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DBQ Headaches filled out, Opinions?


Please give me your opinion on how this headache DBQ is filled out.  This was done by a board certified neurologist.  My left knee is is rated at 10% for limitation of flexion.  There are STRs that state my knee gave out in service.  I have current medical records that also state my knee goes out.  I'm also going to claim knee instability (I didn't know about this when I filed the first time.)  I have a work accommodation forms filled out by my VA PC and Neurologist that state I need to leave work, not show up, and be allowed to complete my work on nights and weekends.  The forms also state things like "Can't do any other activity during severe headaches" and "bedridden".  I also have a letter from work stating they granted these work accommodations and 14 buddy letters.

I'm planning on asking for an extra-schedular rating since the headache schedule doesn't talk about involuntary body tics, ability to focus/keep on task, interference with reading, and interference with driving.

Opinions requested for:

  1. Nexus
  2. Does this fit extra-schedular ratings criteria?
  3. Does 1C and 2A cover medical reasoning that would normally be needed in an IMO to back up the doctor's nexus?
  4. What if anything should I ask the doctor to change?



1A. Does the Veteran now have or has he or she ever been diagnosed with a headache condition?

    Yes = Checked

1B. Select veteran's condition

    Other = Occipital Neuralgia     ICD Code = M54.81   Date of Diagnosis = REDACTED

1C. If there are additional diagnoses that pertain to a headache condition, list using above format:

    Post - Traumatic Occipital Neuralgia M54.81 + G44.309

2A. Describe the history (including onset and course) of the veteran's headache conditions

    Veteran's left knee gave out and he fell down stairs, striking the right occipital region of his head on the edge of the stairs.  Occipital neuralgia headaches began shortly afterward.

2B. Does the Veteran's treatment plan include taking medications for the diagnosed condition?

    Occipital nerve block injections, indomethacin, sumatriptan, flexeril

3A. Does the Veteran experience headache pain?

    Yes = Checked

    Constant head pain = Checked

    Pain worsens with physical activity = Checked

    Other = Stabbing and electric shock on right occipital region radiating to top of head

3B. Does the Veteran experience non-headache symptoms associated with headaches?

    Yes = Checked

    Other = Involuntary body tics from electric shock pain when headaches are severe.

3C. Indicate duration of typical head pain

   1-2 days = checked

    Other = Milder headaches up to one day, severe headaches 1-2 days

3D. Indicate location of typical head pain

    Other = Right occipital region radiate in direction of top of head

4A. Migraine - Does the Veteran have characteristic prostrating attacks of migraine headache pain?

    No = Checked

4B. Does the Veteran have very frequent prostrating and prolonged attacks of migraine headache pain?

    No = Checked

4C. Non-Migraine - Does the Veteran have characteristic prostrating attacks of migraine headache pain?

     Yes = Checked

    More frequently than once per month = checked

4B. Does the Veteran have very frequent prostrating and prolonged attacks of non-migraine headache pain?

    Yes = Checked

5A. Does the veteran have any scars related....

    No = Checked

5B. Does the veteran have other pertinent physical findings, complications, conditions, signs or symptoms related...

    No = Checked

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

    No = Checked

7. Does the veteran's headache condition impact his or her ability to work?

    Yes = Checked

    Mild headaches make it hard to concentrate/focus, read, keep on task, or drive.

    Severe headaches are fully debilitating and cause the veteran to be bedridden.

8. Remarks

    Milder headaches occur up to five days a week, severe headaches 3 to 5 per month, but may last 2 days each.  My medical impression is that these occipital neuralgia headaches are due to his left service connected knee.  The veteran's complete C-file was reviewed.


Thank you

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 If this all has been Service connected?

I would say with this above  the rater should look at your ICD Codes and rate per manual as to what the ratings should be according to the ICD disability codes.

you need to look at the rating chart per each condition and know where your condition is as to what the medical records state.  for a true rating.

beings you have a letter from a qualified Dr stating  that you can't work because of the headaches  then the VA will ''probably'' give you the extra schedular rating and apply the IU. if they don't  or you don't like what they rated you Appeal the decision. request the IU  Fill out the IU fast letter.

Edited by Buck52

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The occipital neuralgia hasn't been service connected.  I'm hoping that this DBQ will service connect it, I haven't filed yet.  I'm filing next week.

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You have gotten the cart before the horse.  First, you need to establish service connection with the Big 3 caluza elements of current diagnosis, in service event or aggravation, and nexus.  A nexus is an opinion from a medical professional that your current diagnosis is "at least as likely as not" due to military service.  

After you get service connected, then you will be rated on symptoms.  

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I haven't gotten the cart before that horse. The DBQ is for headaches/occipital neuralgia due to my knee giving out and causing me to fall down stairs.

The board certified neurologist states in the DBQ, "My medical impression is that these occipital neuralgia headaches are due to his left service connected knee." So there is the Nexus, no?  Should I have her change the word impression to opinion?

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