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!

[TiredCoastie]

Sorry for the condition, but glad your level of life-impact is finally acknowledged.

And for you, too.

[Valhalla0321]

Quick Question:

I have been out of work due to Headaches being one of the issues, it's going on 30 months since i last worked. I have been going to school online and because of failing grades, i have been assigned a tutor for 10 plus hours a week. My concern is that i am in the Same boat.. i was awarded 30% and not 50% for migraine and it was not because of school, the rator made a error.

I have headache logs for 2 years and it shows 3 to 5 or 2 to 3 migraines a Week!! and i guess they overlooked that on my previous 30% rating, so i NOD'd it and not only am i concerned about the school thing, but during my C&P exam.. The VA Doctor Said that she can only check off 1x a month because the C&P computer only allows this ... WHY??? She did put in writing comments that i have more than 1x a month migraine, but i am concerned i am going to be iced again on NOD rating.. who ever wants to read my Exam note... i will list them below and please tell me what you think.. i am at pending decision approval right now.. so it's only a matter of time i find out what it will be, but i would like to here from you all.

Thanx...

Headaches (including Migraine Headaches)

Disability Benefits Questionnaire

Name of patient/Veteran: Valhalla

Indicate method used to obtain medical information to complete this

document:

[ ] Review of available records (without in-person or video telehealth

examination) using the Acceptable Clinical Evidence (ACE) process

because

the existing medical evidence provided sufficient information on which

to

prepare the DBQ and such an examination will likely provide no

additional

relevant evidence.

[ ] Review of available records in conjunction with a telephone interview

with the Veteran (without in-person or telehealth examination) using the

ACE process because the existing medical evidence supplemented with a

telephone interview provided sufficient information on which to prepare

the DBQ and such an examination would likely provide no additional

relevant evidence.

[ ] Examination via approved video telehealth

[X] In-person examination

Evidence review

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

Was the Veteran's VA claims file reviewed?

[ ] Yes [X] No

If yes, list any records that were reviewed but were not included in the

Veteran's VA claims file:

If no, check all records reviewed:

[ ] Military service treatment records

[ ] Military service personnel records

[ ] Military enlistment examination

[ ] Military separation examination

[ ] Military post-deployment questionnaire

[ ] Department of Defense Form 214 Separation Documents

[X] Veterans Health Administration medical records (VA treatment

records)

[ ] Civilian medical records

[ ] Interviews with collateral witnesses (family and others who have

known the Veteran before and after military service)

[ ] No records were reviewed

[ ] Other:

1. Diagnosis

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

Does the Veteran now have or has he/she ever been diagnosed with a headache

condition?

[X] Yes [ ] No

[X] Migraine including migraine variants

ICD code: 346.90 Date of diagnosis: active service

[X] Tension

ICD code: 339.12 Date of diagnosis: active service

2. Medical History

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

a. Describe the history (including onset and course) of the Veteran's

headache conditions (brief summary):

40 years old male USMarine veteran from 1996 to 2000, is here for an

increase C&P evaluation on his headache condition. His last C&P

evaluation was in 12/24/2013. He is currently rated at 30%.

He had recent Neurology consult here at VA on 1/29/2015:

See Below

LOCAL TITLE: NEUROLOGY CONSULT

STANDARD TITLE: NEUROLOGY CONSULT

DATE OF NOTE: MAR 06, 2015@11:35 ENTRY DATE: MAR 06, 2015@11:35:08

AUTHOR: b EXP COSIGNER:

URGENCY: STATUS: COMPLETED

Chief Complaint: Headaches

HPI: 40 yr old man with chronic recurrent headaches. He had minor head

trauma in the Marines in 1999 and headaches began subsequently. He has

ringing

in ears, sleep disturbance and sensitivity to odors. He is currently on

Topiramate, but then feels it wears off. He gets headaches every few

days.

Pain is mainly in the temple areas, and sometimes in nuchal/occipital

area.

Med Hx: as above and per chart.

Meds: as per chart, and reviewed with patient.

Fam Hx: nc

Social/Work hx: non-smoker, no etoh.

Significant operative/invasive procedures:

Allergies: as per cover sheet, and reviewed with patient. No new

allergies.

Pain Assessment Score: 0

BP: 119/74

Relevant Labs discussed with patient: MRI of Head showed cavernous

malformation in the pons, MRA was negative however. CT showed L

maxillary

sinusitis.

Review of Systems (Neurologic): negative for additional neurologic

symptomatology

not described in HPI above.

Screen for suicide risk and signs of abuse/neglect: negative

Depression screen: negative

NEUROLOGIC EXAM:

The patient is alert and oriented. There is no cognitive impairment.

Speech is clear without dysarthria. There is no aphasia.

Pupils 3/3 RLA.

Full EOM's. There is no nystagmus.

Fundi: normal with direct ophthalmoscopy.

Visual fields: full to finger confrontation method, bilaterally.

The face is symmetric. Facial sensation is normal.

Tongue, gag, and palate exam is normal.

Muscle bulk is normal; there is no atrophy.

Strength is full in all extremities.

Normal muscle tone.

DTR's: 2 to 2+ and symmetric. Plantars downgoing.

Normal rapid alternating movements and finger/nose.

Normal gait, balance, and station. There is no ataxia. Romberg is

negative.

Sensory: no losses to LT, pin, vibration, nor proprioception.

IMPRESSION:

1. Recurrent Headaches.

2. Hx of Sleep Apnea.

RECOMMENDATIONS/PLAN:

1. Increase Topiramate to 50mg bid.

2. Add Esgic i po q3-4 h prn.

3. RTC 6-8 weeks.

*Tobacco Use Screen:

Lifetime non-tobacco user. Never smoked and never used tobacco in

entire life.

