April 3, 2025 • 54 mins
Migraine headaches require meticulous documentation for successful VA disability claims because they are purely subjective conditions with no objective tests to verify symptoms. Bethanie Spangenberg of Valor 4 Vet explains the critical components of the Migraine DBQ and rating criteria.
• "Prostrating" is the magic word determining VA ratings—meaning attacks causing extreme exhaustion, powerlessness, debilitation, or incapacitation
• Frequency of prostrating attacks directly correlates to rating percentages
• Secondary service connection (linking to already service-connected conditions) is often easier to establish than direct service connection
• Documentation is crucial—keep headache journals, seek proper medical care, get imaging when appropriate, and ensure workplace supervisors are aware of your condition
• Evidence wins claims—gather and maintain all medical records, civilian and military, in a fireproof safe
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
J Basser (00:03):
Welcome folks to another episode of Exposed Vet
Productions.
On this Thursday it's April 3rd2025.
A beautiful day outside.
It only had seven inches ofrain, but still a pretty day out
there.
If you want to stay dry, stayin the house.
Got Mr Ray Cobb down in thegreat state of Tennessee out to
Alabama.
He'll probably get washed downinto Alabama here if it keeps
(00:25):
raining.
He'll be on washed down intoAlabama here.
If it keeps raining, he'll beon Lake Guntersville here by the
morning probably catching fish.
Ray Cobb (00:31):
We hadn't had any rain today.
We had some real high winds inthe middle of the night, but
we've been okay today.
J Basser (00:38):
Well, that's great.
And then we got a residenttornado chaser up there in
southern Ohio.
Her name is Bethany Spangenberg.
She sent me a picture of a tanktoday.
I told her she needed that tochase storms with and have me a
tornado shelter.
She's Bethany Spangenberg.
She is the owner and the chiefprincipal officer of the company
called Valor for Vet, and Valorfor Vet is a company that takes
(01:01):
veterans' disabilityexamination and puts all the
information in to help a veteranwith a disability claim.
And Bethany, how are you doing?
Bethanie Spangenberg (01:11):
I'm doing well.
I'm glad that we got over thiscrazy storm and we survived and
not a lot of trees down, so youknow, I feel blessed in that
aspect, so it was crazy.
J Basser (01:23):
Well, that's good.
I know we've been touching inthe last several months.
We've been going down to DBQsand trying to, you know, break
them down into where I guesspeople can understand them,
because you know it's a big long, it's a big process.
You know, so many we've been, Ithink we've probably done eight
or 10 shows on the dbqs itself.
You know, since I'm here, we'restaying on the neurological
(01:44):
section, is it?
But we're going to cover uh, uh, subjects near and dear to me,
called migraine headache, and uh, I know we talked about a
little bit earlier in the day.
So if you want to, won't youjust go ahead and get started
and uh, we'll, uh, we'll jump infrom time to time there and, uh
, we won't give each other aheadache in the process, sounds
good, I appreciate it.
Bethanie Spangenberg (02:06):
You know, I'm actually surprised we
haven't talked about themigraine headaches yet, because
it is such a common condition.
It's something at Valor for Vetthat we write a lot of nexus
letters for the ACE criteria,which means that we can conduct
(02:27):
an interview without doing aphysical and gather the
information for the DBQ for theveteran to submit it as evidence
for their claim.
So that's why I said I wassurprised, because it's
something that we deal with on aregular basis, and so I was
just looking at our statisticsyesterday actually, because I
was writing a report on migraineheadaches and 58% of the nexus
(02:51):
letters that we write related toheadaches are due to a mental
health condition.
So of all the nexus letterswe've written, 58% are written
for headaches as secondary to amental health condition.
So that was actually surprisingto me, because there are a lot
of things that can causeheadaches and we can talk more
(03:13):
about that as we go through theDBQ.
But just a unique conditionclaim process for veterans, and
what also makes it unique isthat headaches themselves are
purely subjective.
There's no way for a clinicianto do a test to verify that
you're experiencing a headacheor that you're experiencing
(03:36):
visual changes because of theheadache.
We can't even tell if you'rehaving nausea from the headache.
You have to verbalize everyaspect of your headache symptom.
And so for the VA it makes itchallenging to try to make it
objective in order to provide adisability rating, because they
(03:56):
like this objective testing andall that other good stuff to
verify that the veteran istelling the truth.
So headaches they're not thatway, so they kind of have to
collect.
The VA has to collect theirdata a little bit differently in
order to help the veteran get arating or decide what rating
they receive.
(04:19):
So, all right, jumping straightinto the headaches DBQ.
It is five pages long.
First section opens up with theveteran's information and the
medical examiner is to lay outthe relationship that they have
to the veteran, if it's theirpatient seen in their clinic or
(04:40):
if it's not, and how the veteranwas examined.
The first page also asks forevidence, review.
Evidence is always important.
You have to provide it to theVA for their C&P examiners.
You also need to provide it toprivate companies that you're
asking them to complete the DBQ,for what's interesting in this
case is that the M21, which isthe VA manual for their
(05:06):
employees and raters to gothrough and decide what rating
the veteran gets.
They actually outline specificevidence that they want to see
for headache claims and that'snot typical for a lot of your
disability claims.
But the M21 tells the rater toanalyze the medical records, the
veteran's statement regardingtheir symptoms if there's a
(05:28):
headache journal, anyprescription medications and
even witness statements.
So if I was a veteran making aclaim for their headache or
their headache condition, Iwould make sure that I had all
of those in there as evidence tosupport my claim.
Section one is the diagnosis.
Always open up with thisquestion regarding the diagnosis
(05:51):
, this is word for word Does theveteran now have, or has he or
she ever been, diagnosed with, aheadache condition?
This is absolutely importantfor a veteran making a claim.
You need to show that you havehad a diagnosis for the
condition that you are claiming.
If they mark no, they couldcompletely close the DBQ and be
(06:13):
done so you want to make surethat that information is in
there that shows the diagnosis.
If we look at page two, sectiontwo, it's the medical history.
It's pretty straightforward Forme personally, I like to
document all of the veteran'smedical history from start to
(06:34):
finish.
Even if the veteran is alreadyservice-connected, I still like
to understand how that headachecondition has transpired.
Any questions?
So far no.
J Basser (06:48):
I didn't notice a lot of information.
I mean, I guess you're right,my headaches, you know it's kind
of subjective because there'sno actual physical path to
determine a headache.
You know a headache is actuallyhappening.
The thing is PTSD too, thoughit's also subjective too, right?
I think it's PTSD too, thoughit's also addictive too, right,
(07:10):
it's true.
Bethanie Spangenberg (07:12):
The Section 2 also looks at
medications specifically for theheadache condition.
The examiner is supposed todocument that.
Section 3 looks at the symptoms.
The examiner is to document thetype of pain that the veteran
(07:33):
is experiencing, whether it'sconstant, pulsating throbbing
localized to one side of thehead, if it's on both sides of
the head or if the pain worsenswith physical activity.
Now, those particular symptomsdo not have anything to do with
the reading schedule, but theymay support the limitations you
experience in your workenvironment or at home.
(07:54):
Additional symptoms the medicalexaminer is to document that
are considered to benon-headache symptoms are nausea
, vomiting, sensitivity to lightor sound, changes in vision or
changes in sensations such aspins and needles in the hands or
(08:17):
the fingers.
Again, that has nothing to dowith the rating schedule, just
supports any type of limitationsthat you have in the work
environment.
Question 3C looks specificallyat the typical duration of the
headache pain.
They want to know how long theheadache pain lasts.
(08:41):
And the options are less than aday, one to two days, more than
two days or other.
Now, a lot of times I haveveterans that will answer yes to
all of them and they actuallygo on to talk about how they
have headaches that can lastseven to 10 days or even longer
and that you also want to put inyour statement to support the
(09:06):
documentation.
And again, we're looking at thelocation of the typical head
pain.
In my opinion, it's kind ofredundant.
They want to know if it's theright side, the left side or
both sides.
I think that's more of aclinical question so that way we
can understand what may becausing or triggering the head
pain or the headaches.
If you have somemusculoskeletal conditions, they
(09:31):
can trigger the location of thepain.
So I think that's primarily whyit's there.
Any questions regarding thosespecific set of symptoms
regarding those specific set ofsymptoms.
Ray Cobb (09:53):
Bethany, one thing that came up that brought to my
attention as you were talkingthere military-connected.
What would happen to a veteranfor him to be military-connected
for these headaches?
I mean, would it be like a loudsound or a shell going off near
him, or did he hit his head, oris it chemically?
Bethanie Spangenberg (10:12):
So typically what we see for
veterans that have a serviceconnection for migraines direct
to military service is going tobe some type of head trauma or
head injury going to be sometype of head trauma or head
injury.
Typically we see the serviceconnections as a secondary
condition.
(10:33):
The problem with migraines isthat, or headaches in general,
is that when we developheadaches we don't always see a
doctor or get medical treatmentfor them, unless there's
something significantlytraumatic like a head injury.
So sometimes when we're understress in a military environment
(10:53):
or if we're exposed to achemical that we're working with
, we just say, oh man, thatsmells really getting to me, I
need to get away from it.
Then we'll separate ourselvesand then self-treat with
ibuprofen or Tylenol and it'snot until it becomes a recurrent
issue that we seek clinicalcare.
(11:13):
So a lot of times the limitationwith veterans getting a direct
to service connection is thatthey don't seek treatment while
in service.
It's one of those things thatthey push off.
On the secondary side of things, yes, they can be related to
chemicals.
Yes, they can be related tomental health stress.
(11:33):
They can be related to anythingthat affects the balance in the
brain system and chemicals thebrain system and chemicals.
So the idea, you know, theydon't know from the medical side
of things exactly why headachesoccur, but the theory is is
that there is a threshold forthe body and so if we start out
(11:56):
our day up here and let's say,you know we, we didn't sleep
well, so that threshold that barlowers, and then maybe we
forgot our thyroid medicationthat day, that can lower the
threshold.
And you know what, my neck isreally bothering me today
because I just I slept wrong andI was triggered my neck
(12:20):
condition and then it lowersthat threshold to where a
headache is triggered.
So there's a lot of things inour bodies or in our environment
that can trigger the headaches.
And from the medical expertside of things, when we write
these nexus letters, we reallyhave to understand the veteran's
full history.
You know what kind of medicalconditions are at play.
(12:43):
What are they suffering with orexperiencing on a regular basis
?
J Basser (12:49):
Does that make?
Bethanie Spangenberg (12:50):
sense.
J Basser (12:51):
Yeah, that kind of puts a big onus on you too,
because you've got to realizethat if you're doing this and
you're doing an exam forsomebody and you realize that,
okay, this guy has got headaches, say the guy did have a pretty
severe neck injury in theservice, plus he probably had,
say he had severe high bloodpressure, okay, and say he kept
going to sick, call he's hadseveral headaches in service
over this issue.
