This is part 3 in a 3 part series on maximizing your VA disability compensation for headaches.
And you can learn more about how to get the highest VA Rating for migraine headaches in Part 2 of this series by clicking here.
In this part I want to show you how to maximize your VA Disability compensation for headaches, by giving you 5 pointers that are frequently overlooked by Veterans with VA disability claims for headaches.
Let’s get to it…..
5 Pointers for Maximizing VA Disability Compensation for Headaches.
Pointer #1: You can get Compensation for more than just “Migraine” Headaches.
This rating criteria is commonly thought to apply just to migraine headaches. This would be wrong.
VA Disability compensation for headaches is available for ALL types of headaches – not just migraines.
If you have TBI headaches, you are going to want to push for rating of your condition using a hyphenated Diagnostic code. For example, consider diagnostic code 8045-8100.
A hyphenated diagnostic code is used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the evaluation assigned. 38 C.F.R. § 4.27.
So, in the above scenario of TBI headaches, Diagnostic Code 8045 represents residuals of traumatic brain injuries, while Diagnostic Code 8100 addresses headaches. 38 C.F.R. § 4.124a.
In rating the residuals of a TBI (on or after October 23, 2008), the VA instructs its raters to evaluate subjective symptoms that are residuals of a traumatic brain injury, whether or not they are part of cognitive impairment, under the subjective symptoms facet in the table.
However, the rater is to separately evaluate any residual with a distinct diagnosis that may be evaluated under another diagnostic code, such as migraine headache or Meniere’s disease, even if that diagnosis is based on subjective symptoms, rather than under the table 73 Fed. Reg. 54693 (Sept. 23, 2008).
What does that mean? If your headaches result from a TBI, maximizing your VA disability compensation for headaches means getting a headache rating that is SEPARATE from the TBI rating.
Another example are Tension Headaches.
Tension headaches are not a listed disability in the rating schedule for VA disability compensation.
So what do you do?
When an unlisted condition is encountered, it is permissible to advocate for the VA to rate you using the diagnostic code from a closely related disease or injury in which not only the functions affected, but the anatomical localization and symptomatology are closely analogous. 38 C.F.R. § 4.20 (2014).
That’s a mouthful.
Let’s apply it to the tension headache claim.
Since there is no rating schedule for tension headaches, and since the migraine headache DC 8100 is closely related because it discusses the same symptomatology in regards to the same anatomical body part, 38 CFR 4.20 compels the consideration of DC 8100 to rate the unlisted tension headaches.
For you “code-sheet” geeks, according to VA policy, when a disability is not specifically listed, the Diagnostic Code will be “built up,” meaning that the first 2 digits will be selected from that part of the schedule most closely identifying the part of the body involved, and the last 2 digits will be “99.” 38 C.F.R. § 4.27 (2014). In the instant case, the Veteran’s disability is listed under code 8199-8100.
Bottom line – you can maximize your VA disability compensation for headaches by recognizing that ANY kind of headache that is relate to military service, caused by another service connected condition, or aggravated by treatment of a service-connected condition entiles you to VA disability compensation for headaches
Pointer #2: Medication and Flareups in the Compensation and Pension Exam.
Obviously, many of us with headaches use medicine to treat them.
The VA cannot consider the ameliorative effect of your medication for your headaches because the Diagnostic Code doesn’t specifically allow it do so.
So, when rating your migraines, the VA C&P Examiner must look at your condition over a period of time to determine its severity….but if they consider reducing your rating, or give you a lower rating because you are taking medication for your headaches, there is error in this decision and it is worth appealing. Don’t file a reconsideration – file an appeal!
It’s also pretty common to see the VA deny a compensable rating for migraines or headaches – or low-ball the rating – because you aren’t experiencing headaches at the time of the exam.
That’s silly, when you think about it.
What are the odds that at the exact moment of your C&P Exam you will experience a headache that characterizes your condition? Actually, given that we are dealing with the VA, probably pretty high, rate?
All kidding aside, in the next pointer I will talk to you about the importance of a “Headache Journal” – this will help you give the examiner an idea of the picture of your whole headache condition over a period of time.
If you share this information with them – preferably in Sworn Declarations – and they still rate you low or at a 0% level because you weren’t having a headache at the time of the exam, you might want to give strong consideration to filing a Notice of Disagreement and appealing what is likely a low-balled rating.
Pointer #3: Keep a Headache Journal to Maximize the rating.
The day you file your claim for VA disability compensation for headaches, run down to Office Depot and grab yourself a $1.99 notebook.
In that notebook, start keeping a headache journal.
