According to the VA’s 2019 Annual Benefits Report, migraine headaches are the ninth most prevalent service-connected disability among new compensation recipients, with 43,185 veterans receiving service-connected compensation for migraine headaches. However, based on our attorneys’ experience, migraine headaches are one of the most impairments for which the VA assigns veterans a lower percentage disability rating than they are actually entitled to based on the medical and other evidence already in their claims file. For example, the VA routinely assigns veterans a 10 or 30 percent schedular disability rating for their migraine headaches when they are in fact entitled to a 50 percent schedular disability rating, which is the maximum schedular disability rating allowed by the VA under its rating schedule (see Diagnostic Code 8100).
Furthermore, because migraine headaches can be debilitating due to the intensity and duration of the throbbing head pain that they cause, not to mention the other symptoms, such as nausea, vomiting, and photophobia, that often accompany such pain, veterans who suffer from service-connected migraines are often unable to work as a direct result of their migraine headaches. Veterans who are unable to work due to their service-connected migraine headaches are eligible for a total disability rating based on individual unemployability (TDIU), which provides 100 percent compensation from the VA, often on a permanent and total (P&T) basis. As described in the below sections, if you experience very frequent, prostrating and prolonged migraine headache attacks productive of severe economic inadaptability, you are entitled to a 50 percent schedular disability rating for migraine headaches from the VA, but you may also be entitled to a TDIU rating on the same basis as experiencing very frequent, prostrating and prolonged migraine headaches alone precludes a veteran’s ability to maintain regular attendance at any job, which is one of the main requirements of a substantially gainful occupation (SGO). It is self evident that incapacitating migraine headache attacks are unpredictable and, therefore, that they will result in unscheduled work absences. Any vocational expert will confirm that no competitive employer can accommodate such unscheduled and unpredictable absences (if they occur frequently enough) because the unpredictability of such absences makes it impossible for any employer or supervisor to get another worker to fill in for the absent employee incapacitated by a migraine headache.
In this guide, we will outline what evidence is needed to get service connected for migraine headaches, how the VA assigns veterans a percentage rating for migraines, and how veterans can strengthen their claim or appeal for service connection for migraine headaches or an increased schedular disability rating for migraine headaches.
Getting Service Connected For Migraine Headaches: What Evidence Is Needed
In order for the VA to award service connection for migraine headaches, a veteran must show that his or her migraine headaches (1) began while the veteran was still in service, (2) were caused by an in-service incident, or (3) were caused by another service-connected impairment. If a veteran can show that his or her service medical records reflect that he or she was diagnosed with and treated for migraine headaches while still in service, then there is a very high likelihood that the VA will grant his or her claim for service connection for migraine headaches. However, if a veteran’s service medical records reflect treatment for headaches and not migraines specifically, the VA may require a medical nexus opinion opining that the veteran’s in-service headaches were in fact the same migraine headache attacks that the veterans continues to experience after his or her service.
Similarly, if the veteran’s migraine headaches began only after his or her discharge from the military but were caused by an in-service injury, illness, or even exposure, the VA will require a medical nexus opinion opining that the veteran not only has migraine headaches but also that such headaches were caused by his or her in-service injury, illness, or exposure. It is important that the physician completing such a medical nexus opinion states in his or her medical nexus opinion that he or she has reviewed the veteran’s service personnel or medical records or other documents corroborating the veteran’s in-service injury, illness, or exposure.
Lastly, many veterans develop migraine headaches on a secondary basis, meaning that their migraine headaches are caused by another service-connected impairment. Here again, the VA will require a medial nexus opinion showing that the veteran’s migraine headaches are caused by another service-connected condition, such as a traumatic brain injury (TBI), tinnitus, etc. It is important for the physician completing such a medical nexus opinion to (1) summarize the general causative link between such conditions and cite relevant clinical research demonstrating such a causative link exists generally and (2) explain how the veteran’s specific disease process has caused the development of migraine headaches on an at least as likely as not basis.
How The VA Assigns Disability Ratings For Migraine Headaches
As described in the above, the VA rates migraine headaches under Diagnostic Code 8100, which allows for veterans to receive a percentage disability rating of 0, 10, 30, or 50 percent disabling.