So it makes your job easier.
(13:12):
But now do you have to pinpointas to which condition actually
caused the headaches, or can youdo a general relate to both of
them?
Bethanie Spangenberg (13:20):
Often we try to throw everything at it
because that's the way thecondition, that's the way
migraines occur.
It's not typically one thing.
It's typically mental healthand sleep apnea, or it's mental
health and a musculoskeletalcondition.
J Basser (13:50):
So we try to use everything to support that, to
show that those play a role incausing or contributing to the
onset of the headache condition.
Good, because when you get donewith the DBQ, I want to go
through and I want to give ourlisteners, I want to give them
some great advice on what to doand I don't feel good.
Stay tuned, folks, you're notgoing to miss this one.
Okay, go ahead, ben.
Bethanie Spangenberg (14:08):
So section we just finished section three.
If we look at section four,this is where the VA is going to
look to give you a rating andit has to do with prostrating
attacks of the headachecondition.
The term prostrating is anolder term that we don't use in
(14:32):
today's medicine.
When we hear that term, if aclinician hears that term and
they're familiar with the VAdisability, they get a red flag
and they're like, oh, they'refamiliar with the VA disability.
They get a red flag and they'relike, oh, they're either
looking for VA disability ordiscussing VA disability or
that's a trigger word for theclinician to kind of understand
(14:58):
the direction of where theveteran's going For their VA
rating.
Prostrating is the word thatthey lean on for your rating.
Now the M21 defines the wordprostrating as causing extreme
exhaustion, powerlessness,debilitation or incapacitation,
(15:23):
with substantial inability toengage in ordinary activities.
A lot of times what we hearwith veterans when they
experience a prostratingheadache it's that they get a
headache that is so severe thatthey have to excuse themselves
from whatever they're doing, gointo a dark room, turn the
(15:43):
lights off and just kind of getaway from the stimulus, overload
, the sensory overload and takemedication typically.
So when we think of prostrating.
That's the first thing thatcomes to my mind of it's so bad.
I need to get out of thisenvironment and kind of separate
myself to get everything tosettle down, separate myself to
(16:09):
get everything to settle down.
Question 4A it says does theveteran have characteristic
prostrating attacks of theheadache pain?
The first option for theexaminer to document or to mark
is with less frequent attacksand that's kind of based on a
scale, the M21, I know I keepreferencing the M21, but it
(16:30):
really is the most helpful andkind of trying to understand how
the VA works with this.
The 38 CFR, which is the ratingschedule for the migraines, is
not very helpful in trying tounderstand how these things are
rated.
So the M21 says less frequentis characteristic prostrating
(16:55):
attacks on average are more thantwo months apart over the last
several months.
So that's what they mean bybeing less frequent the last
several months.
So that's what they mean bybeing less frequent and that you
can understand a little bitbetter when you look at the next
option for the examiner todocument.
The next option is they havethese prostrating attacks once
(17:16):
in two months.
That gets the veteran a 10%rating If the veteran
experiences one prostratingattack every month, that's a 30%
rating.
The last option is greater thanonce per month.
Question 4B talks aboutcompletely prostrating and
(17:41):
prolonged attacks of themigraine or non-migraine
headache pain, and those optionsare the same.
So if they have less frequentattacks, that's 0%.
If they have it once in twomonths, that's 10%.
Once every month, that's 30%.
And the last one for thecompletely prostrating and
(18:04):
prolonged attacks greater thanonce per month is a 50% rating,
and that's typically some of themore severe headache conditions
.
That's where it lands.
Any questions about Section 4?
J Basser (18:21):
All right, no, you didn't.
Bethanie Spangenberg (18:27):
The magic word now the 38 cfr.
I like to pull it up, um,because in the 38 cfr for a 50
percent rating, it specificallysays with very frequent
completely prostrating andprolonged attacks so, and then
(18:52):
it goes on to say productive ofsevere economic inadaptability,
the attacks, productive ofsevere economic inadaptability.
That kind of goes hand in handif you have these completely
prostrating and prolongedattacks.
So that basically what you haveto do to get the 50% is you
(19:13):
really have to lay out how thisaffects your job, how this
affects your function incompleting your work tasks and
we'll talk a little bit moreabout that later on in the DBQ,
(19:34):
about that later on in the DBQ.
Section five is a place for theexaminer to put other pertinent
findings regarding theheadaches.
5b asks about scars related tothe headaches.
I've seen a few of these withthe head trauma.
They'll have a scar on theirhead somewhere Not very common.
Section six is diagnostictesting.
Testing and it asks are thereany other significant diagnostic
(19:56):
test findings or results?
And for me when I complete thesedbqs, if you are, if I look at
what we expect to happen in theclinic versus what the veteran
is saying for their disability,I want those things to align.
I want them to be clinicallyconsistent.
(20:16):
So if a veteran is telling mein the clinic that they are
having completely prostratingand prolonged attacks of their
headaches, that I'm going to putevery tool out there to figure
out why these are happening Inthe clinic.
I'm going to do lab work, I'mgoing to do some type of imaging
(20:38):
, a CT scan typically and I mayrefer them to a specialist.
A lot of times what I see is Ihave these veterans that will
say they have completelyprostrating attacks and they
occur once a week and for me Iwant to see that they've had
(20:59):
testing done, that they've beenreferred to a neurologist.
That's also a red flag.
If they haven't so when Icomplete these DBQs I will put
in there.
The veteran was encouraged toseek workup for their headache
condition based on the symptomsprovided, because there can be
something wrong anatomically inthe brain or in the body that is
(21:21):
causing these headaches and ifthey're not worked up then there
can be consequences for thoseuntreated health conditions.
So for Section 6, fordiagnostic testing, if they're
telling me that their headachesare prostrating, I want to see
that they've had testing done.
(21:42):
I feel that the other VA C&Pexaminers are along the same
thinking, because if they haveto write a nexus letter or they
have to make a medical opinion,then they're going to want to
believe that veteran and whatthey're experiencing.
And if they've brought thathistory and those complaints to
(22:04):
the VA for benefits, then theyshould be seeking clinical care
as well.
That is the typical thinkingand as a clinical mindset, so I
guess the better way to say itis.
It makes your report ofsymptoms believable.
It makes it look like you'retelling the truth if you have
(22:25):
sought care for your headachesthat are this severe.
Does that make sense.
J Basser (22:32):
Yeah, it does.
I tell you, though, if you'vegot bad migraines like that I
mean you know, I can guaranteeyou from a personal standpoint,
if you've had them for a verylong time then your medical
evidence is going to be off thechart, because I mean, I know,
certain times when you get thembad enough, you go straight to
(22:52):
the emergency room and you showup in your file with the VA and
the examiner looks at the PC's30 pages or 40 visits to the
emergency room with a veteranwith a migraine, or a guy
getting shot up his birth setand pentagon, and you know so I
mean that helps you out a wholelot too in that situation.
So keep records, people.
Bethanie Spangenberg (23:15):
yes I, when we write a nexus letter, if
they have the workup, I canreally lean on that, as you know
.
Hey, it's not because they havea foreign um, you know, some
type of nodule or tumor diseasein the brain that's causing
these headaches, and so I canreally lean on that workup to
(23:38):
support the nexus.
Here for the last page of theDBQ, looking at section seven,
this is the functional impact.
This is what I wanted to reallystress.
The question asks does theveteran's headache condition
impact his or her ability towork?
When I do these DBQs, I want toknow a specific example.
(24:00):
Tell me a time that yourheadache affected your job duty.
Tell me the story.
I know it's probably happened aton, but I want to know that
example.
Tell me what you'reexperiencing.
What are you doing?
Who's around?
I want to really be able topaint a picture in my report of
(24:23):
what is happening when you getthese headaches.
This is also Pardon.
J Basser (24:31):
What was the stress level?
Bethanie Spangenberg (24:33):
Yes, this is where the headache journal
also comes into play.
The M21 talks about looking ata headache journal, like I
mentioned earlier, and itactually says they want your
headache journal to say theheadache frequency, want your
headache journal to say theheadache frequency, the symptoms
(24:54):
, including whether or notthey're prostrating, and what
type of work limitations youhave.
So if you are building aheadache journal, you need to
make sure that you put thosethings in there as evidence to
support your claim.
The work limitations from yourheadache journal will also go to
support that functional impactand will go to support a 50%
disability rating, becauseyou're showing that it's
(25:17):
contributing to an economicissue.
Right, section 8 is the remarksection.
Section eight is the remarksection.
It's just a blank section forthe examiner to put any other
details that they want regardingthe headache condition.
Normally what I do is I willask the veteran, you know, is
(25:41):
there anything else that youwant me to know about your
headaches that we haven't talkedabout today?
These DBQs are designed forrating schedules and not
necessarily for clinical issuesand applications.
J Basser (26:01):
So when they tell me the remarks.
Bethanie Spangenberg (26:02):
I will plug any of those additional
remarks that I think arevaluable into that section.
The last section is Section 9,and it is the examiner,
certification and signature.
Typically this DBQ, if it'sdone over the phone, takes 10 to
15 minutes.
If it's done in person, maybe15 to 20 minutes.
So there's no physical exam,there's no prompting for a
(26:24):
physical exam.
They're purely looking at thesymptom and the evidence in the
file.
J Basser (26:36):
Makes sense.
Bethanie Spangenberg (26:38):
Any questions.
J Basser (26:44):
Ray, you got anything.
Ray Cobb (26:50):
No, not right off hand .
I mean I'm sitting therethinking I mean here's a problem
I have.
I think I would imagine I'veonly had a total of maybe three
headaches in my entire life, umand so therefore this is all
brand new to me.
I mean, I say that now I'veheard people say I've had a
(27:10):
migraine, I've had my grandsonthat he gets them and he has to
do what she was saying go laydown in a dark room and close
all the curtains and block outas much sound as he can and try
to go to sleep.
So you know, that's been kind ofmy experience is hearing what
(27:33):
others have said, uh, I can'trelate to it to say, oh, I know
what you're talking about,because I really don't.
It would be hard for me tothat's when I'm going to have to
turn a veteran over to you orsomebody else, because I have a
hard time understanding the painfactor, although I've seen
people.
Just actually in my work I hadan individual that it got so bad
(27:59):
that, like you were sayingearlier, she actually threw up
and you know they sent her homefor the rest of the day.
But you know, for my personalexperience I've had none of that
, nor has any of my immediatefamily had any of them.
This is really all new to me.
Before it's just been kind of ahearsay situation.
(28:22):
You hear about it but you knowyou don't actually see it.
You don't actually see it.
I'm assuming that mostindividuals when they come on
they go to a quiet place or theystay at home or they don't get
out and try to move aroundbecause they don't feel like it.
That's what I'm assuming fromwhat I've gathered here tonight.
Bethanie Spangenberg (28:49):
Severity will vary from person to person.
