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wilspeak

Requesting Advice an increase for VA Migraine rating

Question

 I am 20% (SC) for Migraines. I have Migraines 2 -3 times a week and other problems connected to migraines. The doctor increased my meds for migraines. I went to the ER because of my Migraines.   I am now trying to make a case for an increase of my Migraines. My Primary Doctor ordered an appointment to NeurologyI have been waiting for a call from Neurology to make that appointment with Neurology. I never received a call from Neurology, so I finally called Neurology and was told the appointment in July had been canceled. They said I was sent back to my Doctor, to "Evaluate and Treat". I think this is outrageous! No one informed me that my appointment had been canceled and then I had no one tell me to make another appointment to see my Primary care Doctor so he/she can "Evaluate and Treat". I then reported this to the local VA Patient Advocate and was told that Neurology was not taking any new patients UNLESS they are having seizures or brain surgery. Shouldn't I be referred to an Outside Neurology clinic? The only response I got from my Doctor is she will make another referral to Neurology and after that, it is out of her hands. Also my so called "Doctor" is really a Nurse Practitioner. Mean while I am not being treated. What can I do about this and now what is my next move ?? Thank You all in advance.

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The best thing you can do is read the VA rules and make the best of them.  Here is the VA criteria for migraines:

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

 

end of regulation quote.  

Notice VA regs are somewhat vague:   What does the term "several" mean?  2?  4?  12?   I dont know.  You might be able to find out what "several months" means by reading CAVC case law, doing a search on "migraines" and you can see what the judges think.  

I find it empowering to understand this:  THE VA DOES NOT CARE WHAT "I" THINK.  Their "customer service" is pretty much a big zero.  In order for you to get an increase, you need to have A DOCTOR state something close to:  The Veteran has "very frequent prostrating and prolonged " migraine attacks that have severely affected his work.  

Are your migraines "prostrating"?  That means you go to bed and dont get up for a while.  

If you meet the above criteria, AND HAVE IT DOUCMENTED BY A DOCTOR, then you should get the applicable increase.  

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I will humbly suggest you dont get your underwear in a knot over the term "evaluate and treat".  One Veteran posted and made it clear he got his benefits in no small part because he waa "nice" even tho VA employees are often "not nice".  

ALL doctors "Evaluate and treat".  "Evaluate" generally means the doctor makes a diagnosis of your condition.  He also may document the severity.  So, if the doctor documents the severity of your migraines, then that may well be a good thing, and result in an increase.  

I think you are taking the "evaluate and treat" strictly as a negative thing and it may not be.  I think maybe you think "evaluate" means you are being "evaluated" for a REDUCTION in benefits.  While this IS possible the evaluation could result in a proposed reduction, its equally possible that your evaluation results in an increase in rating, if your symptoms suggest the same.  

Now, the good part is that a doctor will largely let you self report your symptoms.  I do not recommend taking advantage of this and lying about the frequency or duration of migraines, as they have ways of finding this stuff out, and the results wont be ones you will like.  

For example, lets say you report you get "frequent" prostrating migraines and they last 2 to 3 days, twice a month.  

Ok, so the VA contacts your employer and asks how many days in the past year have you missed work?  The look and say, "Gee, he hasnt missed any work since 2013".  

Uh, oh.  You blew it.  Dont go there, ever.  

I wont even talk about what happens in this example, but i CAN ALMOST PROMISE YOU WONT LIKE IT.  

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Hello broncovetI was Not upset about the "Evaluate and treat" statement. I didn't like the way Neurology had me waiting for over a month and then canceled my referral to them Without contacting me and saying that they are going to send me back to my Doctor for further treatment and for not explaining to me that they were only taking certain patients at the time. I would not have found out unless I called them then,  Finally, they told me what had happened, keep in mind my appointment had been canceled over a month ago and I didn't know Until I called them.  The  "Evaluate and treat" statement is how they just left me hanging. Also, my primary Doctor didn't contact me either, I got the feeling she either forgot  OR didn't even know till I reported what was going on.  I am going to call the VA Choice Program and see if an Outside Neurologist turns down an appointment from a Vet and Then does not call them to tell them. Thank You

Edited by wilspeak

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