C&p For Migraines Not Happy With It

[soriol36]

Tell me what you guys think. I told the examiner that I take my medication as needed when I get my migraines and for the duration of the attacks and that I also take Excedrin. But he got nerves to insinuate that I lied about my medications!! and then look at my results. He marked less than frequent attacks when I specifically told how often I get the attacks.

The examiner was very rude...

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: 784.0 Date of diagnosis: is SC for that

2. Medical History ------------------

a. Describe the history (including onset and course) of the Veteran's headache conditions (brief summary): Veteran states that she is taking the Butalbital every day every 4-6 hours or 4 times a day. However, this is not consistent with the prescription refill. I asked her twice if she was taking the Butalbital 4 times a day every day and she replied in the affirmative. She states that her headaches last from 1 day to weeks. Veteran states that she misses 2-3 days a week due to headaches.

This is her statement. 10/27/14 (Mail) released 10/28/14 RENEWED FROM RX # 4676332 2/5/15 (Mail) released 2/6/15 3/27/15 (Mail) released 3/30/15 5/3/15 (Mail) released 5/5/15 7/2/15 (Mail) released 7/2/15

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): Fioricet 4 times a day every day

3. Symptoms -----------

a. Does the Veteran experience headache pain? [X] Yes [ ] No [X] Constant head pain [X] Pulsating or throbbing head pain [X] Pain localized to one side of the head [X] Pain on both sides of the head [X] Pain worsens with physical activity

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] Sensitivity to sound [X] Sensory changes (such as feeling of pins and needles in extremities) c. Indicate duration of typical head pain [X] More than 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] With less frequent attacks

b. Does the Veteran have very prostrating and prolonged attacks of migraines/non-migraine pain productive of severe economic inadaptability? [ ] Yes [X] 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? [X] Yes [ ] No If yes, provide type of test or procedure, date and results (brief summary): CT of the head in October 19, 2015 was totally normal

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: Per veteran statement, she states that she misses 2-3 days per week due to her headaches. She works for the school district at Palm Beach County School district.

8. Remarks, if any: ------------------- The veteran states that in the last month, her left eye twitches when she has a migraine attack.

[USMC_VET]

how many times a month do you have to lay down for periods of time due to the migraine? what did you tell them?

if you said every few months then that makes sense, however if you are missing multiple days a week....

As far as medication goes what htey are doing is looking at your medications and amounts

This is her statement. 10/27/14 (Mail) released 10/28/14 RENEWED FROM RX # 4676332 2/5/15 (Mail) released 2/6/15 3/27/15 (Mail) released 3/30/15 5/3/15 (Mail) released 5/5/15 7/2/15 (Mail) released 7/2/15

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): Fioricet 4 times a day every day

if you received say 120 pills, at 4 times a day then its only good for one month and your prescription renewal shows a prescription in october 14, then february 15, march 15, may 15 and the july 15. There are gaps there more than 1 month apart which is why they were sticking to that line of "i asked here, she said 4 times a day, etc."

Im not agreeing with them, im just going off the normal 1 month prescription norm and looking at the data they inputted.

Look back at your medication history yourself, see if that matches. if you got prescriptions from private, outside the va that fills those gaps that is also something to get ahold of for you Notice of Disagreement (NOD).

[soriol36]

Hi thanks for your input.

Yes I can two or three per week, it varies. But I was very clear when I told him than I also use Excedrin because I feel like it works better on me sometimes and he neglected to add that statement to the notes.

The problem with the medication is that I do not take every single day I only take them when I get the attacks.

[USMC_VET]

Hi thanks for your input.

Yes I can two or three per week, it varies. But I was very clear when I told him than I also use Excedrin because I feel like it works better on me sometimes and he neglected to add that statement to the notes.

The problem with the medication is that I do not take every single day I only take them when I get the attacks.

Once again not trying to sound adversarial, just going off what was in the report and what you said.

In the report he makes it sound as if he was asking you if you were taking Butalbital 4 times a day, you said yes you take butalbital 4 times a day and that didnt jive with the prescription history. Did you say in the exam that it was either butalbital OR excedrin 4 times a day.

