Postural Orthostatic Tachycardia Syndrome (POTS) Information

DV26

Registered Member
I went through an Army medboard starting in July 2011 and finally retired in December 2013 due to autonomic nervous dysfunction diagnosed officially as Postural Orthostatic Tachycardia Syndrome (referred to as POTS henceforth). When I was going through the process I had a hard time finding specific information about this condition and how it is rated so I thought I would share some of what I learned.

POTS is the name for a combination of symptoms caused by an autonomic nervous system dysfunction. It can affect all of the subconscious bodily functions. Symptoms typically include tachycardia (fast heartrate) when moving from laying flat to sitting or standing, dizziness/lightheadedness, swelling/blood pooling in the lower extremities, fainting, shortness of breath, fatigue, headaches, irritable bowels, blood pressure irregularities, heart issues and more. It is typically diagnosed with a tilt table test performed by a cardiologist or neurologist, which involves your heart rate, blood pressure, and symptoms being monitored while laying flat on a table then again multiple times after being tilted to the upright position over about 45 minutes. If the heart rate increases by about 30 bpm or more after 5 minutes of standing and you experience symptoms then that is generally indicative of POTS. More information about the condition can be found here: http://www.dinet.org/

It can be a difficult condition to properly diagnose and even more difficult to treat. It took the Army years before they could figure out what was wrong with me. I encourage anyone who thinks they may have this but haven't received a diagnosis yet to request a tilt table test.

When it comes time to submit paper work to the VA is very important that you have documented your symptoms as clearly as possible so they rate you properly. Even then it seems they are still having trouble rating POTS patients since there is nothing defined in the VASRD for it. For myself and at least one other person that I spoke with they tried to initially rate POTS under diagnostic code 7010 Supraventricular Arrhythmias.

Diagnostic code 7010 seems to be the go to rating because it also has tachycardia in the name. However I am very strongly opposed to POTS ever being rated under this since it barely scratches the surface on what the symptoms encompass.

Until the VA wisens up and adds a new diagnostic code to cover POTS or autonomic dysfunction I think, if possible, all POTS patients should be rated under diagnostic code 7011 Ventricular Arrhythmias (sustained).
This code covers the shortness of breath, fatigue, chest pain, dizziness and fainting aspects of POTS and allows the condition to be rated up to 100%. Additional symptoms such as migraines or irritiable bowel syndrome can then be rated under their corresponding codes, but should be noted as caused by POTS.

Diagnostic code 7011 for POTS is rated based on the results of a Cardiac Exercise Stress Test, typically using the Bruce Protocol or Modified Bruce Protocol. Essentially you are put on a treadmill and begin walking at a predetermined speed and incline. There are generally 7 to 10 stages, each progressively faster and steeper. After 3 minutes you advance to the next stage.

Each stage of this test is given a Metabolic Equivalent or MET unit which is meant to represent how strenuous your activity can be before resulting in symptoms such as dizziness, fatigue, chest pain, shortness of breath or fainting. The higher your METS result the better you performed on the test.

For diagnostic code 7011, the rating and METS correspond as below:
0-3 METS : 100% Rating
3-5 METS : 60% Rating
5-7 METS : 30% Rating
7-10 METS : 10% Rating

You can find more information on METS here:
http://en.wikipedia.org/wiki/Metabolic_equivalent

More information on the Bruce Protocol:
http://en.wikipedia.org/wiki/Bruce_Protocol

It is very important that you notify your nurse/doctor immediately when you start experiencing symptoms and that they stop the test at that time. When I initially had my stress test performed for my C&P exam I tried to keep going even though I was fatigue, short of breath and dizzy. I ended up making it 6 minute and 12 seconds before they stopped me because I was passing out on the treadmill and my heart rate was around 172. My resulting MET score corresponded to the final time I made it, not when I started having symptoms so I ended up with a score of 7 METS instead of the 3 or 5 METS from when I started having issues.

I am currently in the process of waiting for the VA to schedule me for a new stress test so I can receive an increased rating.

One additional thing I'd encourage all POTS patients to consider is to file for SSDI if their symptoms preclude them from being able to work even if they are still currently in the military. I applied a year or two into my MEB while I was still in the Army since I was on an incredibly restrictive profile and wasn't able to perform my job. SSA approved my claim and backdated it 12 months from the date I filed (the maximum allowed under law) to as close as they could get to my MEB start date and gave me a very healthy back pay check. I haven't been able to work since leaving the military and it has been a great help to me while I continue seeking treatment.
 
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