Proving POTS as a Medically Determinable Impairment (POTS Part Two)

Welcome to Season 2, Episode 12 of Winning Isn't Easy: Navigating Your Social Security Disability Claim. In this episode, we'll dive into Proving POTS as a Medically Determinable Impairment (POTS Part Two).

In a POTS disability claim, symptoms alone aren’t enough. Before the Social Security Administration evaluates how disabling your condition is, you must first prove that POTS qualifies as a medically determinable impairment. Without that foundation, a claim can be denied outright, no matter how severe the symptoms. That requirement may sound technical, but it often decides whether a claim moves forward at all. A medically determinable impairment must be supported by objective medical evidence from recognized clinical or laboratory testing. For POTS, this frequently includes detailed physician documentation and diagnostic testing such as a tilt table study. The challenge is that POTS can be difficult to diagnose and document. Symptoms often overlap with conditions like chronic fatigue syndrome or fibromyalgia, giving the SSA reason to question whether POTS truly explains a claimant’s limitations. If the medical evidence isn’t clear and well documented, even a legitimate diagnosis may not be enough. In this episode of Winning Isn’t Easy, we explain how to establish POTS as a medically determinable impairment, what evidence the SSA looks for, and why proper testing and documentation can determine whether a disability claim succeeds or fails.

In this episode, we'll cover the following topics:

One - The “Medically Determinable Impairment” Requirement

Two - Diagnosing POTS and the Role of Testing

Three - Similar Conditions, Coexisting Conditions, and SSA Confusion

Whether you're a claimant, or simply seeking valuable insights into the disability claims landscape, this episode provides essential guidance to help you succeed in your journey. Don't miss it.


Listen to Our Sister Podcast:

We have a sister podcast - Winning Isn't Easy: Long-Term Disability ERISA Claims. Give it a listen: https://wiedisabilitypodcast.buzzsprout.com


Resources Mentioned In This Episode:

LINK TO YOUR RIGHTS TO SOCIAL SECURITY DISABILITY: https://mailchi.mp/caveylaw/your-rights-to-social-security-disability-benefits

FREE CONSULT LINK: https://caveylaw.com/contact-us/


Need Help Today?:

Need help with your Social Security Disability claim? Have questions? Please feel welcome to reach out to use for a FREE consultation. Just mention you listened to our podcast.

Review, like, and give us a thumbs up wherever you are listening to Winning Isn't Easy. We love to see your feedback about our podcast, and it helps us grow and improve.

Please remember that the content shared is for informational purposes only, and should not replace personalized legal advice or guidance from qualified professionals.

Transcript

Nancy Cavey [00:00:10]:
 In a POTS disability claim, symptoms alone won't cut it with the Social Security Administration. You have to prove that your condition is a medically determinable impairment to get moving through the Social Security's five Step Sequential Evaluation Test. Welcome back to Winning Isn't Easy. Social Security Disability Benefits this is the podcast where we break down everything you need to know about navigating the Social Security system. I'm your host, Nancy Cavey. Before we get started, I've got to give you that lasted legal disclaimer. This podcast isn't legal advice. The Florida Bar association says I have to tell you this.
 
 Nancy Cavey [00:00:48]:
 Now that I've told you that this isn't legal advice. Nothing will prevent me from giving you an easy to understand overview of the Social Security disability claims process, the games that can be played, and what you need to know to get the Social Security disability benefits you deserve. So off we go. If you thought that getting a POTS diagnosis was enough to get your Social Security disability benefits, you need to think again. The single most critical hurdle in any claim is proving that your POTS qualifies as what's called a medically determinable impairment. Now, without that proof, the Social Security Administration will often deny a claim, no matter how debilitating the symptoms are. A medically determinable impairment isn't a fancy phrase. It's a legally required foundation for your case.
 