This is why even though i take other stuff for my migraines during the day other than the prescribed medication (as you do) i have put reminders on my phone to reorder prescriptions every 30/60 days so that the record is there. its not anything you can change, just do that for the future. Why? because now lets say best case scenario comes and you get the rating you deserve. 1-5 years from now you will be going back in for a re-evaluation. if you still have missing gaps in your report you could get hit for a lowering of rating because (in their eyes) obviously you are better because you arent taking the medication as often? catch my drift.

If you have a private primary care i would go to them and have a visit and state that you take excedrin and butalbital depending on what works but you take one or a mixture of both 4 times a day.

If you dont write up a sworn declaration describing ALL your symptoms the declaration template is there, courtesy of Chris Attig's law firm).

write when they started, how it affect syou, days you miss, how it hurts relationships, what you take for it and how often to take it.

if you can get friends, family, spouses to write ones as well. sounds like the decision hasnt been made so you still have time to submit new evidence. I would write these up, collect more medical evidence if you can and upload via ebenefits AND mail it certified mail/return receipt.

Edited August 5, 2015 by USMC_VET

[soriol36]

Got it. Thanks for the advice. I will get the letters and will write a statement. My claim stills under review so I think I have time to submit this evidence. Thank you so much for your advice :)

[ATCJen]

I am 50% SC for Migraines as of this year. I used to be 30%, but got an increase this year. For some reason, the VA had me on a 5-year "reevaluation" of this condition. This is something that most vets have never seen, as migraines are typically a static chronic conditions. Anywho, I went in for my first 5-year C&P to have them reevaluate me. The examiner was incredibly rude and gave me a whole shpeel about how he didn't believe me because I hadn't been treated for migraines at a VA facility (even though I have been treated through a private doctor this whole time), and that I wasn't taking my medication (I CANT TAKE ANYTHING PRESENTLY as I am pregnant and prior to this I was under the care of a reproductive endocrinologist to GET pregnant and he took me off my meds which are contraindicated during fertility treatments). So the examiner literally laughed in my face and had me out of his office in less than 10 minutes. I waited to see his report, and just like in your report, he didn't put that I relied on OTC drugs because the heavy stuff was out of the question in my pregnant condition. What he wrote would have likely LOWERED my %, note that I said "WHAT HE WROTE" because that was not what I reported. When I saw that, I called the VA, reported what happened and informed them that I was going to see my personal doctor to get a DBQ filled out. I printed out the DBQ, had my doctor fill it out. Mind you, I told the exact same story to my doctor as I did to the VA examiner and with what she wrote on the DBQ, I ended up getting rated at 50% and my condition is now listed as static and will no longer require future C&P exams. I suggest you do the same. Arm yourself with knowledge from the CFR 38 where it lists the criterion for the certain percentages for your condition. Then take the DBQ paperwork to a doctor and have them fill it out according to your symptoms and frequency of headaches. They basically want to know: how many headaches per week, how/where do you feel the pain, do you have to lie down or sleep off the headache, do you experience nausea or dizziness, does this impair your ability to work, what medications are you on (including OTC). Then upload/send in the DBQ. I uploaded mine when my claim still said "under review" and it was used in the final determination. I hope this helps! 

[Navy04]

I am sorry if the Doc was rude, but as stated by USMC they will Verify everything and word we say as Vets, just part of the process. As far as Migraine Meds, I am 50% for Migraines/TBI, and I take a totally different Med, and I get close to 40 Injections thru the VA Neuro Doc every  Months, which is the Max the VA will treat and yet I am only 50%. I have had Neuro Stimulation Tests and Brain Scans just for VA to Verify what was there all along. When Vets ask me what to say or do prior to Exams, I always inform them not to over due it, even if it is true, let the Medical Evidence speak for Itself. As USMC stated now the VA has documented you stating the you are taking so much meds, yet the Prescription Timeline did not match, and you have not been hospitalized, VA stated your CT scan was normal. Not saying you don't have or suffer from Migraines, but if you are well documented thru the VA treatment records, then just go with that. Either way good luck and God Bless