Migraines and Headaches
Common migraine symptoms include severe throbbing pain, frequently worse on one side of the head, nausea, light and sound sensitivity. Sometimes a migraine may be preceded by visual disturbances known as an aura. Other migraine symptoms include sleep disturbances, the sensation of pressure at the temples and behind the eyes, mood changes and body aches.
Migraines affect 1 in 5 women and 1 in 16 men, affecting more than 37 million people in the United States, according to the American Migraine Foundation. Most people who suffer migraines experience migraines several times per month. The Department of Veterans Affairs has issued a publication acknowledging that veterans who have deployed are more likely to develop migraines and headaches.
The VA will compensate veterans who suffer migraines that began in service, or that were caused or aggravated by service. Veterans can also obtain service-connection for diagnosed chronic headaches, including tension headaches and cluster headaches. Usually the biggest problem is that the veteran has never sought medical help for the migraines and so never get a diagnosis. This article will discuss the way the VA approaches migraines and other headache conditions, which hopefully will make for smoother sailing when you make your claim. As we discuss below, if you suffer from headaches and want to make a claim for VA compensation, go see a doctor and start keeping a diary of the severity and frequency of your headaches.
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We do not charge for an initial consultation, so if you have questions about your own case, please give us a call. What follows are just the basics on migraine and headache conditions – we do not intend to provide any legal advice with this information. We do hope it assists you as much as it assists our attorneys and staff when tackling a VA compensation denial.
Migraine and Headache Ratings
What follows is a summary of the way the VA rates migraine claims. For an even deeper dive into the VA’s rating system, please refer to the VA’s ratings codes. Generally speaking, the VA will normally only rate your headache or migraine condition according to the symptoms listed in the the VA’s Diagnostic Code. The VA only has a rating code for migraines, DC 8100. For other kinds of headaches, the VA typically also assigns a rating under DC 8100, under a rule for applying what is called an “analogous rating.” (38 CFR 4.20). Diagnostic Code 8100 states:
50-percent Frequent completely prostrating and prolonged attacks productive of severe economic inadaptability.
30-percent Characteristic prostrating attacks occurring on an average once a month over last several months.
10-percent Characteristic prostrating attacks averaging one in 2 months over last several months.
0-percent Less frequent attacks.
The VA places great importance on how often a veteran suffers from a “prostrating” headache or migraine. There is no VA regulation that defines what “prostrating” means. However, the VA’s internal handbook does describe what the VA considers to be “prostrating”:
|Prostrating, as used in 38 CFR 4.124a, DC 8100, means “causing extreme exhaustion, powerlessness, debilitation or incapacitation with substantial inability to engage in ordinary activities.”
Completely prostrating as used in 38 CFR 4.124a, DC 8100, means extreme exhaustion or powerlessness with essentially total inability to engage in ordinary activities.
The Board of Veterans Appeals has issued decisions that rely on dictionary definitions of the word “prostrating” to essentially mean extreme exhaustion. In practice, to suffer “completely prostrating” migraine, you must be able to do nothing other than rest or sleep. And there is the short-hand way to remember what the term “prostrating” means: the need to lie down.
The best evidence of your suffering from prostrating headaches will ideally come from your doctor and will include a medical diagnosis and hopefully documentation of the severity and frequency of your headaches, and whether they are severe enough to render you unable to do anything but rest or sleep.
The VA will also consider your own testimony regarding the frequency and severity of your headaches, but it is better to have documentation to back up your statement. Keeping a “headache diary” regarding your symptoms is a common recommendations from doctors, and that diary can also help you prove how frequently you suffer headaches, and whether the attacks were “prostrating.” You should also note how the attack impacted work or school (did you have to go home early, or use sick leave?) There are now available numerous phone apps to make keeping the headache diary easier.
Notably, the VA’s highest schedular rating for migraines — 50-percent — requires the prostrating attacks to be “frequent” and “prolonged.” The VA’s internal handbook indicates that the VA will consider migraine headaches to be “very frequent” if they “are less than one month apart over the last several months.” (The 30-percent rating requires one migraine headache a month, and the 10-percent requires one migraine every two months.)
The VA does not state what it considers to be a “prolonged” migraine. The best strategy is too not minimize your symptoms and let your medical provider know if your headaches are lasting several or many hours.
TDIU and Migraine Headaches
An interesting aspect of the VA’s code for migraines is that the highest rating it offers — 50-percent — takes into account the impact of the headaches or migraines on the veteran’s ability to work. The VA’s handbook describes “severe economic inadaptability” as denoting “a degree of substantial work impairment. It does not mean the individual is incapable of any substantially gainful employment. Evidence of work impairment includes, but is not necessarily limited to, the use of sick leave or unpaid absence.”
This means that a veteran can still be working and obtain the highest rating under the VA code for headaches — 50-percent.
However, if the headaches become so bad that the veteran must stop any kind of substantial work, it becomes possible for the vetearn to request Individual Unemployability (a.k.a. TDIU) on the basis of the headaches. In this way, a veteran can obtain a full 100-percent rating from the VA.