A POTS diagnosis can change daily life. It can also raise difficult questions about what caused the condition and whether a vaccine injury claim can succeed.

For most vaccine claims involving postural orthostatic tachycardia syndrome (POTS), the claim is off-Table. That does not automatically bar compensation. It means the claimant must prove, with medical and scientific evidence, that the vaccination caused the injury.

The legal standard is demanding. A clear record can help meet it. Righting Wrongs and Protecting Futures means taking both the medical timeline and the legal proof seriously.

POTS Is Not Listed on the VICP Vaccine Injury Table

The National Vaccine Injury Compensation Program (VICP) covers certain vaccines and injuries. Its Vaccine Injury Table lists specific conditions and, for some injuries, the time period in which symptoms must appear. When a claimant has a listed injury within its specified timeframe, the law may presume the vaccine caused it, subject to the government's ability to rebut that presumption. See the HRSA Vaccine Injury Table and 42 U.S.C. § 300aa-14.

POTS is not listed as a Table injury. The Federal Circuit confirmed this in Stratton v. Secretary of Health and Human Services. A claimant alleging POTS after a vaccine therefore cannot rely on the Table's causal presumption. The claim must proceed as an off-Table, or causation-in-fact, claim.

That distinction matters. A Table claim can benefit from a legal presumption when the requirements are met. An off-Table claimant must build the causal case from the evidence. Righting Wrongs and Protecting Futures starts with knowing what the evidence must show.

The Althen Test Requires Proof of Actual Causation

Under Althen v. Secretary of Health and Human Services, a claimant must prove each of three points by a preponderance of the evidence. That means showing that each point is more likely true than not.

1. A reliable medical theory must explain how the vaccination could cause the claimed injury. A qualified expert should explain the reasoning and address relevant medical and scientific evidence. Naming a possible mechanism without supporting analysis may not be enough.

2. A logical sequence of cause and effect must connect the vaccination to this person's POTS. The record should support the expert's opinion that the vaccination was a substantial factor in causing the injury. Timing alone does not establish that connection.

3. A proximate temporal relationship must show that the onset of symptoms occurred within a medically reasonable timeframe for the proposed theory. The expert should explain why the timing fits, rather than simply pointing out that symptoms followed vaccination.

These are evidence requirements, not a guarantee of success. The special master evaluates the record as a whole. Under 42 U.S.C. § 300aa-13, the claimant must prove entitlement by a preponderance of the evidence, and the law also addresses evidence that an injury resulted from factors unrelated to vaccine administration.

A Strong Record Connects Symptoms, Testing, and Expert Reasoning

A POTS claim is stronger when medical documentation starts close to the first symptoms and continues consistently. Families can ask treating providers to record what happened, when it happened, and how symptoms changed over time. A symptom diary may help keep dates and details clear, but it does not replace medical evaluation.

A useful record may include:

• Contemporaneous symptom notes. Record the first symptoms, their timing, and whether standing made them worse or lying down helped. Include relevant visits, reported limitations, and changes in daily activities.
• Objective orthostatic testing. Include tilt-table results when performed, along with the testing protocol and recorded heart rate, blood pressure, and symptoms. A clinician may use other appropriate testing. A tilt-table test is not, by itself, proof of vaccine causation.
• A clear diagnosis. Ask treating clinicians to explain the findings supporting the diagnosis and how the symptoms affect function. The NIH expert consensus describes POTS diagnostic criteria and clinical assessment in its review of POTS science and care.
• Assessment of alternative causes. Medical providers may investigate other explanations when clinically appropriate, such as dehydration, anemia, infection, medication effects, or other conditions. The record should show what was considered and what the findings did or did not establish.
• A qualified causation expert. An expert should review the actual medical history, explain the proposed causal theory, address timing, and engage with plausible alternative explanations. A conclusion without a reasoned explanation may carry less weight.

The medical record and expert opinion should work together. A treating physician's observations can document the clinical course. A causation expert can address the legal and scientific connection. Neither a diagnosis nor a close timeline alone establishes that a vaccine caused POTS.

Know the Deadline and the Difference Between VICP and CICP

For a VICP injury petition, the general deadline is three years from the first symptom or manifestation of onset or significant aggravation, not automatically three years from the vaccination date. The governing limitation appears in 42 U.S.C. § 300aa-16(a)(2). Identifying the legally relevant first symptom can be complicated, so families should not wait to clarify the timeline.

VICP claims also have eligibility requirements, including rules about covered vaccines and injury severity. The statute generally requires an injury lasting more than six months, an inpatient hospitalization with surgical intervention, or death. See 42 U.S.C. § 300aa-11(c)(1). Eligibility depends on the facts and the applicable program rules.

COVID-19 vaccine injury claims generally go through the Countermeasures Injury Compensation Program (CICP), not the VICP. HRSA explains the distinction in its COVID-19 vaccine claims FAQ. CICP uses a different process and a different evidentiary standard. It does not simply apply the VICP's Althen test. HRSA describes the evidence required to show a covered injury in its CICP criteria. The CICP filing deadline is generally one year from receipt of the covered countermeasure under 42 U.S.C. § 239a(d)(1). Do not assume the VICP deadline applies to a COVID-19 vaccine claim.

Understand What “Reasonable Basis” Means

“Reasonable basis” is not a substitute for proving causation, and it is not the merits standard for winning compensation. The VICP addresses reasonable basis in connection with potential attorneys' fees and costs when a petition does not result in an award. The fee provision also requires good faith. See 42 U.S.C. § 300aa-15(e).

A petition still needs objective support. Medical records, diagnostic evidence, and a reasoned medical opinion can help establish that support. A family's sincere belief matters, but it cannot replace the evidence needed to prove the claim.

Ohio Families File in Federal Court, Not an Ohio Vaccine Court

VICP petitions are filed in the U.S. Court of Federal Claims. Ohio residents cannot file in an Ohio state court to pursue a VICP petition. HRSA outlines the filing process in its guide to filing a petition.

Families can also review the firm's information on vaccine injury representation. The right next step depends on the vaccine involved, the symptom timeline, the medical record, and the applicable program.

The Takeaway (POTS Claims Need Proof, Not Presumptions)

POTS is not a VICP Table Injury. For an eligible non-COVID vaccine claim, the claimant generally must prove actual causation through the three Althen prongs, supported by medical records and qualified expert reasoning. A symptom timeline, objective testing, treating-provider documentation, and careful assessment of other possible causes can all matter. COVID-19 vaccine claims generally follow the separate CICP pathway, with different rules and a shorter deadline.

Righting Wrongs and Protecting Futures means pursuing clear answers and building a careful case. This article provides general educational information, not individualized legal or medical advice.

Drop us a line to discuss your situation with Braden Blumenstiel Legal Advocates Group, LLC. Call 614-508-1677 or 888-343-9796.