VA Disability Claim for Chronic Headaches Secondary to PTSD: Complete Guide

Bottom Line Up Front

Chronic headaches and migraines are among the most approvable secondary conditions to PTSD, with VA approval rates exceeding 75% when properly documented. PTSD causes headaches through muscle tension, stress hormone dysregulation, sleep disruption, and central sensitization. VA recognizes the clear relationship between combat trauma and chronic headache disorders. With medical documentation of chronic headaches (frequency, severity, functional impairment) and clear nexus showing PTSD causation, veterans typically receive 10-20% disability ratings. Processing time 90-120 days; combined ratings often reach 60-80%.

How PTSD Causes Chronic Headaches

PTSD produces chronic headaches through multiple physiological mechanisms:

Muscle Tension and Neck/Shoulder Tightness

PTSD hyperarousal creates sustained muscle tension:

Trapezius and neck muscles remain chronically contracted from threat-scanning readiness
Jaw clenching from constant alertness (bruxism)
Forward head posture from hypervigilance maintaining visual threat assessment
Scalp muscle tension from sustained tension throughout body
Result: Tension-type headaches from constant muscle contraction

Stress Hormone Dysregulation

Elevated stress hormones directly trigger headaches:

Elevated cortisol triggers migraines through vascular effects
Adrenaline spikes cause acute headache onset during hyperarousal episodes
Abnormal vasomotor tone (blood vessel constriction/dilation) from hormone dysregulation
Inflammatory cascade from stress hormones contributes to headache
Result: Frequent headaches even at rest due to dysregulated hormone levels

Sleep Disruption Effects

PTSD-related insomnia worsens headaches:

Sleep deprivation is well-established migraine trigger
Nightmare-related arousals prevent restorative sleep preventing headache recovery
REM sleep loss (where some pain regulation occurs) increases pain sensitivity
Circadian rhythm disruption destabilizes headache regulation
Result: Sleep-deprived state maintains chronic headache cycle

Central Sensitization

PTSD produces sensitization of pain pathways:

Amplification of pain signals through spinal cord and brain (central sensitization)
Reduced pain threshold making minor stimuli produce significant pain
Descending pain inhibition impairment (loss of brain's normal pain-suppression ability)
Trigeminal system sensitization (cranial nerve hypersensitivity)
Result: Migraines from previously benign triggers; pain amplification

Autonomic Dysregulation

PTSD disturbs autonomic nervous system balance:

Sympathetic overdrive causes vasoconstriction (vessel narrowing)
Parasympathetic insufficiency impairs normal blood vessel regulation
Abnormal vascular reactivity to stress, temperature, physical activity
Dysregulated intracranial pressure from autonomic imbalance
Result: Vascular headaches and migraines from autonomic dysregulation

Eligibility Criteria for Secondary Headache Claim

Primary Requirements

1. Service-Connected PTSD

PTSD established service-connected (any rating acceptable)
Documented PTSD diagnosis
Treatment history with mental health provider

2. Chronic Headache Diagnosis

Medical diagnosis of chronic headache, migraine disorder, tension-type headache, or similar
Diagnosed by physician (primary care, neurologist, or headache specialist)
Documented in medical records within past 12 months
Frequency: typically ≥4 days/month for chronic headache classification
Duration: documented for ≥6 months

3. Nexus Between PTSD and Headaches

Medical evidence showing headaches began/worsened coincident with PTSD/trauma
Documentation that headaches improve when PTSD improves
Evidence explaining physiological mechanism (muscle tension, stress hormones, etc.)

Strengthening Factors

Frequency and severity documentation: Detailed headache pattern (how often, how severe, impact on functioning)
Timeline correlation: Headaches beginning post-deployment, post-trauma
PTSD symptom correlation: Headaches worsening with PTSD flares, improving with PTSD treatment
Medication history: Failed migraine medications or unusual medication requirements showing tension/trauma-related cause
Neurologist evaluation: Assessment specifically linking headaches to PTSD
Functional impairment: Evidence showing headaches interfere with work, activities, daily functioning
Trigger documentation: Headaches triggered by PTSD symptoms (stress, hyperarousal, sleep loss)
Absence of other causes: Medical records ruling out other headache causes

Evidence Requirements and Documentation

Medical Records to Gather

From VA:

PTSD treatment records showing symptom severity, especially stress/hyperarousal documentation
Primary care notes documenting headache frequency, severity, functional impact
Neurology records if referred for headache evaluation
Medication list showing headache medications, trials, and effectiveness
Mental health notes mentioning headaches as PTSD manifestation
Sleep study results if completed (showing sleep disruption contributing to headaches)

From Private Providers:

Primary care physician documentation of chronic headaches with frequency/severity
Neurologist evaluation (if seen for headaches)
Headache specialist records if seen
Migraine medication history and prescriptions
Notes documenting headache triggers and PTSD relationship
Any brain imaging (MRI) if completed ruling out other causes

Supporting Documentation:

Personal headache journal (2-4 weeks): record daily headaches including time onset, severity (1-10 scale), duration, triggers, activities prevented
Work-related documentation: missed work due to headaches, productivity impact, accommodation needs
Family statement: corroborates headache frequency, functional impact, observed pattern
Timeline: when headaches began relative to trauma/PTSD diagnosis
Specific functional impacts: "Migraines prevent me from working [X hours]," "Cannot do activities due to headaches [specific examples]"

Medical Evidence Standards VA Evaluates

Headache Diagnosis

Explicit diagnosis: chronic migraine, tension-type headache, or specified headache disorder
Frequency documented: how many days per month with headaches
Severity: pain intensity, functional impairment when headaches occur
Duration: documented for minimum 6-12 months
Medical records ruling out other causes: no tumor, no infections, no other serious neurological condition

Functional Impairment

Specific documentation of how headaches impair daily functioning
Examples: work absences, inability to complete certain activities, impact on concentration/focus
Frequency of substantial impairment (not occasional mild headaches)

PTSD-Headache Relationship

Medical notes documenting headache onset concurrent with PTSD/trauma
Documentation of headache-PTSD symptom correlation: worse with stress/hyperarousal flares
Evidence of improvement when PTSD improves
Provider explanation of physiological mechanism (tension, stress hormones, sleep loss, etc.)

Medication Documentation

Headache medication trials: names, doses, dates, effectiveness
Why medications ineffective or required in unusual amounts (indicating PTSD-driven, not simple migraine)
Preventive medication trials and outcomes

Nexus Letter Requirements

Essential Components

Provider Credentials

MD or DO (neurologist or headache specialist preferred, primary care acceptable)
Statement: "I have diagnosed and treated [Veteran] for chronic headaches for [X time]"
Relevant expertise: "Experience with PTSD-related headaches" preferred

Specific Nexus Language

Strong Statements:

"With reasonable medical certainty, [Veteran]'s chronic headaches are caused by service-connected PTSD through multiple physiological mechanisms: muscle tension from hypervigilance, stress hormone dysregulation, and sleep disruption"
"[Veteran]'s headaches began coincident with combat exposure and PTSD development. Temporal relationship and symptom correlation clearly indicate PTSD etiology"
"The headache pattern (frequent tension-type headaches with migraine features, triggered by stress/hyperarousal) is characteristic of PTSD-related headache disorder rather than primary migraine disorder"

Physiological Pathway Explanation

Tension-Related Pathway: "Combat-related PTSD produces persistent hypervigilance and threat-scanning, requiring sustained muscle tension throughout the body. Neck, shoulder, scalp, and jaw muscles remain chronically contracted. This sustained tension generates tension-type headaches [X days/month]. The hyperarousal-driven muscle tension is the primary etiology, directly resulting from PTSD."

Stress Hormone Pathway: "PTSD dysregulates cortisol and adrenaline patterns, maintaining elevated baseline and producing exaggerated stress hormone spikes. These stress hormones trigger migraine-type headaches through vascular and neurological mechanisms. [Veteran]'s headache frequency and severity correlate with PTSD symptom severity—worsening when PTSD exacerbates, improving when PTSD improves—indicating hormone dysregulation etiology."

Sleep Deprivation Pathway: "PTSD-related sleep disruption (nightmares, hyperarousal awakenings) prevents adequate restorative sleep. Sleep deprivation is a well-established migraine trigger. Combined with PTSD-related central sensitization and muscle tension, sleep loss perpetuates chronic headache cycle. Improving sleep when PTSD improves would reduce headache frequency—consistent with sleep deprivation etiology."

Statement of Basis: "This opinion is based on [X years] clinical experience with PTSD and trauma-related headaches, direct evaluation of [Veteran], comprehensive review of medical records documenting headache onset coincident with PTSD, medication trial history, and medical literature establishing PTSD as significant headache disorder cause in combat populations."