 Nancy Cavey [00:01:38]:
 And it requires objective evidence and recognized clinical and laboratory testing. And that leads us to our problem. Diagnosing POTS is notoriously tricky. And unlike any condition with a simple, definitive test like an MRI or a CT scan, POTS can be a diagnosis by exclusion. It can be made based on a detailed medical history, physical exams, and specialized testing like tilt table tests. And even the test, which is considered to be the closest thing to a gold standard test, can be misinterpreted or improperly documented. If Social Security doubts the test results, your claim is at risk. And that's why every physician note every test, every piece of diagnostic evidence matters.
 
 Nancy Cavey [00:02:24]:
 Now, complicating matters, POTs share symptoms with many other conditions, like ME CFS to fibromyalgia to sinus tachycardia. And Social Security often uses these overlaps to argue that your limitations aren't due to POTS or aren't solely due to pots. And to counter that, your medical records have to not only confirm the POTS diagnosis, but rule out or clearly differentiate other conditions and, of course, explain the functional impact on your daily life. In this episode, I'm going to break down exactly how to establish POTS as a medically determinable impairment, what tests and documentation matter most, and how to prevent the common pitfalls that can sink your claim. Or before it gets started. Now, I'm going to talk about three things today. One is medically determinable impairments. Two, diagnosing POTs and the role of testing.
 
 Nancy Cavey [00:03:20]:
 And then three, talk about the similar conditions, coexisting conditions, and Social Security Administration's confusion. But before we get started, we're going to take a quick break. And when you come back, please come back with a piece of paper and a pencil because I'm going to be talking in detail about proof issues, and I want you to make sure that you're taking really good notes. Got it?
 
 Narrator of Disability Insurance Advertisements [00:03:42]:
 Are you considering filing for Social Security disability or has your claim been denied already? Either way, you require a copy of your rights to Social Security disability benefits, which will cover everything you need to know about the Social Security disability claims process. Request your free copy of the book@kvlaw.com today.
 
 Nancy Cavey [00:04:18]:
 Welcome back to Winning Isn't Easy. Medically determinable impairments. If there is one concept that will make or break a POTS claim, it's this. You have to prove that POTS is a medically determinable impairment, so known as mdi. And this is not optional, and it's not a technicality. It's the foundation of your case. You have the burden of proof. You have to prove that you have a physical or mental impairment that's severe enough to prevent you from working and not just any old job, but at any job in the national economy.
 
 Nancy Cavey [00:04:51]:
 So what is this definition, this magic definition that Social Security uses of an mdi? All right. It's defined as follows. An impairment that results from an anatomical, physiological, or psychological abnormality that can be shown by medically acceptable clinical and laboratory diagnostic techniques. So let's take this apart. Social Security is not going to pay benefits based on symptoms alone. So you can have dizziness, brain fog, fatigue, palpitations, exercise intolerance, but if Social Security doesn't think that these symptoms are supported by objective medical evidence, your claim is going to be denied. And quite frankly, that's why POTS claims are often denied. And particularly before we see a diagnosis of POTS, where we have this constellation of symptoms with no hard diagnosis, or again, we don't have clear diagnostic criteria and objective medical evidence to substantiate the diagnosis.
 
 Nancy Cavey [00:05:49]:
 POTS is often diagnosed by exclusion. Now, the tilt table test is the gold standard test, but I have found in my experience that even cardiologists will misread the tilt table test. And there have been Times when I've even represented physicians where I've had to have my physician client go back to the cardiologist and say, we think that you misread the tilt table test. Would you reread it? That doesn't necessarily make the doctor happy, but they do make mistakes. The other thing that's interesting, I think in POTS cases is that symptoms will vary from person to person. And the other problem we have, of course, is that not all physicians understand POTS enough. I'm sure that many of you have visited emergency rooms and been sent away with something like it's all in your head type of a comment, which is horrific. Or even doctors that you know don't understand POTS and will sort of poo poo.
 
