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Is POTS Syndrome a disability?
Yes. If you are dealing with POTS and struggling to remain upright, maintain focus, or sustain a full workday, the issue is usually not just the diagnosis — it is whether your symptoms prevent you from working consistently.
POTS claims are often challenged because symptoms like fatigue, dizziness, and brain fog can fluctuate and are not always fully captured in objective testing. Insurers frequently argue that a claimant can perform sedentary work, without accounting for the difficulty of sitting upright, maintaining concentration, or functioning reliably over time.
While POTS may be a sole diagnosis, often it is found alongside other conditions such as Ehlers-Danlos Syndrome (“EDS”) and Chronic Fatigue Syndrome (“CFS”).
This page explains when POTS can quality for long term disability benefits, what evidence matters most, and why these claims are often denied.
Why POTS disability claims are often denied
POTS claims are frequently denied or terminated, even when symptoms are significant. This is because insurers often focus on isolated findings rather than how symptoms affect day-to-day function.
Common denial arguments include:
- “You can perform sedentary work”
- “Your testing does not show severe impairment”
- “Your symptoms are subjective”
- “You appear stable or improved in your records”
These arguments often fail to account for the difficulty of remaining upright, the impact of fatigue and cognitive symptoms, and the inability to sustain consistent work activity.
How POTS affects your ability to work
In a disability claim, the key issue is not just which symptoms you experience, but how those symptoms affect your ability to function consistently in a work setting. Many individuals with POTS can perform activities briefly but cannot sustain them throughout a full workday.
Symptoms
People with POTS experience orthostatic tachycardia, the medical term for spiked heartrate, when changing position from laying down or sitting to standing.
As a result, POTS can cause physical and cognitive symptoms such as:
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- Fainting
- Chronic headaches
- Lightheadedness
- Fatigue
- Brain fog
- Heart palpitations
- Chest pain
- Nausea
- Blurred vision
- Muscle weakness
- Shortness of breath
- Blood pooling and circulation issues
These symptoms are often triggered by activities such as standing or sitting for prolonged periods, exercise, alcohol consumption, eating large quantities, or heat exposure. Any of these symptoms can be disabling if they present severely enough.
Positional limitations and work capacity
A central issue in many POTS claims is the difficulty of remaining upright for extended periods. Even in sedentary roles, the ability to sit upright consistently is required.
If your symptoms improve only when reclining, this can significantly limit your ability to perform even desk-based work.
What evidence helps prove a POTS claim
Those with POTS usually find relief from their symptoms by remaining in a reclining position. Understandably, this can cause issues with performing work duties.
When filing a long term disability claim for POTS, your insurance company will require proof of your diagnosis and symptoms before approving your benefits. This means providing medical evidence to your insurance company and explaining how your symptoms interfere with your ability to work.
Getting A POTS Diagnosis
First, proof of diagnosis will be needed. POTS is typically diagnosed through a variety of tests, the most common of which is called a tilt table test. The tilt table test involves harnessing a patient to a table which is tilted upward to recreate the motion of standing. The doctor administering the tilt table test will record your heart rate and blood pressure. The results will show any abnormalities indicative of POTS and rule out other diagnoses.
Tilt tables are not always available for physicians. Alternatively, POTS may be diagnosed by a physician evaluating changes in blood pressure and heart rate as the patient manually moves from a prone position to standing. The tilt table test will offer a more objective and detailed diagnostic report, so we always recommend our clients looking for a diagnosis undergo the tilt table test if at all possible.
Obtaining Medical Evidence of Your POTS Symptoms
A diagnosis alone is not enough. The strength of a POTS claim depends on showing how your symptoms translate into functional limitations that prevent consistent work activity.
Your symptoms must be documented and verified through objective measures. This can be especially challenging when many POTS symptoms, such as fatigue and headaches, are considered subjective – meaning there are not always cut-and-dry methods of measuring them. Instead these symptoms are more often self-reported. Insurance companies are usually skeptical of subjective symptoms that cannot be verified through objective testing. They may assume you are exaggerating how you feel.
Still, there are ways to bolster your POTS long term disability claim and obtain strong medical evidence. It will require a supportive doctor who understands your condition, symptoms, and work restrictions and limitations. Due to its varied symptoms, POTS may be treated by different types of specialists, but cardiologists are the most likely to diagnose POTS in patients. However, you may be treating with other doctors as well, such as a primary care physician and/or a neurologist.
Medical Records
Medical records are one of the lynchpins of a successful POTS-related long term disability claim. Consistency across your records is critical, as insurers often look for discrepancies to challenge a claim. Every time you visit with one of your doctors, the details of your visit are recorded in an office visit note. These records can be essential in documenting your POTS to your insurance company.
Because of this, it is important to relay all of your symptoms to your doctor, even if it is not the reason for the visit. For example, maybe you have scheduled an appointment with your cardiologist due to some irregular chest discomfort. You may not think to mention the continuing fatigue that has not improved since your last visit. Even though the fatigue is not the purpose of your appointment, you should still make your cardiologist aware so your medical records reflect all of your ongoing symptoms.
Other Testing Options For POTS
Beyond your regular doctor visits, there are testing options available to document your POTS symptoms in an objective manner.
As mentioned before, the tilt table test is the most common testing to verify a POTS diagnosis. However, there are a few additional tests you may find helpful for your POTS long term disability claim.
