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I am about to file a claim for Headaches. Below is the information I will supply in the claim. Do you think it will suffice?


Wico1337

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Hello all, below is what I plan on filing with my VA claim. Do you think it will suffice? I was sure to point out I have a current diagnosis by the VA. A convincing nexus along with how the condition has already been acknowledged as being secondary to my current rated condition. Backed by citation of another veterans review. And finally, criteria of my condition and how it falls in line with the 50% rating for headaches.

Beginning of claim

"Headache Claim

 
 
With a recent suggestion of my VA Primary Care physician to include daily intake of Zyrtec and Flonase to ease my Allergic Rhinitis symptoms, my headaches have began to occur less frequently and less severe since taking the Medications suggested by the VA. This has made it apparent that my Allergic Rhinitis has caused my Headaches for many years. The ENT specialist at the VA diagnosed me with Allergic Rhinitis and prescribed me medication so I do not need to continue buying Zyrtec and Flonase.
 
The VA has already ruled that there is a direct nexus between Allergic Rhinitis and Headaches.
 
According to VA Citation Nr: 1048433
 
 
Quote “Service connection for migraine headaches as secondary to allergic rhinitis is granted.”
 
All headaches, including Migraine Headaches, fall under the same category of ratings which is 38 CFR 8100. 
 
I have a diagnosis of Chronic Headaches from the VA Primary Care physician on file.
 
The following VA Finding means that while I am describing my symptoms, I will refer to my symptoms for my condition as unmedicated, as medication is not mentioned in the rating schedule for Headaches.
 
In Jones v. Shinseki, 26 Vet.App. 56, 63 (2012), the Court held that the veteran is entitled to a rating based upon his unmedicated condition – that is, the higher disability evaluation – if the effects of medication are not explicitly mentioned under the applicable diagnostic code of the rating schedule.
 
My condition for Headaches occur very frequently, forcing me to assume the prostrating position which is where I need to lay down in a dark area and rest my body and mind. This can last anywhere from hours to days. This has caused severe economic inadaptability. Causing me to cancel meetings with people, miss hours or a day of work, miss spending time with wife, miss participating in my things in life. All because of the extreme head pain and overall extreme body exhaustion that my headaches cause."

End of claim.

With all of the information above. How should I present my symptoms to the examiner? The examiner will be asking how frequently headaches occur. Should I follow the guidelines of pre-medication? Or when they ask me questions about how often I get headaches, should I answer them how I feel currently with medication? If I answer with how I feel while medicated, I have a feeling that the Rater will see the symptoms as a 30% rating. And I would have to appeal for a 50% rating as I should have been rated for 50%. What would be the best way to approach? And do you have any feedback on my claim statement above?

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Posted (edited)

You might be getting the cart before the horse, skipping too many steps.     It sounds like this is your first date, and you are figuring out which school to send your future children to.  

Just because "another Veteran" got SC for headaches secondary to allergic rhinitis , (in 2011).  does not guarantee you will.  

You will still need, as always,  to establish Service connection prior to picking out which car you want to buy with your retro.  You need

1.  current diagnosis.  Has a doctor so diagnosed you, with migraines?    It needs to be in your records and those records need to be in VA's hands. 

2.  "If" you are service connected for allergic rhinitis, then (and only then) can you be SC for migraines "provided that" your doctor makes a nexus statment saying YOUR migraines are at least as likely as not caused by your allergic rhinitis.  

      No, it will not suffice that a Veteran in 2011 at the BVA was rated thusly, you have to demonstrate that YOUR migraines were caused by YOUR allergic rhinitis.  Only a medical professional can provide you with this nexus.  If your doctor so stated, you should be good to go, and then we can discuss percentages.  

Its always in this order:  

First date (Service connection)

Dating  for how long? (disability percentage)

Marriage proposal, acceptance and wedding date (effective date).  

    It rarely goes well for you to call and ask a woman for her  hand without these other steps first.  In a similar manner, dont get the cart before the horse, and start figuring disability percentages when you dont even have a nexus.  

Please accept my apology if, indeed ,you have a valid nexus.  

Edited by broncovet
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7 hours ago, broncovet said:

You might be getting the cart before the horse, skipping too many steps.     It sounds like this is your first date, and you are figuring out which school to send your future children to.  

Just because "another Veteran" got SC for headaches secondary to allergic rhinitis , (in 2011).  does not guarantee you will.  

