Winning Your POTS Claim: Symptoms, Severity, and Outsmarting the SSA (POTS Part Three)

Welcome to Season 2, Episode 14 of Winning Isn't Easy: Navigating Your Social Security Disability Claim. In this episode, we'll dive into Winning Your POTS Claim: Symptoms, Severity, and Outsmarting the SSA (POTS Part Three).

Postural Orthostatic Tachycardia Syndrome, or POTS, is a condition defined largely by symptoms - yet the Social Security Administration often discounts subjective complaints. Lightheadedness, brain fog, fatigue, palpitations, and exercise intolerance can significantly disrupt daily functioning, even when routine exams appear normal. That makes documenting, quantifying, and explaining symptoms essential. Because POTS includes multiple types (neuropathic, hyperadrenergic, hypovolemic, and secondary), clear medical records are critical. Without identifying your specific type, symptoms, and resulting functional limitations, even a correct diagnosis may not translate into benefits. In this episode of Winning Isn’t Easy, we explain how POTS is evaluated in disability claims, why symptom evidence carries so much weight, and how detailed documentation can make the difference between denial and approval. We also examine common pitfalls, the role of medical and third-party evidence, and how cases are won at the hearing level.

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

One - Subjective Evidence and Why the SSA Discounts It

Two - Types of POTS the SSA Does Not Understand

Three - The Disability Process and Why Representation Matters

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 [00:00:00]:
 Foreign. Disability claim isn't just about having the right diagnosis. It's about proving your symptoms, showing the severity of your symptoms, demonstrating how they result in restrictions and limitations, and outsmarting the Social Security Administration's cookie cutter approach to to Potts cases. 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. And I'm your host, Nancy Cavey. Before we get started, I have to give you a legal disclaimer.
 
 Nancy Cavey [00:00:45]:
 This podcast isn't legal advice. The Florida Bar association says I have to tell you that. So I've done it. But nothing will prevent me from giving you an easy to understand overview of the Social Security disability claims process, the games that are played, and what you need to know to get the Social Security disability benefits you deserve. So off we go now. POTS is a condition defined almost entirely by symptoms. Yet the Social Security Administration notoriously discounts subjective complaints, lightheadedness, brain fog, fatigue, palpitations, exercise intolerance, all real, all daily challenges. But they may not show up dramatically like a routine physical exam.
 
 Nancy Cavey [00:01:27]:
 And that's why documenting, quantifying and explaining your symptoms is essential. Now, I think that symptom diaries, statements from family and friends, and detailed physician notes that link your symptoms are crucial. But I'm going to talk about a formula that I try to use in POTTS cases that I think should be the foundation for symptom diaries or statements from family and friends and which will also assist your doctoring, writing their reports, but also filling out some forms that I think are crucial to POTS cases. They're called Residual Functional capacity forms that we Social Security lawyers have created. Now, I also want to remind you, and you live with it daily, is that POTS is just not a single condition. There are multiple types of POTs. There's neuropathic, hyperallergenic, hypovolemic, and secondary, and each one of these affect the body differently. Social Security will ignore these distinctions and it makes it critical, in my view, that your records clearly identify the type of pots because they generally don't understand POTS to begin with and they certainly don't understand the different types of pots.
 
 Nancy Cavey [00:02:41]:
 What's important here is that we're talking about what type of POTS you have the symptoms that it causes, the resulting functional limitations. And I will tell you that without detail, even the correct diagnosis may not translate into Social Security benefits. The reality is stark. Over two thirds of initial claims are denied and many requests for reconsiderations, which is the first level of appeal fail. But I will also tell you that at the hearing level, experience representation approval will really improve your race or chances of success. Now, the reason that I think that this is important is that many times initial applications are not well put together and that will lead to a claim denial that'll lead in terms to an appeal called the request for reconsideration. And even then, people don't understand why their claim has been denied. But I will tell you, if your claim has been denied it twice, you really need to have that experience representation because that attorney will understand how Social Security evaluates evidence, they will anticipate common denials, and they will know how to present your case strategically.
 
