Postural Orthostatic Tachycardia Syndrome (POTS) is a chronic condition that affects the autonomic nervous system, which regulates involuntary bodily functions like heart rate, blood pressure, and digestion. While not always severe, POTS can significantly impact an individual’s daily life. This article explores how POTS is considered a disability and the avenues for legal recognition and support.
Defining Disability for POTS
For a medical condition to be considered a disability, it must cause significant functional limitations that impair major life activities. POTS, a form of dysautonomia, can present a wide range of symptoms that interfere with an individual’s ability to work, learn, and care for themselves. The impact of these symptoms, rather than the diagnosis itself, determines disability status.
POTS symptoms often worsen with upright posture and can include severe fatigue, lightheadedness, brain fog, exercise intolerance, and fainting (syncope). These manifestations can profoundly limit activities such as standing, walking, and even sitting upright for extended periods. Cognitive issues like difficulty concentrating, memory problems, and slowed processing speed can also affect an individual’s ability to perform mental tasks.
The chronic and fluctuating nature of POTS symptoms means individuals may experience good days and bad days, making consistent performance in employment or education challenging. Some individuals with POTS find their symptoms so debilitating that normal activities like bathing, housework, or eating become significantly limited. Approximately 25% of individuals with POTS are unable to work due to their symptoms, highlighting the profound functional impairment the condition can cause.
Legal Recognition and Protections
POTS is not explicitly listed as a disabling condition under legal frameworks, but individuals with POTS can still be covered if their symptoms substantially limit a major life activity. This functional approach to disability allows for protection and support based on the actual impact of the condition.
The Americans with Disabilities Act (ADA) protects individuals with disabilities from discrimination in employment and public spaces. Under the ADA, an individual with POTS may be considered disabled if their impairment substantially limits one or more major life activities. Employers are required to provide reasonable accommodations that enable an employee with POTS to perform their job duties, provided these accommodations do not cause undue hardship to the business. Examples of such accommodations include:
Flexible work schedules
More frequent breaks
Adjustments to lighting or temperature
Access to food, liquids, or medication
Ergonomic seating
Additional time for tasks
Telecommuting options
POTS can also qualify an individual for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) benefits through the Social Security Administration (SSA). While POTS is not specifically listed in the SSA’s “Blue Book” of impairments, an applicant can qualify if their condition prevents them from engaging in substantial gainful activity due to a medically determinable impairment expected to last at least 12 months. The SSA evaluates the individual’s residual functional capacity (what they are still able to do) to determine if they can perform any job. Symptoms of POTS can align with various medical listings, such as those for cardiovascular or neurological disorders, if they meet the severity criteria.
Educational accommodations for students with POTS are available under Section 504 of the Rehabilitation Act of 1973. This federal civil rights law requires school districts to provide a free and appropriate education for qualified students with disabilities. A “504 plan” can be developed to outline specific accommodations a student needs to succeed in school. These plans are individualized and protect students from discrimination based on their medical condition. Examples of accommodations include:
Preferential seating
Extended time on assignments and tests
Reduced homework
Permission for frequent bathroom breaks due to increased fluid intake
Navigating Disability Claims and Support
Obtaining disability status or accommodations for POTS requires thorough documentation of the condition and its impact. Medical records are foundational, including clinical evaluations, diagnostic tests, and a history of treatments received. Objective tests like the tilt table test, which measures heart rate and blood pressure responses to changes in body position, are used to confirm a POTS diagnosis. Functional capacity evaluations and neuropsychological assessments can provide objective evidence of physical and cognitive limitations caused by POTS.
When applying for Social Security Disability benefits, a detailed personal statement outlining how POTS symptoms affect daily activities and work capabilities is important. Statements from healthcare providers are also valuable, as they can detail symptom severity, functional limitations, and prognosis. The application process for Social Security Disability can be lengthy, often involving initial denials, but appeals with additional evidence can be successful.
For requesting accommodations in educational or employment settings, clear communication with institutions or employers is beneficial. Providing medical documentation that explains the specific accommodations needed due to POTS symptoms can facilitate the process. Patient advocacy groups, such as Dysautonomia International and Standing Up to POTS, offer resources, information, and support for individuals navigating life with POTS, including guidance on disability claims and accommodations. These organizations can connect individuals with legal aid specializing in disability claims.