Va Rater Requests An Increase For A Disorder W/highest Rating

[blanco63]

I received a decision in oct 2009 granting me 50% for migraines after having a c and p exam in june with a va doctor. in nov, i filed for chronic pain syndrome secondary to migraines. at the end of nov, i got a va letter saying that they got my claim and also added a request for an increase for migraines. what? i already get 50%, the highest for migraines. anyway, on dec 7, i sent them a 21-4138 and an iris stating that i want to withdraw all claims at this time. rater called me on dec 14 and says that i cannot withdraw claims and said i have to go to a c and p exam on dec 29. she explained about their request for an increase but i could not understand. what are they trying to do? i already get the highest. can they not accept a withdrawal and make you continue your claim and go to the c and p? isn't chr pain syn supposed to be a psychiatric disorder and the c and p conducted by a psychiatrist or clinical psychologist? well, guess who did my c and p? yes, the same physicians assistant who did my exams for 10 and 30% migraines and did not want me to even have those ratings and wrote negative reports to the va. i was denied both times until i did recons with my doctor's letters. so i went back to him on dec 29 and he is upset and wondering how the heck did i get 50%? now he is seeing me for mig increase and chr pain syn. anyway, the whole exam was about migraines, nothing about my claim for chr pain syn. so of course the va got another negative report. do you think this c an p was the va's way of trying to decrease me? i am worried. could they after i actually withdrew my claims and then a c and p done by a p.a. who i believe shouldn't even be doing this type of c and p? should i be worrying? i will be very grateful for your thoughts and opinions.

Edited January 1, 2010 by blanco63

[JamesBreckenridge]

Ok, so you claimed (an increase in?) migraines and were evaluated at 50 percent in October.

In November you filed a claim for "Chronic Pain Syndrome" secondary to your migraines.

First of all, what is "chronic pain syndrome?" I've never heard of it. Furthermore, are the symptoms of Chronic Pain Syndrome separate and distinct from the migraines? If they're really the same symptoms as the migraine, even if it's a separate issue, it would be "pyramiding" to service connect and evaluate them; the same symptoms are already being compensated under the migraine condition. It would help if I knew what this Chronic Pain Syndrome was. I don't know what it is, but if you want to get granted service connection for it and compensated for it, it needs to be its own problem with its own set of symptoms, separate and distinct from migraines.

Secondly, it appears that they are treating your claim for service connection for chronic pain syndrome secondary to migraine headaches as a claim for an increased evaluation of your migraines. If you were not already at the maximum compensable evaluation, this would make a lot of sense. The thing is, there is always room for an increased evaluation; even though 50 percent is the maximum schedular evaluation, there is also EXTRA schedular consideration. If your particular migraines are so bad that the rater thinks they be 100 percent disabling in your particular case, they can send it to Central Office for consideration.

Third, were you scheduled for a routine future exam for your migraines? Or has the VA said that they are "permanent"? When were you last evaluated for migraines?

I think you can pretty clearly state that you have not filed a claim for extra schedular consideration of your migraines, and that you are ONLY filing a claim for service connection for Chronic Pain Syndrome secondary to migraines. Thing is, depending on what Chronic Pain Syndrome is, they may need to evaluate your migraines anyway. They can't reduce you based on one exam anyway; you need to show sustained improvement, and the following exams that show the improvement have to be at least as thorough as the one that supported the 50 percent evaluation.

I hope that helps.

[blanco63]

hi james, thanks for the good info. i do not know a whole lot about chronic pain syndrome but i do know that it is considered a psychiatric disorder per va, affects more of the body than what migraines do, and has its own rating. once i saw that the same p.a. was going to do my c and p, i just wanted to keep my 50% rating for migraines. at the c and p, there was no mention of improvement, just that things have not worsened but have remained the same as at my last c and p in june (with the doctor who wrote a positive report for my 50%). he said that is what he will put in his report but i really do not believe it. if he states or does not state this, i do not need to worry about a reduction, correct? my last eval was that c and p in june and the va's decision letter in oct said that i would not have another eval until after oct 2011, but already had one in 2 months, wow, that's a good one. i just hope to see a va letter saying that they are keeping me at my current rating. please get back to me. thanks for the help! already requested a copy of this c and p.

Edited January 1, 2010 by blanco63

[JamesBreckenridge]

hi james, thanks for the good info. i do not know a whole lot about chronic pain syndrome but i do know that it is considered a psychiatric disorder per va, affects more of the body than what migraines do, and has its own rating. once i saw that the same p.a. was going to do my c and p, i just wanted to keep my 50% rating for migraines. at the c and p, there was no mention of improvement, just that things have not worsened but have remained the same as at my last c and p in june (with the doctor who wrote a positive report for my 50%). he said that is what he will put in his report but i really do not believe it. if he states or does not state this, i do not need to worry about a reduction, correct? my last eval was that c and p in june and the va's decision letter in oct said that i would not have another eval until after oct 2011, but already had one in 2 months, wow, that's a good one. i just hope to see a va letter saying that they are keeping me at my current rating. please get back to me. thanks for the help! already requested a copy of this c and p.