 Nancy Cavey [00:04:01]:
 And all of that can improve your chances of success. So in this episode, I want to break down how to gather and present evidence, differentiate the types of pots and and navigate the disability process to give yourself the best chance of winning your claim. So I'm going to talk about, number one, subjective evidence and why the Social Security Administration discounts it. Two, the type of pots but Social Security just doesn't understand, and three, why you need representation in the disability claims process and why it matters. Got it. Now, before you take a break, I want you to come back to this episode with a piece of paper and a pen and pencil because I'm going to be giving you lots of valuable information that can and will make the difference in your claim. So I'm going to give you a break. Go get that pad and pen.
 
 Nancy Cavey [00:04:54]:
 See you in a minute.
 
 Speaker B [00:04:55]:
 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 [00:05:21]:
 Welcome back to Winning Isn't Easy. Let's talk about subjective evidence and why the Social Security Administration discounts it. Now, POTS is a condition that is diagnosed in part based on symptoms, and Social Security does not like subjective conditions. So when you see your doctor, you may be reporting lightheadedness, brain fog, fatigue, exercise intolerance, palpitations, nauseousness, all sorts of symptoms that are subjective in nature and you may not present with dramatic findings on physical exam. In other words, you may not have an episode in the doctor's office observed by the doctor. Many times, Social Security can disregard or minimize the subjective complaints. That's why your subjective complaints have to be documented, explained, and quantified. I represent many people with pots and their symptoms are personal and they vary from day to day, week to week, month to month.
 
 Nancy Cavey [00:06:19]:
 But Social Security doesn't necessarily look at an individual or their symptoms as they're supposed to. I find that Social Security uses a cookie cutter approach in POTS cases. And that's why a symptom diary can matter. Now I want to give you my formula for how a symptom diary or a worksheet should be kept. And the idea is that ultimately you're going to be giving this to your doctor. So this isn't a Dear Diary entry, okay, that you would have done when you were a nine year old. What we want to talk about is this. I want you to take out a piece of paper and on the top of it I want you to write pots.
 
 Nancy Cavey [00:07:06]:
 And on the left hand side, I want you to write down every one of your symptoms. There might be 5, there might be 10, there might be 15. Whatever they are, write them down. Now on the top of that paper we want to write the words symptoms, As I said, 1, 2, 3, 4, 5. And the next word is going to be location of the symptom. The next word is going to be the duration of the symptom. How long does it last? The next word is going to be frequency. The next word is going to be intensity.
 
 Nancy Cavey [00:07:42]:
 And the last column on the right hand side of that piece of paper is going to be an example of functional issues. So we want to do this, I think, at least, you know, once a week, if you will. And you may also want to have your family and friends do the same kind of documentation. This can provide real world context that medical records can't. But there also can be inconsistencies. And if there are, that's going to blow up your claim. That isn't to say you should sit next to each other and copy each other's homework, but the report of the symptoms, the location, the duration, the intensity, the frequency and examples of the impact of your symptoms should be fairly consistent. Okay? Now ultimately, your doctor, as a result of your physical, your history of your symptoms, your physical exam and diagnostic studies, is going to make a diagnosis of pots.
 
 Nancy Cavey [00:08:46]:
 That's great, but we need to take it a step further. We need to have your doctor complete a form called pots Residual Functional Capacity form. And I find that doctors do a better job in filling out that form when the person is coming to them with an interval history of their symptoms and functionality. Not a diary, because they're not going to read it. Symptoms and functionality worksheet. If you might want to do, if your gap between your visits is three months. Do sort of a, I mean, you can keep like a weekly one if you wish, but kind of summarize it into a monthly sheet and then do one for month one, month two, month three. And you want to ask the doctor to make it a part of your medical records.
 