Um, a lot of times we havepatients that will get what they
call an aura, or they'll getlike uh, like blurred vision, or
they'll get symptoms before thehead pain actually occurs, and
so when they develop that aura,they can take ibuprofen or their
medication to kind of abort theheadache symptoms.
(29:12):
So for me personally, when Iget a migraine, it's vision
affecting my right side.
As soon as I get that vision,it kind of just tunnel visions
on one side.
When I get that, I run and Igrab three or four ibuprofen and
within hour I get no pain andthat vision has returned.
So you're you're lucky that youdon't experience the headaches
(29:36):
or the migraines, because theyare very common and they're
actually one of the topdisabilities in the world, for,
you know, across across theworld as far as limitations and
occupational impairment, it'snot really that bad stuff.
J Basser (29:50):
I mean, you're right.
I mean I know you can feel it,the aura of it coming up the
back of your neck, you know, andit just creeps up to me, and
the time it gets to a certainpoint is too late, no matter
what I take.
And so when I was, you know, Ijust basically I'd lay down
until I got bad enough and thenI'd have to take a blood
(30:11):
pressure, because a lot of timesduring the headache the blood
pressure would go extremely,extremely high.
I'm talking 215, 220, high over180.
And so there I'd go off to theemergency room and I'd be
getting all these fancymedications and I'd come home
and sleep for hours upon endbecause of the pentagram and the
(30:32):
other medication.
And so in the past probably 10or 12 years, I stopped taking
the medication.
I stopped saying, okay, here'swhat you know, I don't want to
take this no more.
After this stuff is making meloopy, I found out there's one
medication that works better onyou.
If you've got a migraine, go tothe ER, get a Toradol shot.
That works better than anystinking narcotic.
(30:57):
Plus, you're not loopy and youcan return to function pretty
quickly after the fight.
Bethanie Spangenberg (31:03):
When I covered the urgent care clinic.
We would have patients come injust for Toradol for their
migraines.
J Basser (31:09):
It works.
But now I've been to everyspecialist known to mankind.
I've been to several differenttypes of neurologists.
I've had CTs, mris.
I've had all the workups done.
I've had the Pocomaxes and theChocomaxes and the what do you
call them?
(31:29):
The ones you've got to take20,000 milligrams of that
stinking pill.
I can't stand it.
It's Neurontin, it isNeurological Rotten.
I've had it all.
I've had every psych.
It's psych meds, more or lessright.
Bethanie Spangenberg (31:49):
It does it affects your brain.
Some of it's used for psychreasons.
There are psych meds more orless right.
It does it affects your brain.
Some of it's used for psychreasons.
They're old meds and they justhonestly, they, they tested them
and they're like, oh okay, well, it worked.
And 50 of the patients.
So now we're going to start topush this for migraines to see
if it helps somebody else.
I mean, there's really no truescience behind it.
J Basser (32:07):
It's trial and error all the medications.
I was like the dude that had anIQ of 10 in college.
I failed them all, but I've gotsome good advice for it.
I mean it's difficult.
So if you're doing an exam foran initial service connection,
(32:28):
you really have to dig and see,because you've got to be the one
related to the service therehas to be enough evidence to
show it or related to acondition that's already service
connected, like hypertensionand sleep apnea and things like
that.
That's probably one of thehardest things to do for a CMP
examiner.
Now, as far as an increase,it's still kind of a catch-22
because the severity is an issueto which it's got to be proven
(32:51):
right.
If a person is 30 and wouldn'tgo to 50, you've got to prove
that his migraines have becomevery prostrating or severe
economic impact for his workingability.
You know it's a catch-22 in myopinion, but it all depends on
(33:13):
how it's written up.
Bethanie Spangenberg (33:16):
That's very true, it does.
J Basser (33:23):
There's a lot of pointers.
There's a headache journal.
It used to be called a headachediary.
I guess they changed it tojournal over the last few years.
You need to write that downEvery time you get a migraine.
You's called a headache diary.
I guess they changed it tojournal over the last few years.
You need to write that downEvery time you get a migraine.
You need to write it down.
Today's technology you don'tneed to write a thing down.
If you've got an iPhone, youcan say Siri, make a note.
Then you can combine thosenotes.
The next thing you know, boom,you've got a headache journal.
Bethanie Spangenberg (33:46):
There's actually apps out there for it
too so you download the app andyou pop it open and it will ask
you what symptoms you'reexperiencing and the date and
the time.
What you think triggered it.
And even that's helpful for mewhen I write an access letter,
if, if you kind of give mefeedback on what's you know.
What do you think triggered it?
You know what you know becauseyou know what?
(34:07):
you know, because you know yourbody the best.
And so if you can tell me well,you know I got yelled at at
work or I got a nasty email atwork, or you know that that
stress component can help me tokind of decipher, you know
what's happening.
J Basser (34:24):
Experience is a very big factor, I don't care what
people tell you, is a very bigfactor, big factor in headache,
I don't care what people tellyou, it's a very big factor.
If you're in high stressfulconditions and jobs and things
like that.
Say, okay, you're a.
Say like Joey Jones, your jobis to disarm bombs, that's
pretty dang impressive.
Say, if you're in qualitycontrol and your job is to keep
an assembly line going,manufacturer automobiles.
(34:46):
Say your company makes a defect.
Next thing you know you'regoing to stop the line.
When you stop the line it's somany thousand dollars a minute
until you get it fixed.
You know that's stressful.
Where you sit there makingmillion-dollar decisions in
about 30 seconds, that'sstressful.
They can cause migraine.
If I tell you something elsecauses migraine, the people will
get mad at me for saying it.
(35:07):
A lot of migraine-conditionedfolks are hereditary.
Bethanie Spangenberg (35:12):
Yeah, when we do consider those, when we
write our nexus letter, we liketo look to see that family
history component and then atthat point we look okay, well,
is this condition nowaggravating, you know, or is it
aggravated by aservice-connected condition?
So you know, that plays a partin the nexus as well.
J Basser (35:33):
It does.
It does.
You know it's crazy, though Imean it's not fun, but you know
they do say and I haven't seenthis personally yet but they say
the older you get, the less youreally become and eventually it
might go away.
But what I have noticed too iswhen you get up in your 50s,
pushing the big six zero excusemy French you still have the
(35:58):
aura and you still have themigraine, but you've had so many
that the neurological system inyour head, where it's aching,
is not as much as pounding.
Because usually if you havethat bad, every time your heart
beats it's a thump, but over aperiod of time it's more of a
numbness than it is a thumping.
(36:21):
That's my personal note.
That's kind of something tolook forward to folks.
I mean it's serious, I hate tosay it, but it don't matter what
.
It takes rid of the pain and itworks.
So you know, I mean it's justmy own personal experience.
I mean I hate to see anybodysuffer through.
You know I hate to see it, butwhen you get knocked in the back
(36:50):
of the head at a young age, itdoes give you a headache.
Bethanie Spangenberg (36:52):
yeah, yeah , no, nope, nope nope, yeah,
yeah are your parents no, nope,nope, nope, nope.
J Basser (37:03):
There's a guy named Dougie.
What's playing up for anothershow what not to do in the
military.
What not to do how to stayalive in non-combat situations
with their own soldiers.
Bethanie Spangenberg (37:20):
I can see that Michael's told me some
stories.
I can only imagine You've toldme some stories about you when
you were younger, so I figuredyour parents probably gave you a
thump or two.
J Basser (37:36):
My parents were the ones that mean the situation.
They were just didn't know howto raise kids.
It's a pretty sad situation.
We didn't raise ourselves.
They were good to us, we hadfood on the table and things
like that.
We survived.
We're still here.
We're not dead yet.
Let's have a piece of wood toknock on.
(37:59):
I think we done.
Still here, we're not dead yet.
Let's have a piece of wood toknock on, I think we done.
Lost Ray.
I think he's already tuned out.
Are you ready?
Ray Cobb (38:05):
No, I'm sitting here just picking up on all this
stuff because, like I saidearlier, I was fortunate the way
I grew up too.
I'm kind of one of the luckyones.
I had an older sister thatwatched out for me and my
parents.
I was fortunate the way I grewup too, I'm kind of one of the
(38:26):
lucky ones.
I had an older sister thatwatched out for me and my
parents was always.
You know.
I definitely didn't have anyproblems.
My biggest thing was putting aguy in the trunk of the car,
putting ketchup on his leg anddriving up to a red-ace service
station asking if I could borrowhis shovel.
That was the biggest trouble Igot into.
Bethanie Spangenberg (38:42):
He thought I had a dead man.
Ray Cobb (38:42):
Yeah, he thought I had a dead man in the back of the
car and called the police.
J Basser (38:53):
They came to check me out to see if I could make sure
that I wasn't riding around witha corpse in the back of my
trunk.
We only had done that when wewere deer hunting.
We put our shovels in the backof the toolbox and we'd drive
around to our deer hunting spotand see these protesters and
we'd get the shovels out.
They didn't hang around verylong.
Ray Cobb (39:06):
Laughter, laughter our biggest thing was back when I
grew up here in middle Tennessee.
You know August was really agreat month to be a young man
and you know in your early teensand mid-teens these watermelon
patches.
They're an awful lot of fun togo into at night and get you two
(39:29):
or three watermelons and takethem out to your girlfriend's
house and leave them on theporch and you made a lot of
brownie points that way, youknow.
J Basser (39:38):
Well, you learned a lot of footballie points that
way, you know.
Well, you learned a lot offootball moves too, didn't you?
Yeah, no, but listen, I'm gonnatake this.
Um, folks, migraines areserious business.
It really doesn't matter whatcause that you're going to
suffer through it because youknow you're the victim of it,
because it's going to hit, youdon't suffer.
You know, if your serviceconnected in the va regardless
(40:01):
of what percentage, I mean, youknow, especially if you're
supposed to take for headaches,especially and you don't live
too far away from the va it'sgot a virtue room, you get a
migraine, go to merchant, get atour doll shot, because that's
your best way of building thisissue up, because one day, you
know, it gets bad enough, you'regoing to need an increase and
you've got to build it.
It's kind of like making fireon a survivor you don't build it
(40:24):
right and the other guy's goingto win and another point to
that.
Ray Cobb (40:30):
you know, john, I was thinking a moment ago.
Something you said, or somethingBethany said, popped into my
mind.
You know, if you're at work andyou have a migraine, don't just
sit back and suffer with it orjust shrug it off.
You make sure that your manageror your supervisor or someone
above you knows that you'rehaving a migraine.
(40:52):
That's okay if you keep working,if you keep working.
But the purpose of that is, atsome point down the line, if you
file a claim for a migraine, ifthat individual, that
supervisor, could say, yes, hehad migraines quite often at
work, that's just going tostrengthen the case to which
(41:16):
frequency and how it affectsyour ability for an income could
show up, like Bethany wastalking about earlier, that they
look for when she does it, sothat you know that's a very
important guys.
