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Wednesday, May 27, 2015

Rating POTS for Military Disability

I want to discuss how to rate a condition that we are asked about quite a bit: Postural Orthostatic Tachycardia Syndrome (POTS).

POTS is an odd condition. Period. The cause of POTS is not very well understood medically, and the symptoms can differ dramatically from one person to the next. The only symptom that is common in every case of POTS, and is literally defined in its name, is a significant increase in heart rate (“tachycardia”) when transitioning into an upright position (“postural orthostasis”). Basically, anytime anyone with POTS stands up, their heart starts racing.

Other symptoms of POTS can include chest pain, dizziness, weakness, blurred vision, fainting, migraines, trouble sleeping, chronic fatigue syndrome, and more.

Some cases of POTS are thought to be a type of partial dysautonomia. Dysautonomia occurs when the part of the nervous system that controls the heart, intestines, blood vessels, bladder, etc., does not properly communicate with these organs/systems.

Other cases are attributed to things like low blood volume, or other conditions, like diabetes.

Assigning a Military Disability Rating for POTS can be tricky, especially since each case can be so different.

Since the VASRD does not have a VASRD Code for POTS, it is going to have to be rated analogously under the condition that is closest to it. Again, since each case of POTS is unique, finding the best analogous code(s) can be tricky.

The first thing to consider is the underlying cause for your POTS. Dysautonomia? Diabetes? Whenever rating conditions for Military Disability, always look at the bigger conditions that cause any of the smaller conditions/symptoms first. Many times, a single rating for that larger condition will cover the smaller conditions and will be the only thing that needs to be rated.

Remember the Pyramiding Principle! This principle states that a single symptom can only be rated ONCE, so if it is used to rate a larger condition, it is already rated, and cannot be given an additional rating or be used at all in another rating.

Let’s look at a quick example to better illustrate these rules. Let’s say Vicki has POTS. Her doctor determined that her POTS was caused by dysautonomia from a damaged vagus nerve. Her only symptoms are a high heart rate and high blood pressure. Since the vagus nerve is the cause of the condition, we should first look at the ratings for the Vagus Nerve. We find in the discussion on our site that “damage to the vagus nerve often results in high heart rate and high blood pressure,” so we know that a rating for the vagus nerve already covers both of her symptoms. Vicki will then only receive one rating for the vagus nerve since that one rating covers everything. She has nothing additional to rate separately. 

If the underlying cause can be rated, and that rating covers everything, then rating POTS can be simple. In many cases, however, things get a bit muddier. If the condition that caused POTS either doesn’t have its own rating or doesn’t cover everything, then individual symptoms can be rated separately, again only as long as each is only rated once.

Let’s look at another example. Let’s say Gary has POTS. His POTS was caused by diabetes. His symptoms include dizziness, fainting, high heart rate, weakness, and the inability to exercise (low physical activity level). First look at the rating for Diabetes. In the discussion of rating diabetes, it clearly states that secondary conditions (POTS, in Gary’s case) can be rated separately. Because of the Pyramiding Principle, however, we know that we can’t use any of Gary’s symptoms that are already covered by his diabetes rating.

So, looking at the ratings for diabetes, we see that it includes weakness and low physical activity level. Those are covered under Gary’s diabetes’ rating, so now we are left with dizziness, fainting, and a high heart rate that still need to be rated.

When deciding which symptom to rate next, choose the one that is the most dominant. Since high heart rate (tachycardia) basically defines POTS, then that should be the one we rate next. If you search for tachycardia on our site, you’ll find that it is rated under code 7010, supraventricular arrhythmias. Gary will get one rating under this code. This code does not cover the dizziness or fainting, however, so those symptoms still need to be rated.

Both dizziness and fainting are symptoms of peripheral vestibular disorders (balance disorders), and so Gary can receive one final rating under code 6204.

Now all of Gary’s POTS symptoms have been rated, but each only once. In total, Gary will receive three separate ratings: one for diabetes, one for tachycardia, and one for a balance disorder.


When figuring out how best to rate your POTS, start with the underlying cause and work outward until all symptoms are properly covered. Remember, however, that the Rating Authorities have the ultimate say in how every condition is rated. They will determine each case separately, and they have the power to decide how to rate each case of POTS in whatever way they think best. The principles discussed in this blog are the guiding factors for the Rating Authorities, but they may interpret things slightly differently. Ultimately, it is always up to them.

