PTSD Does Not Cause Migraines

[Rakkasan]

So I received the notes today from my migraine C&P. Under the remarks at the end he says that my migraines are less likely as not due to or the result of PTSD. His rational is: PTSD does not cause tension headache or migraine headache. Also states that "He is not on any medication for headache." I am prescribed Sumatriptan by the VA!

 

I know several people who have migraines secondary to PTSD but the real kicker is that I am not claiming migraines to PTSD. I am claiming secondary to anxiety. I even had a nexus written by my neurologist stating that my migraines are connected to my anxiety. I am not for sure the C&P examiner had access to my nexus that I submitted. Am I screwed?

Edited May 10, 2018 by Rakkasan

[Rakkasan]

An addendum has been ordered last week. This seems like good news that they noticed ththat discrepancies. Will keep updating this thread.

[Rakkasan]

On 5/12/2018 at 2:01 PM, Grumpbox said:

Did you see the Neurologist before or after the C&P?  I will assume after.

If your claim was at the, "Preparation for Decision" phase and then went back to, "Gathering of Evidence" this is a GOOD thing!  I see this from personal experience...here is why. Although, this is just my opinion.

Your VA Reviewer that is ultimately handling your case, might have noticed a hiccup in the process.  For example, this reviewer might have seen the notes from the Neurologist and put two and two together.  Meaning, its not ready for a decision. Why, because maybe there is another C&P required.  This is what happened to me.

I was up for my five year PTSD Review. At the time I was 100%.  When I completed my C&P for my initial PTSD, I noticed the doctor never checked my records...HOW DO I KNOW? Because he didn't check TBI nor did he checked other mental issues/illnesses.  Here's a prime example of how waiting to see what happens plays to your favor.  A few weeks pass and I get a call for a TBI C&P and it was with a Neurologist.  She did her tests and asked me specific questions, as to the DBQ for TBI.  As a result, she recommended an increase in my Post Concussion Headaches award and acknowledged my TBI....FINALLY - after many years coupled with loss of money!

This prompted me to yet again, another C&P - this time for another PTSD C&P.  When I arrived to this one, the lady doctor apologized for all that had occurred and how the previous doctor failed to not only review my records, but how he failed to list other mental/illnesses (TBI).  I could hardly believe that right in front of me, here is a doctor from the VA apologizing about another doctor's inadequacies.  In the end, VA found me 100% P&T.  

Most noteworthy....I never inquired, called, raised hell, or filed any kind of complaint or additional claims. I was calm, always thanked everyone, tried to answer my questions to the best of knowledge (which is a negative factor for me.)  In the end, I just let it ride.

I am glad I did for two reasons: 1) if I had tried to fight the system while it pursued, I might have knocked my fate off course; and, 2) even if I had tried to argue or file another claim during the whole process, I wouldn't be able to see the final reason from the VA ---  "WHY" they denied me various disabilities. (NOTE/DISCLAIMER: THIS DOES NOT ALWAYS APPLY FOR EVERY VETERAN'S SITUATION.)  What I mean is this.  Once they finish with your claim, they will send you documentation describing the WHY.  This WHY  is your NEW TACTIC to take in order to debunk the VA's reason for denying your claim(s).  It gives you the next direction to take - that's all I am trying to say; however, without this form of intel, you have zero information in order to develop your next future move.  Like chess - I suppose...

I'd be curious to see what happens next after the, "Gathering of Evidence."  Please keep us updated so we can guide you, accordingly. 

GB

 

 

Here is the copy of the addendum that was sent in to the VA in Evansville.

 

 

ELECTRONIC CLAIMS FOLDER AVAILABLE.
CLAIMS FILE BEING SENT FOR REVIEW BY THE EXAMINER. RXXX TXXXXXX
xxx-xx-xx72

Date of claim: 03/14/2018 Days pending: 58

Attention C&P clinical staff - This exam request was scheduled at your location because this is an addendum request for an exam completed at your facility.
These remarks were generated using version 4.0 of the Exam Request Builder (ERB_v_4.0).

The Veteran does NOT need to report for the following exam(s):

DBQ NEURO Headaches (including migraine headaches) ____________________________________________________________________________

Active duty service dates:

Branch: Army
EOD: 05/25/2004
RAD: 05/25/2012
***Addendum only***
***Veteran need not report***
DBQ NEURO Headaches (including migraine headaches):

Please ha
ve examiner Hxxxxx Oxxxxxx, MD provide an addendum to the examination he conducted on the Veteran on 05/07/2018.

Please review the Veteran's electronic folder in VBMS and state that it was reviewed in your report.
Please provide the following clarification:
Examiner, the Veteran was diagnosed with both tension and migraine/migraine

TXXXXXXXX RXXXX SXXXXX CONFIDENTIAL Page 9 of 9

variants headaches. The DBQs both private and VAMC provided only opine on tension headaches. Please review all evidence and opine with supporting rationale. Please direct any questions regarding this request to: 477 Michigan Ave Detroit, MI 48226 Email: XXXXXXX@va.gov ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, Examiner, the Veteran was diagnosed with both tension and migraine/migraine variants headaches. The DBQs both private and VAMC provided only opine on tension headaches. Please review all evidence and opine with supporting rationale. The diagnosis of "TANSION HEADACHE" is recorded in Problem list of CPRS, but the veteran is on SUMATRIPTAN SUCCINATE 100MG TAB TAKE ONE TABLET BY ACTIVE MOUTH AS INSTRUCTED FOR MIGRAINE. TAKE AT ONSET OF HEADACHE. MAY REPEAT AFTER 2 HOURS (CHOICE RX) NOT TO EXCEED 2 TABLETS IN 24 HOURS OR 4 TABLETS PER WEEK which is being prescribes for Migrain headache on 16 Feb 2018 by neurologist located at /carbondale, IL. His diagnosis: Migraine with aura. /es/ , MD MD Signed: 05/17/2018 15:50 Receipt Acknowledged By: * AWAITING SIGNATURE * * AWAITING SIGNATURE *

[Grumpbox]

It looks like someone finally saw the error.  Hopefully, they will reevaluate their decision for your rating/amount of percentage.  

