How Does the VA Rate Migraine Headaches?
What Are Migraine Headaches?
Migraine headaches are a type of headache characterized by intense pain that can be accompanied by nausea, vomiting, sensitivity to light and sound, lightheadedness and blurred vision. Migraines can be debilitating and can last anywhere from hours to days depending on the person. It is unclear what causes migraines but triggers can include hormonal imbalance, alcohol, stress, sensory stimulation, certain foods, and changes in environment.
How to get Service Connection & Secondary Service Connection for Migraines
When attempting to obtain service connection for migraine headaches, VA will likely schedule you for a Compensation and Pension exam. The examiner will gather information about your condition in order to render an opinion as to whether it is at least as likely as not you’re your current diagnosis is related to your service. However, if the outcome of the exam is unfavorable, there are ways to challenge it. Obtain a copy of your VA exam to see if any information discussed during the appointment is missing or noted inaccurately. If the VA examiner concludes there is no connection between your condition and your military service, a second opinion from your treating physician may provide the positive nexus needed. In addition to attending all VA exams, it can also be helpful to submit lay statements because you are able to attest to the severity of your symptoms and how they affect you on a daily basis.
While you may not necessarily have an official diagnosis of migraine headaches, chronic headaches or head pain can still cause functional loss or have an effect on your ability to earn wages. In other words, if you do not have a diagnosis of migraines, you may still be able to receive compensation long as there is proof of effect on functionality. Once service connection is established for a disability, veterans may then be eligible to receive compensation for any other conditions that service-connected condition causes or irritates. This is called secondary service connection. When a service-connected condition causes and/or aggravates a non-service-connected condition, that condition can then be service connected. For example, if a veteran is service connected for a cervical spine condition which causes migraine headaches, the veteran may be able to get the migraine headaches service connected on a secondary basis.
How Does the Appeals Modernization Act Come into play?
On February 19, 2019, VA implemented its new benefits appeals system under the Appeals Modernization Act (AMA). If a veteran previously filed a claim for service connection for headaches and was denied, he or she can refile their claim if they have new and relevant evidence. There needs to be evidence that did not exist or was not considered at the time of the denial, whether it is updated medical treatment records, lay statements, service records, and so on.
How Does the VA Rate Migraines?
In order to obtain service connection for migraine headaches, there must be a link between the current disability and an injury, illness, or in-service event. Once service connection is established, VA will rate migraine headaches under 38 C.F.R. 4.124a diagnostic code 8100. The diagnostic code includes disability ratings from 0 percent to 50 percent, and entitlement to each rating depends on the severity and frequency of migraines. For instance, a 0 percent rating stipulates less frequent attacks of migraine headaches, but the 50 percent rating is warranted for a veteran who has “very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability.”
VA uses the word “prostrating” in the rating criteria for migraine headaches. To have a prostrating migraine means that the headache is debilitating. An example of a prostrating migraine could be if a veteran becomes physically weak and exhausted and so sensitive to light that he or she is bedridden in a dark room. If your migraines are so disruptive to your daily life such that they prohibit you from completing your activities of daily living or from going to work, they could be considered prostrating.
How Do I Prove That My Migraines are Connected to Service?
Upon filing a claim for service connection for migraines, VA may schedule you for a compensation and pension exam. VA may also schedule a veteran for a C&P exam if a condition is already service connected, but an assessment of severity is needed. For C&P exams for migraine headaches, the examiner will assess whether your migraines are prostrating. When you attend your exam, be sure to thoroughly explain the severity of your symptoms to the examiner. It is important to detail your symptoms and limitations during a migraine episode so the examiner can accurately assess the impact of your migraines.
How Can I Show That My Migraines are Prostrating?
There are a number of ways veterans can show VA that their migraines are prostrating. The first is to submit lay statements. Lay statements can be useful as they give veterans a chance to detail their symptoms and the impact they have on their daily life or ability to work. In your lay statements, it may be useful to explain what happens when you get a migraine and what activities you are not able to do when you experience one.
Another useful piece of evidence that a veteran can submit is a medical opinion. Medical opinions can be provided by your personal physician and can be used to provide medical evidence of prostration. Your doctor can attest to the severity of your migraines and whether they can be considered prostrating. Speak to your doctor to see if he or she would be willing to write a letter in support of your claim.
Am I Eligible for TDIU Due to My Migraine Headaches?
If a service-connected migraine headache condition precludes a veteran from obtaining and maintaining substantially gainful employment, he or she may be eligible for a total disability rating based on individual unemployability (TDIU). VA requires that veterans fill out VA Form 21-8940 Veteran’s Application for Increased Compensation Based on Unemployability for all TDIU claims.
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