Please Help Experts!

[oldtimer92]

Sorry in advance, but this is a long one.

History: currently 30% for migraines. Diagnosed with this eye condition through MRI and told it is caused by migraines. Had C&P exam for increase on migraines. then they scheduled this one. I have attached both exam. the first one is for the increase. the second one is for the secondary conditions that I feel are caused by the migraines. This last exam looks like it shot my in the head dead. please tell me you opinion. first exam no medical opinion. second exam states IMP not related. but I have an appointment with the VA opthamologist surgeon later this month.

Was the Veteran's VA claims file reviewed? [X] Yes [ ] No

If yes, list any records that were reviewed but were not included in the Veteran's VA claims file: vbms If no, check all records reviewed: [ ] Military service treatment records [ ] Military service personnel records [ ] Military enlistment examination [ ] Military separation examination [ ] Military post-deployment questionnaire [ ] Department of Defense Form 214 Separation Documents [ ] Veterans Health Administration medical records (VA treatment records) [ ] Civilian medical records [ ] Interviews with collateral witnesses (family and others who have known the Veteran before and after military service) [ ] No records were reviewed [ ] Other:

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: 784.0 Date of diagnosis: 2009

2. Medical History ------------------ a. Describe the history (including onset and course) of the Veteran's headache conditions (brief summary): CO- "patient not aware when headache and migrains strated but got got worst in basic training, also in Germany after she delivered her daughter with migrains".

Frequency of headache and migrains-18 per month.

Prostrating attack frequency-5 per month.

Work:- Computer private sector-full time for past three years

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): Meloxicam.Sumatriptan.

3. Symptoms ----------- a. Does the Veteran experience headache pain? [X] Yes [ ] No

[X] Pain on both sides of the head [X] Other, describe: sharp 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 sound [X] Other, describe: dizzy,eye twitches,concentration problems

c. Indicate duration of typical head pain [X] 1-2 days

d. Indicate location of typical head pain [X] Both sides 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

b. Does the Veteran have very prostrating and prolonged attacks of migraines/non-migraine pain productive of severe economic inadaptability? [X] Yes [ ]

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 56 conditions listed in the Diagnosis section above? [X] Yes [ ] No

If yes, describe (brief summary): HTN,Anxiety

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: Slows her prodoctivity.

8. Remarks, if any: ------------------- PE: BP-136/75 -HEENT-normocephlaic,EOME,PERLA,no facial drops or tongue deviations,cranial nerves II/XII gorssly normal. -Neck-Supple, no JVD or carotid bruits.

Current level of headache and migrain severity:- moderate to sever based on subjective reporting by patient.

[X] In-person examination Evidence review --------------- Was the Veteran's VA claims file reviewed? [X] Yes [ ] No If yes, list any records that were reviewed but were not included in the Veteran's VA claims file: VBMS If no, check all records reviewed: [ ] Military service treatment records [ ] Military service personnel records [ ] Military enlistment examination [ ] Military separation examination [ ] Military post-deployment questionnaire [ ] Department of Defense Form 214 Separation Documents [ ] Veterans Health Administration medical records (VA treatment records) [ ] Civilian medical records [ ] Interviews with collateral witnesses (family and others who have known the Veteran before and after military service) [ ] No records were reviewed [ ] Other:

1. Diagnosis ------------ Does the Veteran have a peripheral nerve condition or peripheral neuropathy? [X] Yes [ ] No

Diagnosis #1: henifacial spasm Date of diagnosis: 2014

2. Medical history ------------------ a. Describe the history (including onset and course) of the Veteran's peripheral nerve condition (brief summary): 51 Y/O female. Service connected for headaches. Pt was in the National Guard until 2003. Onset of twiching left eye in 2012. The twiching has progressed to a left hemifacial spasm at the present. b. Dominant hand [X] Right [ ] Left [ ] Ambidextrous

3. Symptoms ------ Does the Veteran have any symptoms attributable to any peripheral nerve conditions? [X] Yes [ ] No Constant pain (may be excruciating at times)

[X] Other symptoms (describe symptoms, location and severity): Left facial nerve

4. Muscle strength testing -------------------------- a. Rate strength according to the following scale: 0/5 No muscle movement 1/5 Palpable or visible muscle contraction, but no joint movement 2/5 Active movement with gravity eliminated 3/5 Active movement against gravity 4/5 Active movement against some resistance 5/5

Were special tests indicated and performed for median nerve evaluation? [ ] Yes [X] No

b. Does the Veteran have any other pertinent physical findings, complications, conditions, signs or symptoms? [X] Yes [ ] No If yes, describe (brief summary): Pt received the first and only Botulin toxin injections March 2015 with an improvement of the spasms of 60%. it was a small dose.

