Migraine - 30% Vs 50%?

[TiredCoastie]

Got the white envelope in the mail today. The good news is that the VA rated me 30% for migraines, which put me in bed flat between 2.25 and 2.5 days per month, with migraines running for up to 5 days. Looking at the decision package, they rated me at 30% based on having, on average, one prostrating migraine per month over the last several months. The trip wire for 50% is defined by 38 CFR 4.120 is "With very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability." The raters did not find that my claim met that threshold, despite the outside doctor stating that I cannot work and my migraines are twice the 30% rating threshold.

Do I have an argument for a 50% rating?

Edited March 22, 2014 by TiredCoastie

[meghp0405]

obtain a copy of your C/P exam. Take it to your neurologists, have him/her review it. Then write a letter specifically stating the # of migraines you have on a weekly or monthly basis. The doc also has to put that statement you said "very frequent completely prostrating and prolonged attacks of severe economic adaptability" If you have additional medical documentation that proves you have these this often, submit them as well. Complete a VA FM 21-8940 (notice of disagreement) and submit to your VARO.

One thing you might want to consider is going to the emergency room, your PCM every time you get a migraine . That way you will have undisputable documentation for your claim.

I know the last thing you want to do is get into a vehicle and go to the doc when you have a migraine, but it's undisputable evidence.

[TiredCoastie]

Thanks, Meghp. Great advice, as always. I'll check that C&P but the basis of the decision seems to be the weight of the DBQ filled out by my neurologist. I'll also go back and review the DBQ again to see exactly what she checked and stated. Off the top of my head, there wasn't an option worded quite like 38 CFR 4.120.

I've used the medical event log within MyHealtheVet as my headache log, and that's the most complete list. I have been in the ER a couple of times but no where near every time. That's great advice. When my migraine gets prostrating, I turn over driving to my wife. Honestly, I hate going into the ER unless it's a particularly troubling situation that's looking stroke related because there isn't much they'll do unless they admit me, and that's a pain in and of itself.

[justrluk]

Also, I've said before on this forum: keep a journal. Document frequency, duration, pain level and impact on your life. I went in for an increase from 30% because I had 2 TIAs and frequent migraines. I used two calendars to send the VARO the dates, duration, etc. and won the 50% rating (max). You can do this, but you have to document.

[TiredCoastie]

Also, I've said before on this forum: keep a journal. Document frequency, duration, pain level and impact on your life. I went in for an increase from 30% because I had 2 TIAs and frequent migraines. I used two calendars to send the VARO the dates, duration, etc. and won the 50% rating (max). You can do this, but you have to document.

Thanks! I've been doing just that for several years using MyHeatheVet's medical events log.

How often do you have prostrating migraines? Sorry to pry, but looking for something more solid than the CFR as a gauge before submitting a NOD.

It seems to me that the criteria is very subjective and very open to local interpretation anyway. As Meghp says, if I just give the RO a statement from my neurologist that matches the language in the reg, it's hard to argue. I'm just trying to figure out if that information is already in hand on the DBQ.

Edited March 27, 2014 by TiredCoastie

[carlie]

You can also do research at the BVA level, for more specifics,at the following link:

http://www.index.va.gov/search/va/bva.html

[carlie]

When my migraine gets prostrating, I turn over driving to my wife.

I sure hope so because prostrating means having to lay down

and it's hard as heck to drive, anytime your laying down : - ).

Use caution when corresponding with VBA.

Sometimes they are easy to take things out of context, and run with it.