I don't see anything remotely like "chronic pain syndrome" in 38 CFR 4.130 or 4.124a. Maybe the hospital treats it like a psychiatric condition, but I have no idea what Diagnostic Code is going to be used to rate your claim (treatment and benefits are two very different things). What type of C&P exam are you being sent to? Neuro? Mental Disabilities Other Thatn PTSD?

I hope your migraines get better, really I do. Migraines are aweful. Because your migraines might get better is why you've been scheduled for a "routine future exam" in two years. You shouldn't have to worry about a reduction in evaluation for migraines unless your migraines have actually improved, or unless the rating granting you the 50 percent was a Clear and Unmistakable Error. Most likely, though, your evaluation will remain the same until at least 2011.

[LarryJ]

I don't see anything remotely like "chronic pain syndrome" in 38 CFR 4.130 or 4.124a. Maybe the hospital treats it like a psychiatric condition, but I have no idea what Diagnostic Code is going to be used to rate your claim (treatment and benefits are two very different things). What type of C&P exam are you being sent to? Neuro? Mental Disabilities Other Thatn PTSD?

I hope your migraines get better, really I do. Migraines are aweful. Because your migraines might get better is why you've been scheduled for a "routine future exam" in two years. You shouldn't have to worry about a reduction in evaluation for migraines unless your migraines have actually improved, or unless the rating granting you the 50 percent was a Clear and Unmistakable Error. Most likely, though, your evaluation will remain the same until at least 2011.

James, here it is:

Somatoform Disorders

------------------------------------------------------------------------

9421 Somatization disorder

9422 Pain disorder

9423 Undifferentiated somatoform disorder

9424 Conversion disorder

9425 Hypochondriasis

9422 = Pain Disorder.........often referred to as Chronic Pain Syndrome.

Actually, as many patients as our Pain Clinic at the VAMC in Dallas has, it is a wonder that more peeps do NOT know about the #9422.

Many sufferers of degenerative joint disease (such as myself) suffer almost constant pain (I have bone on bone throughout my left ankle/foot and just the pain associated with attempting to turn over in bed at night, with the weight of the bedcovers (sheet and/or blanket) will, literally, cause me to cry out before I can become fully awake and stifle my reactions....). Anyway, that is the DC 9422, along with the loss of sleep, curtailment of activities, yada, yada, yada.

[JamesBreckenridge]

James, here it is:

Somatoform Disorders

------------------------------------------------------------------------

9421 Somatization disorder

9422 Pain disorder

9423 Undifferentiated somatoform disorder

9424 Conversion disorder

9425 Hypochondriasis

9422 = Pain Disorder.........often referred to as Chronic Pain Syndrome.

Actually, as many patients as our Pain Clinic at the VAMC in Dallas has, it is a wonder that more peeps do NOT know about the #9422.

Many sufferers of degenerative joint disease (such as myself) suffer almost constant pain (I have bone on bone throughout my left ankle/foot and just the pain associated with attempting to turn over in bed at night, with the weight of the bedcovers (sheet and/or blanket) will, literally, cause me to cry out before I can become fully awake and stifle my reactions....). Anyway, that is the DC 9422, along with the loss of sleep, curtailment of activities, yada, yada, yada.

And there it is... I wish the rater luck fitting "I'm in intense pain" type symptoms into the General Rating Formula for Mental Disabilities, which to me seems more geared towards PTSD, Dementia, and other "impaired thinking" conditions. I guess I have never been in enough pain to not think straight, but I could see how it could happen.

But how would it be secondary to Migraines without pyramiding? Migraines is about "pain" in part, after all. Or is this pain located somewhere else in the body other than the head? If so, what rationale can the doctor use to say the pain syndrome in your legs (for example) is secondary to your migraines?

[LarryJ]

And there it is... I wish the rater luck fitting "I'm in intense pain" type symptoms into the General Rating Formula for Mental Disabilities, which to me seems more geared towards PTSD, Dementia, and other "impaired thinking" conditions. I guess I have never been in enough pain to not think straight, but I could see how it could happen.

But how would it be secondary to Migraines without pyramiding? Migraines is about "pain" in part, after all. Or is this pain located somewhere else in the body other than the head? If so, what rationale can the doctor use to say the pain syndrome in your legs (for example) is secondary to your migraines?

Actually, I agree, in part.

What you have to do, is, you have to consider that the "actual" pain (in this instance, the "actual" pain of the migraine) is one thing. The "syndrome" associated with the migraine pain can actually be something entirely seperate from the Migraine itself, i.e. the Disassociative effect of removing yourself from any stimulus associated with the migraine.........thereby causing you to become reclusive, abusive, etc. In other words, the pain of the migraine and the psychiatric side effects.

In my instance, the chronic pain causes very real effects/affects, such as loss of sleep leading to irritability, inabiliity to drive due to the very real possibility of simply going to sleep (I woke up, yesterday, when the guy behind me honked his horn because I was stopped at a stop sign and hadn't moved............like I said VERY REAL consequences of pain syndrome due, in my instance, to being up 5 times night before last before finally taking enough codiene to be able to sleep and having this carryover into my daylight attempted activities!).

This is such a, well, confuserating medical/mental/pshchiatric conglomeration of cause and effect that even the classifying of it as a somatoform disorder is being reconsidered by the practitioners.