You will still need, as always,  to establish Service connection prior to picking out which car you want to buy with your retro.  You need

1.  current diagnosis.  Has a doctor so diagnosed you, with migraines?    It needs to be in your records and those records need to be in VA's hands. 

2.  "If" you are service connected for allergic rhinitis, then (and only then) can you be SC for migraines "provided that" your doctor makes a nexus statment saying YOUR migraines are at least as likely as not caused by your allergic rhinitis.  

      No, it will not suffice that a Veteran in 2011 at the BVA was rated thusly, you have to demonstrate that YOUR migraines were caused by YOUR allergic rhinitis.  Only a medical professional can provide you with this nexus.  If your doctor so stated, you should be good to go, and then we can discuss percentages.  

Its always in this order:  

First date (Service connection)

Dating  for how long? (disability percentage)

Marriage proposal, acceptance and wedding date (effective date).  

    It rarely goes well for you to call and ask a woman for her  hand without these other steps first.  In a similar manner, dont get the cart before the horse, and start figuring disability percentages when you dont even have a nexus.  

Please accept my apology if, indeed ,you have a valid nexus.  

I appreciate it... How do I go around asking a professional in the field to make a medical opinion? Like I am willing to pay a doctor for their time and all. But there are guidances on how they need to word their nexus letter. Do I coach them on how to phrase it? (IE - "please be sure to add "at least likely as not"")

For the best route, do I just need to call each local clinic and ask "Hello, I am needing a professional medical opinion and am willing to pay a doctor for their time. Would a physician at this facility be interested in reviewing my medical conditions and then typing their honest medical opinion for me?"

 

I have been rated for 5 things using a similar system as described in original post, but I got a feeling that this one may recieve pushback. Ratings just seem to get harder and harder.

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8 hours ago, broncovet said:

You might be getting the cart before the horse, skipping too many steps.     It sounds like this is your first date, and you are figuring out which school to send your future children to.  

Just because "another Veteran" got SC for headaches secondary to allergic rhinitis , (in 2011).  does not guarantee you will.  

You will still need, as always,  to establish Service connection prior to picking out which car you want to buy with your retro.  You need

1.  current diagnosis.  Has a doctor so diagnosed you, with migraines?    It needs to be in your records and those records need to be in VA's hands. 

2.  "If" you are service connected for allergic rhinitis, then (and only then) can you be SC for migraines "provided that" your doctor makes a nexus statment saying YOUR migraines are at least as likely as not caused by your allergic rhinitis.  

      No, it will not suffice that a Veteran in 2011 at the BVA was rated thusly, you have to demonstrate that YOUR migraines were caused by YOUR allergic rhinitis.  Only a medical professional can provide you with this nexus.  If your doctor so stated, you should be good to go, and then we can discuss percentages.  

Its always in this order:  

First date (Service connection)

Dating  for how long? (disability percentage)

Marriage proposal, acceptance and wedding date (effective date).  

    It rarely goes well for you to call and ask a woman for her  hand without these other steps first.  In a similar manner, dont get the cart before the horse, and start figuring disability percentages when you dont even have a nexus.  

Please accept my apology if, indeed ,you have a valid nexus.  

Also to answer your questions.

1. They have technically rated me for "Chronic Headaches with light sensitivity and nausea/fatigue." I was told since the rating schedule for all headaches and migraines are the same. It does not matter for the purpose of rating if someone has by definition headaches or migraines.

2. Filed for presumptive Allergic Rhinitis about a month ago and was told that it should be passed in a week. I for sure will not file until after the presumptive condition kicks in. I know that it is ALWAYS better to err on the safe side of things. But I have never gotten a Nexus letter and find it extremely stressful and have no idea how to approach a doctor for it. In the past, all of my rating appointments have created the nexuses for me. Heck, for blood pressure, I just pointed to an nih.gov website abstract/conclusion in which it referenced how there is a connection between my medication for Anxiety and high blood pressure. They approved that too. Any info on combatting my concerns and the easiest/best way to request a nexus letter would be appreciated.

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I would have to agree with Bronco. I know that this is a fast paced world as of today but slow your roll. 

You stated that you have been rated for chronic headache, if that is the case, what is the percentage?  We're you rated or do you just have a diagnosis? If you have an actual rating, let's say zero, wouldn't it be better to file for an increase?

 As for as coaching a Dr for a Nexus, let me know how that work out. Most doctors will not do it unless they have been treating you for some time. Not saying that I can't happen but it's hard. 

A Nexus letter is very helpful when filing a claim but if the facts are already in you smr, the Nexus may have already been established. 