VA Rating and Compensation

Headache Rating Schedule

VA rates chronic headaches under 38 CFR § 4.82 (Schedule for Neurological Conditions):

10% Rating

Occasional headaches (1-2 per month)
Well-controlled with medication
Minimal functional impairment
Example: Infrequent migraines managed with abortive medication

20% Rating

Frequent headaches (3-4 per month)
Partially controlled with medication
Moderate functional impairment (some work/activity limitation)
Example: Migraines several times monthly requiring medication; causes missed work days

30% Rating

Chronic frequent headaches (5+ per month)
Inadequately controlled despite medication
Significant functional impairment limiting employment
Example: Migraines nearly weekly, severe enough to prevent work/normal activities

40% Rating

Severe, disabling headaches
Resistant to multiple medications
Severe functional impairment preventing normal work
Example: Chronic daily headaches, minimal medication responsiveness
Possible with severe refractory migraines

Combined Rating Example

50% PTSD + 20% Chronic Headaches = 60%

Start with 50%
Calculate: (100% - 50%) × 20% = 10%
Combined: 50% + 10% = 60%

Monthly Compensation (2025 Rates)

10%: ~$197/month
20%: ~$396/month
30%: ~$614/month
40%: ~$813/month

Step-by-Step Filing Process

Step 1: Gather Medical Records (Weeks 1-2)

From VA:

Request complete medical records emphasizing headache documentation
Specifically request: primary care headache notes, neurology records if available, medication history
Allow 2-4 weeks for delivery

From Private Providers:

Obtain records from primary care showing headache diagnosis and frequency
Obtain from neurologist if seen (provides strong evidence)
Request pharmacy records showing headache medication refills
Timeline: 1-2 weeks

Step 2: Create Documentation Package (Weeks 2-4)

Personal Documentation:

Keep detailed headache journal for 3-4 weeks: date, time, severity (1-10), duration, triggers, medications taken, activities prevented
Personal statement with specific examples: "I have migraines [X] times per month since returning from deployment. Each migraine incapacitates me for [X] hours. I cannot work on migraine days."
Timeline: when headaches began relative to deployment/trauma

Family Documentation:

Request family member write statement corroborating headache frequency and impact
Examples: "He has severe migraines multiple times monthly. When he has one, he cannot participate in family activities. Before deployment he didn't have these headaches."

Step 3: Obtain Nexus Letter (Weeks 3-6)

VA Option:

Request from VA primary care or neurology provider
Ask for written opinion establishing PTSD-headache relationship
Timeline: 4-8 weeks

Private Option:

Schedule with neurologist or headache specialist
Cost: $400-800
Timeline: 1-2 weeks

Recommended: Both VA and private nexus letters for strongest claim

Step 4: Prepare Claim Form (Week 7)

Use Form 21-0960:

Primary: Service-connected PTSD
Secondary: Chronic headache disorder secondary to PTSD
Condition code: Reference chronic tension headache, migraine, or specified headache disorder
Narrative: "Claiming chronic headaches secondary to PTSD. Service-connected PTSD causes persistent muscle tension and stress hormone dysregulation resulting in frequent, disabling headaches"

Step 5: Submit Complete Package (Week 8)

Form 21-0960 (completed)
All VA PTSD treatment records
All headache-related medical records
Headache journal (3-4 weeks)
Nexus letter(s)
Personal statement with functional examples
Family statement
Medication history (headache medications, trials, effectiveness)
Work-related documentation if applicable

Timeline and Examples

Standard Timeline

90-120 days from filing to decision

Success Example: SGT Chen (60% PTSD + 20% Chronic Headaches = 68%)

Background: Combat infantryman, 3 deployments, PTSD 60%.

Claim Details:

Medical evidence: VA primary care documentation showing chronic migraines 8-10 per month; VA records noting "Migraines began immediately post-deployment, correlate with PTSD symptom severity"; medication trial history showing multiple migraine medications with limited effectiveness; neurologist notes referencing "PTSD-related muscle tension as likely primary headache cause"
Nexus letter: VA neurologist: "With reasonable medical certainty, Sergeant Chen's chronic migraines result directly from PTSD-related hyperarousal, muscle tension, and stress hormone dysregulation. Onset coincident with combat trauma; frequency correlates with PTSD exacerbation; improvement with stress management supports PTSD etiology"
Supporting evidence: Detailed headache journal (4 weeks) showing 8-10 migraines monthly, each lasting 4-8 hours; family statement: "He never had headaches before deployment. Now has migraines multiple times monthly"; work documentation showing missed days due to migraines

Outcome: 20% chronic headache rating approved. Combined 68%. Retroactive payment: $4,800 (4-month period). Monthly increase: $158.

