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 extremely debilitating and can last anywhere from hours to days depending on the person.
Migraines often occur in four stages, known as the prodrome, aura, attack, and postdrome:
- Prodrome: The prodrome, or the “warning” stage, can begin hours or days before the impending migraine. Symptoms include mood changes, food cravings, muscle stiffness, and increased thirst, urination, or sleepiness.
- Aura: The aura occurs immediately before the migraine, with symptoms such as blurred or blind spots, flashing lights, zig zags of color, vision loss, numbness or tingling on one side of the body, muscle weakness, difficulty speaking, and hearing noises. This stage usually lasts no more than 60 minutes.
- Attack: The attack (i.e., the actual migraine headache) is the main stage and the most painful.
- Postdrome: The postdrome is the recovery stage. Sufferers may feel fatigued and experience changes in mood. This stage may last one or two days.
Although it is unclear what causes migraines, triggers can include hormonal imbalance, alcohol, stress, sensory stimulation, certain foods, and changes in environment.
How to Get Service Connection for Migraines
To obtain Department of Veterans Affairs (VA) service connection for migraine headaches, veterans generally must show proof of the following three things:
- An in-service event, injury, or illness;
- A current diagnosis by a medical professional; and
- A medical nexus, or link, between the in-service event, injury, or illness and current diagnosis.
Even if a veteran does not have an official diagnosis of migraine headaches, chronic headaches or head pain can still cause functional loss or affect their ability to earn wages. In other words, if a veteran does not have a diagnosis of migraines, they may still be able to receive compensation if there is proof that the condition affects functionality.
To submit a claim for service connection, veterans can fill out and submit a claim via VA Form 21-526EZ. This form can be submitted online or directly to VA in person.
Secondary Service Connection for Migraines
If a veteran is service connected for a disability that causes them to develop migraines, they can file a claim for secondary service connection. VA grants secondary service connection to veterans that show:
- A diagnosis for the secondary condition (i.e., migraines); and
- Medical evidence showing the connection between the service-connected condition and the secondary condition.
Some common service-connected conditions that may cause migraines include:
VA Ratings for Migraines
VA rates migraine headaches under 38 CFR § 4.124a diagnostic code 8100. The diagnostic code includes disability ratings ranging from 0 to 50 percent, with criteria based on the severity and frequency of migraines. The criteria are 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 of once a month over the last several months
- 10% – with characteristic prostrating attacks averaging one in two months over the last several months
- 0% – with less frequent attacks
The term “prostrating” generally means the migraine headaches are so severe and debilitating that the veteran must lay down for an extended period of time due to complete exhaustion and physical weakness. Typically, prostrating migraines also require veterans to stop all activity and possibly take medication or seek medical attention.
VA Compensation and Pension (C&P) Exams for Migraines
VA will likely schedule veterans for a Compensation and Pension (C&P) exam to determine if a nexus (i.e., the link between the in-service occurrence and the veteran’s current disability) exists. A C&P examiner will gather information about the condition during the exam to decide if it is “at least as likely as not” that the current diagnosis is related to the veteran’s service.
VA may also schedule a C&P exam to evaluate the severity of a veteran’s migraine headaches, in which they will assess whether the migraines are prostrating. Veterans should be sure to thoroughly explain the severity of their symptoms to the examiner. It is important to detail all symptoms and limitations that occur during a migraine episode so the C&P examiner can accurately assess their impact.
If the outcome of a C&P exam is unfavorable, there are ways to challenge it. Veterans should obtain a copy of their exam to see if any information discussed during the appointment is missing or noted inaccurately. Veterans can also request a second opinion from a private physician or medical professional.
How Can I Show That My Migraines are Prostrating?
There are several ways veterans can show VA that their migraines are prostrating. In addition to attending all VA C&P exams for migraines, it can also be helpful to submit lay evidence. Lay statements give veterans the opportunity to directly attest to the severity of their symptoms and how their migraines affect their day-to-day life.
Another useful piece of evidence is a medical opinion. Private physicians can provide medical opinions that can be used as medical evidence of prostration. Doctors can attest to the severity of a veteran’s migraines and whether they can be considered prostrating.
TDIU for Migraines
If service-connected migraine headaches prevent a veteran from obtaining and maintaining substantially gainful employment, they may be eligible for total disability based on individual unemployability, or TDIU. TDIU allows veterans to receive compensation equal to a 100 percent VA rating for migraines, even if their combined disability rating is less than that.
VA grants TDIU on a schedular or extraschedular basis. To be awarded schedular TDIU, veterans must have:
- One condition rated at least 60 percent disabling; OR
- Two conditions that can be combined to reach at least 70 percent, with one condition rated at least 40 percent.
Veterans who do not meet these qualifications may be eligible for extraschedular TDIU. To receive extraschedular TDIU for migraine headaches, veterans must prove that their migraines uniquely hinder their ability to maintain substantially gainful employment.
Were You Denied VA Disability for Migraines?
If VA denied your claim for disability compensation for your migraine headaches, the experienced veterans’ advocates at Chisholm Chisholm & Kilpatrick LTD may be able to help. Call CCK today to schedule a free consultation with a member of our team.
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