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]

They rated under 8100, because that most closely proximates the vet's disability

[jbasser]

The VA will rate headacheds under Migraine criteria.

There is no other rating criteria for Headaches.

The ratings are based on number of episodes or hedaches and the frequency of the headache.

[timetowinarace]

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.

Not saying your stupid. 9304 and 9305 are ratings for dementia of different causes. Dementia is cognative disorder. And they are rated under the general rating formula for mental disorders.

8045 and 8046 may be the - codes your thinking of. they do cover headaches as symptomatic with a max 10% rating unless there is a diagnoses of dementia. But you can't have both of the ratings. If you get the dementia rating you will not have a seperate rating for headaches.

I have the same rating table as you. However I know these rating codes mentioned forward and back as I am rated under them. I have migraines ratable at 50% but cannot be rated for them under these codes. I cannot be rated for them at all.

Don't take it personal but your assesment of those particular codes is wrong.(if you can show me different, I need to re-open my claims) Unless of course the claimant has had a service connected TBI. Then a 10% rating and no more under 8045 would be expected for the headaches.

Time

Edited January 26, 2008 by timetowinarace

[mountain tyme]

Hello...Thank you all for your insight on this claim...there is one part of the original VA decision that was given back in 1994 when the vet retired that I would like to clarify...

In the original determination for the migraine/headaches the VA wrote:

"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)."

After talking to the vet the most likley reason why they did not give him a rating of more then 0 percent was because at the time that the paper work was being done at the VA he was not having the frequency of migrains or headaches due to the medication that they were giving him to control them...at the time he answered them honestly that he only had a few episodes in the past couple of months..he never thought or did it occur to him to mention or say he was on medication due to the fact he was not having a problem that day...

So I believe that is why they service connected him at that rating and with that statement "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)."

that is just my opion on the matter...

now fast forward it to 2007 in his medical records there is a paper trail that he still was having headaches...and the medication he was on is not effective anymore hence the new regime of medicine has begun...

that is why he is putting in for an increase...also in his service medical records it clearly states that he had a history of migraines...and even was in relaxation therapy to help him with them...

but anyways I just wanted to clear that statement up...I may be misinterpeting the statement myself...

Thank you again

MT

Edited January 26, 2008 by mountain tyme

[rentalguy1]

No, MT...you're reading it correctly. THe VA has him rated based upon information that the vet gave them that he was not having ratable episodes of migraines. They also assigned the dx code of 8100 because it most closely apporximates his condition. He need to file for an increase as I instructed before (be sure to highlight the pertinent parts of his medical records). When he writes his 21-4138, be sure that he states it in terms of his worst days/weeks/months, and not on the current (i.e. medicated) state he is in. He also needs to do the same in any C&P that the VA may request, as well as take his medication to the exam. After he recieves this increase, he need to NOD for a EED.

[luvHIM]

Glad this issue was raised on here. I too have a claim in for entitlement to SC for migraines. I was diagnosed in the military with tension, migraine, and chronic headaches...depending on what doc I was seeing. I am still having them and being treated at the VAMC for them. It will be interesting to see how the rating specialist handles my claim. It was filed back in May 07 and I still haven't heard anything.