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Latest News

How the VA Rates Migraine Headaches

VA Rates Migraine

 

Migraines Statistics in the US

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 Migraine Research Foundation provides surprising statistics on the prevalence and implications of migraine headaches in the U.S. 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.

Migraine Ratings for Veterans Benefits

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 deployments to other areas as well.

In spite of its acutely disabling effects, migraines take up a very small section in the VA diagnostic rating code and are rated at a maximum of 50%. Migraines are principally rated according to the frequency of the migraine attacks.

  • 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 magic word for an increased rating, therefore, would appear to be “prostrating.” We find that this is exactly the case. 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

What are Prostrating Migraines and What Are Their Ratings?

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.

When you add the adjudication manual definitions to the rating criteria language, you will find that the Disability Benefits Questionnaire questions translate to this:

  • Less than once every two months = 0%
  • Once in two months = 10%
  • Once every month = 30%
  • More frequently than once a month = 50% AND
  • Very frequent prostrating and prolonged attacks of migraine headache pain = 50%

The magic word “prostrating” holds even more weight, as the adjudicators tend to look only at Section IV – Prostrating Attacks of Headache Pain (as shown below) in making their determination. The examiner does not check the “Yes” box under 4A or 4C, the adjudicators will not award a higher rating.

However, the adjudication manual cautions adjudicators that even if the term “prostrating” does not appear in the Veteran’s medical record—or in the C&P examination, for that matter—equivalent symptomology would warrant that rating. For example, the manual states that if a Veteran provides testimony that he/she 1) experiences severe headaches and vomiting when exposed to light; 2) does not engage in any activities when this occurs; and 3) must rest or sleep during these episodes; and if there is medical evidence that the claimant’s description of symptoms is in fact symptoms of migraine headaches, a determination that the headaches cause prostration can be made.

What does all this mean for you?

With the fate of your migraines 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 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 examinations, 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.

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