25 comments:

  1. Thank you for posting this. I have been in for 12 years and last year started passing out every time I would run. I had never had any serious health conditions. This lead to uncontrollable tachycardia. At first I was diagnosed with Inappropriate Sinus Tachycardia, but after a year + of testing they have decided I have a autonomic nervous system disorder, POTS and DOPA deficiency. The med board process is going to start soon and before reading your blog I honestly had no idea what could happen. Thank you again!

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    1. Glad I could help. The MEB Process can be a bit overwhelming, so check out our website if you have any questions about that.

      http://www.militarydisabilitymadeeasy.com/medicalevaluationboard.html

      And, of course, if you ever have additional questions, feel free to contact us anytime, and we'll help guide you the best we can.

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    2. Can you stay in the military with POTs or is an automatic MEB referral? My dr suspects I may have pots. I fit the criteria just waiting to see cardiologist. My GP wants me to start a beta blocker but won't that mask symptoms before seeing cardiology?

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    3. POTs is not an automatic MEB referral. It all depends on your systems and their severity. If they interview with your ability to properly perform your job requirements, then, yes, they will refer you to the MEB. If not, they could choose to keep you on for some time.

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    4. I was just wondering if you can update what happened to ur case? I started my meb for POTS recently ur input will be great!

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  2. I was in the military from 1997-2001 but diagnosed with POTS in 2013. Do you think I could get VA disability compensation? Based on other who have received benefits for POTS what percentage disability were they awarded?

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    1. Honestly, no. Unless you can provide proof that your POTS was a direct result of your military career, which is highly unlikely, you won't be able to get compensation for this. And because of how tricky it is to rate POTS, it's impossible to predict the percentage without knowing full details about the case. Ultimately, however, it seems very unlikely that your condition is related to your military service. It's been too long and is just as likely caused by other things. Sorry for the bad news.

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  3. I took tilt table test 4 days ago and I got fairly dizzy and my heart jumped to 151bpm during the test and I threw up some.

    Gonna see my cardiologist on 23rd of feb and see what results he has for me. I have only been in the army for 1 year and really don't wanna get out because If I get out right now, I am only gonna get part of my GI Bill. If I get chaptered, I hope I get some money to start a new life. So far I have only been able to save up 3.5k in my bank :( I am really concerned about it.

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    1. Hi Haider -

      I'm sorry to hear about your situation. The results of this test definitely don't sound promising, but depending on your official diagnosis, things may not be too bad. Some conditions that are indicated by a positive tilt table test can be treated, and so won't necessarily make you unfit for duty. Ultimately, however, until the official diagnosis is made, it's impossible to really say what is going to happen. The next time you meet with your physician, discuss treatment options and definitely address the possibility of remaining on duty. If you are diagnosed with something that cannot be treated enough to have you remain on duty, then you should be given a significant rating that will help compensate your for your condition. Again, impossible to say without a diagnosis and full details.

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    2. Hi,
      Anyone who read it. I thought I should update here. My tilt test table came Negative but the doctors are convinced that I have POTS. So I will start my Med Board next week.

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    3. I started my Meb last week. Got to a few briefings. Today I scheduled my VA meetings I am looking forward for this process to get over pretty soon

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  4. Seems my pots was temporarily caused by medication I was on. One I stopped it it resolved slowly in about a month. It was documented on several DR visits. By the time I got to the cardiologist it was resolved. I had night sweets as well which when I told my GP he had me stop the medication suspected and he was right.

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  5. I just got my official formal PEB back. I have not worked for over 18 months but was found fit. My attorney submitted an appeal and I was found unfit for AUTONOMIC NEUROPATHY / CHRONIC POSTURAL
    ORTHOSTATIC TACHYCARDIA SYNDROME, CHRONIC MIGRAINES. They did not find me unfit for Ehlers-Danlos since I can control most of the joint hyper mobility with bracing and they felt if it were not for the other two issues, I could perform as an LPO on shore duty. Now just to wait and see what the VA comes back with.

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    1. Sounds like they made a fair judgment. Good thing the appeal was successful. Luckily, the VA will rate all of your conditions, so hopefully they'll give you a fair rating right off the bat, and you'll be good to go.

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  6. Can I join the navy with POTS? I've been on medication for the past year and it seems to have stopped all my symptoms. Apart from postural tachycardia I am fit and healthy, I don't know if having this condition will make me fail the medical and I would be most grateful for your advice. I also spoke to a recruitment officer and they said that due to me being on medication it's unlikely that I will be able to join. I am worried that because I used to faint (due to the POTS) my application won't even be considered. Thank you.

