Vanderbilt Orthostatic Symptom Score (VOSS)
Nine symptoms rated 0–10 while upright: the standing symptom score from POTS trials
The Vanderbilt Orthostatic Symptom Score comes from the Vanderbilt Autonomic Dysfunction Center, where Satish Raj and colleagues used it in POTS drug studies from 2005 onwards. It has since been used in the Calgary compression garment trial, exercise studies in post-COVID POTS, and a growing list of others. You rate nine symptoms from 0 (absent) to 10 (the worst you have experienced) for how you feel right now. The total runs from 0 to 90.
Unlike the weekly Malmö POTS score or the broader COMPASS-31, the VOSS is a snapshot. In trials it is completed at the end of a 10-minute stand or tilt, which makes it a natural companion to the NASA lean test: rate your symptoms at the end of the standing phase and you have a symptom number to sit alongside the heart-rate numbers. Rated lying down and again after standing, the difference shows how much standing itself drives your symptoms.
Your VOSS score
Symptom breakdown
Understanding your score
Published reference points, all rated while upright: healthy adults after 10 minutes of head-up tilt averaged about 12 (SD 12); people with POTS after 10 minutes of tilt averaged 26 (SD 17) without compression and 12 with full abdominal and leg compression (Bourne 2021); POTS patients after a stand test scored a median of about 35; and people with post-COVID POTS averaged 41 after an active stand, falling to 33 after a 12-week exercise programme. A mild unselected post-COVID cohort scored a median of 1 while standing.
Treatment effects in trials were around 5–14 points, so a change of that size between two ratings under the same conditions is the kind of difference the studies treated as meaningful. There is no cut-off that identifies POTS: that needs the heart-rate response recorded by a stand or tilt test.
To use the VOSS as a tracker, keep the conditions constant: same time of day, same posture, same duration standing. Rating at rest and then at the end of a standing period, and noting both, gives you the orthostatic component specifically. Record scores in a note or the stand test logger alongside your heart-rate readings.
This is not a diagnosis. Discuss your results with your doctor or specialist.