Does The Va Make A Distinction Between Migraines And Headaches

[mountain tyme]

Hello I have some pointed questions and need help.

I am in the middle of helping a retired veteran with his va claim. At the time of discharge he was granted...0 percent I may be reading his record wrong so please read the following out of his VA records (yellow paper) done at time of retirement.

Decision:

4. Service connection is afforded for muscle tension headaches and a less than 10 percent evaluation is in order.

reason:

4. Service medical records show initial complaint of headaches as early as xx/xx/83 at which time migraine was diagnosed. Subsequent service medical records show diagnosis of tension headaches or muscle tension headaches and this was the diagnosis at the time of the VA exam. A diagnosis of migraine headaches was not given, however. The veteran stated that these have been present for 15 years and are located in the posterior occipital area. Tey occur approximately every 10-12 days and last about 4-8 hours. However, they are not accompanied by nausea or vomiting and there is no vison change. Service connection is afforded as the headaches were chronic in service. However, as migraines were not involved a 10 percent or higher evaluation is not in order. (Which could be assigned with characteristic prostrating attacks averaging one in two months over the last several months).

FAST FOWARD____________

In Feb. 07 the said veteran put in for an increase for muscle tension headaches. In Oct 07 the veteran received his decision the decision stated...

*We determined that the following service connected conditions haven't changed: Muscle tension headaches 0%

reason:

2. Evaluation of muscle tension headaches currently evaluated as 0 pecent disabling.

VA exam shows you reported that you have two to three headaches per week that are not prostrating. Your motor and sensory exams were normal.

The evaluation of the muscle tension headaches is continued as 0 percent disabling because the evidence fails to show this condition has worsened to a compesable level. A noncompensable evaluation is assigned unless there are charateristic prostrating attacks averging one in two months over the last several months.

With that said...

I went through his decision and discovered that his medical records from the family practice clinic at the base (he has tricare)were not included in the evidence. I asked the veteran if he submitted the doctor's notes and he said that he was told by the service rep (state of M0.) that the VA would get those records. What the VA did was they retrived the records from his VA health care team which they did.

but not from the air force base's primary care department.

This veteran has been seen on a regular basis for headaches thoughout his retirement...and the headaches turned into migraines...

As noted in Feb 07...his medical records state

Cheif Complaint:

Pt is here for migraines pt had migraine yesterday, stillhas headache today pt. states he has had two migrines in the last two weeks.

Migraine headaches, treated with imittrex. Has frequent "non migraine" headaches, states he can feel the difference with photophobia, N/V imitrex not aborting HA's

:Gastrointestinal symptoms: Nausea with migraine and vomiting with migraine

:Head symptoms: Headache preceded by aura

Conclusion:

1.) Migraine Headache: naprosyn 500mg bid for 2 weeks then PRN. Imitrex not aborting migraines so will swith to Maxalt 20mg.

F/U in two weeks

_____________________________________________________

in two weeks he went in for his F/U and he was still having increased migraines that he had to stop whatever he was doing and lay down...his wife called the family practice at the base and talked to the doctor and he would tell her if his pain does not subside within 4 hours or gets worse to bring him into the ER...

at his two week appointment they added another medication to help prevent the migrains which is called.

so he is not taking

Rizatriptan (Maxalt)10 mg twice a day

Propranolol (inderal) 40 mg. three times a day

The veteran told me that the medication has helped but he still has migraines at least 3 times a month but not as frequently as he did...as long as he stays on his medication as prescribed.

So this brings us back to the claim for increase...

since the VA is stating muscle tension headaches and do not use the word migraine...should the veteran put in a NEW CLAIM FOR MIGRAINS or should he just put in for a reconsideration and send in the medical records from the family practice clinic from the base.

I feel based on the Diagnosic code 8100 that this veteran should rate out at the 30% level...

I don't want to tell them the wrong thing...but after reading the decision that you have before you...I think the VA only addressed the headaches and not the migraines...

We will be very grateful for any help you can give us in how to proceed with this claim...i have another tread regarding this but I had two issure in that thread so I want to concentrate on this one first.

Thank you all in advance

MT

[rentalguy1]

On a VA Form 21-526 he needs to state, "I wish to claim an increase in my service connected comspensation for headaches. This condition has greatly worsened in severity over the last year. Thank you for your timely attention to this matter.

On a VA Form 21-4138 he needs to state in his own words that his headaches have matched the criteria listed under dx code 8100 for a 30% rating, from 38 CFR 4. This will be his sworn statement, so it needs to be truthful, but he also needs to use their language. He then needs to sate that he has included XX pages of medical evidence to substantiate his claim. He also need to fill out and sign a VA Form 21-4142 so the VA can retrieve all of his medical records from all the doctors he has seen (one form for each doctor).

He then needs to number each page 1 of XX, 2 of XX, etc... Then send it to his VARO via certified mail, return receipt requested. Hope this helps.

[mountain tyme]

Thank You rentalguy...One more question....since the VA had him come in for a C/P for his headaches back in May o7 will he only need to have the medical records sent or should I say give authoration for are those that they do not have...as in the family practice clinic up at the base...and those from the VA clinic that are new since he put his claim in back in o7....

Thanks in advance...

MT

[rentalguy1]

you only need a release for those that are civillian records. If they are SMR's (or smr related) or VA records, they can attain those on their own. You do need to obtain copies of all of them yourself, however. You want one copy of all pertinent records to send in with the 21-4138, and at least one copy to keep on record and take to the exam with you in an attempt to get the examiner to look at them.

[mountain tyme]

rentalguy wrote: "You want one copy of all pertinent records to send in with the 21-4138, and at least one copy to keep on record and take to the exam with you in an attempt to get the examiner to look at them."

Question since he has already had a VA c/p for the headaches will they have him come in for a second c/p? when he ask's for a reconsideration for the migrains...or will the rater just look at the doctor reports that are going to be submitted with the reconsideration for a higher percentage...he is still within the year time limit.

Thanks

MT

[rentalguy1]

I would say that they can rate based upon the evidence that you are going to send, but they still might want to do another C&P.

[Ricky]

9304 Dementia due to head trauma.

I'm doubting he was rated under that code. It's a mental disability rating not neuro.

It is usually neurologists that specialize in diagnosing and treating migrains. I would suggest going to one, both for better treatment and a diagnoses the VA can't reject as easily.

Time

Just taking a stab in the dark. OP said no one knew what code it was rated under. OP provided that va said : However, as migraines were not involved a 10 percent or higher evaluation is not in order. Based upon this if they provided in the rating decision that migraines was not diagnosed then why would they stick it under 8100? Who knows, we are speaking of the VA. Anyway, take a look at the rating schedule my friend, many of the neuro conditions with subjective complaints allow for a rating under 9304 with the use of the ole hypen. So yes I understand his condition was not a mental (I am not stupid) but this and 9305 can be used for neuro purposes. That is unless you have a different rating schedule than I do.