You know, go to the ER, gettreatment, get that record on
your or get that information onyour records, get the
information with your employerthat you're having them, even if
you don't have to go home, butif it may cause a slowdown in
(41:38):
your work.
But if anything else, it mightallow him to take some of the
pressure off of you instead ofpushing you to get something
completed by the end of that day, knowing that that might make
it worse.
Or, if you make a mistake, itwould at least be a reason as to
why you made the mistake, notbecause of negligence.
J Basser (42:01):
Let me go through the general advice, and Beth will
agree with this.
Guys, no matter if you've got amigraine or if you get any
condition, it's not going tofall a claim on you.
You may not even know it'sclaimable right now.
But my best advice for you ifyou get out of service and
you've got to get a copy of yourmilitary medical record, your
military service records, andwhen you get out of service,
(42:22):
anytime you go to the hospital,doctor or whatever I don't care
if you get bit by a spider orget in a car wreck you make sure
that everything you do, you getall the copies of that visit
and you put in your house.
It's somewhere in a fireproofsafe.
No matter what, every documentyou can get your hands on.
You're going to need that laterdown the road.
And if you file a claim with theVA and the Veterans Claim
(42:44):
Assistance Act of 2000 gave theonus on the VA to actually
obtain the documents that are inpossession of the United States
government.
So they kind of get the onus onthem to do that of the United
States government.
So they kind of get the onus onthem to do that.
It says they will attempt toreach out and contact your
private treatment places to getyour civilian records or your
(43:05):
private medical records.
Okay, the key word here isattempt.
You know, if I attempt to winthe powerball it doesn't mean
I'm going to right I like thatexample.
I'm serious, you get yourrecords and you keep them on you
because you make this littlelady's job a lot easier.
She can write you a stone cold,stiglossian opinion that she
(43:28):
can come off the top rope andshe can elbow that claim right
through the mat and you're readyto go.
And that's a fact.
Evidence wins claim.
Only problem is you're thecarpenter.
(43:48):
You got to have your evidence,you got to build it.
If not, and these people arenot your friend folks.
I hate to say this because, uh,what I've seen the past couple
of days.
I'm sorry.
I'm sorry.
As a matter of fact, I haven'tchanged the name of the VBMS or
the VBMS.
I called it the VMBIS.
Ray Cobb (44:13):
Well, you're right, they're not your friends.
And if it means you know onething, I did and I think others
have done it too.
You know, if you have asituation, and especially if
it's not at the VA, you knowyou're outside doctors or
(44:34):
whatever.
It's your responsibility to seethat it's gotten doctors or
whatever.
It's your responsibility to seethat it's gotten.
Highlight whatever it is thathelps prove your case.
Make a copy of it and get itturned in and send it to end
with your claim.
Now you cannot anymore.
You cannot go to your doctorand say, would you put this in
(44:54):
my medical records?
They're not allowed to do thatanymore.
I don't know if you guys haveheard that or not in the last
two or three years, but whatthey do, they say, well, did
they send you to that person forcommunity care?
And you say, no, well, that'snot acceptable for us, we can't
put it in your records.
Well, that means that you haveto turn that information, those
(45:16):
reports, those exams.
It's up to you then to turnthem in with your claim so that
a proper decision can be made.
I found out personally.
I went down and found out whenI gave an outside report to my
podiatrist and he said, yeah,I'll get it turned in.
(45:38):
I checked two weeks later.
It wasn it turned in.
I checked two weeks later itwasn't turned in.
I called the records.
They said oh well, we're notallowed to accept that.
I said well, what happened tothe report?
Oh, it probably ended up in thetrash.
J Basser (45:50):
There you go.
The way that I did it.
I had a lot of stuff going on.
I was going through the spinalcord stuff and I had a lot of
information that we had to gothrough and they had to look at
it all because it's kind of a,you know, it's very
comprehensive and the doctoractually bypassed all those
rules and got it in therebecause basically it's for, you
(46:13):
know, a certain condition.
So I mean, I guess it alldepends.
I mean, look, personally, Ithink the courts are too lazy to
do it.
But you know, like, just myopinion, probably, yeah, and you
know, it's just, I don't knowwhat do you think Bethany?
Do you think they do their jobsor do you think they need help?
Bethanie Spangenberg (46:34):
I don't think we have enough time to go
into this discussion.
I just to me.
I think you know we've had thisdiscussion many a times, but I
(46:55):
think it's all a numbers gameand so they'll they deny
everything or they'll give you alot of veterans who will get
our DBQs and they'll submit ourDBQs and they'll be like well,
based off of what you reported,I should be getting this
percentage, but they only gaveme this lower percentage.
And then you know, we tell them, based off the DBQ, you're
correct, you should be gettingthis percentage.
(47:17):
You need to appeal it, you needto talk to a representative,
you need to fight thatdisability rating that they gave
you, and so that's probably,when it comes to migraines,
that's a very common report thatwe get and it just supports the
idea that they make you workfor anything you get, make you
(47:39):
fight.
J Basser (47:42):
Well, in your world, you know I mean veterans will
call us I've been lowballed, youknow, and lowball means they
underrate you.
I see it every day and I'm sureyou see it more than we do.
As far as that and yourday-to-dayday activities, and
Ray sees it all the time, youknow, and just like migraine,
(48:03):
you know guys get 0% frommigraines and you look up yeah
well, he didn't have aprostrating thing on here and it
looks in the medical recordthat shows what he's going
through and yeah, it'sprostrating.
All right, you know, he mightas well write it down.
You know, somebody didn't writeit down.
So you know that's a magic word.
It is a magic word.
I mean, no matter whateverybody talks about migraine,
(48:24):
this is your magic wordprostrating.
And that doesn't mean if theprostrate you got prostate
disease, okay, that's adifferent word altogether.
So if you tell a doctor you gotprostrating condition, he says
you tear your roll and youbetter look out.
Bethanie Spangenberg (48:43):
Yeah, if the exam is the wrong area, make
sure you clarify Up here, uphere.
J Basser (48:55):
We've got to keep it fun and light, though.
We've been through a whole lotof DBQs in the past several
months, bethany, since, I guess,the last year, and you know
we'll keep going.
We'll have a whole new ballgame.
I don't know what.
Have you heard anything aboutthe Federal Register deal and
neurological stuff?
Any late stuff?
I don't know what to say, hmm.
Bethanie Spangenberg (49:16):
Nope.
J Basser (49:18):
I haven't know what to say.
Bethanie Spangenberg (49:20):
Hmm, nope, I don't anticipate hearing
anything for a while.
J Basser (49:24):
Mm-hmm.
Bethanie Spangenberg (49:25):
We got a lot of work cut out for them.
J Basser (49:27):
Mm-hmm.
Well, I know we got so manyoars in the water here.
We try to keep the boat goingstraight.
It's hard to keep it goingstraight, you know.
You try to cut your arm off.
You can be going around thecircuit.
We'll figure it out.
On Tuesday, guys Ray's got hisshow on WZYX in McCown Tennessee
(49:51):
.
Ray Cobb (49:52):
Yeah, that's right, I finally got a.
After what?
15 years?
I finally did a webpage.
And what 15 years.
I finally did a web page.
And so you know it's BettsRoadmap, small letters
B-E-T-S-R-O-A-D-M-A-Pcom.
You can look it up and I've gotBethany.
(50:14):
Matter of fact, I put aconnection to your page on there
and I got one to you, john, andgot one to James Cripps and one
to Alex Graham and then, I'mgoing to be putting up a little
more.
I got a blog about myself and myjourney with the VA and I've
got I've got ready to put up acouple more photos and a list
(50:36):
that you provided concerninggood agents, that if they need
to try to find an agent, it hastheir email and telephone number
and they can reach out to them.
J Basser (50:47):
The brave ones can never share.
You need to share scrapbooksfrom the photographs you've
taken over the years.
Man, that's pretty cool.
I mean I'm serious.
I mean you know you lived apretty good life'm serious, I
mean you know, I mean thereyou've uh, um, you lived a
pretty, pretty good life doingthis stuff.
You know, and you're reallygood at what you did and that
was your livelihood well, it was.
I mean, that's how I made aliving, yeah anytime you can
(51:10):
photograph atlanta brave theplayers, presidents and things
like that.
That's something you know.
That's something to be proud of, buddy.
Ray Cobb (51:19):
Well, and you know the interesting part, I've got to
live the dream that most menwould love to live.
I mean, you know, when you'redown at a Super Bowl and you're
close enough to the players thatyou can hear all those dirty
words they're saying to eachother, there's a lot of guys
that would like to be at thatposition to watch the game that
(51:40):
close, or bowl games, or playoffgames.
I had the privilege and honorof attending the first ncaa
college football playoff betweentennessee and florida state,
and so you know I've been veryfortunate, even though my I was
(52:02):
actually fortunate in themilitary too.
I mean, you know, I've followedgenerals around and took
pictures of them putting medalson and shaking hands, and that's
not much of a military life tohave to go through.
But at the same time, because Iwas the only military
photographer at Fort McCallum, Igot exposed to Agent Orange
because I had to go into a placewhere they were about to spray
(52:24):
it and they did spray it.
So you know, kind ofinteresting.
J Basser (52:30):
It is.
That's pretty cool.
I bet you didn't know thatabout you, did you?
Bethanie Spangenberg (52:37):
But actually maybe on your website
there can be like like a littlebutton to where you can share
all those photos.
J Basser (52:42):
That would be neat.
I'm curious.
I mean, that would be good Allright?
Ray Cobb (52:47):
Well, I have a book that I probably should have
published that goes back into mymilitary time and there's 120
photos in it and I had it madeinto a coffee table type book
and I got them from Germany andLondon.
Bethanie Spangenberg (53:05):
I got the.
Ray Cobb (53:05):
Super Bowls, playoffs, NASCAR.
Matter of fact, I got one ofthe last known photographs made
of Dale Earnhardt before he waskilled in Daytona, so you know,
things like that have been veryfortunate.
J Basser (53:25):
That guy should have wore that strap better, had a
better strap on his car.
He didn't like them.
Pretty sad.
Yeah, all right, guys, listen,we'll thank you guys for coming
on.
Bethany, thank you for beingyou, because every time you come
on we learn something, andwe're going to learn a whole lot
more.
You know, but we'll keep youglued in.
I mean, you're going to have ahard time leaving now.
You're invested.
(53:46):
No, I'm just kidding.
Thank you for having me.
Bethanie Spangenberg (53:50):
I appreciate it yeah.
J Basser (53:51):
And we'll do something else.
Next week, guys.
I'll advertise it.
Next month we'll bring it backon and we'll start something new
or whatever.
We'll let her decide and giveher time to think about it and
relax a little bit.
She spends a lot of time onthis stuff, guys, and we think
what she does.
And, ray, we'll be hollering atyou, man, because I'm going to
(54:12):
be on your show Tuesday andwe've got some laundry to air.
