POTS Syndrome and Long Term Disability: What You Need To Know

Is POTS Syndrome a disability?

Postural orthostatic tachycardia syndrome, commonly referred to as “POTS”, is a type of dysautonomia that may be disabling in individuals who have it.  Dysautonomia is an autonomic nervous system disorder that causes problems with regulating heartrate, blood pressure, digestion, and other functions, leading to fainting, dizziness, and other symptoms.  POTS is most often characterized by a markedly increased heartrate when moving from the supine (prone) position to standing.

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”).

Many people are able to live and function normally with POTS; others, however, experience debilitating symptoms that may prevent them from working.  Obtaining long term disability benefits for POTS can be complicated due to the relative lack of understanding of this condition by the medical community.

If you are considering filing for long term disability due to POTS, here is what you need to know.

What are the disabling symptoms of POTS?

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:

• • 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.

How do I prove POTS as a disability?

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

The proof your POTS diagnosis alone is not enough for your insurance company to approve your disability claim.  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.  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.  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.  Beyond your documented medical condition, your insurance company must understand why you can no longer perform the duties of your occupation 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.

Can an attorney help me get long term disability for POTS?

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.