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Help With Migraine Claim


Scott D

Question

The Seattle VA has already service connected my migraines. They have established a frequency of 3-4 a month. They have awarded service connection at 0%. They claim that there is no evidence to show they are "prostraing in nature". In my SMR my family practice doctor documents the following symptoms photophobia, sound sensitivity, pain, nausea, and vomiting. How can any logical person come to the conclusion that these symptoms are not prostrating in nature. What do I need to do to appeal this claim?

Thanks

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3 to 4 per month. Get your Neurologist to describe the headache. Have him use the words prostrating and submit it with your appeal. If the headaches present a severe ecomonic hardship because you miss a lot of work, have your employer also write a letter. Soetimes the VA will low Ball the claim. at 0 percent, it is still service connected, but in your case, it is not near the correct percentage rating. You can also get a IMO from another Doctor, But a Neiurologist will be the best bet for you. First thing is to send a Notice of Disagreement to the RO. State why you disagree with the decision. Put on the NOD that this is not a request for reconsideration. They will send you a Statement of Case and insitiate the appeal. You can ask for a DRO review as well as a formal appeal.

You beed to move quickly on this isssue. The sooner the NOD is received the Sooner you will get your claim setteled. Be aware of Va time constraints for NOD and Appeals.

I wish you the best. I am awaiting my decision on migraines.

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'

The Seattle VA has already service connected my migraines. They have established a frequency of 3-4 a month. They have awarded service connection at 0%. They claim that there is no evidence to show they are "prostraing in nature". In my SMR my family practice doctor documents the following symptoms photophobia, sound sensitivity, pain, nausea, and vomiting. How can any logical person come to the conclusion that these symptoms are not prostrating in nature. What do I need to do to appeal this claim?

Thanks

Scott,

I am 50% SC for migraines. I have had my migraines get worse over the years, and have had to fight the VA for every increase in SC % for them.

First, did you just get the VA decision of a 0% rating?

How long have you been out of service?

If you were rated at 0% then you are SC for them, now you have to begin the fight for increasing the rating.

Are you working with a POA with one of the SO's?

BoonDoc

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Scott,

I may get shot down for this -- but thats OK -- it's only my opinion.

I think the key word I'm not seeing in your symptoms is if you need to lay down when you have these headaches, check your records for this. Search BVA cases for diagnostic code 8100.

Good luck,

JMHO,

carlie

mi·graine

A severe recurring headache, usually affecting only one side of the head, that is characterized by sharp pain and is often accompanied by nausea, vomiting, and visual disturbances. Also called hemicrania, megrim, sick headache.

Miscellaneous Diseases

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

Rating

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

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....................................

char·ac·ter·is·tic

1. A distinguishing feature or attribute; character.

2. A structure or function determined by a gene or genes; trait.

pros·trate (prstrt)

tr.v. pros·trat·ed, pros·trat·ing, pros·trates

1. To put or throw flat with the face down, as in submission or adoration: "He did not simply sit and meditate, he also knelt down, sometimes even prostrated himself" Iris Murdoch.

2. To cause to lie flat: The wind prostrated the young trees.

3. To reduce to extreme weakness or incapacitation; overcome: an illness that prostrated an entire family; a nation that was prostrated by years of civil war.

adj.

1. Lying face down, as in submission or adoration.

2. Lying flat or at full length.

3. Reduced to extreme weakness or incapacitation; overcome.

4. Botany Growing flat along the ground.

Verb 1. prostrate - get into a prostrate position, as in submission

bow down

lie down, lie - assume a reclining position; "lie down on the bed until you feel better"

2. prostrate - render helpless or defenseless; "They prostrated the enemy"

alter, change, modify - cause to change; make different; cause a transformation; "The advent of the automobile may have altered the growth pattern of the city"; "The discussion has changed my thinking about the issue"

3. prostrate - throw down flat, as on the ground; "She prostrated herself with frustration"

throw - project through the air; "throw a frisbee"

Adj. 1. prostrate - stretched out and lying at full length along the ground; "found himself lying flat on the floor"

flat

unerect - not upright in position or posture

2. prostrate - lying face downward

prone

unerect - not upright in position or posture

at·tack

An episode or onset of a disease, often sudden in nature.

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Yes I have been SC at 0%. This can be a very frustrating experience. Also I have documented evidence in my SMC thats states bed rest is used as a treatment. I guess I will just have to spell it out line for line for the VA. My SO has just changed so I have not talked with the new guy yet. He will get a call today.

Thanks

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  • HadIt.com Elder

Scott,

You stated the following;

"In my SMR my family practice doctor documents the following symptoms photophobia, sound sensitivity, pain, nausea, and vomiting. How can any logical person come to the conclusion that these symptoms are not prostrating in nature"

The VA needs to see that those conditions currently exsist. The notes in your SMR's only helped obtained service-connection. The pertentage assigned for a disability is derived of the current symptoms and disabling affects.

What did your last C&P exam results reflect as far as the migraines?