Write down the date and time of the headache, how long it lasted, how it felt, how you responded to it (laid down, found dark room, threw up in bathroom, etc), who saw it happen or was around when it happened, etc. You don’t need to write “War and Peace”…just key memory joggers about the time, duration and effects of the headache.
This becomes crucial when you read Point #4. If you have been keeping a good “headache journal”, when you need to build the Sworn Declarations to maximize your VA disability compensation for headaches at the rating stage.
All you have to do is go through your headache journal and turn it into a sworn declaration.
If there is ever a question – in an increased rating claim, or a staged rating scenario, for example – of when your condition got worse, or when you became entitled to the higher rating, this Headache Journal essentially becomes the key to getting you the earliest and highest rating or effective date possible.
Pointer #4: MORE Lay Evidence means MORE VA disability compensation for headaches.
I touched on this in the second part of this series of posts, and I go into great detail on using Lay Evidence to prove service connection and rating criteria in VA Claims in my VA Claims Evidence Field Manual.
But it is important enough to emphasize here, again.
When it comes to securing the highest rate of VA disability compensation for headaches, it is Lay Evidence that will make or break your case. Once you have a medical record of headaches, tension headaches, migraine headaches, etc., then what is most important to maximize the rating is Lay Evidence.
That Lay Evidence should focus on 3 things, and be developed by affidavits or sworn declarations from as many people as you can identify:
The FREQUENCY of your headaches and prostrating attacks, and the interference with your economic viability: how many times do you experience these symptoms in a given time period. 3 times a day? 10 times a week? Daily every month? Prove up the Frequency in your sworn declarations.
The CHRONICITY of your headaches and the resulting prostrating attacks or economic inadaptability. Chronicity differs from frequency in this way: given a particular frequency of a set of symptoms, how long over time have you experienced those symptoms? In other words, frequency speaks to having headaches “every hour during the day”. Chronicity speaks to having headaches “every hour during the day, for the last 5 years”. See the difference? It’s crucial particularly when the VA has to figure out what rating you should be assigned historically in your claim. (Posts on staged ratings are coming soon).
The SEVERITY of your headaches is the essence of a VA rating for the condition. This is where you describe how the headaches feel, what they result in, and where it is hurting you. You really need to paint a picture. It is one thing to discuss the Frequency and Chronicity of your headaches by saying: “I have headaches every hour during the day for the last 5 years” It is a whole different ball-game when you can paint the picture of the SEVERITY: “I have headaches every hour during the day for the last 5 years, and when they hit me, I have to find a dark room to lay down in for 40 minutes, while a throw-up from the dizziness, and cry because my head feels like its being crushed in giant vice.”
Pointer #5: Don’t forgetVA disability compensation for headaches secondary to another service-connected condition.
Headaches are secondary to a whole host of medical conditions – and as explained in the example of the TBI related headaches above, should be rated as separate conditions by the VA.
Have a Brain Tumor? Dehydration from cancer treatment frequently causes headaches – bad ones. So secure secondary service connection and a secondary rating for your headaches resulting from the Brain Tumor.
TMJ pain is pain that results from the joint/hinge that connects your jaw to your skull. TMJ pain is discussed and explained here – and I think you’ll agree with me that any Veteran that has had severe head or neck jaw is at a high risk for TMJ pain. When a Veteran experiences TMJ related pain, headaches are a pretty common result. Again, think secondary service connection and separate headache rating here.
Here’s list of a whole bunch of other common Veteran medical conditions that cause – or result in – severe and prolonged headaches: Neck and Cervical sprains and strains, Sinusitis, Chronic Rhinitis, and Upper Respiratory Tract Infections, Strokes, Traumatic Brain Injuries, Concussions, Chronic Fatigue Syndrome (CFS), Fibromyalgia, CMSI from Gulf War Syndrome, Sleep Apnea, other Sleep Disorders, Renal failure, thyroid issues, chronic dehydration, rhabdomyolosis….the list goes on and on.
More than that though, think about how many of your medications prescribed by the VA result in headaches as a side effect. When VA treatment results in another condition, you have 2 other legal theories to consider: secondary service connection, and service connection due to VA Medical treatment.
Bottom line, if you have any service-connected condition, and headaches are a symptom or result of that condition or its treatment, you should be considering secondary VA disability compensation for headaches.
That ends this 3-part series.
And it’s a TON of information.
If after reading it, you have any questions about VA disability compensation for headaches, use the form in the lower right corner (or the green support button on any page of the Veterans Law Blog) to send me your questions.
My goal is to make the Veterans Law Blog the BEST resource for Veterans trying to cut through the FOG of VA Claims, and I can only do that if you let me know where you need MORE information.