Migraine headaches have become a growing problem for veterans as they return home from deployments. In fact, one study shows an increase of nearly 60% in migraine diagnoses in U.S. Army members between the years 2001 and 2007. Veterans suffering from migraines suffer from debilitating symptoms, and also face challenges when looking for jobs or trying to finish school. Studies have shown that migraines have a substantial negative affect on a person’s ability to earn a living. Individuals with migraines have reduced productivity at work and a greater number of missed workdays.
According to the Mayo Clinic, “a migraine headache can cause intense throbbing or pulsing in one area of the head and is commonly accompanied by nausea, vomiting, and extreme sensitivity to light and sound. Migraine attacks can cause significant pain for hours to days and be so severe that all you can think about is finding a dark, quiet place to lie down.” The VA rates migraines under the diagnostic code 8100.The rating percentages for migraines are assigned as follows:
- 50% – with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability
- 30% – with characteristic prostrating attacks occurring on an average once a month over last several months
- 10% with characteristic prostrating attacks averaging one in 2 months over last several months
- 0% – with less frequent attacks
The best kind of evidence to show that the veteran is suffering from migraines is medical evidence showing a diagnosis of migraines. For example, a diagnosis from a neurologist, migraine specialist, ophthalmologist, optometrist, or even a primary care doctor. However, in order to be accurately rated, there must be more than just a diagnosis. The rating criteria for migraines takes 2 things into account: frequency (how often the migraines occur) and severity (how bad the migraines are). VA regulations use the word “prostrating” to address the severity factor and define “prostrating” as, “causing extreme exhaustion, powerlessness, debilitation or incapacitation with substantial inability to engage in ordinary activities.” Regulations do not specifically define the terms “less frequent” or “very frequent”.” Assigning a rating for migraines is a factual basis and the VA is supposed to consider the following evidence:
- Medical progress notes
- Competent and credible lay evidence on how often the veteran experiences symptoms (as long as those symptoms have been competently identified as symptoms of migraine headaches)
- Contemporaneous notes, such as a headache journal
- Prescription refills
- Witness statements
Despite recognizing the possible debilitating effects of a migraine, the highest rating possible for migraines is 50%. A 50% rating is assigned when a veteran’s migraines cause “very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability.” The VA defines “completely prostrating” as extreme exhaustion or powerlessness with essentially total inability to engage in ordinary activities. In other words, a 50% rating is assigned when a veteran’s migraines are so severe that they are totally incapacitated often enough to render them unemployable. Despite recognizing the incapacitating effects of migraines, the VA’s rating criteria for migraines makes it impossible for a veteran with the highest migraine rating available meet the VA’s criteria for individual unemployability on a schedular basis (which requires a rating of at least 60% when there is one service-connected disability that affects a veteran’s ability to work). Also, VA regulations specifically note that “severe economic inadaptability” does not mean a veteran is incapable of any substantially gainful employment. Rather, the VA says that severe economic inadaptability means a veteran has substantial work impairment. It’s clear to see that the rating criteria for migraines is completely inadequate while also completely contradicting itself.
The VA says that migraines can render a veteran unemployable while at the same time saying the veteran does not have a high enough rating for individual unemployability. If you have been denied IU based on not meeting the rating requirements, don’t forget about extra-schedular IU. Extra-schedular IU allows a veteran to receive individual unemployability even when their service-connected disabilities do not meet the percentage requirements that schedular IU requires. It can be much more difficult to prove entitlement to IU on an extra-schedular basis. Because of that, it is important to carefully document your migraine symptoms and how they affect you in order to present a strong claim. One of the best ways to do this is by keeping a headache journal. It’s important to specifically include notes in your headache journal about how a migraine attack affects your ability to remain productive at work, or even remain in the office at all. For example, do you have to leave work every time a migraine attack occurs in order to go home and lay down in a dark quite room? How many days of the month does this occur? Don’t forget about including notes about how the migraine continues to affect you even after the initial onset. For example, include notes about how many days of work you miss when a migraine attack occurs due to prolonged pain, exhaustion, or medication side effects. Keeping track of how often migraine attacks happen and how they affect you will be valuable information for not only ensuring an accurate rating for your migraines, but also in showing that you are unable to work without special accommodations.
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