Ray Cobb (54:15):
Yeah, we're going to burn up the airwaves Tuesday,
aren't we?
I mean, I'm looking forward tothat.
We're going to let people knowwhat's really going on out there
in the world firsthand.
J Basser (54:25):
That's right, well, isn't that, guys?
This is John.
They call me Jay Basher.
I'm John Stacy.
I'm the owner of Expose it.
We'll be shutting her down fornow.
Welcome folks to another episode of Exposed Vet
Productions.
On this Thursday it's April 3rd2025.
A beautiful day outside.
It only had seven inches ofrain, but still a pretty day out
there.
If you want to stay dry, stayin the house.
Got Mr Ray Cobb down in thegreat state of Tennessee out to
Alabama.
He'll probably get washed downinto Alabama here if it keeps
(00:25):
raining.
He'll be on washed down intoAlabama here.
If it keeps raining, he'll beon Lake Guntersville here by the
morning probably catching fish.
Ray Cobb (00:31):
We hadn't had any rain today.
We had some real high winds inthe middle of the night, but
we've been okay today.
J Basser (00:38):
Well, that's great.
And then we got a residenttornado chaser up there in
southern Ohio.
Her name is Bethany Spangenberg.
She sent me a picture of a tanktoday.
I told her she needed that tochase storms with and have me a
tornado shelter.
She's Bethany Spangenberg.
She is the owner and the chiefprincipal officer of the company
called Valor for Vet, and Valorfor Vet is a company that takes
(01:01):
veterans' disabilityexamination and puts all the
information in to help a veteranwith a disability claim.
And Bethany, how are you doing?
Bethanie Spangenberg (01:11):
I'm doing well.
I'm glad that we got over thiscrazy storm and we survived and
not a lot of trees down, so youknow, I feel blessed in that
aspect, so it was crazy.
J Basser (01:23):
Well, that's good.
I know we've been touching inthe last several months.
We've been going down to DBQsand trying to, you know, break
them down into where I guesspeople can understand them,
because you know it's a big long, it's a big process.
You know, so many we've been, Ithink we've probably done eight
or 10 shows on the dbqs itself.
You know, since I'm here, we'restaying on the neurological
(01:44):
section, is it?
But we're going to cover uh, uh, subjects near and dear to me,
called migraine headache, and uh, I know we talked about a
little bit earlier in the day.
So if you want to, won't youjust go ahead and get started
and uh, we'll, uh, we'll jump infrom time to time there and, uh
, we won't give each other aheadache in the process, sounds
good, I appreciate it.
Bethanie Spangenberg (02:06):
You know, I'm actually surprised we
haven't talked about themigraine headaches yet, because
it is such a common condition.
It's something at Valor for Vetthat we write a lot of nexus
letters for the ACE criteria,which means that we can conduct
(02:27):
an interview without doing aphysical and gather the
information for the DBQ for theveteran to submit it as evidence
for their claim.
So that's why I said I wassurprised, because it's
something that we deal with on aregular basis, and so I was
just looking at our statisticsyesterday actually, because I
was writing a report on migraineheadaches and 58% of the nexus
(02:51):
letters that we write related toheadaches are due to a mental
health condition.
So of all the nexus letterswe've written, 58% are written
for headaches as secondary to amental health condition.
So that was actually surprisingto me, because there are a lot
of things that can causeheadaches and we can talk more
(03:13):
about that as we go through theDBQ.
But just a unique conditionclaim process for veterans, and
what also makes it unique isthat headaches themselves are
purely subjective.
There's no way for a clinicianto do a test to verify that
you're experiencing a headacheor that you're experiencing
(03:36):
visual changes because of theheadache.
We can't even tell if you'rehaving nausea from the headache.
You have to verbalize everyaspect of your headache symptom.
And so for the VA it makes itchallenging to try to make it
objective in order to provide adisability rating, because they
(03:56):
like this objective testing andall that other good stuff to
verify that the veteran istelling the truth.
So headaches they're not thatway, so they kind of have to
collect.
The VA has to collect theirdata a little bit differently in
order to help the veteran get arating or decide what rating
they receive.
(04:19):
So, all right, jumping straightinto the headaches DBQ.
It is five pages long.
First section opens up with theveteran's information and the
medical examiner is to lay outthe relationship that they have
to the veteran, if it's theirpatient seen in their clinic or
(04:40):
if it's not, and how the veteranwas examined.
The first page also asks forevidence, review.
Evidence is always important.
You have to provide it to theVA for their C&P examiners.
You also need to provide it toprivate companies that you're
asking them to complete the DBQ,for what's interesting in this
case is that the M21, which isthe VA manual for their
(05:06):
employees and raters to gothrough and decide what rating
the veteran gets.
They actually outline specificevidence that they want to see
for headache claims and that'snot typical for a lot of your
disability claims.
But the M21 tells the rater toanalyze the medical records, the
veteran's statement regardingtheir symptoms if there's a
(05:28):
headache journal, anyprescription medications and
even witness statements.
So if I was a veteran making aclaim for their headache or
their headache condition, Iwould make sure that I had all
of those in there as evidence tosupport my claim.
Section one is the diagnosis.
Always open up with thisquestion regarding the diagnosis
(05:51):
, this is word for word Does theveteran now have, or has he or
she ever been, diagnosed with, aheadache condition?
This is absolutely importantfor a veteran making a claim.
You need to show that you havehad a diagnosis for the
condition that you are claiming.
If they mark no, they couldcompletely close the DBQ and be
(06:13):
done so you want to make surethat that information is in
there that shows the diagnosis.
If we look at page two, sectiontwo, it's the medical history.
It's pretty straightforward Forme personally, I like to
document all of the veteran'smedical history from start to
(06:34):
finish.
Even if the veteran is alreadyservice-connected, I still like
to understand how that headachecondition has transpired.
Any questions?
So far no.
J Basser (06:48):
I didn't notice a lot of information.
I mean, I guess you're right,my headaches, you know it's kind
of subjective because there'sno actual physical path to
determine a headache.
You know a headache is actuallyhappening.
The thing is PTSD too, thoughit's also subjective too, right?
I think it's PTSD too, thoughit's also addictive too, right,
(07:10):
it's true.
Bethanie Spangenberg (07:12):
The Section 2 also looks at
medications specifically for theheadache condition.
The examiner is supposed todocument that.
Section 3 looks at the symptoms.
The examiner is to document thetype of pain that the veteran
(07:33):
is experiencing, whether it'sconstant, pulsating throbbing
localized to one side of thehead, if it's on both sides of
the head or if the pain worsenswith physical activity.
Now, those particular symptomsdo not have anything to do with
the reading schedule, but theymay support the limitations you
experience in your workenvironment or at home.
(07:54):
Additional symptoms the medicalexaminer is to document that
are considered to benon-headache symptoms are nausea
, vomiting, sensitivity to lightor sound, changes in vision or
changes in sensations such aspins and needles in the hands or
(08:17):
the fingers.
Again, that has nothing to dowith the rating schedule, just
supports any type of limitationsthat you have in the work
environment.
Question 3C looks specificallyat the typical duration of the
headache pain.
They want to know how long theheadache pain lasts.
(08:41):
And the options are less than aday, one to two days, more than
two days or other.
Now, a lot of times I haveveterans that will answer yes to
all of them and they actuallygo on to talk about how they
have headaches that can lastseven to 10 days or even longer
and that you also want to put inyour statement to support the
(09:06):
documentation.
And again, we're looking at thelocation of the typical head
pain.
In my opinion, it's kind ofredundant.
They want to know if it's theright side, the left side or
both sides.
I think that's more of aclinical question so that way we
can understand what may becausing or triggering the head
pain or the headaches.
If you have somemusculoskeletal conditions, they
(09:31):
can trigger the location of thepain.
So I think that's primarily whyit's there.
Any questions regarding thosespecific set of symptoms
regarding those specific set ofsymptoms.
Ray Cobb (09:53):
Bethany, one thing that came up that brought to my
attention as you were talkingthere military-connected.
What would happen to a veteranfor him to be military-connected
for these headaches?
I mean, would it be like a loudsound or a shell going off near
him, or did he hit his head, oris it chemically?
Bethanie Spangenberg (10:12):
So typically what we see for
veterans that have a serviceconnection for migraines direct
to military service is going tobe some type of head trauma or
head injury going to be sometype of head trauma or head
injury.
Typically we see the serviceconnections as a secondary
condition.
(10:33):
The problem with migraines isthat, or headaches in general,
is that when we developheadaches we don't always see a
doctor or get medical treatmentfor them, unless there's
something significantlytraumatic like a head injury.
So sometimes when we're understress in a military environment
(10:53):
or if we're exposed to achemical that we're working with
, we just say, oh man, thatsmells really getting to me, I
need to get away from it.
Then we'll separate ourselvesand then self-treat with
ibuprofen or Tylenol and it'snot until it becomes a recurrent
issue that we seek clinicalcare.
(11:13):
So a lot of times the limitationwith veterans getting a direct
to service connection is thatthey don't seek treatment while
in service.
It's one of those things thatthey push off.
On the secondary side of things, yes, they can be related to
chemicals.
Yes, they can be related tomental health stress.
(11:33):
They can be related to anythingthat affects the balance in the
brain system and chemicals thebrain system and chemicals.
So the idea, you know, theydon't know from the medical side
of things exactly why headachesoccur, but the theory is is
that there is a threshold forthe body and so if we start out
(11:56):
our day up here and let's say,you know we, we didn't sleep
well, so that threshold that barlowers, and then maybe we
forgot our thyroid medicationthat day, that can lower the
threshold.
And you know what, my neck isreally bothering me today
because I just I slept wrong andI was triggered my neck
(12:20):
condition and then it lowersthat threshold to where a
headache is triggered.
So there's a lot of things inour bodies or in our environment
that can trigger the headaches.
And from the medical expertside of things, when we write
these nexus letters, we reallyhave to understand the veteran's
full history.
You know what kind of medicalconditions are at play.
(12:43):
What are they suffering with orexperiencing on a regular basis
?
J Basser (12:49):
Does that make?
Bethanie Spangenberg (12:50):
sense.
J Basser (12:51):
Yeah, that kind of puts a big onus on you too,
because you've got to realizethat if you're doing this and
you're doing an exam forsomebody and you realize that,
okay, this guy has got headaches, say the guy did have a pretty
severe neck injury in theservice, plus he probably had,
say he had severe high bloodpressure, okay, and say he kept
going to sick, call he's hadseveral headaches in service
over this issue.
So it makes your job easier.
(13:12):
But now do you have to pinpointas to which condition actually
caused the headaches, or can youdo a general relate to both of
them?
Bethanie Spangenberg (13:20):
Often we try to throw everything at it
because that's the way thecondition, that's the way
migraines occur.
It's not typically one thing.
It's typically mental healthand sleep apnea, or it's mental
health and a musculoskeletalcondition.
