Migraine Increase Denied. Suggestions Please.

[K9MAL]

I was originally awarded 30% in 2002 for tension headaches with features of migraines. I've been seeing a VA neurologist for the past year and a half and my headaches have gotten progressively worse, this is documented in my VA medical records.

I had to quit my job due to absences and the inability to travel as frequently as the job necessitated. I decided to apply for Ch. 31 educational benefits and was approved due to service connected disabilities requiring me to quit my job. I'm currently a "full-time student" but my schedule is quite minimal. Tuesday I have 3 classes throughout the day and I have 1 morning class on Wednesday and Thursday, that's it.

I know that the frequency and the severity of my headaches meets the standard for 50% under the rating code. However, the response from the VA was as follows:

We reviewed the evidence received and determined your service-connected condition hasn't increased in severity sufficiently to warrant a higher evaluation. Records show you have maintained employment and are now a full time student. The records and your statements do not support a finding of severe economic in adaptability due to headaches.

Is this worth filing a NOD? Is the fact that I'm attending classes going to result in me being denied again or is it worth pursuing? If I provide my limited school schedule and the records from my neuro would this suffice? Not sure if this is worth pursuing or not and would appreciate advice from the experts here at hadit.

Thank you!

[NavyWife]

8100 ​Migraine:

​With very frequent completely prostrating and prolonged attacks

​productive of severe economic inadaptability​ 50

​With characteristic prostrating attacks occurring on an average once

​a month over last several months....................................​30

​With characteristic prostrating attacks averaging one in 2 months over

​last several months. ​10

​ With less frequent attacks. ​0

Looking at the rating guide for rating code 8100, The 30% says one migraine per month, that basically requires you to lay down in a dark room. 50% rating doesn't give a specific number of migraines, but if you compare it to the 30% rating it should be two or more per month that require you to lay down. It also adds the phrase "severe economic inadaptability". If you break that down word by word, Economic only refers to making money. The phrase means it's hard to have or keep a job due to the migraines.

It doesn't say anything about going to school. If you are having two or more of these migraines per month I think you should most definitely fight for the 50%. It also sounds like your circumstances changed from the time you applied to the time when your rating actually happened. Correct me if I'm wrong but it sounds like you were working when you first applied and then by the time you got your rating you were no longer working.

I would send in a statement detailing these things I have mentioned and spell it out for them so they can understand. Tell them specifically that you are no longer working because of your headaches. Tell them being a student is not listed in the rating schedule and has nothing to do with economic inadaptability

And tell them the number of migraines you are having each month.

If you need more medical evidence that shows two per month then go to the VA Medical Center at least twice next month, when you are having migraines and ask for treatment. Even though there's really not much treatment they can offer you and you'll be in too much pain to drive so maybe take a cab --the frequency of migraines will then be documented in your medical records which can then be used to get this approved.

What evidence did they use to make this decision?

Did you have a C&P? and if so how many migraines did the doctor state you were averaging per month? If it was two or more, then you need to fight this.

The rater is trying to use misdirection --kind of like a magician would --by mentioning that you are a full-time student now. Students don't make any money last time I checked!

Raters do this all the time in their denials. They talk about some reason why they denied you that has absolutely nothing to do with the rating schedule.

[K9MAL]

If you break that down word by word, Economic only refers to making money. The phrase means it's hard to have or keep a job due to the migraines.

It doesn't say anything about going to school. If you are having two or more of these migraines per month I think you should most definitely fight for the 50%. It also sounds like your circumstances changed from the time you applied to the time when your rating actually happened. Correct me if I'm wrong but it sounds like you were working when you first applied and then by the time you got your rating you were no longer working.

I would send in a statement detailing these things I have mentioned and spell it out for them so they can understand. Tell them specifically that you are no longer working because of your headaches. Tell them being a student is not listed in the rating schedule and has nothing to do with economic inadaptability

And tell them the number of migraines you are having each month.

What evidence did they use to make this decision?

Did you have a C&P? and if so how many migraines did the doctor state you were averaging per month? If it was two or more, then you need to fight this.

The rater is trying to use misdirection --kind of like a magician would --by mentioning that you are a full-time student now. Students don't make any money last time I checked!

Raters do this all the time in their denials. They talk about some reason why they denied you that has absolutely nothing to do with the rating schedule.

You, are brilliant! My VA neuro guy has put in my records that I get multiple, roughly 5 to 6, migraines a month.

The school angle and not making money is so very true and something I hadn't thought about in the "magician" way you'd described.

Maybe there is some hope after all. I can't thank you enough!

[justrluk]

I'm at 50% for migraines, with two TIAs as a result. I recorded work absences, leave use, etc. and presented my case received the increase. I refuse to have poisons injected into my head - I'd rather live with the pain, meds, visits, etc. Don't let them do this to you. If you qualify, keep pressing. Keep a log at your bedside w/pain levels, duration, location, etc. and take it with you to the neurologist when you go. I've had to do this for years and I think it is the only way I've been able to "maintain". God bless you for enduring these.

[K9MAL]

The rater is trying to use misdirection --kind of like a magician would --by mentioning that you are a full-time student now. Students don't make any money last time I checked!

Raters do this all the time in their denials. They talk about some reason why they denied you that has absolutely nothing to do with the rating schedule.

What about something like this for the NOD?

"Contrary to the RO decision I have not been employed since May, 2012 due to the severity and frequency of my migraine headaches. My neurologist at the VA, Dr. John M. Kirk, has noted on multiple occasions that I have severe prostrating attacks up to 8 times a month in his reports these are located in my VA medical records. Please find attached.

The RO decision states that my denial is also in part due to being a full-time student. Looking at the rating guide for 8100, it states “severe economic inadaptability”, and does not mention anything in regards to school activity. Being a student is not mentioned in the rating, requires far less time outside of the home than a job, I am not collecting a paycheck, and has nothing to do with economic inadaptability. Also, at this time, I am not a full-time student; and this is in conflict with the RO’s decision as well"

[justrluk]

I tend to get a little more analytical:

In your decision dated mmddyyy, on page (##) you state (& quote) words, words and more words..... about denial(& quote)

According to (rule/section, etc.), the criteria for X% for migraine headaches is: (copy/paste from regs)

Currently, I am unemployed due to this condition per the letter dated mmddyyy from Dr. Freeze (encl.)

Although I am a student, I attend part-time and as is proven by my attendance record (if you can get this or if it is in favor of your contention), (enclosed).

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

I have an accommodation signed by my doctor regarding late attendance, submission of assignments, etc. due to having long and prostrating migraines. I did this because while I was getting ready for the end-of-course paper, I ended up in bed for several days and almost blew the class because I didn't have time to get the final paper written. As you know, it can be a bit challenging to focus, study and write with a migraine! I've had to submit the letter with each class, but at least I am protected. I would suggest getting this in place for your classes and for your claim.

[K9MAL]

Thanks justrluk! I'd thought of something similar but was told to dumb it down for the VA. I like your approach better, thanks for the advice.

I'm going to file a reconsideration straight away and if nothing develops I'll be moving forward with a NOD in February.