Migraines and VA Disability: How the VA Rates Migraine Headaches
Migraines can be debilitating, affecting your ability to work or complete daily tasks. If you’re a veteran whose migraines resulted from your time in the service, you may be eligible for VA disability benefits. Here’s what you should know.
What is a Migraine?
A migraine is a painful headache. One or more of the following symptoms accompany it:
- intense throbbing or pulsing in one area of the head,
- and/or extreme sensitivity to light or sound.
The attacks can last for hours or days. The National Headache Foundation estimates that more than 29.5 million Americans suffer from migraines. Women suffer from migraines three times more often than men.
What causes Migraines?
The medical literature indicates several factors can trigger migraines including sleep problems, medications, stress, and depression. In addition to these factors, I’ve also seen disabled veterans with migraines that are due to spinal problems, traumatic brain injury, or eye injuries.
Many veterans complain of severe headaches; however, they fail to recognize that they may be suffering from migraines. Unfortunately, doctors often misdiagnose migraines as sinus headaches or tension headaches. Some doctors simply do not have the experience to properly diagnosis migraines.
How Common Are Migraines in the United States?
One of the most debilitating medical conditions of our modern age is migraine headaches. From a medical standpoint, migraines are described as moderate-to-severe headache pain that can last a few hours to a few days, accompanied by physiological symptoms, such as nausea, vomiting, and sensitivity to light and sound. Functionally, migraines can be crippling and completely debilitating. Often people who suffer from migraine headaches must lie down in a dark, quiet room for the duration of the attack, and are unable to work or tend to the needs of their families. The veteran population is no stranger to migraine headaches. In fact, a recent study found that 36% percent of veterans who had completed a 12-month deployment to Iraq were either diagnosed with or exhibited symptoms of migraine. Notice that the study only discussed deployments to Iraq. One can imagine that those statistics, if true for Iraq deployments, must also hold true for military service and deployments to other areas as well.
The Migraine Research Foundation provides surprising statistics on the prevalence and implications of migraine headaches in the United States and worldwide:
- Migraine is the 3rd most prevalent illness in the world and the 6th most disabling illness in the world.
- Nearly 1 in 4 U.S. households includes someone with migraines.
- 12% of the population – including children – suffers from migraines.
- 18% of American women, 6% of men, and 10% of children experience migraines.
- 85% of chronic migraine sufferers are women.
- About half of female sufferers have more than one attack each month, and a quarter experience 4 or more severe attacks per month.
- Migraine is most common between the ages of 18 and 44.
- More than 90% of sufferers are unable to work or function normally during their migraine.
- More than 157 million workdays are lost each year in the US due to migraines.
- More than 4 million adults experience chronic daily migraines – with at least 15 migraine days per month.
- Migraine sufferers, like those who suffer from other chronic illnesses, experience the high costs of medical services, too little support, and limited access to quality care.
- Having migraines increases the risk of other physical and psychiatric conditions.
- The vast majority of migraine sufferers do not seek medical care for their pain.
- Only 4% of migraine sufferers who seek medical care consult headache and pain specialists.
Does The VA Recognize Migraines as a Disability?
VA recognizes migraines as a service connected disability, so long as the veteran can prove a connection with military service. In other words, if the veteran can prove that the migraines began in service it is service connected. Another way is a secondary service connection. If the migraine relates to other service-connected conditions, then she may obtain service-connected disability for this condition.
How Does The VA Rate Migraines?
Veterans suffering from migraines may be experiencing this ailment due to an in-service incident. In this case, you may be eligible for VA disability compensation for your migraines. By proving service connection and gathering enough medical evidence, former service members can take steps to obtain veterans benefits.
In spite of its acutely disabling effects, migraines take up a very small section in the VA diagnostic code for ratings and have a maximum schedular rating of 50%. VA ratings for migraines are principally rated according to the frequency of the migraine attacks.