J Basser (13:50):
So we try to use everything to support that, to
show that those play a role incausing or contributing to the
onset of the headache condition.
Good, because when you get donewith the DBQ, I want to go
through and I want to give ourlisteners, I want to give them
some great advice on what to doand I don't feel good.
Stay tuned, folks, you're notgoing to miss this one.
Okay, go ahead, ben.
Bethanie Spangenberg (14:08):
So section we just finished section three.
If we look at section four,this is where the VA is going to
look to give you a rating andit has to do with prostrating
attacks of the headachecondition.
The term prostrating is anolder term that we don't use in
(14:32):
today's medicine.
When we hear that term, if aclinician hears that term and
they're familiar with the VAdisability, they get a red flag
and they're like, oh, they'refamiliar with the VA disability.
They get a red flag and they'relike, oh, they're either
looking for VA disability ordiscussing VA disability or
that's a trigger word for theclinician to kind of understand
(14:58):
the direction of where theveteran's going For their VA
rating.
Prostrating is the word thatthey lean on for your rating.
Now the M21 defines the wordprostrating as causing extreme
exhaustion, powerlessness,debilitation or incapacitation,
(15:23):
with substantial inability toengage in ordinary activities.
A lot of times what we hearwith veterans when they
experience a prostratingheadache it's that they get a
headache that is so severe thatthey have to excuse themselves
from whatever they're doing, gointo a dark room, turn the
(15:43):
lights off and just kind of getaway from the stimulus, overload
, the sensory overload and takemedication typically.
So when we think of prostrating.
That's the first thing thatcomes to my mind of it's so bad.
I need to get out of thisenvironment and kind of separate
myself to get everything tosettle down, separate myself to
(16:09):
get everything to settle down.
Question 4A it says does theveteran have characteristic
prostrating attacks of theheadache pain?
The first option for theexaminer to document or to mark
is with less frequent attacksand that's kind of based on a
scale, the M21, I know I keepreferencing the M21, but it
(16:30):
really is the most helpful andkind of trying to understand how
the VA works with this.
The 38 CFR, which is the ratingschedule for the migraines, is
not very helpful in trying tounderstand how these things are
rated.
So the M21 says less frequentis characteristic prostrating
(16:55):
attacks on average are more thantwo months apart over the last
several months.
So that's what they mean bybeing less frequent the last
several months.
So that's what they mean bybeing less frequent and that you
can understand a little bitbetter when you look at the next
option for the examiner todocument.
The next option is they havethese prostrating attacks once
(17:16):
in two months.
That gets the veteran a 10%rating If the veteran
experiences one prostratingattack every month, that's a 30%
rating.
The last option is greater thanonce per month.
Question 4B talks aboutcompletely prostrating and
(17:41):
prolonged attacks of themigraine or non-migraine
headache pain, and those optionsare the same.
So if they have less frequentattacks, that's 0%.
If they have it once in twomonths, that's 10%.
Once every month, that's 30%.
And the last one for thecompletely prostrating and
(18:04):
prolonged attacks greater thanonce per month is a 50% rating,
and that's typically some of themore severe headache conditions
.
That's where it lands.
Any questions about Section 4?
J Basser (18:21):
All right, no, you didn't.
Bethanie Spangenberg (18:27):
The magic word now the 38 cfr.
I like to pull it up, um,because in the 38 cfr for a 50
percent rating, it specificallysays with very frequent
completely prostrating andprolonged attacks so, and then
(18:52):
it goes on to say productive ofsevere economic inadaptability,
the attacks, productive ofsevere economic inadaptability.
That kind of goes hand in handif you have these completely
prostrating and prolongedattacks.
So that basically what you haveto do to get the 50% is you
(19:13):
really have to lay out how thisaffects your job, how this
affects your function incompleting your work tasks and
we'll talk a little bit moreabout that later on in the DBQ,
(19:34):
about that later on in the DBQ.
Section five is a place for theexaminer to put other pertinent
findings regarding theheadaches.
5b asks about scars related tothe headaches.
I've seen a few of these withthe head trauma.
They'll have a scar on theirhead somewhere Not very common.
Section six is diagnostictesting.
Testing and it asks are thereany other significant diagnostic
(19:56):
test findings or results?
And for me when I complete thesedbqs, if you are, if I look at
what we expect to happen in theclinic versus what the veteran
is saying for their disability,I want those things to align.
I want them to be clinicallyconsistent.
(20:16):
So if a veteran is telling mein the clinic that they are
having completely prostratingand prolonged attacks of their
headaches, that I'm going to putevery tool out there to figure
out why these are happening Inthe clinic.
I'm going to do lab work, I'mgoing to do some type of imaging
(20:38):
, a CT scan typically and I mayrefer them to a specialist.
A lot of times what I see is Ihave these veterans that will
say they have completelyprostrating attacks and they
occur once a week and for me Iwant to see that they've had
(20:59):
testing done, that they've beenreferred to a neurologist.
That's also a red flag.
If they haven't so when Icomplete these DBQs I will put
in there.
The veteran was encouraged toseek workup for their headache
condition based on the symptomsprovided, because there can be
something wrong anatomically inthe brain or in the body that is
(21:21):
causing these headaches and ifthey're not worked up then there
can be consequences for thoseuntreated health conditions.
So for Section 6, fordiagnostic testing, if they're
telling me that their headachesare prostrating, I want to see
that they've had testing done.
(21:42):
I feel that the other VA C&Pexaminers are along the same
thinking, because if they haveto write a nexus letter or they
have to make a medical opinion,then they're going to want to
believe that veteran and whatthey're experiencing.
And if they've brought thathistory and those complaints to
(22:04):
the VA for benefits, then theyshould be seeking clinical care
as well.
That is the typical thinkingand as a clinical mindset, so I
guess the better way to say itis.
It makes your report ofsymptoms believable.
It makes it look like you'retelling the truth if you have
(22:25):
sought care for your headachesthat are this severe.
Does that make sense.
J Basser (22:32):
Yeah, it does.
I tell you, though, if you'vegot bad migraines like that I
mean you know, I can guaranteeyou from a personal standpoint,
if you've had them for a verylong time then your medical
evidence is going to be off thechart, because I mean, I know,
certain times when you get thembad enough, you go straight to
(22:52):
the emergency room and you showup in your file with the VA and
the examiner looks at the PC's30 pages or 40 visits to the
emergency room with a veteranwith a migraine, or a guy
getting shot up his birth setand pentagon, and you know so I
mean that helps you out a wholelot too in that situation.
So keep records, people.
Bethanie Spangenberg (23:15):
yes I, when we write a nexus letter, if
they have the workup, I canreally lean on that, as you know
.
Hey, it's not because they havea foreign um, you know, some
type of nodule or tumor diseasein the brain that's causing
these headaches, and so I canreally lean on that workup to
(23:38):
support the nexus.
Here for the last page of theDBQ, looking at section seven,
this is the functional impact.
This is what I wanted to reallystress.
The question asks does theveteran's headache condition
impact his or her ability towork?
When I do these DBQs, I want toknow a specific example.
(24:00):
Tell me a time that yourheadache affected your job duty.
Tell me the story.
I know it's probably happened aton, but I want to know that
example.
Tell me what you'reexperiencing.
What are you doing?
Who's around?
I want to really be able topaint a picture in my report of
(24:23):
what is happening when you getthese headaches.
This is also Pardon.
J Basser (24:31):
What was the stress level?
Bethanie Spangenberg (24:33):
Yes, this is where the headache journal
also comes into play.
The M21 talks about looking ata headache journal, like I
mentioned earlier, and itactually says they want your
headache journal to say theheadache frequency, want your
headache journal to say theheadache frequency, the symptoms
(24:54):
, including whether or notthey're prostrating, and what
type of work limitations youhave.
So if you are building aheadache journal, you need to
make sure that you put thosethings in there as evidence to
support your claim.
The work limitations from yourheadache journal will also go to
support that functional impactand will go to support a 50%
disability rating, becauseyou're showing that it's
(25:17):
contributing to an economicissue.
Right, section 8 is the remarksection.
Section eight is the remarksection.
It's just a blank section forthe examiner to put any other
details that they want regardingthe headache condition.
Normally what I do is I willask the veteran, you know, is
(25:41):
there anything else that youwant me to know about your
headaches that we haven't talkedabout today?
These DBQs are designed forrating schedules and not
necessarily for clinical issuesand applications.
J Basser (26:01):
So when they tell me the remarks.
Bethanie Spangenberg (26:02):
I will plug any of those additional
remarks that I think arevaluable into that section.
The last section is Section 9,and it is the examiner,
certification and signature.
Typically this DBQ, if it'sdone over the phone, takes 10 to
15 minutes.
If it's done in person, maybe15 to 20 minutes.
So there's no physical exam,there's no prompting for a
(26:24):
physical exam.
They're purely looking at thesymptom and the evidence in the
file.
J Basser (26:36):
Makes sense.
Bethanie Spangenberg (26:38):
Any questions.
J Basser (26:44):
Ray, you got anything.
Ray Cobb (26:50):
No, not right off hand .
I mean I'm sitting therethinking I mean here's a problem
I have.
I think I would imagine I'veonly had a total of maybe three
headaches in my entire life, umand so therefore this is all
brand new to me.
I mean, I say that now I'veheard people say I've had a
(27:10):
migraine, I've had my grandsonthat he gets them and he has to
do what she was saying go laydown in a dark room and close
all the curtains and block outas much sound as he can and try
to go to sleep.
So you know, that's been kind ofmy experience is hearing what
(27:33):
others have said, uh, I can'trelate to it to say, oh, I know
what you're talking about,because I really don't.
It would be hard for me tothat's when I'm going to have to
turn a veteran over to you orsomebody else, because I have a
hard time understanding the painfactor, although I've seen
people.
Just actually in my work I hadan individual that it got so bad
(27:59):
that, like you were sayingearlier, she actually threw up
and you know they sent her homefor the rest of the day.
But you know, for my personalexperience I've had none of that
, nor has any of my immediatefamily had any of them.
This is really all new to me.
Before it's just been kind of ahearsay situation.
(28:22):
You hear about it but you knowyou don't actually see it.
You don't actually see it.
I'm assuming that mostindividuals when they come on
they go to a quiet place or theystay at home or they don't get
out and try to move aroundbecause they don't feel like it.
That's what I'm assuming fromwhat I've gathered here tonight.
Bethanie Spangenberg (28:49):
Severity will vary from person to person.
Um, a lot of times we havepatients that will get what they
call an aura, or they'll getlike uh, like blurred vision, or
they'll get symptoms before thehead pain actually occurs, and
so when they develop that aura,they can take ibuprofen or their
medication to kind of abort theheadache symptoms.
(29:12):
So for me personally, when Iget a migraine, it's vision
affecting my right side.
As soon as I get that vision,it kind of just tunnel visions
on one side.
