Many veterans develop migraine headaches as a result of their service. Traumatic brain injuries (TBIs) often result in migraine headaches. TBIs also result in other medical conditions as well, some of which VA presumes to arise secondary to the TBI.
In order to qualify for VA disability benefits, a veteran must show that their particular disability is the result of their military service. But, even after receiving service connection for a disability, the veteran needs to make sure VA rates the condition properly.
How are migraine headaches rated?
VA ratings come from VA’s regulations in the Code of Federal Regulations (CFR). Different conditions have different “diagnostic codes”.
For migraine headaches, VA uses diagnostic code 8100. This diagnostic code falls within the “neurological conditions and convulsive disorders” sections of VA’s diagnostic codes.
VA rates migraine headaches using a couple of different factors. These factors are:
- The frequency of the migraine attacks over the last several months
- The severity of the headaches when they do occur
What must you show to qualify for a 30 percent rating for migraine headaches?
In order to qualify for a 30 percent rating, VA says that you must have, “characteristic prostrating attacks occurring on an average once a month over the last several months.” To understand what this means, we need to break down several different terms:
- The last several months
To understand these terms, it is helpful to compare it to the definitions for a 10 percent rating and a 50 percent rating. The only difference between a 10 percent and a 30 percent rating is the frequency of the migraines.
The 10 percent rating averages one “characteristic prostrating attack” every two months “over the last several months”. The 30 percent rating averages one a month over the same time frame.
But, that still does not necessarily explain what characteristic and prostrating mean. Characteristic means typical. Prostrating means lying down.
When I think of migraine headaches, I think of someone’s head hurting and needing to lie down. Often, they need to do so in a dark room. So, a characteristic prostrating attack would be a typical migraine that causes you to need to lie down.
We can also compare it to what VA requires for a 50 percent rating. With a 50 percent rating, VA says they have to be “completely prostrating” and “prolonged attacks”.
In my mind, deleting the word completely from the 30 percent rating means that your attacks are still prostrating but not completely so. Maybe the migraine requires you to lie down in bed or on the couch, but you can get up some and then lie down again when it becomes more severe.
How frequent do the migraines have to be for a 30 percent rating?
VA’s migraine regulation says that the “characteristic prostrating attack” must occur “an average of once a month over the last several months. The averaging part of the regulation is pretty easy. However, what period of time VA uses can matter in whether you qualify for a 10 percent or a 30 percent rating.
Suppose you had the following “characteristic prostrating attacks”:
- One this month
- None the month before that
- One the month before that
- Two the month before that
You have averaged one “characteristic prostrating attach” per month for the last four month. That looks like a 30 percent rating.
But, if VA only looked at the last 3 months then you would have average 0.67 “characteristic prostrating attacks) per month over the last three months. That meets the 10 percent standard but not the 30 percent standard.
How long do the migraines have to last?
At the 10 and 30 percent levels, the VA regulation only talks about the migraines being “characteristic”. That could potentially refer to the length of the migraine, but it could also refer to what you feel while having the migraine.
At the 50 percent level, VA uses a general term about the length of the migraine. They says the migraines must be “prolonged”. So, 30 percent migraine attacks do not have to be “prolonged” since that term is omitted.
Because prolonged is omitted, your headaches can be shorter in duration and still qualify you for the 30 percent rating. Often, your rating decision from VA will tell you why they rated you at 10 percent instead of 30 percent or 30 percent instead of 50 percent.
Going through these rating decisions piece by piece will help you see which part you may or may not have met. Understanding the different parts of VA’s migraine rating diagnostic code can help you know what evidence you need to develop to prove the appropriate rating level. This way you can make sure you receive the proper rating from VA.