A Functional Capacity Evaluation (“FCE”) is used to assess your capacity for physical function. If your POTS causes physical symptoms such as muscle weakness, exercise-induced fatigue, or chronic pain, an FCE can provide objective evidence of your limitations. However, FCEs may not fully capture the positional and fluctuating nature of POTS symptoms. The test can be conducted over a one or two-day period. The FCE involves a series of tests measuring different aspects of your physical capabilities such as strength, balance, and level of fatigue.
For many, POTS can cause cognitive dysfunction due to symptoms such as brain fog. If this is the case for you, you may consider undergoing a Neuropsychological Evaluation. The neuropsychological evaluation, conducted by a neuropsychologist, will measure how your POTS affects your memory, attention span, verbal functioning, speed processing, and executive function, among other cognitive abilities. The raw data from the neuropsychological evaluation is analyzed by the neuropsychologist to determine your cognitive deficits due to POTS.
Both the FCE and the neuropsychological evaluation include what are called “validity measures.” Validity measures are embedded tests within the evaluations that can confirm you are putting forth your maximum effort. This adds value and legitimacy as objective medical evidence of your POTS Syndrome that your insurance company must consider.
Vocational Evidence Can Help Your POTS Claim
While medical evidence is vital, it is not the only type of evidence your insurance company will consider when reviewing your POTS long term disability claim. Many POTS claimants are able to perform tasks intermittently but struggle with reliability, attendance, and sustained performance. Beyond your documented medical condition, your insurance company must understand why you can no longer perform the duties of your occupation on a reliable basis due to POTS.
Your insurance company may know your job title, but we always recommend our clients provide a detailed job description encompassing all work duties. This way your insurance company can understand what your day-to-day work activities include.
For example, your insurance company may assume that since your job is classified as “sedentary,” you should not have a problem continuing to work even with POTS. However, your occupation may necessitate physical activity—leaving your desk to attend meetings, traveling for work, etc.—thus triggering your POTS symptoms. Of course, POTS symptoms are often only alleviated by laying in a reclined position. Even if your work is truly sedentary, sitting upright at a desk for a full workday may not be feasible for you.
You may consider obtaining a Vocational Assessment. A vocational assessment offers a detailed, expert opinion that explains why you cannot work due to your POTS. The assessment is written by a vocational expert who provides a comprehensive analysis of your job duties and responsibilities and explains your inability to perform the functions of your occupation.
Case Study: POTS
Claire, a marketing executive, had been working at a top firm for many years when she began experiencing increasing muscle weakness, neuropathy, headaches, and lightheadedness. At first her doctors could not make a clear diagnosis and assumed Claire’s symptoms were due to some old sports injuries. Her symptoms did not improve even as she followed her treatment plan. Eventually, Claire had no choice but to leave work as her condition worsened.
Claire’s insurance company initially approved her long term disability benefits, but after six months they terminated her claim without warning. The insurance company alleged Claire’s condition had improved, even though that wasn’t the case – her muscle weakness, pain, headaches, and fatigue still prevented her from returning to work. In fact, after the termination, Claire finally underwent testing that gave her a diagnosis of hEDS, with POTS as a secondary diagnosis. Both conditions had contributed to her inability to work.
Frustrated by the insurance company’s unfair termination, Claire decided to hire Riemer Hess to handle her long term disability insurance appeal.
Riemer Hess immediately recommended Claire undergo a Functional Capacity Evaluation to document her symptoms. Our attorneys also connected Claire to a trusted vocational expert who provided an assessment of her occupation, as the insurance company made it clear they misunderstood the level of physical function needed for her job duties.
Riemer Hess worked with the FCE evaluator and the vocational expert to make sure their reports were accurate and thorough. They also requested supportive letters from Claire’s treating doctors, gathered new medical records, and helped Claire secure a witness statement from a coworker who had witnessed how her disability affected her job performance. Additionally, Riemer Hess made sure to supplement her appeal letter with literature on Ehlers-Danlos Syndrome and POTS. That way the insurance company had no room to feign ignorance of her conditions.
Riemer Hess prepared a detailed, comprehensive appeal letter on Claire’s behalf. The appeal letter summarized the newly acquired evidence and addressed every unwarranted reason for denial from the insurance company.
Sure enough, in the face of Riemer Hess’s evidence, the insurance company reversed their termination of Claire’s disability benefits. Claire received her benefits immediately and chose to retain Riemer Hess to monitor her disability claim going forward.
This outcome reflects the importance of combining medical, functional, and vocational evidence to address how POTS affects real-world work capacity.
FAQs
Can I qualify for disability if I can still do some activities?
Yes. The key issue is whether you can work consistently, not whether you can function occasionally.
Why does the insurer say I can do sedentary work?
Sedentary work still requires sustained sitting and concentration, which may be limited by POTS.
Is a tilt table test required?
It is helpful but not always required. Claims are evaluated based on the total evidence.
When to speak with a lawyer about a POTS long term disability claim
You may want to speak with a lawyer if your symptoms are affecting your ability to work, your claim has been denied, or your insurer is questioning the severity of your condition.
If you’re looking to file for long term disability due to your POTS Syndrome, an experienced ERISA attorney can help. Riemer Hess knows what evidence LTD insurance companies look for when considering a POTS Syndrome long term disability claim. To arrange for a consultation with lawyers at Riemer Hess, call us at 212-297-0700 or click the button below to schedule an exploratory call.
