– Hi and welcome to Hill and Ponton's Veterans Disability Blog. I'm Natalia Jofre, the company's COO. – Hi, I'm attorney Allison Reddick. – So today we're gonna be
talking about migraines. A lot of our clients suffer
from migraine headaches and so I think, Allison,
it would help, at first, you just gave an overall view
or idea what a migraine is. – So a migraine is a type of headache. There are multiple types of headaches.
There are migraine
headaches, tension headaches, cluster headaches. What a migraine headache is, it's basically defined
off of its symptoms. So a migraine is usually
a more severe form of a headache. It has a long duration. It can last hours to days. It usually focuses on
one side of your head and the pain is moderate to severe. The symptoms that are associated, which differentiate it from
other types of headaches are, you can experience
sensitivity to light, sensitivity to noise, nausea, vomiting, and that is one type of headache. The other types are cluster headaches, which, as it sounds, cluster to one side, but what's interesting
about them is they can move.
– Okay. – So, and that pain is
more of a pressing pain. And then tension headaches are kind of like a band over across your entire head. Those headaches, they
have shorter duration and the pain is more moderate, and they usually don't have
those associated symptoms. Migraine headaches also
can affect your ability to engage in physical
activity whereas tension and cluster headaches usually do not. What is also interesting
is cluster headaches usually are more in men
and migraine headaches are more frequent in women. – So when you say cluster versus migraine, the cluster and the tension headaches, don't fall under the
same migraine umbrella. – So in terms of the VA they do. – They do, okay. – They're all rated
under the same criteria. It's just basically what your doctor is diagnosing you with. The criteria is labeled you migraine but you can still get service connection for tension headaches, cluster headaches, migraine headaches. You can get all three. You can get one or the other. Or, if your doctor diagnoses
you with something else, its all based off of your diagnosis.
– And based on what you were saying you can see very easily
why someone would be unable to work if they have these frequent migraine headaches. When you're talking about
sensitivity to light, like even being in this room, that would be an impossibility. You'd normally need to be in a dark room. – Absolutely. – Everything's off even the sound of a TV on might bother you. I know that residual light
from the TV could bother you. If you're nauseous or vomiting,
makes it difficult to work. – And I think what is really
difficult when, assessing this, is because unless you
experience them you don't know how severely they
affect your daily activities.
– I know that a lot of people, for example I'm one of them, you lose sight in an eye or words start blending together. Really odd symptoms. It almost feels stroke like– – Oh absolutely. – when it starts to happen. And I know a lot of people
have what they call auras, where you start seeing lights
or some kind of trigger that lets you know it's coming. – When I get migraines
I get tunnel vision. I can't see or, like you said,
you'll see flashing lights. It is very similar to stroke symptoms.
– And I think that when our Veterans have that happening they know,
it's almost like, take cover. – Oh, absolutely. – Like get in a dark room. Don't eat anything. Pull off the road and stop driving. – Ice pack on the head. – Yeap, because they know it's coming. – Yes. – So talking about all these symptoms and what it really is like in real life, so the VA schedules you for a C&P exam, Compensation and Pension exam.
What should you know? What should you do to prepare? What's going to happen in that evaluation? Because really if you're not having a migraine actively in that moment, what are they going to look at? How are they going to evaluate this? – In all honesty, if
you're having a migraine, you're probably not going to
be able to go to the exam. – That's true. – Majority of the time
you aren't experiencing a headache or migraine during the exam. So it's really important
that you share your symptoms and how it
affects your daily living. When you go to a C&P exam,
they will ask you questions. If you have a migraine, cluster headaches, what type of pain you have. Is it throbbing, pressing,
one side of the head, both sides of the head? When I think about going to a C&P exam for migraines I think of three things. I think of duration,
frequency, and severity. – Okay, that's important. So duration, frequency, and severity.
– Yes. – So duration– – How long do they last? Do they last 30 minutes, an
hour, four hours, three days? I had a migraine last three days before. – Wow, that's brutal. Frequency– – Frequency, how often are they occurring? Do you have it once a day, once a week, multiple times a week, once
a month, every other month? – And then severity. – How severe is the pain? They can ask you on a
pain scale of one to ten. They'll ask you, what are
called prostrating attacks. And basically what prostrating
attacks are it means you basically can't do anything. You have to lie down, like we said, in a room until the migraine passes.
– I think that one of
the things you hit on in terms of severity
and how bad is the pain, one of the problems that we encounter is that when people go to
an evaluation, because they don't have the pain at that time, they forget how bad it is. Or they will say "Well
right now, I'm like at a two "or I'm at a zero or it's not that bad". Shouldn't they focus on the
way that it normally is, on the severity on their worst days? – Absolutely, and I
think that is something that gets very confusing because a lot of Veterans have multiple
types of headaches. They'll have the
migraines and they'll have cluster headaches everyday. So the cluster headaches they'll say "Oh I'm about a three or a four". But it's those migraines
that you are having once a week, once every
other week, once a month, where you're a nine or a ten and you're completely
incapacitated laying in bed.