 Nancy Cavey [00:06:48]:
 Your suggestion that that's what you might have. That's why it's really important that you're seeing a specialist and you can get on sites that will have list recognized POTS providers across the United States. I strongly suggest that you consult these types of lists and consult with doctors who specialize in pots. Not only will it give, you know, accurate diagnosis and treatment, but it'll give you a peace of mind that it is not all in your head and that, you know, you're just making all of this up. The first line of defense for Social Security is that there's no objective basis of the POTS diagnosis and or we disagree that the tilt table test is truly positive. Now, you're going to have to have evidence to overcome that. We will normally see this arise in an initial application and Social Security denies it. And when they issue the notice of denial, they will talk about the lack of an mdi.
 
 Nancy Cavey [00:07:44]:
 If you get a denial that talks about lack of an mdi, you need to immediately hire an experienced Social Security disability attorney because that's going to involve one looking at the record Social Security had, getting the complete chart and then taking apart why it is they've taken the position that there's no mdi and there are times when we have to get letters from the treating physicians and explaining why Social Security is wrong and why this in fact, is an mdi. One of the ways, of course, we try to do that is also through a residual functional capacity form that will set forth the basis of the diagnosis and ultimately comment on restrictions and limitations. Got that? Let's take a break. Welcome back to Winning isn't easy diagnosing POTS and the role of testing. As I've said in earlier segments, diagnosing POTS is complicated and Social Security knows it. Now, the diagnostic process will normally start with a Physical examination, blood work, a standing test, or a heads up tilt table test. The tilt table test is considered the closest thing to gold standard. And during the test, you are secured flat on a table, which is then raised to an upright position.
 
 Nancy Cavey [00:09:11]:
 And as this happens, your heart rate, blood pressure, blood oxygen levels, exhaled carbon dioxide are carefully measured. And ultimately you can be diagnosed with POTS if all three of the following elements are present. Number one, you have an abnormal heart rate response to being upright. Number two, your symptoms worsen when you're upright. And number three, you don't develop orthostatic hypotension within the first three minutes. The third element can be critical because if your blood pressure drops too early, Social Security may argue that you don't have POTS at all and that your symptoms are not a medically determinable impairment, and therefore we're going to deny your claim. Now, I've seen cardiologists misread the heart rate responses and, and I've also seen the Salsky administration challenge the validity of the test results. I can't emphasize enough that it's really essential that you are being evaluated by a POTS specialist, not necessarily your garden variety cardiologist.
 
 Nancy Cavey [00:10:16]:
 With all due respect to them, it's really also crucial that they are documenting their findings. So what are the other findings that Solsk Scree is looking for? The Valsalva maneuver testing, quantitative pseudomode or axon reflex testing, and an MRI or other imaging that will rule out tumors or abnormalities. In my experience, the more testing you have, the harder it becomes for Social Security to argue that your condition is not a medically determinable impairment. But I also think that that testing is helpful at steps four and five of the five step sequential evaluation test. At step four and five, there are obviously vocational issues and medical issues. At step four, the question is, can you go back to the lightest and simplest job, both physically and cognitively, that you had before your claim was decided in the last five years? And at step five, where there's other work in the hypothetical, mythical, not real world national economy that you couldn't do in view of your age, your education, your restrictions and limitations. And in both instances, it's the restrictions and limitations that are going to be employed from a vocational standpoint to determine whether in fact you can do your past work or other work, the test results can impact obviously your restrictions and limitations. So we Social Security Lawyers have created POTs residual functional capacity forms that we want our clients doctors to fill out.
 
 Nancy Cavey [00:11:37]:
 And in part, what they're doing is addressing at step three whether you meet a listing. But at step four and five they are addressing your restrictions and limitations and and in this RFC form they're also explaining what test results they're relying on in rendering an opinion about your restrictions and limitations. Now, in earlier episodes I've harped on giving an accurate interval history of your symptoms and functionality. And that's important because again, Social Security is going to be looking for consistency. Consistency in your report of symptoms, consistency in your report of difficulties with activities, and consistency with what you've told your doctor about your symptoms and your functionality. And these test results can cooperate back up, reinforce the nature of the restrictions and limitations that the doctor has assigned and your history of your symptoms and functionality. So that's why it's so important that you have a accurate and complete history of your symptoms and functionality that you're seeing. A POT specialist who understands the diagnostic criteria will document that in your medical records and then ultimately complete a residual functional capacity form documenting your restrictions and limitations.
 
