Basic Stuff

  • Name: ABC
  • Country: United States
  • State: Ohio
  • City: Mount Vernon
  • Gender: Female
  • Age: 44
  • Education: Jr. College
  • Primary Illness: Dysautonomia/postural orthostatic tachycardia syndrome (POTS)
  • Diagnosis:
    • Postural Orthostatic Tachcycardia Syndrome (POTS)
    • Migraine
    • Mast Cell Activation Syndrome (MCAS)
  • Year Illness Began: 2019

Functioning Interrupted

Former Level of Functionality: 90
(No symptoms at rest; mild symptoms with activity; normal overall activity level; able to work full-time without difficulty.)
Current Level of Functionality: 20
(Moderate to severe symptoms at rest. Unable to perform strenuous activity; overall activity 30%-50% of expected. Unable to leave house except rarely; confined to bed most of day; unable to concentrate for more than 1 hour a day.)

Work Interrupted

  • Years of Work Lost: 4
  • Current Work Status: Not working now (not on disability)

Income Interrupted

  • Minimum Current Annual Income Loss:

    $69,928

  • Total Projected Economic Losses For Years Not Worked:

    $257,601

Other Interruptions

Certified Disabled: No

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