I noticed there was only one page here.....it was page 9 of 9??  Where is your entire addendum? This might shed more light on a rating??

[Rakkasan]

1 hour ago, Grumpbox said:

It looks like someone finally saw the error.  Hopefully, they will reevaluate their decision for your rating/amount of percentage.  

I noticed there was only one page here.....it was page 9 of 9??  Where is your entire addendum? This might shed more light on a rating??

 

I am also attaching the DBQ and nexus my neurologist filled out before I had my C&P. The addendum was added at the bottom of the over the phone C&P. Here it is altogether:

 

*** MEDICAL C&P EXAM MA Has ADDENDA ***

Headaches (including Migraine Headaches) Disability Benefits Questionnaire

Name of patient/Veteran: Rxxx Sxxxxx Txxxxx

Is this DBQ being completed in conjunction with a VA 21-2507, C&P Examination

Request?
[X] Yes [ ] No

ACE and Evidence Review
-----------------------
Indicate method used to obtain medical information to complete this

document:

[X] Review of available records in conjunction with a telephone interview with the Veteran (without in-person or telehealth examination) using the ACE process because the existing medical evidence supplemented with a

Txxxxxxx, Rxxx Sxxxxxxxxx CONFIDENTIAL Page 24 of 48

telephone interview provided sufficient information on which to prepare the DBQ and such an examination would likely provide no additional relevant evidence.

Evidence Review
---------------
Evidence reviewed (check all that apply):

[X] VA e-folder (VBMS or Virtual VA) [X] CPRS

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: R51 Date of diagnosis: 2010

[X] Tension
ICD code: G44.209 Date of diagnosis: 2010

2. Medical History
------------------
a. Describe the history (including onset and course) of the Veteran's

headache conditions (brief summary):
The veteran served in the Army from 25 May 2004 to 25 May 2012. Hserved in Iraq 2 tours 2005 to 2006 and 2007 to 2008, total of 28 months.

Hx from the veteran by phone on 7 May 2018:
Stated his headache started about 7 or 8 years ago.
He was seen at Marion VA Hospital on 31 Oct 2017 for headache,

CT head and CT sinuses was done both were negative for disease. He is not on any medication for headache.

Hx from C&P exam of 17 Nov 2017:
Veteran is claiming disability pattern for headaches, migraines. Medical opinion is requested. Veteran reports that he had headaches
start while in service in approximately 2010 after his second deployment
to Iraq. Reports that he did not seek medical care for his headaches
while in the service. Reports that he has sporadic headaches with
migraines about 2 times a month. Reports that he treats his migraines
with Excedrin Migraine as needed. Reports that his typical

Txxxxxx, Rxxx Sxxxxx CONFIDENTIAL Page 25 of 48

migraine
will last about 3 hours- reports that he will have to go into a
dark
room and lay down with a washcloth on his head. Reports that he is not
able to complete his normal day to day activities during
migraine-
reports that he has missed work or had to leave work early- reports that
he is sensitive to light and has blurry vision and unable to concentrate
due to the headache pain. Reports that over the past year he
has had to
leave work about 2-3 times a month related to his migraine headaches.

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):

Over counter medication.

3. Symptoms
-----------
a. Does the Veteran experience headache pain?

[X] Yes [ ] No

[X] Pain on both sides of the head
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] Sensitivity to light

[X] Sensitivity to sound
c. Indicate duration of typical head pain

[X] Less than 1 day
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? [ ] Yes [X] No

5. Other pertinent physical findings, complications, conditions, signs, symptoms and scars

-----------------------------------------------------------------------
a. Does the Veteran have any other pertinent physical findings,

complications, conditions, signs or symptoms related to any conditions

Txxxxxx, Rxxx Sxxxxx CONFIDENTIAL Page 26 of 48

listed in the Diagnosis Section above? [ ] Yes [X] No

b. 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

c. Comments, if any:
No response provided.

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 head and CT sinuses on 6 Nov 2017: Reported negative except Deviated nasal septum with spurring as noted.

7. Functional impact
--------------------
Does the Veteran's headache condition impact his or her ability to

work?
[ ] Yes [X] No

8. Remarks, if any: -------------------

VBMS is reviewed.

Opinion is requested: The veteran's tension headache is less likely as not

(<50/50 probability) proximately due to or the result of PTSD.

Rational; PTSD does not cause tension headache or migraine headache. Suppor is medical litrature.

/es/ Hxxxxxx Oxxxxx, MD MD
Signed: 05/07/2018 16:08

Headaches+DBQ.pdf

Nexus+Letter+for+Migraines.pdf

[Grumpbox]

Do you currently receive VA Disability for Migraines? 

Or....Post Concussion Headaches, Headaches, etc?

[Rakkasan]

1 hour ago, Grumpbox said:

Do you currently receive VA Disability for Migraines? 

Or....Post Concussion Headaches, Headaches, etc?

No, I do not.