Migraine Criteria For Rating

[mountain tyme]

Hello...

I believe that we are ready to put in a reconsideration regarding this vets decision on his migraine headaches just to refresh the claim I am helping with...

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

[mountain tyme]

Now here is the update (below is the information form the first thread...)

Update....He went ahead and had his records copied from the base primary care clinic from 2007 until present...so we can submit them along with the migraine log he has been keeping since 2007...now here is the question...this log is pages and pages long (45 pages) it includes not only the Server Migraines which are prostrating in intensity but dull aching headaches that he experiance on a weekly basis...

Should I just go ahead and modify and only submit the dates and information regarding the actual migraines which average 2-3 per month the ones that he had to stay in bed due to the server pain?

Also would it help if he wrote and his wife wrote a statement on how these migraines have effected there family life...since some of the migraines did occur on special occasions and prevented him from particapting in the activities...also his wife told me that due to the Serverity of the Migraines (which are documented in his medical records) she needs to take the kids out or leave them at other family members homes due to the noise intensifies his pain as well as light.

Not sure what to tell them on that one...never did a claim for migraines before...by the chart he will most likley will reach the 30% criteria because he is still working...his employer is very understanding and he can lay down at work until his wife is able to get there to bring him home.

anyways any insight will be appriciated.

God Speed

MT

8100 Migraine:

With very frequent completely prostrating and prolonged 50

attacks productive of severe economic inadaptability.........

With characteristic prostrating attacks occurring on an 30

average once a month over last several months................

With characteristic prostrating attacks averaging one in 2 10

months over last several months..............................

With less frequent attacks.................................... 0

8103 Tic, convulsive:

Severe........................................................ 30

Moderate...................................................... 10

Mild.......................................................... 0

Note: Depending upon frequency, severity, muscle groups

involved.

[mountain tyme]

Of all things...I asked my son to look over this thread...he is active duty AF stationed in CO. he told me that after he and a few of his co-workers read the theads they told him to write me the following...

in the decision

"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."

it does not mention MIGRAINES and that is what the claim was put in for an increase for Migraine headaches...also in the part that states "VA EXAM SHOWS YOU REPORTED THAT YOU HAVE TWO OR THREE HEADACHES PER WEEK THAT ARE NOT PROSTRATING"...

So I asked him if he told the examiner that and he said I told him that when I have a full blown migraine that I have to stop everything and go to bed because of the intense pain it comes on sudden sometimes but at other times I get these headaches prior to the major unset...the "HEADACHES ARE NOT PROSTRATING...BUT the migraines are"

I think that is why he did not get an increase...the vet is saying Migraines and the VA is saying headaches...I think he will have to go up and get a copy of the c/p and see what happened...

any insight on what my son and his co-worker observed...where should we go from here if indeed they based the c/p on the headaches and not the actual migraines as what he requested in the original claim?

thanks again MT

[jbasser]

You need to see a Neurologist to do a history with your records in hand. They will use prostrating. IMO

The VA will rate muscle tension hedaches with the criteria used for migraines. The main point for compensable service connection is the frequency and duration of the headache. I am rated 30 percent for migraines and have the following symptoms. Every 12 to 14 days I have one. I get sick at my stomach and I cant see very well. The Light hurts my eyes.

Now here is the main point I want to make. A Doctor needs to use a headache diary and describe the headaches as they are occurring and the doc needs to use the following words. Prostrating Attack.

That means the headache is debilitating enough to stop all activities to lay down, medicate and try to sleep it off.

People with muscle tension headaches and headaches assiciated with cervical disk disease do get nausea and light sensitivity.

Prostrating,number of occurances and serious effect on earning capacity will warrant a 50 percent rating.

Keep a headache chart.

1: Occurances. Write the date

2: Pain Scale: 1-10. 10 should be the main.

3: Nausea, Blurred vision, ect.

4. Take BP readings. My Bp goes to 200/140 during one.

Date2-9-2008 H/A 7am went away at 4pm. Meds. Hydrocodone, phenegren,

Pain scale 10/10 Pulsating.