 Nancy Cavey [00:09:37]:
 Ask the nurse or whoever handles the medical records to add that. But you also want to give it to the doctor and say, here it is. I want to, you know, I know you don't have time to take a detailed history of my symptoms, but I would like you to make this, put this as part of my chart. You also need to keep a copy of it because I want to, as a Social Security disability attorney, file this with the Social Security Administration if I think there's a gap in the records. Now, ultimately, again, that's going to help your doctor fill out the residual functional capacity form because the former is going to ask what your functional limitations are. How long can you sit, stand, stoop, walk, bend, stoop, lift? Do you have postural issues? Do you have to use the restroom? Do you have side effects from the medication or other treatment? How long do you sleep? Are you on task, off task? Would you be absent from work? And this kind of information can help the doctor, help you win your Social Security disability claim. Got it. Let's take a break.
 
 Nancy Cavey [00:10:36]:
 Foreign. Welcome back to Winning Isn't Easy. Let's talk about the types of POTS that Social Security just doesn't understand. Now, I don't think that they understand what POTS is to begin with, but there are different forms of pots, and they're not mutually exclusive. For example, neuropathic POTS involves damage to the small fiber nerves that regulate blood vessel constriction, and this can cause limb dysfunction and gastrointestinal problems. And I will tell you that Social Security and judges don't really get that. Then there is the hyperallergenic POTS that involves elevated norepine levels that can lead to tremors, migraines, sweating, cold extremities, and increased urination. And so this norepine is really important because we want to document the tremors, the migraines, the frequency of the migraines.
 
 Nancy Cavey [00:11:55]:
 We want to certainly document the increased urination because that would impact brakes. Now there's the hypovolemic POTS that involves abnormally low blood volume that can result in weakness and poor tolerance for activity. We talked in the last segment about keeping a diary or a sheet of symptoms and functionality if you have poor tolerance for activity. We want to talk about how that Feels. Now, I know that sounds silly, but you may wake up feeling like you never slept. You might feel like after you have swept your kitchen or done the dishes that you've run a marathon and now you're exhausted and you're drained and you're having obviously episodes of, of. Of symptoms that have been increased just by this minimal activity. There's also secondary pots and that occurs when there's another condition such as diabetes, Lyme, lupus, sodrens cause autonomic dysfunction, quite frankly, representing a lot of POTS clients and people who have connective tissue disorders or other types of disorders.
 
 Nancy Cavey [00:13:14]:
 It's not uncommon for me to see POTS as a secondary presentation. So we're covering the lupus, if you will, getting medical records, getting residual functional capacity forms for the lupus. But we're also dealing with the secondary POTS issue because I always wanted to argue that the client is disabled either by one condition or multiple conditions. Now I will tell you that the claims examiners don't even know about these distinctions and they really find fail to appreciate how each type impacts functioning. So your medical record should clearly identify one, the types of POTS you have, two, the symptoms that are associated with that, and three, the functional limitations that result from that particular type of pots. Now, as I said, there can be overlap with other medical conditions and you may not be able to sort it out, but to the extent to which you can, you should be doing that in the history that you're giving to your doctor of symptoms and functionality. Now, even when Social Security will accept the diagnosis, they frequently argue that the symptoms aren't severe enough to be disabling. And that's where detailed functional evidence is going to win the case.
 
 Nancy Cavey [00:14:25]:
 I'm going to take a break before we jump back in, but I think you need to really understand that this is part of putting together a winning Social Security disability claim. The diagnosis isn't going to win it. A doctor's note saying you can't work isn't going to win it. Social Security uses that five step sequential evaluation test. And you have the burden basically to prove that you have a medically determinable impairment that impairs your or impacts your ability to do your past work or other work in the national economy. So in English, you have functional, physical, cognitive, even psychological restrictions and limitations that are objectively based that would impact your ability to do your past work or other work in the national economy. That's the key. Got it.
 
 Nancy Cavey [00:15:14]:
 Let's take a break.
 
 Speaker B [00:15:19]:
 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 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 [00:15:50]:
 Welcome back to Winning isn't Easy. Let's talk about the disability process and why representation matters. Now, over two thirds of initial disability applications and requests for reconsiderations are denied. And if your claim is denied, you only have 60 days to appeal. And if you miss that deadline, if you you get to start all over again. Now at the hearing level with experience, representation statistics show that two thirds of cases are approved and that difference is not accidental. An experienced Social Security disability attorney understands how the Social Security Administration thinks, how claims examiners deny claims, and the way to present evidence in a way that meets Social Security's legal standards. Now, I also think that it's just not an experienced Social Security disability attorney you should be talking with, but it's one who's represented people with POTS or long Covid with POTS as a complication or people who have represented folks with me, CFS or fibromyalgia.
 