15. Diagnostic testing a. Have EMG studies been performed? [ ] Yes [X] No

b. Are there any other significant diagnostic test findings and/or results? [X] Yes [ ] No If yes, provide type of test or procedure, date and results (brief summary): Normal MRI and CAT of the head reported by the patient

16. Functional impact --------------------- Does the Veteran's peripheral nerve condition and/or peripheral neuropathy impact his or her ability to work? [X] Yes [ ] No If yes, describe impact of each of the Veteran's peripheral nerve and/or peripheral neuropathy condition(s), providing one or more examples: Data entry on a computer. Spasms distracts her concentration at work.

17. Remarks, if any: -------------------- IMP Left hemifacial Spasms unrelated to her service connected Migraines headaches

[Navy04]

It looks like your Migraines might increase to 50%, hard to say though. As far as your secondary condition, the Doc said that it was not related, so it will be denied. If you feel that it is related to your SC Migraines, then you will need an IMO and submit it along with an NOD or Appeal. Good luck

[oldtimer88]

Hey Navyo4, claim closed on 8/13/15, looks like both were denied. It states on enebefits that decision sent, appeal process blah, blah, blah. No letter generated. What next?

[Navy04]

Sorry to hear that, just wait until you get the official packet, and then post the denial letter or wording. We will help you figure out the next step in the process. Good luck and try not to let it get to you. God Bless

[oldtimer88]

Good Morning Navy04, I got the letter yesterday. See below:

Denial for increase on migraines state:

* Charateristics prostating attacks occurring on an average once a month over last several months. 

* A higher evaluation of 50% is not warranted for migraine unless the evidence shows very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability.

I'm lost on this one because the c & p exam says all of this and on top of that I had to turn in a Headache diary to the VA doctor for the last 4 months because he wanted to see the frequency and pain level as well. I had reported at the end of last year that the headaches were coming more frequent and getting worse and I knew the twitching was a contributing to that. That was from March to July. I gave it to VA doctor in July. They increased my dosage of medicine in October. In July he added another medicine to take as well. That would be the only new evidence I would have to send on this one.

 

Denial for the eye disease, hemifacial spasms/blepharopasm, other facial nerve disorder"

Evidence does not show that the eye disease , etc is not related to the service connected condition of headaches, nor is there any evidence of this disability during military service.

Service connection for eye disease, etc is denied since this condition neither occurred in nor was cause by service.

The VA medical opinion found no link between your diagnosed medical condition and military service. 

I'm lost on this one because I have researched these things to find out where and how the start and there is medical evidence to link hemifacial spasms and migraines. Also, I thought secondary were conditions that were aggravated or caused by sevice connected. The headaches causes worse twitching and vice versa. 

 

With all the crazy conditions and illnesses coming from soldiers that were stationed at FT McClellan, how can they say these strange things are not coming from there. We did have to eat the food, drink and bath in the water, play in the mud and sleep on the ground. I am so digusted, I want to do a reconsideration, NOD, Appeal or whatever I need to do for both. So I need help.

Did I use the wrong terminology on the conditions? 

 

thank you for taking the time to listen and help. You were the ony expert to advise me.

[broncovet]

Its not unusual for VA to deny even when the medical evidence supports an award.  Yes, this is the frustrating part, and why there is hadit.  You need to file a NOD.  

First, check the decision "evidence" section and make sure this exam was listed as evidence.  If not, then you need to submit "new and material evidence".  Dont guess, check the evidence section.  

If the decision evidence section DOES list this C and P as evidence, then you appeal, and cite something similar to:

I disagree with the decision dated, Aug. 15, 2015, and plan to contest the result with a DRO review (or hearing if you so desire).  The denial decision did not give a reasons and bases as to why this exam shows "18 migraines per month".   Next you can show the exam states you have "5 prostrating headaches per month".  Now you need to show how this affects your economic productivity (work).  

 

In other words, you cite the criteria, and cite how your exam meets the criteria.  

The VA has to rate on criteria, they can not rate you on how good your are at xbox video games.  

Edited August 18, 2015 by broncovet

[broncovet]

The VA criteria for migraines is as follows:

 

8100           Migraine:

                    With very frequent completely prostrating and prolonged attacks

 

                        productive of severe economic inadaptability        50

                    With characteristic prostrating attacks occurring on an average once

                        a month over last several months................................................        30

                    With characteristic prostrating attacks averaging one in 2 months over

 

                        last several months   10

                With less frequent attacks    0