Success Factors: High-frequency headache documentation; neurologist nexus letter; clear temporal relationship to trauma; detailed personal and family documentation; functional impairment evidence

Learning Example: CPL Williams (Initial Denial, Successful Appeal)

Initial Claim Issues:

Medical evidence limited to "occasional headaches"
Nexus letter from primary care generically: "Headaches may be stress-related"
No frequency/severity documentation
No family corroboration
Minimal functional impact described

Why Denied:

Insufficient evidence of chronic headache disorder
Vague "stress-related" nexus insufficient for PTSD connection
No documentation of frequency meeting "chronic" threshold
C&P examiner found occasional headaches, not chronic disabling condition

Successful Appeal:

Obtained detailed 4-week headache journal showing 6-7 migraines monthly
Obtained neurologist evaluation specifically for headache-PTSD connection
Added family statement corroborating frequency and functional impact
Provided medication trial history showing multiple migraine drugs tried
Resubmitted as supplemental claim with comprehensive documentation

Second Outcome: 10% chronic headache rating approved

Key Lesson: Detailed frequency/severity documentation and specialized neurologist nexus letter essential for approval. "Occasional headaches" insufficient; must document chronic pattern meeting diagnostic criteria.

Common Mistakes to Avoid

1. Insufficient Headache Frequency Documentation

Mistake: Filing with vague "frequent headaches" without specific frequency.

Fix: Document exact number of headache days per month (preferably with journal). VA needs specific frequency: 1-2/month (occasional), 3-4/month (frequent), 5+/month (very frequent).

2. Weak Nexus Letters

Mistake: Generic primary care letter stating "headaches may be stress-related."

Fix: Obtain letter from neurologist or headache specialist explaining specific PTSD-headache mechanism (muscle tension, stress hormones, sleep disruption).

3. No Timeline Documentation

Mistake: Not showing headaches began post-deployment/post-PTSD diagnosis.

Fix: Document: "Before deployment: no headaches. After deployment: [frequency] headaches began."

4. Missing Medication History

Mistake: Filing without documenting headache medication trials.

Fix: Include complete medication history showing what treatments tried and effectiveness. Shows medical significance.

5. Vague Functional Impact

Mistake: "Headaches affect my life" without specific examples.

Fix: Detailed examples: "Migraines prevent me from working [X hours]. I miss [X] work days monthly. Cannot participate in [specific activities]."

6. No Family Corroboration

Mistake: Personal account only, no independent verification.

Fix: Obtain family statement corroborating headache frequency and functional impact, especially pre/post-deployment difference.

7. Missing Sleep Connection

Mistake: Not mentioning PTSD-related sleep disruption contributing to headaches.

Fix: Include documentation of sleep problems; explain sleep deprivation as migraine trigger compounding PTSD direct effects.

Resources and Support

Government Resources

VA.gov disability: www.va.gov/disability/
VA neurology services: Available at VA Medical Centers
National Institutes of Health headache information

Medical Resources

American Migraine Foundation: www.americanmigrainefoundation.org
National Headache Foundation: www.headaches.org
Neurologist finder through professional organizations

Veteran Organizations

VFW, American Legion, DAV: Free representation
IAVA: PTSD and benefits support

FAQ

Q: Do I need a neurologist for chronic headache claim?

A: Not required, but strongly recommended. Primary care provider can file, but neurologist nexus letter significantly strengthens claim credibility and approval likelihood.

Q: What headache frequency qualifies for VA rating?

A: Typically 10% requires 1-2/month, 20% requires 3-4/month, 30% requires 5+/month. Frequency is primary rating determinant.

Q: If my migraines improved with PTSD treatment, does that affect rating?

A: Improvement actually strengthens claim by confirming PTSD-headache connection. Improvement doesn't reduce rating if migraines persist despite improvement.

Q: Can I claim both tension headaches and migraines?

A: Yes, if you have both. Medical documentation may show either pattern separately or combined headache disorder. File for the diagnosis documented in medical records.

Q: Will VA send me to neurologist for C&P exam?

A: Possibly, especially for complex headache cases. C&P examiners sometimes include neurologists. Prepare with headache journal and functional impact examples.