When I get that, I run and Igrab three or four ibuprofen and
within hour I get no pain andthat vision has returned.
So you're you're lucky that youdon't experience the headaches
(29:36):
or the migraines, because theyare very common and they're
actually one of the topdisabilities in the world, for,
you know, across across theworld as far as limitations and
occupational impairment, it'snot really that bad stuff.
J Basser (29:50):
I mean, you're right.
I mean I know you can feel it,the aura of it coming up the
back of your neck, you know, andit just creeps up to me, and
the time it gets to a certainpoint is too late, no matter
what I take.
And so when I was, you know, Ijust basically I'd lay down
until I got bad enough and thenI'd have to take a blood
(30:11):
pressure, because a lot of timesduring the headache the blood
pressure would go extremely,extremely high.
I'm talking 215, 220, high over180.
And so there I'd go off to theemergency room and I'd be
getting all these fancymedications and I'd come home
and sleep for hours upon endbecause of the pentagram and the
(30:32):
other medication.
And so in the past probably 10or 12 years, I stopped taking
the medication.
I stopped saying, okay, here'swhat you know, I don't want to
take this no more.
After this stuff is making meloopy, I found out there's one
medication that works better onyou.
If you've got a migraine, go tothe ER, get a Toradol shot.
That works better than anystinking narcotic.
(30:57):
Plus, you're not loopy and youcan return to function pretty
quickly after the fight.
Bethanie Spangenberg (31:03):
When I covered the urgent care clinic.
We would have patients come injust for Toradol for their
migraines.
J Basser (31:09):
It works.
But now I've been to everyspecialist known to mankind.
I've been to several differenttypes of neurologists.
I've had CTs, mris.
I've had all the workups done.
I've had the Pocomaxes and theChocomaxes and the what do you
call them?
(31:29):
The ones you've got to take20,000 milligrams of that
stinking pill.
I can't stand it.
It's Neurontin, it isNeurological Rotten.
I've had it all.
I've had every psych.
It's psych meds, more or lessright.
Bethanie Spangenberg (31:49):
It does it affects your brain.
Some of it's used for psychreasons.
There are psych meds more orless right.
It does it affects your brain.
Some of it's used for psychreasons.
They're old meds and they justhonestly, they, they tested them
and they're like, oh okay, well, it worked.
And 50 of the patients.
So now we're going to start topush this for migraines to see
if it helps somebody else.
I mean, there's really no truescience behind it.
J Basser (32:07):
It's trial and error all the medications.
I was like the dude that had anIQ of 10 in college.
I failed them all, but I've gotsome good advice for it.
I mean it's difficult.
So if you're doing an exam foran initial service connection,
(32:28):
you really have to dig and see,because you've got to be the one
related to the service therehas to be enough evidence to
show it or related to acondition that's already service
connected, like hypertensionand sleep apnea and things like
that.
That's probably one of thehardest things to do for a CMP
examiner.
Now, as far as an increase,it's still kind of a catch-22
because the severity is an issueto which it's got to be proven
(32:51):
right.
If a person is 30 and wouldn'tgo to 50, you've got to prove
that his migraines have becomevery prostrating or severe
economic impact for his workingability.
You know it's a catch-22 in myopinion, but it all depends on
(33:13):
how it's written up.
Bethanie Spangenberg (33:16):
That's very true, it does.
J Basser (33:23):
There's a lot of pointers.
There's a headache journal.
It used to be called a headachediary.
I guess they changed it tojournal over the last few years.
You need to write that downEvery time you get a migraine.
You's called a headache diary.
I guess they changed it tojournal over the last few years.
You need to write that downEvery time you get a migraine.
You need to write it down.
Today's technology you don'tneed to write a thing down.
If you've got an iPhone, youcan say Siri, make a note.
Then you can combine thosenotes.
The next thing you know, boom,you've got a headache journal.
Bethanie Spangenberg (33:46):
There's actually apps out there for it
too so you download the app andyou pop it open and it will ask
you what symptoms you'reexperiencing and the date and
the time.
What you think triggered it.
And even that's helpful for mewhen I write an access letter,
if, if you kind of give mefeedback on what's you know.
What do you think triggered it?
You know what you know becauseyou know what?
(34:07):
you know, because you know yourbody the best.
And so if you can tell me well,you know I got yelled at at
work or I got a nasty email atwork, or you know that that
stress component can help me tokind of decipher, you know
what's happening.
J Basser (34:24):
Experience is a very big factor, I don't care what
people tell you, is a very bigfactor, big factor in headache,
I don't care what people tellyou, it's a very big factor.
If you're in high stressfulconditions and jobs and things
like that.
Say, okay, you're a.
Say like Joey Jones, your jobis to disarm bombs, that's
pretty dang impressive.
Say, if you're in qualitycontrol and your job is to keep
an assembly line going,manufacturer automobiles.
(34:46):
Say your company makes a defect.
Next thing you know you'regoing to stop the line.
When you stop the line it's somany thousand dollars a minute
until you get it fixed.
You know that's stressful.
Where you sit there makingmillion-dollar decisions in
about 30 seconds, that'sstressful.
They can cause migraine.
If I tell you something elsecauses migraine, the people will
get mad at me for saying it.
(35:07):
A lot of migraine-conditionedfolks are hereditary.
Bethanie Spangenberg (35:12):
Yeah, when we do consider those, when we
write our nexus letter, we liketo look to see that family
history component and then atthat point we look okay, well,
is this condition nowaggravating, you know, or is it
aggravated by aservice-connected condition?
So you know, that plays a partin the nexus as well.
J Basser (35:33):
It does.
It does.
You know it's crazy, though Imean it's not fun, but you know
they do say and I haven't seenthis personally yet but they say
the older you get, the less youreally become and eventually it
might go away.
But what I have noticed too iswhen you get up in your 50s,
pushing the big six zero excusemy French you still have the
(35:58):
aura and you still have themigraine, but you've had so many
that the neurological system inyour head, where it's aching,
is not as much as pounding.
Because usually if you havethat bad, every time your heart
beats it's a thump, but over aperiod of time it's more of a
numbness than it is a thumping.
(36:21):
That's my personal note.
That's kind of something tolook forward to folks.
I mean it's serious, I hate tosay it, but it don't matter what
.
It takes rid of the pain and itworks.
So you know, I mean it's justmy own personal experience.
I mean I hate to see anybodysuffer through.
You know I hate to see it, butwhen you get knocked in the back
(36:50):
of the head at a young age, itdoes give you a headache.
Bethanie Spangenberg (36:52):
yeah, yeah , no, nope, nope nope, yeah,
yeah are your parents no, nope,nope, nope, nope.
J Basser (37:03):
There's a guy named Dougie.
What's playing up for anothershow what not to do in the
military.
What not to do how to stayalive in non-combat situations
with their own soldiers.
Bethanie Spangenberg (37:20):
I can see that Michael's told me some
stories.
I can only imagine You've toldme some stories about you when
you were younger, so I figuredyour parents probably gave you a
thump or two.
J Basser (37:36):
My parents were the ones that mean the situation.
They were just didn't know howto raise kids.
It's a pretty sad situation.
We didn't raise ourselves.
They were good to us, we hadfood on the table and things
like that.
We survived.
We're still here.
We're not dead yet.
Let's have a piece of wood toknock on.
(37:59):
I think we done.
Still here, we're not dead yet.
Let's have a piece of wood toknock on, I think we done.
Lost Ray.
I think he's already tuned out.
Are you ready?
Ray Cobb (38:05):
No, I'm sitting here just picking up on all this
stuff because, like I saidearlier, I was fortunate the way
I grew up too.
I'm kind of one of the luckyones.
I had an older sister thatwatched out for me and my
parents.
I was fortunate the way I grewup too, I'm kind of one of the
(38:26):
lucky ones.
I had an older sister thatwatched out for me and my
parents was always.
You know.
I definitely didn't have anyproblems.
My biggest thing was putting aguy in the trunk of the car,
putting ketchup on his leg anddriving up to a red-ace service
station asking if I could borrowhis shovel.
That was the biggest trouble Igot into.
Bethanie Spangenberg (38:42):
He thought I had a dead man.
Ray Cobb (38:42):
Yeah, he thought I had a dead man in the back of the
car and called the police.
J Basser (38:53):
They came to check me out to see if I could make sure
that I wasn't riding around witha corpse in the back of my
trunk.
We only had done that when wewere deer hunting.
We put our shovels in the backof the toolbox and we'd drive
around to our deer hunting spotand see these protesters and
we'd get the shovels out.
They didn't hang around verylong.
Ray Cobb (39:06):
Laughter, laughter our biggest thing was back when I
grew up here in middle Tennessee.
You know August was really agreat month to be a young man
and you know in your early teensand mid-teens these watermelon
patches.
They're an awful lot of fun togo into at night and get you two
(39:29):
or three watermelons and takethem out to your girlfriend's
house and leave them on theporch and you made a lot of
brownie points that way, youknow.
J Basser (39:38):
Well, you learned a lot of footballie points that
way, you know.
Well, you learned a lot offootball moves too, didn't you?
Yeah, no, but listen, I'm gonnatake this.
Um, folks, migraines areserious business.
It really doesn't matter whatcause that you're going to
suffer through it because youknow you're the victim of it,
because it's going to hit, youdon't suffer.
You know, if your serviceconnected in the va regardless
(40:01):
of what percentage, I mean, youknow, especially if you're
supposed to take for headaches,especially and you don't live
too far away from the va it'sgot a virtue room, you get a
migraine, go to merchant, get atour doll shot, because that's
your best way of building thisissue up, because one day, you
know, it gets bad enough, you'regoing to need an increase and
you've got to build it.
It's kind of like making fireon a survivor you don't build it
(40:24):
right and the other guy's goingto win and another point to
that.
Ray Cobb (40:30):
you know, john, I was thinking a moment ago.
Something you said, or somethingBethany said, popped into my
mind.
You know, if you're at work andyou have a migraine, don't just
sit back and suffer with it orjust shrug it off.
You make sure that your manageror your supervisor or someone
above you knows that you'rehaving a migraine.
(40:52):
That's okay if you keep working,if you keep working.
But the purpose of that is, atsome point down the line, if you
file a claim for a migraine, ifthat individual, that
supervisor, could say, yes, hehad migraines quite often at
work, that's just going tostrengthen the case to which
(41:16):
frequency and how it affectsyour ability for an income could
show up, like Bethany wastalking about earlier, that they
look for when she does it, sothat you know that's a very
important guys.
You know, go to the ER, gettreatment, get that record on
your or get that information onyour records, get the
information with your employerthat you're having them, even if
you don't have to go home, butif it may cause a slowdown in
(41:38):
your work.
But if anything else, it mightallow him to take some of the
pressure off of you instead ofpushing you to get something
completed by the end of that day, knowing that that might make
it worse.
Or, if you make a mistake, itwould at least be a reason as to
why you made the mistake, notbecause of negligence.
