For veterans living with Postural Orthostatic Tachycardia Syndrome (POTS), daily life can be unpredictable, exhausting, and debilitating. Symptoms like dizziness, rapid heart rate, fainting, and chronic fatigue can make steady employment and routine activities extremely difficult.
Yet despite the severity of these symptoms, many veterans struggle to secure fair VA disability ratings for POTS. The reason is simple: POTS does not have its own diagnostic code in the VA Schedule of Rating Disabilities, forcing the VA to rate it by analogy to other conditions.
“POTS claims are frequently underrated not because the condition isn’t disabling, but because it’s medically complex and often misunderstood by VA examiners,” said a VA-accredited medical consultant familiar with autonomic disorders.
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With the right evidence and strategy, however, veterans can qualify for POTS VA disability ratings ranging from 10% to 100%, including eligibility for TDIU in severe cases.
Overview: How the VA Evaluates POTS
| Factor | How It Affects Your Rating |
|---|---|
| Symptom severity | Determines percentage level |
| Frequency of episodes | Higher frequency = higher rating |
| Functional impairment | Impact on work and daily life |
| Analogous diagnostic code | Controls rating criteria |
| Medical nexus | Required for service connection |
What Is Postural Orthostatic Tachycardia Syndrome (POTS)?
Postural Orthostatic Tachycardia Syndrome is a form of dysautonomia, meaning the autonomic nervous system does not function properly. This system controls involuntary processes such as heart rate, blood pressure, digestion, and temperature regulation.
POTS is diagnosed when:
- Heart rate increases 30 beats per minute or more (or exceeds 120 bpm)
- Occurs within 10 minutes of standing
- Without a significant drop in blood pressure
“POTS is not a single symptom condition. It affects multiple body systems, which is why VA claims must be approached strategically,” a cardiovascular specialist explained.
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Common Symptoms of POTS in Veterans
Cardiovascular and Neurological Symptoms
- Rapid heart rate (tachycardia)
- Dizziness or lightheadedness
- Fainting (syncope)
- Shortness of breath
Systemic and Functional Symptoms
- Chronic fatigue
- Brain fog and cognitive issues
- Headaches or migraines
- Chronic pain
- Gastrointestinal distress
These symptoms often worsen with standing, heat exposure, exertion, or stress, making POTS particularly challenging for veterans with physically demanding service histories.
How the VA Rates POTS Without a Diagnostic Code?
Because POTS lacks a dedicated diagnostic code, the VA rates it by analogy under conditions with similar symptoms.
Most Common VA Diagnostic Codes Used for POTS
| Diagnostic Code | Condition | Rating Range |
|---|---|---|
| DC 7010 | Supraventricular arrhythmias | 10%–30% |
| DC 6354 | Chronic Fatigue Syndrome | 10%–100% |
| DC 8018 | Neurological disorders (MS analogy) | 30%–100% |
| DC 7011 | Ventricular arrhythmias | Up to 100% |
“Choosing the correct diagnostic code can be the difference between a 30% and a 100% rating,” noted a veterans disability advocate.
Chronic Fatigue Syndrome Criteria Often Used for Higher Ratings
When fatigue and functional limitation are dominant, the VA may rate POTS under DC 6354 (CFS).
CFS-Based Rating Levels
- 100% – Nearly constant symptoms restricting almost all daily activities and sometimes self-care
- 60% – Severe symptoms limiting daily activity below 50%
- 40% – Symptoms limit activity to 50–75%
- 20% – Symptoms limit activity less than 25%
- 10% – Symptoms controlled by medication
Understanding the VA’s Pyramiding Rule
Under 38 CFR § 4.14, the VA prohibits “pyramiding,” meaning:
- The same symptom cannot be rated twice
- Overlapping conditions must be carefully documented
For example, dizziness caused by both POTS and migraines will only be rated once.
“Veterans must clearly distinguish which symptoms belong to which condition to avoid rating reductions,” a former VA reviewer explained.
Proving Service Connection for POTS
Service connection is often the hardest part of a POTS claim.
Common Military Triggers Linked to POTS
- Physical trauma or injuries
- Heat exposure during training or deployment
- Infectious diseases
- Environmental toxin exposure
- Chronic stress and PTSD
“Autonomic dysfunction is increasingly recognized as a downstream effect of stress, trauma, and illness experienced during military service,” a neurological specialist stated.
The Three Elements Required for VA Approval
- Current Diagnosis
- Tilt table test
- Heart rate monitoring
- In-Service Event or Aggravation
- Medical or service records
- Medical Nexus
- Professional opinion linking POTS to service
A strong nexus letter can significantly improve approval odds.
Secondary Service Connection for POTS
POTS may qualify as secondary to another service-connected condition.
Common Primary Conditions Linked to POTS
- PTSD
- Traumatic brain injury (TBI)
- Gulf War Illness
- Autoimmune disorders
- Chronic Fatigue Syndrome
“Secondary service connection is often the most successful route for POTS claims, especially when PTSD or TBI is already service-connected,” said a VA claims consultant.
Can POTS Qualify for TDIU or 100% VA Disability?
Yes. Veterans whose POTS:
- Prevents sustained employment
- Causes frequent syncope
- Requires continuous treatment
may qualify for:
- 100% schedular ratings, or
- Total Disability based on Individual Unemployability (TDIU)
“When POTS prevents reliable work attendance or safe functioning, TDIU becomes a powerful option,” a veterans law attorney noted.
Why Many POTS Claims Are Denied or Underrated?
- Incomplete medical documentation
- Poor C&P exam descriptions
- Incorrect diagnostic code selection
- Weak or missing nexus opinions
Final Thought
POTS is a complex, life-altering condition that often goes underrecognized by the VA. But with strong medical evidence, correct diagnostic coding, and clear service connection, veterans can secure ratings up to 100% VA disability or TDIU.
If your symptoms disrupt your ability to work, stand, or function safely, your VA rating should reflect that reality.
You earned these benefits. The key is knowing how to claim them correctly.
FAQs
Is POTS considered a VA disability?
Yes, when properly service-connected and rated by analogy.
Can I receive a 100% VA rating for POTS?
Yes, depending on severity and functional impact.
Does POTS qualify for TDIU?
Yes, if it prevents substantially gainful employment.
Is a nexus letter required?
Not required, but highly recommended.