– Right, the cluster
headaches maybe are very disruptive to your daily
life but the migraines are what really are
keeping you from working. – Absolutely. – Can you tell us about secondary service connected migraines? What does that mean? How does it work? – So, for a migraine to be
secondarily service connected, that means that you have a
service connected disability, that causes migraines or causes headaches. It doesn't have to be migraines. It can be headaches, any type. Conditions that I can think of would be traumatic brain injury. That would be something that could cause a symptoms of headaches. Neck injuries, if you have an injury and one of your cervical spine, that could absolutely
cause tension headaches, cluster headaches, migraines. Other types would be vascular conditions because of your blood flow. – Like hypertension? – Hypertension or I would
say certain vascular heart diseases that your blood
isn't flowing properly. Peripheral vascular
diseases, things like that. The blood isn't flowing
properly and that affects tension and the blood flow to your brain.
And I think you can even make a case for stress, if you have PTSD,
or something like that. The stress that your body is having on a daily basis can cause headaches. If your doctor says
that I absolutely think that's a possibility as well. – Okay, how does the VA
rate migraine headaches? – So, like I said before,
any type of headache it's rated under one criteria.
Symptoms criteria. So, basically it's rated on the frequency. How often you're having them. To get a ten percent rating you're having a migraine or severely
debilitating headache about once every two months. For a thirty percent rating, you're having these prostrating attacks
about once a month. And then for a fifty percent rating, that's the highest you're having them at least, more than a month,
multiple times a month and it's causing severe
economic and adaptability. And basically that just
a fancy way of saying it's affecting your ability to work. – Yeah, you really can't work. So I didn't know that. For migraines it's
capped at fifty percent? – Yes. – Okay, so you really can't
get a hundred percent? – No. – Okay, so along those
same lines, tell people what TDIU is and can you
get it because of migraines? – Yes, so migraines are, as we said, capped at fifty percent.
But, as we've discussed,
they're extremely debilitating. So total disability based on
individual unemployability is basically saying that,
even though your percentages don't add up to one hundred
percent, you can still be paid at the one hundred percent rate because your conditions
are so debilitating that it affects your ability to work. Now, fifty percent you
aren't schedular qualified. You either have to have
one condition at least sixty percent or a
combination of conditions that add up to seventy
percent with one at least forty percent. So in order to get TDIU
for migraines you have to have other conditions involved or you can try to get extra
schedular consideration. And I think that is
something that happens often because we have many
Veterans who their only disabling condition is
migraines and they can't work. So you can still get
individual unemployability solely based off migraines. You have to provide more evidence and show that you are entitled to an
extra schedular consideration. – What is that extra
schedular consideration? – So basically what they means is that if you don't meet the
numbers that they want, but you have provided
enough evidence that it's disabling you to a point
that you can't work, they take your case to, what is called, the Director of Compensation.
Over there they look
at the evidence and say even though they are
not schedular qualified all of this evidence shows
that they are unemployable based off of it. It's just an extra step. – Okay, it almost like
it equals the severity? All right, great. What would you say are common
issues with migraine claims? – I would, like we discussed
during the C&P exams, stating how the frequency and the duration and the severity. I think those are very
important things to discuss that aren't discussed. And sometimes you can't
depend on the questions that the C&P examiners are asking you.
You need to go in and be honest and tell them how your
symptoms are affecting you at their most severe. I think for migraines,
especially service connection, if you have incident in service or that condition in
service, a current diagnosis and a doctor in nexus stating that your current condition
is caused from service. It's a pretty simple thing
to get service connected. – Allison, what do you think about keeping a diary or something to that effect. A journal when you have the
headache, what type is was, what problems it caused,
anything like that.
– Absolutely. – Do you think something
like that would be helpful? – I think even if your not trying to get compensation. I do that. I will document when I have a migraine so I can realize what is contributing to it. But especially for
compensation, anytime you're having a headache,
frequency, duration, severity it's important cause one, you
can tell your doctor that, and they can document
it and put it in your actual medical record. Or, you can write a statement which can state all that information. You can even send your diary and show, look this is how often
I'm having migraines. – Wow, that's great. This was extremely helpful. Thanks Allison. Okay, we're gonna keep
talking about other obviously Veterans related topics. But in the meantime, if
you have any questions you can feel free to visit our website, call our office, and we hope
you join us again next time.
– Thank you..