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 Codefor 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.