Imo, when you provide too much info on the first time, it may intimidate the VA, and they will deny. Now since you have provided everything up front, where is your new and material evidence?

I would submit the headaches as secondary, and see where it goes, get the decision letter to see what I need to establish service connection. It's a long process. 

 

 

 

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2 hours ago, Whodat said:

You stated that you have been rated for chronic headache, if that is the case, what is the percentage?  We're you rated or do you just have a diagnosis? If you have an actual rating, let's say zero, wouldn't it be better to file for an increase?

 

 

 

 

Sorry, I misspoke, I actually meant to say that I have been diagnosed by the VA for chronic headaches.

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31 minutes ago, Wico1337 said:

Sorry, I misspoke, I actually meant to say that I have been diagnosed by the VA for chronic headaches.

Vets have different ways. The way that I would do it, Private Message my PM care team,  ask them due they think that your headaches are caused by your (SC condition). 

They may or may not say it but it's in your records. 

They may say that only a Neurologist can answer that. Try to get a Neuro appt. 

 

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10 hours ago, Whodat said:

Vets have different ways. The way that I would do it, Private Message my PM care team,  ask them due they think that your headaches are caused by your (SC condition). 

They may or may not say it but it's in your records. 

They may say that only a Neurologist can answer that. Try to get a Neuro appt. 

 

Oh my god. I never knew this feature existed. This is so awesome, I just now sent a message to my primary care. I can indirectly ask questions that can later be used as evidence. I am extremely un-confrontational in person, so this is perfect for me. I REALLY wish I had known about this feature years ago, noone has ever told me about this.

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Glad that the Hadit family could help. Sometimes if you go back and read some of the old contents, you can see that we had this discussion. 

MrCue I believe had mentioned it. 

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Yes.  Before grabbing your checkbook and hiring an IMO, I recommend asking your doctor, 

"Do you think (my condition) is related to military service?"  (Wait for his answer). 

If he responds, yes, then ask him to write that down in your records.  

"Ask and ye shall receive".  

Rather than assuming your doc wont provide a nexus, why not just ask him/her?  

 

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Bronco is right.  Always ask as I got all of mine except 1 that I needed an IMO.  

I did this at the VA also.  All of my doctors notated that my issues were caused by and or worsened by issues caused while I was in the military.

The reason I needed the IMO was my PTSD kept getting lowballed at 10% (I am now at 50%) but this is what they do is give you something to shut you up.  

They hope you will not fight it as it is something, but it is not where you should be at.

Also use your Lay statements!  Document everything you can remember and tell them how bad it really is.  

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To clarify:  

A secondary condition is a disability caused by another Service connected condition(s). 

You can not have "headaches" secondary to a non service connected Rhinitis, for example.  

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Very true statement. But if he has something like SC PTSD, insomnia, anxiety/depression. These SC conditions that do not cause headaches but can contribute to his headaches. Could that be a secondary condition?

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Yes, it can be sc secondary, "If" (and only if) your doctor opines that your (diagnosis of headaches) is at least as likely as not due to PTSD/anxiety/depression, etc. (SC conditions).  

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Thank you Bronco. I am not trying to be negative at all. But looks like he it trying to claim a secondary to something that he isn't service connected for. He is trying to get a Nexus or an IMO for something that hasn't been approved. He does an SC mental disorder. I would think that I would try to connect a secondary condition for something that's already serviced connected. Just me. 

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On 7/14/2022 at 8:27 PM, Whodat said:

Thank you Bronco. I am not trying to be negative at all. But looks like he it trying to claim a secondary to something that he isn't service connected for. He is trying to get a Nexus or an IMO for something that hasn't been approved. He does an SC mental disorder. I would think that I would try to connect a secondary condition for something that's already serviced connected. Just me. 

Bingo, he should take the path of least resistance and connect it to a condition already rated. I also highly suggest getting an IMO, unless he has a good working relationship with his VA provider. In my experience, and to my surprise even against VHA policy, I've had a primary care physician for whom I've been seeing for years refuse assistance. The focus should be on getting it documented properly and not who can opine the quickest. 

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I am not trying to be negative at all.

Don't look at our posts as being negative, these are simply the facts and try not to take them personally. We are here to try to help and not discourage. Post may sound insensitive, but they are not meant to be. It is better to be clear and to the point than tell a veteran that the VA should have granted his/her claim when we have already seen and experienced the reality of the VA taking the short cut of denying claims and secondary claims when in fact the claim should have been filed differently. 

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