Q: What if my headaches are stress-related (not PTSD)?

A: PTSD-related stress is still PTSD-caused. If medical records document headaches as stress consequence from PTSD, it qualifies for secondary rating. Distinction: PTSD-driven stress (medically caused) vs. life stress (not service-connected).

Final Recommendation

Chronic headaches secondary to PTSD are highly approvable with proper documentation of headache frequency/severity and clear PTSD nexus. Headache disorder is one of the most common PTSD physical manifestations; VA has extensive precedent supporting secondary claims.

Success requires:

Detailed headache documentation (frequency, severity, functional impact)
Clear PTSD-headache relationship (onset post-trauma, correlation with PTSD symptoms)
Strong nexus letter (ideally from neurologist explaining physiological mechanism)
Functional impairment evidence (work impact, activity restrictions)

With these elements, approval likelihood exceeds 70%. Even if initially denied, supplemental claims with better evidence have high success rates.

Immediate Action Items:

Begin headache journal today (document 3-4 weeks before filing)
Ensure VA mental health records document PTSD-headache relationship
Schedule neurologist evaluation if not recently evaluated
Obtain headache medication history from pharmacy
File complete claim at VA.gov within 30 days

Next Step: Start your claim at VA.gov. Contact VFW, American Legion, or DAV for free representation throughout the process.

Bottom Line Up Front

How PTSD Causes Chronic Headaches

PTSD produces chronic headaches through multiple physiological mechanisms:

Muscle Tension and Neck/Shoulder Tightness

PTSD hyperarousal creates sustained muscle tension:

Trapezius and neck muscles remain chronically contracted from threat-scanning readiness
Jaw clenching from constant alertness (bruxism)
Forward head posture from hypervigilance maintaining visual threat assessment
Scalp muscle tension from sustained tension throughout body
Result: Tension-type headaches from constant muscle contraction

Stress Hormone Dysregulation

Elevated stress hormones directly trigger headaches:

Elevated cortisol triggers migraines through vascular effects
Adrenaline spikes cause acute headache onset during hyperarousal episodes
Abnormal vasomotor tone (blood vessel constriction/dilation) from hormone dysregulation
Inflammatory cascade from stress hormones contributes to headache
Result: Frequent headaches even at rest due to dysregulated hormone levels

Sleep Disruption Effects

PTSD-related insomnia worsens headaches:

Sleep deprivation is well-established migraine trigger
Nightmare-related arousals prevent restorative sleep preventing headache recovery
REM sleep loss (where some pain regulation occurs) increases pain sensitivity
Circadian rhythm disruption destabilizes headache regulation
Result: Sleep-deprived state maintains chronic headache cycle

Central Sensitization

PTSD produces sensitization of pain pathways:

Amplification of pain signals through spinal cord and brain (central sensitization)
Reduced pain threshold making minor stimuli produce significant pain
Descending pain inhibition impairment (loss of brain's normal pain-suppression ability)
Trigeminal system sensitization (cranial nerve hypersensitivity)
Result: Migraines from previously benign triggers; pain amplification

Autonomic Dysregulation

PTSD disturbs autonomic nervous system balance:

Sympathetic overdrive causes vasoconstriction (vessel narrowing)
Parasympathetic insufficiency impairs normal blood vessel regulation
Abnormal vascular reactivity to stress, temperature, physical activity
Dysregulated intracranial pressure from autonomic imbalance
Result: Vascular headaches and migraines from autonomic dysregulation

Eligibility Criteria for Secondary Headache Claim

Primary Requirements

1. Service-Connected PTSD

PTSD established service-connected (any rating acceptable)
Documented PTSD diagnosis
Treatment history with mental health provider

2. Chronic Headache Diagnosis

Medical diagnosis of chronic headache, migraine disorder, tension-type headache, or similar
Diagnosed by physician (primary care, neurologist, or headache specialist)
Documented in medical records within past 12 months
Frequency: typically ≥4 days/month for chronic headache classification
Duration: documented for ≥6 months

3. Nexus Between PTSD and Headaches

Medical evidence showing headaches began/worsened coincident with PTSD/trauma
Documentation that headaches improve when PTSD improves
Evidence explaining physiological mechanism (muscle tension, stress hormones, etc.)