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    1. Hi Lucy -

      Your concerns are valid. Even though POTS is under control currently, it could worsen in the future. Depending on your potential MOS and the needs of the Navy, you MAY still be able to join, but you will be much lower on the list. For the majority of MOS's it will disqualify you. It's up to you on whether or not to still try, but it will definitely make it harder, no question.

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  7. I guess I'm just looking for advice, help, something I all this mess haha. I joined about six years ago, about two years after had a ninety pound weight gain in three months, started having IST, insomnia, syncope. As quick as the weight came on, it came off with rapid weight loss but other symptoms continued and varied; migraines, gastroparesis, complete peripheral neuropathy , lyringa(sp?) spasms, heat intolerance, memory loss, some urinary issues, falling and hitting my face on tables. It's a humiliating thing but after several specialists I was diagnosed with dysautonomia. That was 2 years ago. Work understands my symptoms and has been cautious but they prolonged putting me in for MEB, that was started two months ago but what now, how does someone who has something that varies on the day, the weather, may feel pretty good one day and not be able to walk to next get rated ?

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    1. Hi Devyn -

      Sorry to hear about your case. I actually have a blog about rating dysautonomia that you might find interesting:

      http://blog.militarydisabilitymadeeasy.com/2014/07/rating-dysautonomia-for-military.html

      The key is to make sure that your symptoms are thoroughly documented by your physician. So make sure to see him regularly and that he keeps thorough notes. You might want to also start working with him on keeping a daily diary of your symptoms that he reviews and signs off on so that they are thoroughly documented.

      With documentation like this, the raters will be able to go through everything and see your most prominent symptoms and how they affect your life. They can then get an idea of how your overall conditions interferes with your daily living and determine what rating best reflects your overall disability.

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  8. I realize this is an old thread, but I'm still hoping for some clarity.

    I'm Zack, and I was discharged from the Air Force almost a month into basic training after passing out in the barracks (general discharge because I was in for such a short time). It has taken me until now to get a definitive diagnosis of POTS, and my condition has only worsened since that first incident. I am completely unable to work, and am on medication now to manage day to day.

    Do you think I can qualify for VA disability benefits? It would seem my POTS was triggered initially while in the military, so would this be proof enough for the VA?

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    1. For some clarity, I had no previous history of syncope before that point in basic training, which was in early 2012

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    2. It definitely wouldn't hurt you to apply, but I have to be honest that it is going to be tough, if not impossible, to prove your condition. Normally a condition has to be officially diagnosed within 1 year of separation to be considered service-connected. Since it was just now diagnosed, you would have to have undeniable proof that the episode that occurred during the military was definitely the beginning of POTS. A letter from your physician claiming that it was would help your case, but may still not be enough.

      The condition itself is also going to provide a problem since it is poorly understood and you were in service for such a short time. None of the recognized triggers (viral infection, surgery, etc.) were present in your case, which may indicate that it is more genetic (not ratable). Regardless, with such a short time in service, it is highly unlikely that the military experience itself is what triggered the condition. If they see it this way, your claim will be denied.

      However, they might review all the evidence and instead judge in your favor. So you might as well submit a claim and see what happens. Just be prepared that it will most likely be denied.

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    3. Thanks for your response! I neglected to mention that this episode of syncope was directly following several days of being sick. It was either strep throat or the flu; the doctors were less than ideally communicative. I continued training while ill, as my training instructor would not allow me medical attention when requested. However, after I lost consciousness, he had me sent to the local hospital for evaluation, so there should be some records there. Though they were not shared with me.

      Also, I do not think it will be difficult to have my primary doctor provide a detailed documentation of my symptoms and of this first incident. Thank you for your advice, and I do plan on applying for aid. Being stuck at home with no income, I will follow any possibility of assistance that I can get, even if it's a long shot.

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    4. With the right evidence you have a chance of being successful. Definitely do what you can to obtain those medical records from your service. Those will be necessary.

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  9. Current Naval Aviator with 11 years flying fixed wing fighters. Went to Flight Doctor for symptoms including fatigue, shoulder back pain and fever (night sweats and chills) that were present for a few days prior to visit. Thought I might have the flu or some sort of bug. Doctor did orthostatic pressures to see if I was dehydrated and gave fluids (was not tilt positive for dehydration), but he noted spikes in heart rate. I am a very tall person 6'6" and have never had any of the associated symptoms of POTS. Do you think once the virus clears up and fever symptoms go away that the POTS symptoms will clear. Supine: 78 sitting: 94 Standing: 120... blood pressure remained constant 113:65?

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    1. It's possible, but not definite. Only time will tell on what will happen in your case. There are cases where the symptoms do not become chronic, and others where they do.

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