Migraine - Need Advice

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abyss5150

PEB Forum Regular Member
PEB Forum Veteran
Jason said:
The biggest issue facing Soldiers with migraines is having evidence that the Board will consider in assigning a rating. Having the condition and suffering from a number of migraines over time is not enough.

In order to get rated, the migraine must be "prostrating." That is defined by DODI 1332.39 as follows:
E2.A1.4.1.4. 8100. Migraine. "Prostrating" means that the Service
member must stop what he or she is doing and seek medical attention. The number of prostrating attacks per time period (day, week, month) should be recorded by a neurologist for diagnostic confirmation. Estimation of the social and industrial impairment due to migranious attacks should be made." In practice, the Board requires that prostrating attacks be documented by the Soldier leaving work and going to the ER. Record of this will then be documented by the physician on the Soldier's Narrative Summary. The problem with this is that usually the Soldier has been given a prescription and is told by the treating doctor to go home and take the medicine. The Soldier often does just this, even documenting in a migraine diary when the attack is not enough. The gold standard is ER records. However, the Army Physical Disability Agency has recognized that this is not how doctors treat this condition. As a result, they have carved an exception to the necessity of going to the ER. That exception can be found in I & G #2.
Here is an extract from the APDA's Issue and Guidance #2:

Guidance: When rating cases in which the Soldier is determined to be unfit because of migraine headaches, headaches may be considered to be “prostrating” if the following conditions are met:

1. There must be a valid diagnosis and detailed description of the Soldier’s migraine events historically and currently.
2. There must be evidence that the Soldier’s headache episodes met the DoD definition of “prostrating” prior to initiation of the program described below.
3. The Soldier must have undergone a rational medical treatment program aimed at controlling the migraine headaches.
4. The Soldier must have been, and is, currently compliant with treatment.
5. The attending physician (preferably a neurologist) must provide a written plan of instruction for the Soldier, with a copy in the health record, detailing what the Soldier is to do when experiencing a headache.
6. The plan in item #4 above must include a requirement that the Soldier stop activities and use appropriate medication or other acceptable modalities. The stopping of activities must clearly interfere with the Soldier’s performance of duty and be documented by the Soldier’s chain of command. A brief period of rest (20 min to an hour), once a week or so, would not likely meet the “interference” criterion.
7. There must be evidence that the management plan has been reviewed by the attending physician at least every 6 months.

If you follow the steps above, you can get the condition rated. A word of caution, though. Close is not enough. The APDA is strict with having all 7 conditions met. The usual shortcoming is that there is not a written plan from the neurologist.
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1st off I would like to thank the moderators of this site. It offers a great deal of info and I providing a great service to our men and women of arms.

I would like some advice on my current situation. I have been suffering from migraines for a number of years. The migraines occur approx. twice a week. They have recently gotten worse and more intense. I have been on numerous medications to treat them and each has offered no help. Up to this point I have not been referred to a neurologist. My Doc said that they have to exhaust all resources before a referral can be made. I don’t even know if I have been given a formal diagnosis. In the past, I just suffer through the migraine and frequent spreads of horrible episodes for days at a time. I went to urgent care twice in the past 4 weeks for relief. I received a shot of medication each time which took the edge off and allowed me to get some rest. This is the 1st time in years I was treated with something that provided a bit of relief.

With my conditions seemingly coming to a climax I am worried. I have 11yrs in the service and do not have any aspirations of separating or getting boarded. What I do want is resolution and help. It is devastating to thing that seeking resolution and help may cost me my career. I can no longer “suck it up” and live with this condition. I need resolution!

My question is....How I properly document my debilitating episodes. Is it appropriate or recommended I seek medical attention at an ER or urgent care when an episode is debilitating? I don’t want to be in the ER/urgent care 2-3 times a week. How do I obtain a formal diagnosis? Any help or advice is greatly appreciated.
 
abyss5150 said:
My question is....How I properly document my debilitating episodes. Is it appropriate or recommended I seek medical attention at an ER or urgent care when an episode is debilitating? I don’t want to be in the ER/urgent care 2-3 times a week. How do I obtain a formal diagnosis? Any help or advice is greatly appreciated.
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Welcome aboard,

This is exactly my issue for last 7 years, however I have been diagnosed with migraines officially (at Walter Reed/Bethesda). I had to, to get the medication needed to abort the migraine. Luckily at my job, to stop what I'm doing, and to seek relief (meds) and working, is hardly any contrast. I have been to the ER a couple times, when the meds don't work. However I have never been boarded for that (have for other things though). With the way they define "Prostrating" would be a path of definite discharge though probably with a low (under retirement) rating.

