On September 14, 2023, the VBA updated M21-1 to provide further clarification on a prostrating migraine headache, to include the new VA rating for migraine headaches criteria as well as evidence requirements.
Headaches are still rated from 0% to 50% with breaks at 10% and 30%; however, the symptoms and impairment required for a 50% VA rating for Migraines have been better defined and clarified.
- What is the VA Rating for Migraine Headaches?
- What is the Difference Between a “Prostrating” and a “Completely Prostrating” Migraine Headache?
- Do I Need Medical Evidence of a Prostrating Headache for VA Disability?
- Can Lay Evidence Be Used to Show a Prostrating Migraine?
- What is Severe Economic Inadaptability?
- What are Less Frequent Versus Very Frequent Migraines?
- What Proof Do I Need for the Frequency of Migraine Headaches for VA Rating Purposes?
- About the Author
What is the VA Rating for Migraine Headaches?
Migraine headaches are evaluated under the criteria of 38 CFR 4.124a, DC 8100 as follows:
|DC 8100, VA Rating For Migraine Headaches:
|Migraines with very frequent completely prostrating and prolonged attacks productive of severe economic indaptability
|Migraines with characteristic prostrating attacks occurring on an average once a month over last several months
|Migraines with characteristic prostrating attacks averaging one in 2 months over last several months
|Migraines with less frequent attacks
The VA will look for a medical diagnosis of headaches (in a medical record) along with any link or connection to your military service to include the frequency, severity, and duration of symptoms.
VA disability ratings for Migraines depend primarily on the frequency of attacks and the degree to which symptoms are “prostrating.”
Work impairment due to your headaches is also a factor for a 50% VA rating for headaches.
Important: The Court of Appeals for Veterans Claims, in Holmes v. Wilkie, held that the criteria of 38 CFR 4.124a, DC 8100, contemplate more than merely headache symptoms, and that the DC requires VA to
- Consider all symptoms experienced because of migraine attacks, and
- Evaluate those symptoms based on the overall frequency, severity, and economic impact of the migraine attacks.
Example: A Veteran suffers migraine headaches that occur twice weekly and are prostrating in nature. Symptoms manifested during the migraine headache attacks include frontal headaches, photophobia, nausea, and dizziness. In evaluating the disability under 38 CFR 4.124a, DC 8100, VA must consider all symptoms associated with the migraine headache attacks, and not just the headaches themselves.
What is the Difference Between a “Prostrating” and a “Completely Prostrating” Migraine Headache?
Prostrating Migraine Headache, as used in 38 CFR 4.124a, DC 8100, means “causing extreme exhaustion, powerlessness, debilitation or incapacitation with substantial inability to engage in ordinary activities.”
Completely Prostrating Migraine Headache, as used in 38 CFR 4.124a, DC 8100, means extreme exhaustion or powerlessness with essentially total inability to engage in ordinary activities.
Do I Need Medical Evidence of a Prostrating Headache for VA Disability?
Yes, but the medical evidence might not include the exact use of the term “prostrating.”
Although prostration is substantially defined by how the disabled individual subjectively feels and functions when having migraine headache symptoms, medical evidence is required to establish that the reported symptoms are due to the migraine headaches.
The following is an example of a medical statement that would ordinarily establish the fact of “prostration” if the medical report and the history provided by the claimant are both credible.
The patient reports symptoms of severe head pain, blurred vision, nausea, and vomiting, and being unable to tolerate light or noise, worsened by most activities including reading, writing, and engaging in conversations or physical activities. When experiencing these symptoms, the patient only sleeps or rests. The symptoms reported by the patient are consistent with the diagnosis of migraine headaches and the reported limitations are consistent with those seen in patients suffering from migraine headaches of similar clinical severity.
Note: Medical reports may not use the word “prostration.” However, this is an adjudicative determination based on the extent to which the facts meet the definition of the term.