Vike 17

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Yes I have been SC at 0%. This can be a very frustrating experience. Also I have documented evidence in my SMC thats states bed rest is used as a treatment. I guess I will just have to spell it out line for line for the VA. My SO has just changed so I have not talked with the new guy yet. He will get a call today.

Thanks

Scott,

Make sure that you put the VA decision date on the NOD, and what you disagree with.

Be specific as to why you disagree with their decision.

Use the same law that the VA has to use; 38 CFR, and I would use the M2-1 that Wings quoted from too.

You find the symptoms that most corectly match your migraines, and use the exact wording that the rating schedule and guidlines use and tell the VA exactly why they are incorrect.

I just requested a "De Novo Review" from a senior DRO in my NOD that I filed last month. You can write up a very focused NOD using the law/guidlines and submit it in person if you can to the VA RO nearest you, or send it certified mail. Request a copy of your last C&P exam. and your other VA files, C-file, SMR's from your RO if you don't already have them.

With migraines secondary health issues can be as debilitating/disabling as the migraines themselves, i.e., severe nausia, vomiting, severe photophobia, severe phonophobia, severe visual impairments, depression, anxiety, mood changes, and then effects and side effects of medications treating the SC disability all need to be addressed if they apply. If your able check into the E.R. every time you have a migraine, or better yet check into the VA hospital requesting something be done about your migraines. I did this and after the first migraine, and the nurses having ti clean up after me being sick, they checked me right out, and said yep he's having very frequent, totally prostrating, and for a long duration...get him out'a here. This helped me get my 50%, they need to see something with their own eyes, objective part of the S.O.A.P. notes that will back up the subjective part, what you have told them is happening.

I hope you the best,

BoonDoc

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Hello everyone,

I have a question regarding migraines. I was denied between 1996 (discharge from army) to 2002. They granted me the service connection based on evidence in my military medical records in addition to ongoing medical treatment. I filed a cue claim requesting an earlier effective date back to August 1, 1996. My file is now currently with the BVA. For some reason my rep advised that it would take 2-5years for them to make a decision. I'm really curious of what the outcome will be for all of my issues (depression (anxiety), migraines and lower back pain). I'm also curious as to why they consistently denied the claim then subsequently used the information from all previous claims to establish the service connection. Is this not a little backwards?

Renee

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Good advice all around. I am 50% for migraines. I have kept a migraine log for 4 years, I've kept copies of all private and VA ER visits and my wife took several pictures of myself lying in bed with ice bags around my head (this is the way I am most of the time), and sent this information into the VA and got a quick response. The key word to build my case around was "Prostrate" which means in a horzontial position.

Best of luck!

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Good advice all around. I am 50% for migraines. I have kept a migraine log for 4 years, I've kept copies of all private and VA ER visits and my wife took several pictures of myself lying in bed with ice bags around my head (this is the way I am most of the time), and sent this information into the VA and got a quick response. The key word to build my case around was "Prostrate" which means in a horzontial position.

Best of luck!

This jrenee. I received my claim back from the board of appeals already. It took 5 years to get there and 6 weeks for them to review. I was denied on all of my issues. Especially the earlier effective date concerning my migraines. I'm exasperated now. I want to file a que for the migraines. But I'm discouraged now. Please HELP!!!!!!!!!!!!!!!!!!

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jrenee, We need more information.

What rating do currently have?

What issues did you appeal?

Did you have IMOs?

C&P report?

Does your evidence match the information posted earlier under this topic?

Hi Jim,

My current rating for migraines is 30% from May 2002.To grant this connection they used previous claims, medical records both in service and va medical center as well letter from the neurologist. They contend that the letter from the neurologist was "new material evidence". His letter was drafted based on my in service medical records that I provided to him. All of my evidence matches up with the below. In additon, the first C&P physical was immediately following discharge from the military in October 1996. At which time the examine found history of migraines in my service records. That claim was denied, my represenative at the time did not help me devlop my claim, they canceled my power of attorney for reasons unknown to me to this day.

My other issues are depression at 30% and lower back at 20%. All issues were denied. I'm not certain what an IMO is can you clarify?

Edited by jrenee (see edit history)
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  • HadIt.com Elder

Jrene:

When was last time you were able to work and earned enough money that was more than 900 a month.

CUE's are very tricky and many who think that they have a cue really don't. What I think you really need is to establish 100% in some form or another and than go after any issues that are not resolved to your satisfaction.

Your SO in my opinion is full of beans. There are ways to speed the VA up if they take to long. A Writ of Mandamus seems to have helped many and can be filed successfully after 18 months.

Good Luck

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Jrene:

When was last time you were able to work and earned enough money that was more than 900 a month.

CUE's are very tricky and many who think that they have a cue really don't. What I think you really need is to establish 100% in some form or another and than go after any issues that are not resolved to your satisfaction.

Your SO in my opinion is full of beans. There are ways to speed the VA up if they take to long. A Writ of Mandamus seems to have helped many and can be filed successfully after 18 months.

Good Luck

That may be a problem. I'm salary and earn pretty good money.

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