Here are the ratings according to the Department of Veterans Affairs:
- 0% – With less frequent attacks
- 10% – With characteristic prostrating attacks averaging one in 2 months over the last several months
- 30% – With characteristic prostrating attacks occurring on an average once a month over the last several months
- 50% – With very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability
The VA uses diagnostic code 8100 to rate headaches, including migraine headaches. While the rating code itself is vague, the VA’s internal adjudication manual, the M21-1, provides clarification for these terms for the decision-makers:
Prostrating: causing extreme exhaustion, powerlessness, debilitation or incapacitation with substantial inability to engage in ordinary activities.
Completely prostrating: means extreme exhaustion or powerlessness with essentially total inability to engage in ordinary activities.
Severe economic inadaptability: denotes a degree of substantial work impairment. It does not mean the individual is incapable of any substantially gainful employment. Evidence of work impairment includes, but is not necessarily limited to, the use of sick leave or unpaid absence.
Very frequent: Duration of characteristic prostrating attacks, on average, are less than one month apart over the last several months
Less frequent: Duration of characteristic prostrating attacks, on average, are more than two months apart over the last several months.
The magic word for an increased rating, therefore, would appear to be “prostrating.” We find that this is exactly the case for VA disability claims relating to migraines and it is key to obtaining VA benefits. The Disability Benefits Questionnaire for headaches, which the Compensation and Pension examiners use to conduct their exams, includes a whole section on “prostrating attacks.” The questionnaire prompts the examiner to ask the veteran if the migraine attacks occur:
- Less than once every two months
- Once in two months
- Once every month
- More frequently than once a month
- Very frequent prostrating and prolonged attacks of migraine headache pain
While a 50% schedular rating is the highest rating most veterans will receive for migraines, it may be possible to receive extra-schedular individual unemployability.
How Do I Get a Proper Rating on My Migraines VA Disability Claim?
For a veteran to make VA properly rate her for migraines, she must show the headaches are actually migraines. The best evidence is medical records showing a qualified medical person diagnosing migraines. For example, a diagnosis from a neurologist, migraine specialist, ophthalmologist, optometrist, or even a primary care physician. The nuance, however, for an accurate rating, the veteran must have more than just a diagnosis. The veteran must show evidence of the severity and frequency of the migraines. Helpful evidence would be medical records, headache diaries kept by the veteran, statements from loved ones, employment records showing absenteeism.
A compensation and pension exam is another important element of service connection and disability claims. With the fate of your migraines percent rating essentially in the hands of the C&P examiners, there are a few things you can do to boost your case for an increased rating:
Complain, complain, complain!
As with most other medical conditions, documentation is key for your VA claim for an increased rating. Tell your doctor about your migraine headaches, even if you do not take prescription medication for them. Let them know your symptomology, limitations, frequency of headaches, and precautions you must take during migraine attacks. That way, even if the C&P examiner does not accurately represent the severity of your migraine headaches, the medical record will support the criteria for a higher rating.
Don’t downplay your symptoms.
This goes hand-in-hand with the first point. A good rule of thumb, especially for C&P exams, is to describe the symptoms of your most severe migraine attacks. The headaches might not always be that severe, but the point is for the VA to compensate you for functionality that you lose due to your service-connected conditions. However, this is not to say that you should exaggerate your symptoms, as this could cause problems later on.
Write a statement.
You are your own best historian. You know your migraine condition better than anyone else—so write about it. As with the first point, describe your symptomology, limitations, frequency of headaches, and precautions you must take during migraine attacks. Statements from family members, friends, and/or coworkers who witness you during migraine attacks are also very beneficial. Statements are a strong piece of evidence, especially if you do not see your doctor very often.
How Do I Get The Highest Rating?
As stated above, the highest schedular rating for migraines is 50%. However, this not the highest for a veteran who feels her migraines make her unemployable. Veterans who are unable to work due to migraines may be eligible for Individual Unemployability (IU). IU requires specific evidence from a veteran to qualify for IU benefits. Even though VA doesn’t provide a 100% schedular rating for migraines, a veteran could still get 100% through IU.
Have Questions About VA Ratings for Migraines?
The rating schedule for veteran’s headaches is vague, but that doesn’t mean you’re not entitled to disability benefits. If the VA denied your claim for benefits, or you received a lower rating than you think you deserve, the team at Hill & Ponton can help. Contact our law firm today for a free case evaluation.
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