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Thoughts on this headache/Migraine C&P exam.
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ShuMan
Team,
I'm thinking the below C&P exam will rate me at 30%. Thoughts? feelings? Emotions?
=============================================================================
1. Diagnosis
------------
Does the Veteran now have or has he/she ever been diagnosed with a headache
condition?
[X] Yes [ ] No
[X] Migraine including migraine variants
ICD code: G43 Date of diagnosis: 2015
[X] Tension
ICD code: G44.2 Date of diagnosis: 2003
2. Medical History
------------------
a. Describe the history (including onset and course) of the Veteran's
headache conditions (brief summary):
=============================================================================
The Veteran reports he has a history of tension headaches. He reports
typically these headaches are frontal and bilateral but tend to
gravitate towards the left frontal area more often. The Veteran
reports
his headaches have changed in the last 5 years. They remain frontal
&
occur approximately 3-4 times a month, however they have increased in
severity and now require him to stop what he is doing and if he is at
work he has to leave. They now last typically 24 hours. He reports
nausea and vomits with headaches about 2 times a month.
b. Does the Veteran's treatment plan include taking medication for the
diagnosed condition?
[X] Yes [ ] No
If yes, describe treatment (list only those medications used for the
diagnosed condition):
Sumatriptan succinate 25 mgs at the onset of the headaches. He also
takes ab OTC medication that contains caffeine like Excedrin migraine
3. Symptoms
-----------
a. Does the Veteran experience headache pain?
[X] Yes [ ] No
[X] Pain on both sides of the head
b. Does the Veteran experience non-headache symptoms associated with
headaches? (including symptoms associated with an aura prior to headache
pain)
[X] Yes [ ] No
[X] Nausea
[X] Vomiting
[X] Sensitivity to light
[X] Sensitivity to sound
[X] Changes in vision (such as scotoma, flashes of light, tunnel vision)
c. Indicate duration of typical head pain
[X] Less than 1 day
d. Indicate location of typical head pain
[X] Left side of head
4. Prostrating attacks of headache pain
---------------------------------------
a. Migraine / Non-Migraine- Does the Veteran have characteristic prostrating
attacks of migraine / non-migraine headache pain?
[X] Yes [ ] No
If yes, indicate frequency, on average, of prostrating attacks over the
last several months:
[X] Once every month
b. Does the Veteran have very prostrating and prolonged attacks of
migraines/non-migraine pain productive of severe economic inadaptability?
=============================================================================
[ ] Yes [X] No
5. Other pertinent physical findings, complications, conditions, signs
and/or
symptoms
-----------------------------------------------------------------------------
a. Does the Veteran have any scars (surgical or otherwise) related to any
conditions or to the treatment of any conditions listed in the Diagnosis
section above?
[ ] Yes [X] No
b. Does the Veteran have any other pertinent physical findings,
complications, conditions, signs and/or symptoms related to any
conditions
listed in the Diagnosis section above?
[ ] Yes [X] No
6. Diagnostic testing
---------------------
Are there any other significant diagnostic test findings and/or results?
[ ] Yes [X] No
7. Functional impact
--------------------
Does the Veteran's headache condition impact his or her ability to
work?
[X] Yes [ ] No
If yes, describe the impact of the Veteran's headache condition,
providing
one or more examples:
As already stated, he has to call in to work approximately 3 times per
month.
8. Remarks, if any:
-------------------
STR's 29/93 headache in conjunction with other symptpoms associated
with
acute intoxication dated 01/20/2007.
CPRS note of 07/15/2015 with reference to migraines.
01/19/2006 VBMS P. 1 dated 07/02/2015 Post-deployment health assessment
STR's P. 34/93 denies headaches.
VBMS P. 1 07/02/2015 STR's P.5/93 05/26/2005 headache noted in
conjunction
with acute URI, bronchitis and sinusitis.
The Veteran has an appointment scheduled with neurology tomorrow (09/30)
for further evaluation of headaches.
No additional remarks.
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ShuMan
Ended up with 30% for this one
Vync
I agree with ShuMan. Personally, I think the whole "productive of severe economic inadaptability/hardship" seen on this and a few other ratings does not adequately match the disability percentage
Navy04
Looks like 30% to me bud. Good luck and keep us posted
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