 Nancy Cavey [00:16:51]:
 These medical conditions are sometimes considered by Social Security to be subjective in nature, when in fact they aren't. But the attorney will understand the mindset of Social Security and be able to develop a winning strategy based on whatever's in your medical records to establish 1. That you have a medically determinable impairment 2 that you have an objective basis of the diagnosis and an objective basis of the restrictions limitations that's consistent with your subjective complaints and that the functional restrictions and limitations you have will prevent you from doing your past work or other work. Now, I would strongly suggest that if you have a diagnosis of POTS, long Covid, MECFs, fibromyalgia, immunological issues regardless of the condition, you really owe it to yourself to find an experienced Social Security disability attorney. I am based in Florida, though I handle cases nationwide, and it is taking a year to a year and a half to have a claims examiner assigned to a claim. That delay is horrific. But what's important here is if we if we have this blasted delay, we want to use that delay wisely by teaching you how to give that good interval history based on symptoms, the location of the symptoms, the duration of the symptoms, the intensity of the symptoms, the frequency of the symptoms with good examples. We also want to make sure that your medical records are documenting the objective Basis of the diagnosis and the actual diagnosis explaining what kind of POTS you have.
 
 Nancy Cavey [00:18:44]:
 We want the medical records to explain the treatment that you've gotten in your response to treatment. And we want the doctor to establish, based on objective evidence, your restrictions and limitations, both physically, cognitively, and psychologically. Now, remember that if the claim is denied, you only have 60 days in which to file an appeal. And if that appeal isn't filed, you get to start all over again. So we really want to use this initial application stage time to get everything in a ducks in a row, if you will, so that the claim is approved at the initial stages. I have won cases with people who have pots in their 20s. Incredibly difficult, because Social Security doesn't like cases under 50, and they certainly don't like cases when a person's in their 20s or 30s. But we won those cases because of the preparation and the work that we put in to develop the record to establish to Social Security satisfaction why the person wasn't able to do their past work or other work.
 
 Nancy Cavey [00:19:53]:
 So in my view, Potts case, winning a POTS case really takes a lot of coordination and teamwork between you, your doctor, and the Social Security disability attorney. If we are at the request for reconsideration stage, and you know, you, you've been denied, you filed a request for reconsideration, and that gets denied, you've got 60 days in which to file for a hearing. If you don't do that, you get to start all over again. Now, once you get in front of a judge, if you don't have an attorney at that point, you really do need to have an attorney because the judge is not necessarily going to be your friend. Again, when I am representing someone who has pots and we get the notice of the hearing, which is three to five months before the hearing, I, for example, send out a video that I call the mock Social Security disability hearing. And I also send out a direct exam video where I'm teaching my clients how to tell truthfully their story in a way that the Social Security administration and the judge is going to understand. And we practice that. We go through all the things that I've discussed.
 
 Nancy Cavey [00:21:07]:
 Symptoms, location, duration, intensity, frequency. And we're looking for weaknesses in the medical records so that we can either address them with medical documentation, address them through our client's testimony, or address them through a memorandum of law, because ultimately, at the end of the day, there's going to be another witness after you, and that person will make or break your case. That person is a vocational evaluator, an expert in the world of work. And after hearing your testimony, the judge is going to turn to that vocational evaluator and ask hypotheticals. So let me give you an example. I want you to assume that this hypothetical individual has worked in the past as a dispatcher, sedentary position. I want you to assume that this person who's in front of us has pots. They have a limited ability to turn side to side without triggering an episode, and they will have to be off task at least 5 or 10% of the time when they have episodes.
 
