How does the VA rate migraines?
Migraines are rated 0, 10, 30, or 50 percent under 38 CFR 4.124a, diagnostic code 8100. The rating turns almost entirely on how often you have attacks the VA considers prostrating.
The rating levels
Under diagnostic code 8100 1:
- 50 percent: very frequent, completely prostrating and prolonged attacks productive of severe economic inadaptability
- 30 percent: characteristic prostrating attacks averaging once a month over the last several months
- 10 percent: characteristic prostrating attacks averaging one in two months over the last several months
- 0 percent: less frequent attacks than the above
Fifty percent is the maximum schedular rating for migraines. 1
The word the whole rating depends on
Everything hinges on prostrating, and here is the problem: neither the rating schedule nor the courts have ever defined it. In practice it describes an attack severe enough that you have to stop what you are doing and lie down until it passes. Working through a headache is generally not prostrating. Leaving work, or being unable to function until it passes, generally is.
The distinction between the levels is largely frequency. One prostrating attack every two months sits at 10 percent. One a month sits at 30 percent.
"Severe economic inadaptability" does not mean unemployable
The 50 percent level requires attacks productive of severe economic inadaptability, another undefined phrase. Courts have addressed one common misreading of it: nothing in diagnostic code 8100 requires a veteran to be completely unable to work to qualify for 50 percent. If economic inadaptability meant unemployability, the veteran would be looking at TDIU rather than a 50 percent schedular rating. 2
Substantial work interference can support the 50 percent level without total unemployability.
It is not only head pain
The rating contemplates more than the headache itself. Nausea, vomiting, light and sound sensitivity, dizziness, and visual disturbance are part of the disability picture, and the evaluation is supposed to account for the overall effect of the attacks rather than pain alone. 2
Why so many migraine claims come in low
Migraine ratings frequently land below what the frequency would support, for a structural reason: the evidence usually is not there. Attacks happen at home, in the dark, without a clinic visit. A record that shows three documented migraines in two years does not establish monthly prostrating attacks, even if that is what has been happening.
The kind of evidence that does establish frequency includes a contemporaneous headache log noting the date, duration, severity, and whether the attack was prostrating; treatment records; statements from a spouse, coworker, or supervisor who has observed the attacks; and any record of missed work. Lay evidence is competent for reporting symptoms and their effect on work and daily life. 2
Related conditions
Migraines can be secondary to another service-connected condition, including TBI, neck conditions, and medication side effects. 3 Migraines and TBI can sometimes be rated separately.
An accredited VSO can help with a migraine claim at no cost.