It is a hard one to call. I suggest that you seek medical attention though, because migraines could be a symptom of something much worse (That only a neorolgist could discover). Are you on any preventive and or abortive. Beta Blocker/CCB/Triptan?
 
welcome,
xeno is good w/this stuff.
the key is the neurologist referral. i'm surprised your PCM wouldn't give you a referral. i would try to switch PCM's if you do not think you are getting the care you need, from your current one. are you documenting all of your migrains? if not i would keep a journal of them, the length of them, the date time and place, when they happen. aslo the other key is getting to the doctor's when they are really bad, like xeno said.
the big thing is to getting them under control w/medication mgmt., which the doctors should be doing.
 
Again, I want to thank you for your concern and help. Any help is greatly appreciated.

robs42 said:
are you documenting all of your migrains? if not i would keep a journal of them, the length of them, the date time and place, when they happen. aslo the other key is getting to the doctor's when they are really bad, like xeno said.
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I am beginning to document my migraines. I am going to use a diary found online. I also was thinking about pulling my medical records and going back a few years to document all the different medications I have been given that didn't work. This will also help me pinpoint the time at which I first started suffering(Its been at least 3yrs).

xeno said:
With the way they define "Prostrating" would be a path of definite discharge though probably with a low (under retirement) rating.
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That is one concern of mine and one of the reasons I seek advice from this board. In the past, I would just try to "deal" with it because I don't want to loose my career. If I were to be boarded in the future, I am sure I would meet at least the minimum once a month/30% rating. I suffer an average of twice a week. The problem is, how to properly document this. I actually had a follow-up appt. with my PCM today and I asked her "what should I do when I have an extreme acute episode?" She said "go to a quite dark room or go to the ER/Urgent care if you need to". Then she said "follow up with me in 2-3 months". Although these last two visits to urgent care are the only times I was able to get relief, I am not sure if it is feasible to be in the ER every week...two or three times a week. Plus, I am not eager for another shot in the hip that knocks you out for 5hrs.

xeno said:
Are you on any preventive and or abortive. Beta Blocker/CCB/Triptan?
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I have been through an extensive regimen. My PCM just special ordered some preventative med's (don't recall the name), which should be in within 4days or so. She took me off Maxalt and gave me hydrocodone for acute episodes (temporarily). I cross my fingers and hope this new med works!
 
Good day. I have an update. My Migraines have gotten worse. I experience about 3-4 episodes per week now. I have been to the ER a couple times since my last post. The good news is that I was finally referred to a Neurologist! My doc had me on some sort of anti-depressant for maintenance and Vicodin to take on the onset of the migraines. The Neurologist stopped both of them immediately and put me back on Topomax. Not sure if I agree with that, considering I tried that medication with no success in the past. I am willing to try anything so I won’t complain. I am just happy to finally be in the hands of a specialist. The thing that worries me is that I will eventually be referred for MEB. I love serving and want to continue my career. I have a bit over 11yrs and want to finish this thing. I feel since I now am seeing a Neurologist I may be walking a thin line that I cannot see. Hopefully I have nothing to worry about and get my issue under control without rocking the boat. This Migraine thing started back in 2005, but has been a full blown problem with frequent trips to the ER for over 7mos now! When will the consideration for MEB be made? Am I in danger?
 
I do not know what the cause of your migranes is nor do I presume to be a doctor. I had migranes 5 to 7 times a week, however, mine were being caused by my neck injury. Ever since the first adjustment by the chiropractor I have not had any migranes; only mild headaches once or twice a week. Just a thought.
 
Good day all. I have an update and really need some serious advice. I am still suffering from debilitating migraines with the same frequency and duration. Since my last update I have been placed on several different preventative medications, all which have been Triptans. I have tried 4-5 of them with no success. Apparently Triptans are the “best” and “most effective” type of medication for migraine sufferers, but there are a small percentage of people who do not respond to them. I guess I am one of them. I seen my neurologist the other day and my worst fear almost came true. He dropped those dreaded 3letters. MEB! He raised his hand and signaled as if he was measuring a centimeter with his fingers and said “I am THIS close to initiating an MEB for you because of your condition”. I told him that I enjoy my job, serving my country and that I wanted no part of this. He said that there is only so much he can do and he has an obligation to initiate the board. He is tapering my off my current medication and prescribed a different brand of Triptans hoping I will respond to this one. Now I am really afraid that if this doesn’t work for me, I will get boarded. I almost feel like telling him what he wants to hear so I can continue to serve. I really don’t want to get booted…..what can I do?
 
