfunctional autonomous nervous system is also called dysautonomia. Because the autonomous nervous system controls and affects a large number of quite different organs and organ systems, any dysfunction can have quite varied symptoms depending on which part of the body the POTS dysfunction affects.

Some common symptoms associated with POTS include:

  • anxiety;
  • digestive disorders;
  • fainting;
  • fatigue;
  • headaches;
  • muscle pain;
  • nerve pain;
  • orthostatic hypotension;
  • sensory disorders;
  • sleep disorders.

Applying for a Disability Benefit with POTS

If your POTS symptoms are severe and you are unable to continue working or do not expect that you will be unable to work for at least the next 12 months, then you may be able to obtain a disability benefit from the SSA. The SSA uses a comprehensive guide called the Blue Book to classify disabilities. It doesn’t have an exact listing for POTS, but a match may be found by comparing the symptoms experienced with other listings in the Blue Book depending on the part of the body where the symptoms affect.

Even if a Blue Book listing match cannot be found you may qualify for a medical vocational allowance (MVA) if you can prove that your POTS symptoms prevent you from gainful employment. You will usually need to complete a residual functional capacity (RFC) assessment to help you obtain a benefit through the MVA process. To apply for SSDI with POTS, you can do so on the SSA's website.

Postural Orthostatic Tachycardia Syndrome (POTS) may qualify you for Social Security disability benefits.

Other dysautonomia disorders include:

  • Multiple system atrophy (MSA)
  • Neurocardiogenic syncope (NCS)
  • Neutrally mediated hypotension (NMH)
  • Orthostatic hypotension
  • Pure autonomic failure (PAF)

Many of these conditions have symptoms that are universal or that can cross over. While the actual effects of dysautonomia depend upon the specific disorder and the individual, many dysautonomic disorders can be effectively managed. However, some can be disabling and eventually lead to death because so many body systems can be impacted.

Because of the variation of symptoms, dysautonomia can be challenging to diagnose. In order to treat the symptoms, various medications and treatment plans may be required. Because there is no specific listing for dysautonomia in the Blue Book, which is the medical guide used by the SSA to determine disability, you will have to focus your claim on the similar listings to which your medical condition can be compared, such as the primary body system that is impacted by your disorder.

The Cost of Treating Dysautonomia

According to Dysautonomia International, treating dysautonomia can be expensive. An individual with the disorder will have copays and coinsurance for doctor visits, prescriptions to treat the symptoms, various medical equipment such as compression stockings, and medical tests.

On average, an individual with the disorder that has health insurance pays out about $1,500 per year for the condition. If the condition worsens, or becomes more severe, those costs will increase. There are specialized clinics that treat dysautonomia and those costs considerably more but do often provide a better relief of symptoms. With the help of Social Security Disability, you may be able to receive money to offset these financial challenges.

Medical Qualifications and the SSA Evaluation

The Blue Book is the medical guide used by the SSA that list of conditions that qualify for disability. There is no specific listing for dysautonomia, but there are listings for the different body systems that are impacted by the disorder. In order to file for your condition, you need to focus on the severity of the symptoms and which body systems are most severely impacted.

If you focus on the primary body area that is impacted by your dysautonomia, you can narrow down the listings in the Blue Book that the SSA can compare to your application. This enables you to better understand the medical evidence you need to provide in order to give Disability Determination Services the evidence required to show you are indeed disabled.

As an example, if you are suffering symptoms that impact your blood pressure and heart, you should focus on the Blue Book Section pertaining to the Cardiovascular System, which is Section 4.00 and see if you can match your medical records and their details to the requirements for being disabled according to that particular condition.

There are several other Blue Book sections that may apply to dysautonomia, including:

  • Neurological – Section 11.00
  • Digestive System – Section 5.00

The kind of dysautonomia, the symptoms experienced, and any other medical conditions in conjunction with POTS will impact your eligibility for SSDI benefits. You have to provide evidence to substantiate your disability claim, so you have to provide medical records that document several things, including:

  • Your medical diagnosis
  • Symptoms and length and frequency of episodes
  • Treatments undertaken and their results

Your doctor should include statements that also indicate:

  • The manner of the appearance of symptoms
  • The effect of those symptoms on your abilities and daily life, including work
  • Any other information that may be pertinent in determining how your particular condition limits you

If you cannot prove the severity of your condition by using a Blue Book listing, you may still qualify for benefits through a medical-vocational allowance, which is sometimes called a compassionate allowance.

Qualifying for Disability with a Residual Functioning Capacity and a Medical-Vocational Allowance

Using the medical-vocational allowance, you prove that your symptoms are severe enough to keep you from seeking and maintaining gainful employment while you don’t meet the listed conditions set forth in the Blue Book. This approach uses a residual functioning capacity (RFC), which is a form that clearly states any limitations or restrictions you may have because of your condition.

You have to provide supporting documents that show your medical conditions, along with dysautonomia, prevent you from finding a job and continuously performing it despite your qualifications because of your symptoms. As an example, your RFC may indicate that you cannot stand for more than an hour because of the severity of your fatigue and pain, or you may not be able to stay in one position long because of fainting. This is a very thorough and detailed approach that is effective in getting approved for disability benefits. Documentation is the key to a successful claim.

Applying Specific Medical Tests to Your Disability Case

Dysautonomia can have many symptoms, so your documentation should include extensive test results. These may include a tilt table test to determine blood pressure fluctuations, digestive system testing, and various scans and x-rays as well as lab work.

The SSA may order a medical evaluation from a physician that they choose at their expense to get additional information and to confirm the severity of your condition. This is for informational purposes only and not for medical treatment.

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