J Basser (42:01):
Let me go through the general advice, and Beth will
agree with this.
Guys, no matter if you've got amigraine or if you get any
condition, it's not going tofall a claim on you.
You may not even know it'sclaimable right now.
But my best advice for you ifyou get out of service and
you've got to get a copy of yourmilitary medical record, your
military service records, andwhen you get out of service,
(42:22):
anytime you go to the hospital,doctor or whatever I don't care
if you get bit by a spider orget in a car wreck you make sure
that everything you do, you getall the copies of that visit
and you put in your house.
It's somewhere in a fireproofsafe.
No matter what, every documentyou can get your hands on.
You're going to need that laterdown the road.
And if you file a claim with theVA and the Veterans Claim
(42:44):
Assistance Act of 2000 gave theonus on the VA to actually
obtain the documents that are inpossession of the United States
government.
So they kind of get the onus onthem to do that of the United
States government.
So they kind of get the onus onthem to do that.
It says they will attempt toreach out and contact your
private treatment places to getyour civilian records or your
(43:05):
private medical records.
Okay, the key word here isattempt.
You know, if I attempt to winthe powerball it doesn't mean
I'm going to right I like thatexample.
I'm serious, you get yourrecords and you keep them on you
because you make this littlelady's job a lot easier.
She can write you a stone cold,stiglossian opinion that she
(43:28):
can come off the top rope andshe can elbow that claim right
through the mat and you're readyto go.
And that's a fact.
Evidence wins claim.
Only problem is you're thecarpenter.
(43:48):
You got to have your evidence,you got to build it.
If not, and these people arenot your friend folks.
I hate to say this because, uh,what I've seen the past couple
of days.
I'm sorry.
I'm sorry.
As a matter of fact, I haven'tchanged the name of the VBMS or
the VBMS.
I called it the VMBIS.
Ray Cobb (44:13):
Well, you're right, they're not your friends.
And if it means you know onething, I did and I think others
have done it too.
You know, if you have asituation, and especially if
it's not at the VA, you knowyou're outside doctors or
(44:34):
whatever.
It's your responsibility to seethat it's gotten doctors or
whatever.
It's your responsibility to seethat it's gotten.
Highlight whatever it is thathelps prove your case.
Make a copy of it and get itturned in and send it to end
with your claim.
Now you cannot anymore.
You cannot go to your doctorand say, would you put this in
(44:54):
my medical records?
They're not allowed to do thatanymore.
I don't know if you guys haveheard that or not in the last
two or three years, but whatthey do, they say, well, did
they send you to that person forcommunity care?
And you say, no, well, that'snot acceptable for us, we can't
put it in your records.
Well, that means that you haveto turn that information, those
(45:16):
reports, those exams.
It's up to you then to turnthem in with your claim so that
a proper decision can be made.
I found out personally.
I went down and found out whenI gave an outside report to my
podiatrist and he said, yeah,I'll get it turned in.
(45:38):
I checked two weeks later.
It wasn it turned in.
I checked two weeks later itwasn't turned in.
I called the records.
They said oh well, we're notallowed to accept that.
I said well, what happened tothe report?
Oh, it probably ended up in thetrash.
J Basser (45:50):
There you go.
The way that I did it.
I had a lot of stuff going on.
I was going through the spinalcord stuff and I had a lot of
information that we had to gothrough and they had to look at
it all because it's kind of a,you know, it's very
comprehensive and the doctoractually bypassed all those
rules and got it in therebecause basically it's for, you
(46:13):
know, a certain condition.
So I mean, I guess it alldepends.
I mean, look, personally, Ithink the courts are too lazy to
do it.
But you know, like, just myopinion, probably, yeah, and you
know, it's just, I don't knowwhat do you think Bethany?
Do you think they do their jobsor do you think they need help?
Bethanie Spangenberg (46:34):
I don't think we have enough time to go
into this discussion.
I just to me.
I think you know we've had thisdiscussion many a times, but I
(46:55):
think it's all a numbers gameand so they'll they deny
everything or they'll give you alot of veterans who will get
our DBQs and they'll submit ourDBQs and they'll be like well,
based off of what you reported,I should be getting this
percentage, but they only gaveme this lower percentage.
And then you know, we tell them, based off the DBQ, you're
correct, you should be gettingthis percentage.
(47:17):
You need to appeal it, you needto talk to a representative,
you need to fight thatdisability rating that they gave
you, and so that's probably,when it comes to migraines,
that's a very common report thatwe get and it just supports the
idea that they make you workfor anything you get, make you
(47:39):
fight.
J Basser (47:42):
Well, in your world, you know I mean veterans will
call us I've been lowballed, youknow, and lowball means they
underrate you.
I see it every day and I'm sureyou see it more than we do.
As far as that and yourday-to-dayday activities, and
Ray sees it all the time, youknow, and just like migraine,
(48:03):
you know guys get 0% frommigraines and you look up yeah
well, he didn't have aprostrating thing on here and it
looks in the medical recordthat shows what he's going
through and yeah, it'sprostrating.
All right, you know, he mightas well write it down.
You know, somebody didn't writeit down.
So you know that's a magic word.
It is a magic word.
I mean, no matter whateverybody talks about migraine,
(48:24):
this is your magic wordprostrating.
And that doesn't mean if theprostrate you got prostate
disease, okay, that's adifferent word altogether.
So if you tell a doctor you gotprostrating condition, he says
you tear your roll and youbetter look out.
Bethanie Spangenberg (48:43):
Yeah, if the exam is the wrong area, make
sure you clarify Up here, uphere.
J Basser (48:55):
We've got to keep it fun and light, though.
We've been through a whole lotof DBQs in the past several
months, bethany, since, I guess,the last year, and you know
we'll keep going.
We'll have a whole new ballgame.
I don't know what.
Have you heard anything aboutthe Federal Register deal and
neurological stuff?
Any late stuff?
I don't know what to say, hmm.
Bethanie Spangenberg (49:16):
Nope.
J Basser (49:18):
I haven't know what to say.
Bethanie Spangenberg (49:20):
Hmm, nope, I don't anticipate hearing
anything for a while.
J Basser (49:24):
Mm-hmm.
Bethanie Spangenberg (49:25):
We got a lot of work cut out for them.
J Basser (49:27):
Mm-hmm.
Well, I know we got so manyoars in the water here.
We try to keep the boat goingstraight.
It's hard to keep it goingstraight, you know.
You try to cut your arm off.
You can be going around thecircuit.
We'll figure it out.
On Tuesday, guys Ray's got hisshow on WZYX in McCown Tennessee
(49:51):
.
Ray Cobb (49:52):
Yeah, that's right, I finally got a.
After what?
15 years?
I finally did a webpage.
And what 15 years.
I finally did a web page.
And so you know it's BettsRoadmap, small letters
B-E-T-S-R-O-A-D-M-A-Pcom.
You can look it up and I've gotBethany.
(50:14):
Matter of fact, I put aconnection to your page on there
and I got one to you, john, andgot one to James Cripps and one
to Alex Graham and then, I'mgoing to be putting up a little
more.
I got a blog about myself and myjourney with the VA and I've
got I've got ready to put up acouple more photos and a list
(50:36):
that you provided concerninggood agents, that if they need
to try to find an agent, it hastheir email and telephone number
and they can reach out to them.
J Basser (50:47):
The brave ones can never share.
You need to share scrapbooksfrom the photographs you've
taken over the years.
Man, that's pretty cool.
I mean I'm serious.
I mean you know you lived apretty good life'm serious, I
mean you know, I mean thereyou've uh, um, you lived a
pretty, pretty good life doingthis stuff.
You know, and you're reallygood at what you did and that
was your livelihood well, it was.
I mean, that's how I made aliving, yeah anytime you can
(51:10):
photograph atlanta brave theplayers, presidents and things
like that.
That's something you know.
That's something to be proud of, buddy.
Ray Cobb (51:19):
Well, and you know the interesting part, I've got to
live the dream that most menwould love to live.
I mean, you know, when you'redown at a Super Bowl and you're
close enough to the players thatyou can hear all those dirty
words they're saying to eachother, there's a lot of guys
that would like to be at thatposition to watch the game that
(51:40):
close, or bowl games, or playoffgames.
I had the privilege and honorof attending the first ncaa
college football playoff betweentennessee and florida state,
and so you know I've been veryfortunate, even though my I was
(52:02):
actually fortunate in themilitary too.
I mean, you know, I've followedgenerals around and took
pictures of them putting medalson and shaking hands, and that's
not much of a military life tohave to go through.
But at the same time, because Iwas the only military
photographer at Fort McCallum, Igot exposed to Agent Orange
because I had to go into a placewhere they were about to spray
(52:24):
it and they did spray it.
So you know, kind ofinteresting.
J Basser (52:30):
It is.
That's pretty cool.
I bet you didn't know thatabout you, did you?
Bethanie Spangenberg (52:37):
But actually maybe on your website
there can be like like a littlebutton to where you can share
all those photos.
J Basser (52:42):
That would be neat.
I'm curious.
I mean, that would be good Allright?
Ray Cobb (52:47):
Well, I have a book that I probably should have
published that goes back into mymilitary time and there's 120
photos in it and I had it madeinto a coffee table type book
and I got them from Germany andLondon.
Bethanie Spangenberg (53:05):
I got the.
Ray Cobb (53:05):
Super Bowls, playoffs, NASCAR.
Matter of fact, I got one ofthe last known photographs made
of Dale Earnhardt before he waskilled in Daytona, so you know,
things like that have been veryfortunate.
J Basser (53:25):
That guy should have wore that strap better, had a
better strap on his car.
He didn't like them.
Pretty sad.
Yeah, all right, guys, listen,we'll thank you guys for coming
on.
Bethany, thank you for beingyou, because every time you come
on we learn something, andwe're going to learn a whole lot
more.
You know, but we'll keep youglued in.
I mean, you're going to have ahard time leaving now.
You're invested.
(53:46):
No, I'm just kidding.
Thank you for having me.
Bethanie Spangenberg (53:50):
I appreciate it yeah.
J Basser (53:51):
And we'll do something else.
Next week, guys.
I'll advertise it.
Next month we'll bring it backon and we'll start something new
or whatever.
We'll let her decide and giveher time to think about it and
relax a little bit.
She spends a lot of time onthis stuff, guys, and we think
what she does.
And, ray, we'll be hollering atyou, man, because I'm going to
(54:12):
be on your show Tuesday andwe've got some laundry to air.
Ray Cobb (54:15):
Yeah, we're going to burn up the airwaves Tuesday,
aren't we?
I mean, I'm looking forward tothat.
We're going to let people knowwhat's really going on out there
in the world firsthand.
J Basser (54:25):
That's right, well, isn't that, guys?
This is John.
They call me Jay Basher.
I'm John Stacy.
I'm the owner of Expose it.
We'll be shutting her down fornow.
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