Medication Reconciliation:

The patient was given a copy of their medication profile. The

medications were reviewed with the patient and also evaluated for

polypharmacy.

No medication discrepancies found

No changes are indicated.

40 years old male USMarine veteran from 1996 to 2000, is here for an

increase C&P evaluation on his headache condition. His last C&P

evaluation was in 12/24/2013. He is currently rated at 30%.

Per recommendation by Dr. X Neurologist in

3/6/2015, he had increased his Topiramate to BID. He was also given

Butalbital PRN.

He said that his symptoms doesn't seem to improve. It is not any

better. He described bilateral pain over both temples, which comes at

least 2X-3X/week. He described his headache as throbbing and at the

same

sharp in quality, average 10/10, light sensitivity, nausea. With

Butalbital and Naproxen 500 mg po qd PRN, the headache gradually

diminishes in30-60 minutes. His headache frequency has decreased from

3-5X/week to 2-3X/week X one year since he has been placed on Topirate

daily.

b. Does the Veteran's treatment plan include taking medication for the

diagnosed condition?

[X] Yes [ ] No

If yes, describe treatment (list only those medications used for the

diagnosed condition):

Topiramate 50 mg BID; Butalbital PRN; Naproxen BID PRN

3. Symptoms

-----------

a. Does the Veteran experience headache pain?

[X] Yes [ ] No

[X] Pulsating or throbbing head pain

[X] Pain on both sides of the head

b. Does the Veteran experience non-headache symptoms associated with

headaches? (including symptoms associated with an aura prior to headache

pain)

[X] Yes [ ] No

[X] Nausea

[X] Vomiting

[X] Sensitivity to light

[X] Changes in vision (such as scotoma, flashes of light, tunnel vision)

c. Indicate duration of typical head pain

[X] 1-2 days

d. Indicate location of typical head pain

[X] Both sides of head

4. Prostrating attacks of headache pain

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

a. Migraine / Non-Migraine- Does the Veteran have characteristic prostrating

attacks of migraine / non-migraine headache pain?

[X] Yes [ ] No

If yes, indicate frequency, on average, of prostrating attacks over the

last several months:

[X] Once every month

b. Does the Veteran have very prostrating and prolonged attacks of

migraines/non-migraine pain productive of severe economic inadaptability?

[X] Yes [ ] No

5. Other pertinent physical findings, complications, conditions, signs

and/or

symptoms

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

a. Does the Veteran have any scars (surgical or otherwise) related to any

conditions or to the treatment of any conditions listed in the Diagnosis

section above?

[ ] Yes [X] No

b. Does the Veteran have any other pertinent physical findings,

complications, conditions, signs and/or symptoms related to any

conditions

listed in the Diagnosis section above?

[ ] Yes [X] No

6. Diagnostic testing

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

Are there any other significant diagnostic test findings and/or results?

[ ] Yes [X] No

7. Functional impact

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

Does the Veteran's headache condition impact his or her ability to work?

[X] Yes [ ] No

If yes, describe the impact of the Veteran's headache condition, providing

one or more examples:

The severity and frequency of his headache despite of the prescribed

medications led him to decide to STOP working the past 28 months. Also,

he feels that due to the headache, he seems to dec. in his memory and/

or

concentration ability.

[TiredCoastie]

Looking at your C&P, you actually look like you have a good shot at success if the rater takes the time to read through the notes the C&P doc wrote and looks at the whole document. One section of your DBQ caught my eye:

b. Does the Veteran have very prostrating and prolonged attacks of

migraines/non-migraine pain productive of severe economic inadaptability?

[X] Yes [ ] No

That's the key question per 38 CFR 4.124(a) for the 50% rating and what I had to prove to meet the 50% level.

You ought to win this one during the reveiw of your C-file and claims before generating a decision letter or SOC.

Have you gotten an SOC or SSOC yet?

If you are still denied, use the above statement as the major part of your Form 9 along with your more recent experience in school.

Edited April 14, 2015 by TiredCoastie

[Valhalla0321]

TiredCoastie,

Thank you for your comment and reply.

I agree with you about the CFR, but i also know i am dealing with the VA and how sometimes it is not in favor of the Veteran, i mean nothing else has changed from my Migraine 30% rating 6 months ago, i just had to tell them to look again and provide my headache log's for the past 2 years that actually show 3-5 attacks a week, they just watered it down to give me 30%. I think it was good that the DR. indicated how frequent the attacks were per file, even though The Dr. Claimed that the Exam check box's only allow you to check of (x) once a month.. which to me, its very much shortchanging the Veterans condition. My concern is that even though my claim is in Pending decision approval for multiple contentions including but not limiting to the increase in Headaches.. for some reason , i noticed more Exam's scheduled for Next month. To me this looks like the VA is like hold up, that Exam looks to much favorable to the Veteran who's claim can be taken a couple spaces back to gathering of evidence, in pursuit to another C&P that might be in favor of the VA...

I called the C&P exam department and could only leave a message. I am trying to get to the bottom of this, to see if there trying to get a second opinionated exam.. HUM??

Only thing i can think of is if my claim goes back to gathering, then that's what the C&P is about...

[Gastone]

Never had migrains myself. What evidence did you finally supply that got the 50%? Do Drs have anyway of verifying the frequency of your symptoms or is it all based on your Lay reporting? Do you wear something like a Holter Monitor to record your Migraine episodes?

Semper Fi

Gastone

[K9MAL]

Never had migrains myself. What evidence did you finally supply that got the 50%? Do Drs have anyway of verifying the frequency of your symptoms or is it all based on your Lay reporting? Do you wear something like a Holter Monitor to record your Migraine episodes?

I see the neurologist twice a year and tell them how many headaches I've been experiencing and it's noted in my VA health records. Those reports along with keeping a "headache diary" is what pushed me up to 50%.