Your heart races every time you stand up. The room spins. Fatigue drapes over you like a heavy blanket, making even basic tasks feel monumental. If Postural Orthostatic Tachycardia Syndrome (POTS) has stolen your ability to work, you're not alone in this battle.
When POTS symptoms prevent you from maintaining employment, Social Security Disability Insurance (SSDI) may provide critical financial support. A Boston SSDI lawyer can help you build a strong case that demonstrates how your condition meets the SSA's eligibility requirements for a disability expected to last at least 12 months or result in death.
What Is POTS and How Does the SSA Evaluate It?
Postural Orthostatic Tachycardia Syndrome is a disorder of the autonomic nervous system that disrupts your body's ability to regulate blood flow and heart rate when changing positions. The diagnostic criteria include:
A sustained heart rate increase of 30 beats per minute or more in adults (or 40 beats per minute or more in adolescents ages 12 to 19) within 10 minutes of standing or upright tilt, without orthostatic hypotension
Relevant SSA Blue Book Listings
The Social Security Administration (SSA) has no specific listing for POTS but evaluates these claims under the Neurological Disorders (Section 11.00) and Cardiovascular System (Section 4.00) listings in its Blue Book of impairments.
The SSA has published guidance for adjudicators on evaluating COVID-related POTS claims, which is particularly relevant since Heart Rhythm found that 9% to 61% of COVID-19 survivors experience POTS-like symptoms after infection.
Work Credits and SGA Limits
To qualify for SSDI, you must have sufficient work credits through Social Security-covered employment and demonstrate that your earnings fall below substantial gainful activity (SGA) limits. If you lack sufficient work credits or have limited income and resources, Supplemental Security Income (SSI) may be available.
POTS Symptoms That Impact Your Work Capacity
POTS creates a cascade of debilitating symptoms that can make competitive employment impossible.
Cardiovascular Symptoms
Cardiovascular symptoms include rapid heart rate increases upon standing, heart palpitations, chest discomfort, and near-fainting episodes that create fall risks. Many patients cannot remain standing for more than 10 to 15 minutes without severe tachycardia.
Cognitive Symptoms
Cognitive impairment often proves equally disabling. Brain fog makes concentration difficult, memory problems interfere with following instructions, and slowed information processing prevents meeting workplace productivity standards. Even sedentary jobs become impossible when you can't maintain focus or recall essential information.
Chronic Fatigue
The bone-deep fatigue associated with POTS differs from normal tiredness. Rest doesn't refresh you, and physical activities that once felt routine now leave you depleted for days.
Gastrointestinal Symptoms
Gastrointestinal symptoms, like nausea and abdominal cramping, can strike unpredictably, making consistent work attendance challenging.
How Residual Functional Capacity Impacts POTS SSDI Cases
Your Residual Functional Capacity (RFC) assessment determines what work activities you can still perform despite your limitations. For POTS patients, RFC evidence often becomes the key to winning benefits because it shows the SSA exactly how symptoms prevent sustained work activity.
RFC documentation for POTS should address your need to recline or elevate your legs during the workday, as many patients require periodic position changes and cannot remain upright for extended periods. If your symptoms require unpredictable rest periods, employers cannot reasonably accommodate this need.
Off-task percentages and absenteeism matter substantially. Vocational experts commonly testify under SSA hearing procedures that being off-task more than approximately 10% of the workday or missing roughly two or more days per month is work-preclusive.
Medical Evidence That Strengthens Your Claim
Winning SSDI benefits for POTS requires comprehensive medical documentation.
- Tilt table test results provide objective evidence, showing sustained heart rate increases meeting POTS diagnostic criteria while confirming the absence of orthostatic hypotension.
- Active standing tests with serial orthostatic vital signs offer additional support. These tests should note time intervals and document that blood pressure did not drop significantly.
- Your treating physician's detailed notes should describe specific functional limitations rather than just listing diagnoses. A well-written letter should address your ability to stand, walk, sit for extended periods, concentrate, and handle workplace stress.
- If brain fog affects your work capacity, neuropsychological testing can provide objective evidence of cognitive limitations in memory, attention, processing speed, and executive function.
- Complete treatment records demonstrate you're actively seeking relief from symptoms. Document medication side effects, as some POTS treatments can cause additional limitations.
Common Reasons POTS Claims Get Denied
Social Security denies many SSDI claims because applicants don't provide sufficient medical evidence establishing the severity of their limitations. The SSA needs objective evidence, like tilt table or active standing test results with specific values, to approve your application.
Lack of ongoing treatment can sink your claim, as regular medical visits show you're actively seeking care and that symptoms persist despite treatment. Be honest about both your limitations and your better days, as POTS symptoms fluctuate.
Acknowledging this variability strengthens your credibility. Inconsistencies between reported limitations and medical records raise red flags that can lead to denial.