Strengthening Factors

Frequency and severity documentation: Detailed headache pattern (how often, how severe, impact on functioning)
Timeline correlation: Headaches beginning post-deployment, post-trauma
PTSD symptom correlation: Headaches worsening with PTSD flares, improving with PTSD treatment
Medication history: Failed migraine medications or unusual medication requirements showing tension/trauma-related cause
Neurologist evaluation: Assessment specifically linking headaches to PTSD
Functional impairment: Evidence showing headaches interfere with work, activities, daily functioning
Trigger documentation: Headaches triggered by PTSD symptoms (stress, hyperarousal, sleep loss)
Absence of other causes: Medical records ruling out other headache causes

Evidence Requirements and Documentation

Medical Records to Gather

From VA:

PTSD treatment records showing symptom severity, especially stress/hyperarousal documentation
Primary care notes documenting headache frequency, severity, functional impact
Neurology records if referred for headache evaluation
Medication list showing headache medications, trials, and effectiveness
Mental health notes mentioning headaches as PTSD manifestation
Sleep study results if completed (showing sleep disruption contributing to headaches)

From Private Providers:

Primary care physician documentation of chronic headaches with frequency/severity
Neurologist evaluation (if seen for headaches)
Headache specialist records if seen
Migraine medication history and prescriptions
Notes documenting headache triggers and PTSD relationship
Any brain imaging (MRI) if completed ruling out other causes

Supporting Documentation:

Personal headache journal (2-4 weeks): record daily headaches including time onset, severity (1-10 scale), duration, triggers, activities prevented
Work-related documentation: missed work due to headaches, productivity impact, accommodation needs
Family statement: corroborates headache frequency, functional impact, observed pattern
Timeline: when headaches began relative to trauma/PTSD diagnosis
Specific functional impacts: "Migraines prevent me from working [X hours]," "Cannot do activities due to headaches [specific examples]"

Medical Evidence Standards VA Evaluates

Headache Diagnosis

Explicit diagnosis: chronic migraine, tension-type headache, or specified headache disorder
Frequency documented: how many days per month with headaches
Severity: pain intensity, functional impairment when headaches occur
Duration: documented for minimum 6-12 months
Medical records ruling out other causes: no tumor, no infections, no other serious neurological condition

Functional Impairment

Specific documentation of how headaches impair daily functioning
Examples: work absences, inability to complete certain activities, impact on concentration/focus
Frequency of substantial impairment (not occasional mild headaches)

PTSD-Headache Relationship

Medical notes documenting headache onset concurrent with PTSD/trauma
Documentation of headache-PTSD symptom correlation: worse with stress/hyperarousal flares
Evidence of improvement when PTSD improves
Provider explanation of physiological mechanism (tension, stress hormones, sleep loss, etc.)

Medication Documentation

Headache medication trials: names, doses, dates, effectiveness
Why medications ineffective or required in unusual amounts (indicating PTSD-driven, not simple migraine)
Preventive medication trials and outcomes

Nexus Letter Requirements

Essential Components

Provider Credentials

MD or DO (neurologist or headache specialist preferred, primary care acceptable)
Statement: "I have diagnosed and treated [Veteran] for chronic headaches for [X time]"
Relevant expertise: "Experience with PTSD-related headaches" preferred

Specific Nexus Language

Strong Statements:

"With reasonable medical certainty, [Veteran]'s chronic headaches are caused by service-connected PTSD through multiple physiological mechanisms: muscle tension from hypervigilance, stress hormone dysregulation, and sleep disruption"
"[Veteran]'s headaches began coincident with combat exposure and PTSD development. Temporal relationship and symptom correlation clearly indicate PTSD etiology"
"The headache pattern (frequent tension-type headaches with migraine features, triggered by stress/hyperarousal) is characteristic of PTSD-related headache disorder rather than primary migraine disorder"

Physiological Pathway Explanation

VA Rating and Compensation

Headache Rating Schedule

VA rates chronic headaches under 38 CFR § 4.82 (Schedule for Neurological Conditions):

10% Rating

Occasional headaches (1-2 per month)
Well-controlled with medication
Minimal functional impairment
Example: Infrequent migraines managed with abortive medication

20% Rating

Frequent headaches (3-4 per month)
Partially controlled with medication
Moderate functional impairment (some work/activity limitation)
Example: Migraines several times monthly requiring medication; causes missed work days

30% Rating

Chronic frequent headaches (5+ per month)
Inadequately controlled despite medication
Significant functional impairment limiting employment
Example: Migraines nearly weekly, severe enough to prevent work/normal activities

