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Denied Increase



I recently received my letter of denial for increase on the grounds that I needed to have more than one prostating migraine in 2 months and even though my VA medical records never mentioned the word prostrating the Neurologist does say on multiply times that the patient is unable to work during attacks and he has also stated that I needed to lye down in a dark room. The only problem is that it is a teaching hospital so each time I see a different resident and maybe a different attending also. I have become a test dummy for the Neurologist because I have been on multiple medications and have failed therapy but I still try. My attacks can be from 2-5 headaches a month with each one lasting at least 2 days the only reason I haven't lost my job is that the neurologist filled out a Family Medical leave paper which allow me to miss periods at work without being fired but believe me my job is ready to dismiss me if they can find the loophole. With everything in my medical records I thought I would at least get 30%. Can anyone help me understand what to do? At the C&P the ARNP asked me all the questions and said that she could only write what was in my doctor notes the only thing I could think is that she read the resident notes without reading the attending notes. I have sent back my NOD already highlighting what the attending notes say in my VA medical records for the last two years. Also I have no idea what the C&P notes say because they did not send me that and I can not find it in my medical records. Please Help

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Thank you to everyone for responding and providing me with help. Reason for Descision: We have assaigned a 10 percent evaluation for your migraine headaches based on Characteristic prostrating attacks averaging one in 2 months over the last several months. A higher evaluation of 30 percent is not warrent for migraine unless the evidence shows characteristic prostating attacks occuring on an average once a month over the last several months. When you mention C-file would that be my VA medical records? If so I enclosed them with my NOD highlighted with the Doctors stating that my migraines does not allow me to work if that is not my c-file how do I attain it?

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Your neurologist would not have completed your FMLA paperwork unless you had a chronic health condition that warranted it. You should include your FMLA paperwork as part of your evidence and if you could get an IMO from the neurologist, have him/her discuss the circumstances that justified the completion of that paperwork.

There is no "loophole" in FMLA. That's not to say that employees are not harassed for taking advantage of FMLA, but an employer's interference in an employee's right to access FMLA will be very costly to the employer. Short of a reduction in force that includes other people, the employer would have a very high hurdle to clear trying to defend firing someone who has not exhausted their FMLA leave.

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Sounds like you may already have insurance privately. Costs are money out of pocket I get it but get a consult to a non teaching hospital neurologist and take with you all the documentation and exam notes etc. If you haven't started get a headache diary going. Write daily on the hard copy and then transcribe into the myhealthevet. Go to travel v k health and then medical events log. Do this for headache and everything else sc

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Sorry to hear of your issues bud. I was 30% for migraines/tbi and recently was reviewed by the VA, and it back fired in fact they increased to 50%. I get injections in head every 3 months by Neuro at VA, and take 2 different migraine Meds, and have had Alpha Stem treatment at VA which I was discharged from due to failure. What I am trying to say is that you need a lot of well documented treatment at VA. Good luck and God Bless

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