Military service members who have deployed and been exposed to combat have been found to be at a higher risk for new-onset headaches[1]. More broadly, it has been shown that members of the military with significant headaches share a similar cause – stress – for headaches with their civilian counterparts.[2] Fortunately for veterans, the VA has several avenues to pursue to seek treatment and compensation for headaches related to their military service.
According to the Mayo Clinic, Headaches are defined as “pain in any region of the head” and may occur “on one or both sides of the head, be isolated to a certain location, radiate across the head from one point, or have a viselike quality.” The headaches for most can come on suddenly and last only a short time or persist for several days.[3]
A veteran experiencing headaches or migraines should keep track of their symptoms, most appropriately by keeping a journal to record their symptoms. A recent decision at the Court of Appeals for Veterans Claims emphasized that headaches need to be evaluated based on “frequency, duration, severity, and economic impact.”[4] In other words, the focus for rating purposes is on the actual level of impairment rather than a specific set of symptoms.
Despite the prevalence of headaches and the severity of symptoms many experience, finding the right rating code to claim service-connected disability is not easy and the law is confusing. Nevertheless, the VA has several broad categories that need to be considered, and recent court decisions have helped clarify definitions and rating codes in a way that should be helpful for those making claims.
Direct Service Connection
A veteran could obtain this type of rating through application for service-connected disability. Remember that to obtain service-connected disability the veteran must show 1) a current disability, 2) an occurrence of an injury or event while in service, and 3) a nexus or link between the current disability and that in-service event.[5]Â
The most typical rating for headaches is through the diagnostic code 8100 for migraines. The rating code evaluates symptoms and awards a compensable rating between 0% and 50% . In addition to the documentation of frequency, duration, severity, and economic impact, it is important to understand the meaning of prostration. Prostration is when the headaches cause, “powerlessness or lack of vitality” or “a powerlessness to rise; laid low.[6]” Each increase in rating corresponds to a more frequent prostrating or debilitating attack reaching a maximum of 50% when it produces “severe economic inadaptability” causing the veteran to have a significant impact on their employment.
There are also ratings for direct service connection that would include headaches as a residual of Traumatic Brain Injury (TBI) by applying diagnostic code 8045 and for Temporomandibular disorder (TMJ) under diagnostic code 9905. These conditions are usually severe and are typically caused by external trauma to the head. As a result, the respective rating codes recognize residual injuries and include headaches.
Presumptive Service Connection
Some symptoms do not require evidence of the nexus between the in-service event and the current diagnosis. Presumptive service connections can be granted by virtue of providing evidence of the veterans active service in a specific geographic location. The most common presumptive condition is agent orange in the Vietnam War. More recently, Congress has authorized a series of presumptive conditions for Gulf War Era veterans spanning August 1990 and extended to December 2026. Headaches are listed with other multi-symptom undiagnosed illnesses.
Here is an overview of Gulf War Presumptives:
You can get benefits for your illness or condition if both of these descriptions are true for you and you have one of these presumptive diseases.
Both of these must be true. Your illness or condition:
Caused you to be ill for at least 6 months, and
Resulted in a disability rating of 10% or more
And you have one of these presumptive diseases:
Functional gastrointestinal disorders
Chronic fatigue syndrome
Fibromyalgia
Other undiagnosed illnesses, including but not limited to cardiovascular disease, muscle and joint pain, and headaches
What’s included in the Southwest Asia theater of military operations?
Iraq, Kuwait, Saudi Arabia
The neutral zone between Iraq and Saudi Arabia
Bahrain, Qatar, and the United Arab Emirates (U.A.E.)
Oman
The Gulf of Aden and the Gulf of Oman
The waters of the Persian Gulf, the Arabian Sea, and the Red Sea
The airspace above these locations.[7]
Secondary Service Connection
Secondary service connection is possible when you have a current disability “which is proximately due to or the result of a service-connected disease or injury shall be service connected.” You could also have an aggravation of a non-service connected disability that is “proximately due to or the result of a service-connected disease or injury.”[8] Once rated in this manner, the secondary condition would be deemed to be a part of the original service-connected condition.
You will want to talk to your health care provider, but there are several ways a primary and service-connected medical condition could lead to a rating as a secondary condition. Neck and muscle pain could play a role. A link to hypertension has been found as related to a rapid spike in blood pressure known as a hypertensive crisis.[9] Finally, it is possible to argue secondary conditions related to the spine, neurological issues, or mental health.
In summary, the symptoms of headache can play a major role in reducing your ability to work and have a reasonable quality of life. Armed with some understanding of the rating possibilities, you can advocate for the types of treatment and compensation you earned while serving your country in the armed forces. To get started it is key that you maintain a journal to document your headaches with regard to headache or migraine duration, severity, frequency, and economic impact.
[1] https://pubmed.ncbi.nlm.nih.gov/21675968/
[2] https://pubmed.ncbi.nlm.nih.gov/19925623/
[3] https://www.mayoclinic.org/symptoms/headache/basics/definition/sym-20050800
[4] http://www.uscourts.cavc.gov/documents/HolmesMC_19-2495.pdf
[5] 38 CFR § 3.303
[6] Holmes v. Wilke, ibid.
[7] https://www.va.gov/disability/eligibility/hazardous-materials-exposure/gulf-war-illness-southwest-asia/
[8] 38 CFR § 3.310 – Disabilities that are proximately due to, or aggravated by, service-connected disease or injury.
[9] https://www.healthline.com/health/high-blood-pressure-hypertension/headache#high-blood-pressure-and-headaches