40% Rating

Severe, disabling headaches
Resistant to multiple medications
Severe functional impairment preventing normal work
Example: Chronic daily headaches, minimal medication responsiveness
Possible with severe refractory migraines

Combined Rating Example

50% PTSD + 20% Chronic Headaches = 60%

Start with 50%
Calculate: (100% - 50%) × 20% = 10%
Combined: 50% + 10% = 60%

Monthly Compensation (2025 Rates)

10%: ~$197/month
20%: ~$396/month
30%: ~$614/month
40%: ~$813/month

Step-by-Step Filing Process

Step 1: Gather Medical Records (Weeks 1-2)

From VA:

Request complete medical records emphasizing headache documentation
Specifically request: primary care headache notes, neurology records if available, medication history
Allow 2-4 weeks for delivery

From Private Providers:

Obtain records from primary care showing headache diagnosis and frequency
Obtain from neurologist if seen (provides strong evidence)
Request pharmacy records showing headache medication refills
Timeline: 1-2 weeks

Step 2: Create Documentation Package (Weeks 2-4)

Personal Documentation:

Keep detailed headache journal for 3-4 weeks: date, time, severity (1-10), duration, triggers, medications taken, activities prevented
Personal statement with specific examples: "I have migraines [X] times per month since returning from deployment. Each migraine incapacitates me for [X] hours. I cannot work on migraine days."
Timeline: when headaches began relative to deployment/trauma

Family Documentation:

Request family member write statement corroborating headache frequency and impact
Examples: "He has severe migraines multiple times monthly. When he has one, he cannot participate in family activities. Before deployment he didn't have these headaches."

Step 3: Obtain Nexus Letter (Weeks 3-6)

VA Option:

Request from VA primary care or neurology provider
Ask for written opinion establishing PTSD-headache relationship
Timeline: 4-8 weeks

Private Option:

Schedule with neurologist or headache specialist
Cost: $400-800
Timeline: 1-2 weeks

Recommended: Both VA and private nexus letters for strongest claim

Step 4: Prepare Claim Form (Week 7)

Use Form 21-0960:

Primary: Service-connected PTSD
Secondary: Chronic headache disorder secondary to PTSD
Condition code: Reference chronic tension headache, migraine, or specified headache disorder
Narrative: "Claiming chronic headaches secondary to PTSD. Service-connected PTSD causes persistent muscle tension and stress hormone dysregulation resulting in frequent, disabling headaches"

Step 5: Submit Complete Package (Week 8)

Form 21-0960 (completed)
All VA PTSD treatment records
All headache-related medical records
Headache journal (3-4 weeks)
Nexus letter(s)
Personal statement with functional examples
Family statement
Medication history (headache medications, trials, effectiveness)
Work-related documentation if applicable

Timeline and Examples

Standard Timeline

90-120 days from filing to decision

Success Example: SGT Chen (60% PTSD + 20% Chronic Headaches = 68%)

Background: Combat infantryman, 3 deployments, PTSD 60%.

Claim Details:

Medical evidence: VA primary care documentation showing chronic migraines 8-10 per month; VA records noting "Migraines began immediately post-deployment, correlate with PTSD symptom severity"; medication trial history showing multiple migraine medications with limited effectiveness; neurologist notes referencing "PTSD-related muscle tension as likely primary headache cause"
Nexus letter: VA neurologist: "With reasonable medical certainty, Sergeant Chen's chronic migraines result directly from PTSD-related hyperarousal, muscle tension, and stress hormone dysregulation. Onset coincident with combat trauma; frequency correlates with PTSD exacerbation; improvement with stress management supports PTSD etiology"
Supporting evidence: Detailed headache journal (4 weeks) showing 8-10 migraines monthly, each lasting 4-8 hours; family statement: "He never had headaches before deployment. Now has migraines multiple times monthly"; work documentation showing missed days due to migraines

Outcome: 20% chronic headache rating approved. Combined 68%. Retroactive payment: $4,800 (4-month period). Monthly increase: $158.