 Nancy Cavey [00:22:17]:
 Mr. Mrs. Ve, could there be a dispatcher? Of course, the answer is no. And of course that isn't all the symptoms that this person had. But, but for the purposes of illustration, those are the kinds of restrictions that would preclude that person from doing their past work, which is a job sitting down all day. Now, your job might have involved standing, lifting, bending, but that's not where the case is going to be won. It's going to be one at step five, which is, is there other work in the mythical hypothetical, not real world national economy, in view of your age, your education, the skills you've learned, and those blasted restrictions and limitations. Now, if in my example, the Judge says, well, Mr.
 
 Nancy Cavey [00:22:56]:
 And Mrs. Ve, based on those restrictions and limitations, is there other work? The V is going to say something stupid like surveillance system, monitor. They could address envelopes all day. They could be a router, they could sort nuts and bolts, they could be a, a, a clerk. They could even be an election clerk, they could be a cashier one. I hear all those kinds of jobs every day. Well, you're going to lose. So we have to add things to the hypothetical that would preclude you from doing a stupid job sitting down all day, engaging in bilateral manual dexterity, meaning the pace and production and attendance requirements.
 
 Nancy Cavey [00:23:44]:
 So I'm going to add things. Where are those things coming from? My client's history of their symptoms and functionality, as I've taught them to do, and the residual functional capacity for them. So if we amend the hypothetical to say that this hypothetical individual can't lift five pounds, has to remain in a static position, and they might actually have to be in bed reclined at least five out of eight hours, that when they get up, for example, to use the restroom, they may be in the restroom for five to 10 minutes, but they're going to be in the restroom, you know, a couple times an hour or a couple times in the course of a day based on the treatment, the salt tablets and the liquid that they're taking. In and I want you to assume that they're going to be off task 20% of the time. And I want you to assume that they're going to miss at least two days of work per month. And I want you to assume this and that. So we're building into this hypothetical all of the functional, physical, cognitive and psychological restrictions and limitations, and then we ask the question, well, Mr. And Mrs.
 
 Nancy Cavey [00:24:57]:
 Ve, in view of these additional restrictions and limitations, can this person do the dumb jobs you just identified or any other dumb job in the national economy? Now, that's not exactly how I say it, but that's the sort of point I'm trying to get. And ultimately the goal here is to get the VE to say, no, you can't do your past work or other work. Ultimately, it's the judge that gets to decide the hypothetical. And the judge is going to do that in part based on your credibility and your consistency. What you've told the doctor and how strongly your doctor is, is supporting your claim in terms of the diagnosis, their opinion about your restrictions, limitations, all of that is material. Which is why we've spent this entire series of podcasts on POTS trying to explain why Potts cases are different, what Social Security doesn't understand, and what it really takes in terms of a good interval history and residual functional capacity capacity forms to overcome a claims denial. The key, obviously, is to get your benefits the first time around, which should involve you having representation. But certainly if you're at the hearing stage, you do not want to do this by yourself for all the reasons that I just explained.
 
 Nancy Cavey [00:26:19]:
 Got it. Well, that's a wrap for this episode of Winning Isn't Easy and the whole series that we've done on pots. I believe we've done three podcasts on pots. But I want you to understand that this is an ongoing process, that there is one, one way to win, in my view, and that really is hiring an attorney as quickly as possible. The good medical history, the documentation of the diagnosis, the medically determinable impairment, the documentation of treatment and your response to treatment, the documentation of your residual functional capacity form, and all of that combined, hopefully will result in a favorable decision at the initial application stage and certainly in conjunction with an experienced attorney who's there to do all of that, and a memorandum of law, get you ready for the hearing and cross examine the VE should, cross our fingers, result in a favorable decision. Now remember, Abraham Lincoln said that a fool, the person who represents themselves has a fool for a client. So please don't be a fool. Contact an experienced Social Security disability attorney.
 
 Nancy Cavey [00:27:31]:
 Thanks. Now, I hope you have enjoyed this episode. If you have, please leave us a review. Please tell your family and friends about our podcast and please subscribe to our podcast. We look forward to talking with you in our next episode of Winning Isn't Easy. Thanks.