Can Lay Evidence Be Used to Show a Prostrating Migraine?
Yes, a claimant’s own testimony regarding symptoms and limitations when having those symptoms can establish prostration if the testimony is credible, and symptoms are otherwise competently attributed to migraine headaches through medical evidence.
Example: A claimant provides testimony that she experiences severe headaches and vomiting when exposed to light, does not engage in any activities when this occurs, and must rest or sleep during these episodes. If there is medical evidence that the claimant’s description of symptoms is in fact symptoms of migraine headaches, a determination that the headaches cause prostration can be made.
What is Severe Economic Inadaptability?
Severe economic inadaptability denotes a degree of substantial work impairment.
It does not mean the individual is incapable of any substantially gainful employment.
Translation: You can have a job and still get a 50 percent VA rating for migraine headaches.
Evidence of work impairment includes, but is not necessarily limited to, the use of sick leave or unpaid absence.
Note: In cases where migraine headaches meet the criterion of severe economic inadaptability and, additionally, the evidence shows that the claimant is incapable of substantially gainful employment due to the headaches, referral for consideration of an extraschedular award of a total evaluation based on individual unemployability is appropriate.
What are Less Frequent Versus Very Frequent Migraines?
38 CFR 4.124a, DC 8100 does not define the terms less frequent for the 0% criterion or very frequent for the 50% criterion. However, the overall rating criteria structure for migraine headaches provides a basis for guidance.
As noted in 38 CFR 4.124a, DC 8100, the 10% evaluation specifies average frequency (“averaging one in 2 months over the last several months”), which is half of what is required for a 30% evaluation (“on average once a month over the last several months”).
For definitions of the terms less frequent and very frequent, refer to the table below.
|VA Rating Percentage
|Characteristic prostrating attacks, on average, are more than two months apart over the last several months.
|Characteristic prostrating attacks, on average, are less than one month apart over the last several months.
What Proof Do I Need for the Frequency of Migraine Headaches for VA Rating Purposes?
Frequency of migraine headache attacks or episodes is a factual determination.
Probative evidence for headaches includes:
- Medical progress notes
- Competent and credible lay evidence on how often the claimant experiences symptoms (as long as those symptoms have been competently identified as symptoms of migraine headaches)
- Contemporaneous notes (a headache journal)
- Prescription refills
- Witness statements
Note: The absence of treatment reports is not necessarily probative on the question of headache frequency as a claimant may not seek treatment for headaches during every episode.
Headache journals or mobile tracking apps, which routinely and relatively contemporaneously record headache episodes, may be accepted as credible lay testimony for:
- Headache frequency
- Prostration, and
- Occupational impairment (for example, sick leave due to headaches).
Note: Headaches recorded on non-work days may be used to prove frequency and prostration. However, they will not generally be relevant to work availability, and performance or limitations, which are considerations in determining severe economic inadaptability.
About the Author
Brian Reese is one of the top VA disability benefits experts in the world and bestselling author of You Deserve It: The Definitive Guide to Getting the Veteran Benefits You’ve Earned (Second Edition).
Brian’s frustration with the VA claim process led him to create VA Claims Insider, which provides disabled veterans with tips, strategies, and lessons learned to win their VA disability compensation claim, faster, even if they’ve already filed, been denied, gave up, or don’t know where to start.
As the founder of VA Claims Insider and CEO of Military Disability Made Easy, he has helped serve more than 10 million military members and veterans since 2013 through free online educational resources.
He is a former active duty Air Force officer with extensive experience leading hundreds of individuals and multi-functional teams in challenging international environments, including a combat tour to Afghanistan in 2011 supporting Operation ENDURING FREEDOM.
Brian is a Distinguished Graduate of Management from the United States Air Force Academy, Colorado Springs, CO, and he holds an MBA from Oklahoma State University’s Spears School of Business, Stillwater, OK, where he was a National Honor Scholar (Top 1% of Graduate School class).