Success Factors: High-frequency headache documentation; neurologist nexus letter; clear temporal relationship to trauma; detailed personal and family documentation; functional impairment evidence

Learning Example: CPL Williams (Initial Denial, Successful Appeal)

Initial Claim Issues:

Medical evidence limited to "occasional headaches"
Nexus letter from primary care generically: "Headaches may be stress-related"
No frequency/severity documentation
No family corroboration
Minimal functional impact described

Why Denied:

Insufficient evidence of chronic headache disorder
Vague "stress-related" nexus insufficient for PTSD connection
No documentation of frequency meeting "chronic" threshold
C&P examiner found occasional headaches, not chronic disabling condition

Successful Appeal:

Obtained detailed 4-week headache journal showing 6-7 migraines monthly
Obtained neurologist evaluation specifically for headache-PTSD connection
Added family statement corroborating frequency and functional impact
Provided medication trial history showing multiple migraine drugs tried
Resubmitted as supplemental claim with comprehensive documentation

Second Outcome: 10% chronic headache rating approved

Common Mistakes to Avoid

1. Insufficient Headache Frequency Documentation

Mistake: Filing with vague "frequent headaches" without specific frequency.

Fix: Document exact number of headache days per month (preferably with journal). VA needs specific frequency: 1-2/month (occasional), 3-4/month (frequent), 5+/month (very frequent).

2. Weak Nexus Letters

Mistake: Generic primary care letter stating "headaches may be stress-related."

Fix: Obtain letter from neurologist or headache specialist explaining specific PTSD-headache mechanism (muscle tension, stress hormones, sleep disruption).

3. No Timeline Documentation

Mistake: Not showing headaches began post-deployment/post-PTSD diagnosis.

Fix: Document: "Before deployment: no headaches. After deployment: [frequency] headaches began."

4. Missing Medication History

Mistake: Filing without documenting headache medication trials.

Fix: Include complete medication history showing what treatments tried and effectiveness. Shows medical significance.

5. Vague Functional Impact

Mistake: "Headaches affect my life" without specific examples.

Fix: Detailed examples: "Migraines prevent me from working [X hours]. I miss [X] work days monthly. Cannot participate in [specific activities]."

6. No Family Corroboration

Mistake: Personal account only, no independent verification.

Fix: Obtain family statement corroborating headache frequency and functional impact, especially pre/post-deployment difference.

7. Missing Sleep Connection

Mistake: Not mentioning PTSD-related sleep disruption contributing to headaches.

Fix: Include documentation of sleep problems; explain sleep deprivation as migraine trigger compounding PTSD direct effects.

Resources and Support

Government Resources

VA.gov disability: www.va.gov/disability/
VA neurology services: Available at VA Medical Centers
National Institutes of Health headache information

Medical Resources

American Migraine Foundation: www.americanmigrainefoundation.org
National Headache Foundation: www.headaches.org
Neurologist finder through professional organizations

Veteran Organizations

VFW, American Legion, DAV: Free representation
IAVA: PTSD and benefits support

FAQ

Q: Do I need a neurologist for chronic headache claim?

A: Not required, but strongly recommended. Primary care provider can file, but neurologist nexus letter significantly strengthens claim credibility and approval likelihood.

Q: What headache frequency qualifies for VA rating?

A: Typically 10% requires 1-2/month, 20% requires 3-4/month, 30% requires 5+/month. Frequency is primary rating determinant.

Q: If my migraines improved with PTSD treatment, does that affect rating?

A: Improvement actually strengthens claim by confirming PTSD-headache connection. Improvement doesn't reduce rating if migraines persist despite improvement.

Q: Can I claim both tension headaches and migraines?

A: Yes, if you have both. Medical documentation may show either pattern separately or combined headache disorder. File for the diagnosis documented in medical records.

Q: Will VA send me to neurologist for C&P exam?

A: Possibly, especially for complex headache cases. C&P examiners sometimes include neurologists. Prepare with headache journal and functional impact examples.

Q: What if my headaches are stress-related (not PTSD)?

Final Recommendation

Success requires:

Detailed headache documentation (frequency, severity, functional impact)
Clear PTSD-headache relationship (onset post-trauma, correlation with PTSD symptoms)
Strong nexus letter (ideally from neurologist explaining physiological mechanism)
Functional impairment evidence (work impact, activity restrictions)

With these elements, approval likelihood exceeds 70%. Even if initially denied, supplemental claims with better evidence have high success rates.

Immediate Action Items:

Begin headache journal today (document 3-4 weeks before filing)
Ensure VA mental health records document PTSD-headache relationship
Schedule neurologist evaluation if not recently evaluated
Obtain headache medication history from pharmacy
File complete claim at VA.gov within 30 days

Next Step: Start your claim at VA.gov. Contact VFW, American Legion, or DAV for free representation throughout the process.