Hello all. Once again, I have an update. After some extensive drama my package was finally complied and submitted to the local MEB board. Their recommendation is "Return to Duty". How they came up with that scenario is beyond me. I was completely caught off guard with this and was expecting an unfit finding. Either way, I signed the findings document and forwarded to to the PEBLO. Apparently it was sent & received to AFPC rather quickly because two days later I received an email from my PEBLO with an attachment from the Deputy Chief, Medical Standards stating the following:
“Member's case has been reviewed and will be presented to the IPEB.
I discussed this case with a member of the IPEB, and they think they should look at it despite the local board's RTD recommendation. Forwarding to the IPEB.”
So i guess I can assume that the package is now with the IPEB where it should be. I do have a couple questions for you great people.
1. How heavily weighed are the local MEB recommendations considered at the IPEB?
2. Is there still a backlog at the IPEB?
3. What is the current time-line? My PEBLO is saying 8weeks, but I find this unbelievable?

I am in the same boat as some other people here in the fact that I have a great job lined up that I may lose if i do not get separated in the next 8weeks. Thanx for your time.
 
I'm not sure how long your IPEB will take but I know that Air Force members shouldn't expect to hear anything for atleast 90 days. Hope yours takes less time!
 
There's a backlog @ HQ AFPC. Middle of Feb is the what a number of PEBLOs have told people on this forum (myself included).
 
dubber25 said:
There's a backlog @ HQ AFPC. Middle of Feb is the what a number of PEBLOs have told people on this forum (myself included).
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I see.....so when you say "middle of Feb", What does that mean for me? If my package was forwarded this week, do you predict I will have findings in Feb? I'm hoping that I receive results by march. If that happens, i will be happy with it.
 
abyss5150 said:
I see.....so when you say "middle of Feb", What does that mean for me? If my package was forwarded this week, do you predict I will have findings in Feb? I'm hoping that I receive results by march. If that happens, i will be happy with it.
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Also...asking opinions about my situation:

My DOS in in April
Local MEB Board recommends RTD
My package was fwd to IPEB early Jan2010
IPEB decides to "review the package" despite local board RTD determination

Question?
I have a great job lined up that I may lose if I do not separate in in March. I guess it is safe to assume that the local boards recommendation of RTD will weigh heavily with the IPEB. I feel like I'm waiting out the IPEB for nothing because chances are they will come back with the RTD findings and agree with the local board. If I luck up and get 30% or 50% from the IPEB then that will be 30% or 50% of my high 3 base pay for retirement. An E-6 high 3 averages very close to 3K per month base pay.
30% of 3K = $900
50% of 3K = $1500
So if I wait it out, I'm looking at best an endgame of $900 - $1500 per month before taxes for retirement pay. By waiting it out I will lose the job of my dreams and may end up with nothing. I am considering separating, getting this great job and just filing my claim with the VA. I should be able to recoup about the same amount of $$ via the VA and I will have my dream job. Besides the medical benifits (which I know are huge), is there any other reason why I should wait out this IPEB? I know this may all seem rather asinine, but I just have a million thoughts running around in my head right now and I am so stressed out. I guess I'm a pecimist and I belive that in the future, I'll be replying to the "120+ days and still waiting for results" thread and I can't afford that.......at all. Please give me some direction. All opinions are welcome!
 
You're in a tight spot, that's for sure. I would say to pray alot and talk to your friends and family. If all three line up then you know the decision. Keep in my mind that you may regret cutting the IPEB process short in 6 months to a year down the road. Good luck and let us know the which way you decide.
 
dubber25 said:
You're in a tight spot, that's for sure. I would say to pray alot and talk to your friends and family. If all three line up then you know the decision. Keep in my mind that you may regret cutting the IPEB process short in 6 months to a year down the road. Good luck and let us know the which way you decide.
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I have no idea what I'm going to do about this situation. I guess the plan for the short term is to try to push off the job as long as I can and hope for the best. This hurry up and wait ish that the military pulls is for the birds. This process is so broken. Your coded, ineligible for reenlistment and marked for death. Will you be separated with nothing? "I don't know". Will you be separated with severance? "I don't know". Will you be found fit for duty? "I don't know". Will you be retired? "I don't know". So you just have to wait until god knows how long and your life is in limbo? "That's for sure!" TERRIBLE!
 
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