 Nancy Cavey [00:12:52]:
 Got it? Let's take a break.
 
 Narrator of Disability Insurance Advertisements [00:12:55]:
 Struggling with your Social Security disability case? The right attorney can make all the difference. Get our booklet the Key to hiring a Great Attorney for your Social Security disability case. Discover how to find an experienced attorney who will fight for your rights and navigate the process with ease. Don't leave your future to chance. Request your free copy@kvlaw.com today and ensure you have the expert support you deserve.
 
 Nancy Cavey [00:13:37]:
 Welcome back to Winning isn't easy Similar conditions to pots, Coexisting conditions and Social Security Administration Confusion about the whole bailiwick Now. Many conditions share similar symptoms to pots. For example, people with ME CFS often have fatigue, exercise intolerance, and orthostatic intolerance. There's also sinus tachycardia that involves a resting heartbeat above 100 beats per minute. There's also fibromyalgia that can involve gastrointestinal issues, sweating, fatigue, cognitive issues. Now, Social Security is going to be looking at whether you have any one of these diagnoses, because what they're going to try to do is to point to the similarities to undermine your claim. Why is that important? Well, ME CFS and fibromyalgia also have proof problems. There is not necessarily a gold standard test, if you will.
 
 Nancy Cavey [00:14:35]:
 In the case of fibromyalgia, there is the American College of Rheumatology criteria for the diagnosis. Even so, some Social Security judges don't necessarily believe that fibromyalgia is an objective diagnosis. The same with ME cfs. You know, unless you've had Testing like a CPET exam that will document your fatigue or cognitive issues. Social Security and or judges don't always buy those particular diagnoses or the claim symptoms and functionality. So if Social Security can say, well, yeah, we got this POTS diagnosis, we don't really think it's an mdi. And by the way, we've got this fibromyalgia diagnosis. And we really don't think that those symptoms or the reported symptoms are really consistent or at the level of severity that would preclude somebody from doing their past work or other work that can result in a claim's denial.
 
 Nancy Cavey [00:15:28]:
 And so that's why, in part, for the definition of mdi, we have to have physicians rule out other conditions and clearly document that POTS is the correct diagnosis. Again, this can also complicate other medical conditions. So I have POTS clients who have problems with asthma, inflammatory bowel disease, they have Lyme disease, they have autoimmune disease, such as lupus or Sodrens. And the doctor really has to kind of sort out these conditions, documenting the objective basis of each condition, address the functional impact of each condition, address the functional impact of POTS alone, and then lump it all together and talk about the combined impact of all of these issues. Now, doctors don't always do that because this crosses a number of medical disciplines. But that's why we Social Security lawyers use residual functional capacity forms by issue. We have fibromyalgia ones, we have tachycardia issue RFC forms, we have fibromyalgia forms, we have POTS forms. So we're asking the appropriate specialist to fill these out to really parse the MDI issue, but ultimately to parse and identify the restrictions and limitations.
 
 Nancy Cavey [00:16:46]:
 And even if they overlap, I generally don't have a problem because again, I'm going to be arguing that either it's the POTS condition or the combination of medical conditions that result in my client being unable to do their past work or other work. You can understand that documentation is key, including your history of your symptoms and functionality. Testing is key, and physician explanation is key. We don't want to play into Social Security's hands by submitting incomplete records or documentation. So you can see, I think, that it's really crucial that you're working with an experienced Social Security disability attorney who understands pots, me, cfs, fibromyalgia, cardiological issues, so that the presentation is consistent with the diagnosis for each condition, but is consistent with with the combination of these impairments to prove you can't do your past work or other work. That's it for this episode of Winning Isn't Easy. If you found this episode helpful, please take a moment to like our page, leave a review and share it with your family or friends. And of course, subscribe to this podcast so you'll be notified when a new episode drops.
 
 Nancy Cavey [00:17:56]:
 Please join us next week for another insightful episode of Winning Isn't Easy. Thanks for listening, Sa.