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

[Ricky]

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

Nah, nothing personal. I agree that all headaches should be under 8100. However, the one we just got through NODing was rated 9304-8045 headaches mild. Vet claimed migraines based upon dx of cluster/migraines in 1976 during service. They used 8045 unknown to me as to why cause he never claimed any type of head injury. However, when they did this they then had to hypenate the 9304 to give the 10 percent for headaches. If you will take a look at 8045 and 46 yes they are true neuro issues. However, at the bottom of the rating schedule it clearly states for purely subjective complaints such as headaches etc.... use 9304. Strange way, long way around the bush and the wrong way but service connection was established. Now we just have to get it corrected. Maybe they did it to keep the vet from claiming a rating higher than 10 percent. So maybe you do need to reopen your claim hahahaha

Edited January 27, 2008 by Ricky

[Medic4849]

I have headaches.. all the time, whats really weird is you know how adults say kids are giving me a headache etc.. blah blah when i have a headache i actually find dealing with the kids makes my headaches go away when there fighting screaming etc.. but when its done the headaches start back up again realy weird might be a mental problem

[jbasser]

Most headaches are vascular in nature according to the Headache Diary. Therefore the rating criteria for migraines is broad.

The most common types of heqdaches are

Migraine. will not be diagnosed unless photophobia and nausea are accompanying factors.

Hypertensive headaches , Blood pressure increases placing pressure ont he Vessels in the neck and head expanding them. This is also considred tension headache.

Cervical disk disease. This is more common for neck patients.

A Headache diary and a headache disctionary are useful.

J