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.
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.