Diagnostic Code 8100
- 50 Percent Schedule Disability Rating
With very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability
- 30 Percent Schedule Disability Rating
With characteristic prostrating attacks occurring on an average once a month over last several months
- 10 Percent Schedule Disability Rating
With characteristic prostrating attacks averaging one in 2 months over last several months
- 0 Percent Schedule Disability Rating
With less frequent attacks
Veterans reading the above rating schedule often wonder what exactly the VA means by the terms “prostrating,” “severe economic inadaptability,” and “very frequent” versus “less frequent.” Though the VA’s regulation containing Diagnostic Code 8100, 38 CFR 4.214(a), is silent on defining these terms, the VA’s Manual M21-1MR defines these terms as follows:
means “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.” (Italics Added)
- Less Frequent
means “duration of characteristic prostrating attacks, on average, are more than two months apart over the last several months.”
- More Frequent
means “duration of characteristic prostrating attacks, on average, are less than one month apart over the last several months.”
In order to demonstrate the frequency and severity of his or her migraine headaches, veterans are able to submit the following evidence to the VA for consideration:
- Medical progress notes, examination reports, or opinions
- Competent and credible lay evidence on how often the claimant experiences symptoms
- A migraine headache journal or log
- Records showing the veteran’s history of prescription refills
Generally, a combination of medical treatment records, a neurological opinion, a sworn declaration by the veteran or a family member, and a detailed migraine headache journal establishes the strongest claim for a proper evaluation of a veteran’s migraine headaches.
How To Strengthen Your Claim For Migraine Headaches
In simplest terms, a veteran needs to do everything possible to document the frequency and severity of his or her migraine headache attacks. By far the best evidence is medical evidence (1) diagnosing a veteran with migraine headache attacks that began in service, were caused by an in-service incident, illness, or exposure, or were caused by another service-connected condition and (2) specifying that the veteran has very frequent prostrating and prolonged migraine headache attacks. Such evidence usually comes from a neurologist or a primary care physician who is treating a veteran for migraine headaches. Even if you do not have access to treatment with a neurologist or a doctor that has experience treating migraine headaches, you still need to report your symptoms to your doctor so that there is medical evidence documenting your symptoms as well as the frequency and severity of our migraine headache attacks. If your headaches are so severe that you have had to seek emergency treatment in a hospital’s emergency room and/or receive forehead injections to stop a severe and intractable headache, make sure to obtain the medical records and discharge summary documenting such emergency treatment. This medical evidence is paramount because the VA will almost certainly refer you to a C&P examination with one of its examining doctors, who are often underpaid, overworked, and incentivized to spend as little time reviewing your records, interviewing you, and completing the Migraine Headaches Disability Benefits Questionnaire (DBQ) as possible. Having favorable medical evidence already in your file stacks the deck in your favor that the VA’s C&P examining physician will adopt your treating doctor’s findings regarding your diagnosis and the severity and frequency of your headaches. Plus, in the event the C&P examining doctor misstates the frequency and severity of your migraine headache attacks, there will already be other medical evidence showing the true frequency and severity of your migraines, which can help to combat unfavorable C&P examination findings.
In addition to having proper medical evidence regarding their migraine headaches, every veteran will be well served by keeping a detailed migraine headache log documenting the occurrence of each migraine headache attack as well as its severity, length, and associated symptoms. Such a headache log can be kept in any number of ways: as handwritten notes on a kitchen calendar, Excel spreadsheet entries, or even a running log on a smartphone notetaking application. In our experience, keeping a detailed headache diary for the VA to review lends an additional layer of credibility on top of any sworn statements provided by the veteran or his or her family members.
Lastly, veterans need to be honest and forthright about their symptoms when speaking with the VA’s C&P examining physician. Even if you feel rushed by the doctor or have difficulty opening up about the severity of your headaches with people whom you are unfamiliar, it is important that you quickly and accurately describe the frequency and severity of your migraine headache attacks in a way that the doctor can comprehend even if he or she is only half listening or filling out the DBQ while you talk. Though veterans should never exaggerate their symptoms, veterans need to do what they can to speak accurately and clearly during C&P examinations to make sure the doctor comprehends how severe their migraine headaches are and the limitations such headaches have caused.
Contact The Veterans Law Office About Your Migraine Headaches Claim
If you are a veteran and have not been properly compensated by the VA for migraine headaches you believe are the result of your service in the military, please contact our office for a free case evaluation. Our veterans law attorneys have extensive experience representing veterans with severe migraine headaches in both claims for service connection and claims for increased disability ratings.