J Basser: 0:03

Welcome folks to another episode of Exposed Vet Productions. On this Thursday it's April 3rd 2025. A beautiful day outside. It only had seven inches of rain, but still a pretty day out there. If you want to stay dry, stay in the house. Got Mr Ray Cobb down in the great state of Tennessee out to Alabama. He'll probably get washed down into Alabama here if it keeps raining. He'll be on washed down into Alabama here. If it keeps raining, he'll be on Lake Guntersville here by the morning probably catching fish.

Ray Cobb: 0:31

We hadn't had any rain today. We had some real high winds in the middle of the night, but we've been okay today.

J Basser: 0:38

Well, that's great. And then we got a resident tornado chaser up there in southern Ohio. Her name is Bethany Spangenberg. She sent me a picture of a tank today. I told her she needed that to chase storms with and have me a tornado shelter. She's Bethany Spangenberg. She is the owner and the chief principal officer of the company called Valor for Vet, and Valor for Vet is a company that takes veterans' disability examination and puts all the information in to help a veteran with a disability claim. And Bethany, how are you doing?

Bethanie Spangenberg: 1:11

I'm doing well. I'm glad that we got over this crazy storm and we survived and not a lot of trees down, so you know, I feel blessed in that aspect, so it was crazy.

J Basser: 1:23

Well, that's good. I know we've been touching in the last several months. We've been going down to DBQs and trying to, you know, break them down into where I guess people can understand them, because you know it's a big long, it's a big process. You know, so many we've been, I think we've probably done eight or 10 shows on the dbqs itself. You know, since I'm here, we're staying on the neurological 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 you just go ahead and get started and uh, we'll, uh, we'll jump in from time to time there and, uh, we won't give each other a headache in the process, sounds good, I appreciate it.

Bethanie Spangenberg: 2:06

You know, I'm actually surprised we haven't talked about the migraine headaches yet, because it is such a common condition. It's something at Valor for Vet that we write a lot of nexus letters for the ACE criteria, which means that we can conduct an interview without doing a physical and gather the information for the DBQ for the veteran to submit it as evidence for their claim. So that's why I said I was surprised, because it's something that we deal with on a regular basis, and so I was just looking at our statistics yesterday actually, because I was writing a report on migraine headaches and 58% of the nexus letters that we write related to headaches are due to a mental health condition. So of all the nexus letters we've written, 58% are written for headaches as secondary to a mental health condition. So that was actually surprising to me, because there are a lot of things that can cause headaches and we can talk more about that as we go through the DBQ. But just a unique condition claim process for veterans, and what also makes it unique is that headaches themselves are purely subjective. There's no way for a clinician to do a test to verify that you're experiencing a headache or that you're experiencing visual changes because of the headache. We can't even tell if you're having nausea from the headache. You have to verbalize every aspect of your headache symptom. And so for the VA it makes it challenging to try to make it objective in order to provide a disability rating, because they like this objective testing and all that other good stuff to verify that the veteran is telling the truth. So headaches they're not that way, so they kind of have to collect. The VA has to collect their data a little bit differently in order to help the veteran get a rating or decide what rating they receive.

Bethanie Spangenberg: 4:19

So, all right, jumping straight into the headaches DBQ. It is five pages long. First section opens up with the veteran's information and the medical examiner is to lay out the relationship that they have to the veteran, if it's their patient seen in their clinic or if it's not, and how the veteran was examined. The first page also asks for evidence, review. Evidence is always important. You have to provide it to the VA for their C&P examiners. You also need to provide it to private companies that you're asking them to complete the DBQ, for what's interesting in this case is that the M21, which is the VA manual for their employees and raters to go through and decide what rating the veteran gets. They actually outline specific evidence that they want to see for headache claims and that's not typical for a lot of your disability claims. But the M21 tells the rater to analyze the medical records, the veteran's statement regarding their symptoms if there's a headache journal, any prescription medications and even witness statements. So if I was a veteran making a claim for their headache or their headache condition, I would make sure that I had all of those in there as evidence to support my claim.

Bethanie Spangenberg: 5:46

Section one is the diagnosis. Always open up with this question regarding the diagnosis, this is word for word Does the veteran now have, or has he or she ever been, diagnosed with, a headache condition? This is absolutely important for a veteran making a claim. You need to show that you have had a diagnosis for the condition that you are claiming. If they mark no, they could completely close the DBQ and be done so you want to make sure that that information is in there that shows the diagnosis. If we look at page two, section two, it's the medical history. It's pretty straightforward For me personally, I like to document all of the veteran's medical history from start to finish. Even if the veteran is already service-connected, I still like to understand how that headache condition has transpired. Any questions? So far no.

J Basser: 6:48

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's no actual physical path to determine a headache. You know a headache is actually happening. The thing is PTSD too, though it's also subjective too, right? I think it's PTSD too, though it's also addictive too, right, it's true.

Bethanie Spangenberg: 7:12

The Section 2 also looks at medications specifically for the headache condition. The examiner is supposed to document that. Section 3 looks at the symptoms. The examiner is to document the type of pain that the veteran is experiencing, whether it's constant, pulsating throbbing localized to one side of the head, if it's on both sides of the head or if the pain worsens with physical activity. Now, those particular symptoms do not have anything to do with the reading schedule, but they may support the limitations you experience in your work environment or at home. Additional symptoms the medical examiner is to document that are considered to be non-headache symptoms are nausea, vomiting, sensitivity to light or sound, changes in vision or changes in sensations such as pins and needles in the hands or the fingers. Again, that has nothing to do with the rating schedule, just supports any type of limitations that you have in the work environment. Question 3C looks specifically at the typical duration of the headache pain. They want to know how long the headache pain lasts.

Bethanie Spangenberg: 8:41

And the options are less than a day, one to two days, more than two days or other. Now, a lot of times I have veterans that will answer yes to all of them and they actually go on to talk about how they have headaches that can last seven to 10 days or even longer and that you also want to put in your statement to support the documentation. And again, we're looking at the location of the typical head pain. In my opinion, it's kind of redundant. They want to know if it's the right side, the left side or both sides. I think that's more of a clinical question so that way we can understand what may be causing or triggering the head pain or the headaches. If you have some musculoskeletal conditions, they can trigger the location of the pain. So I think that's primarily why it's there.

Bethanie Spangenberg: 9:39

Any questions regarding those specific set of symptoms regarding those specific set of symptoms.

Ray Cobb: 9:53

Bethany, one thing that came up that brought to my attention as you were talking there military-connected. What would happen to a veteran for him to be military-connected for these headaches? I mean, would it be like a loud sound or a shell going off near him, or did he hit his head, or is it chemically?

Bethanie Spangenberg: 10:12

So typically what we see for veterans that have a service connection for migraines direct to military service is going to be some type of head trauma or head injury going to be some type of head trauma or head injury. Typically we see the service connections as a secondary condition. The problem with migraines is that, or headaches in general, is that when we develop headaches we don't always see a doctor or get medical treatment for them, unless there's something significantly traumatic like a head injury. So sometimes when we're under stress in a military environment or if we're exposed to a chemical that we're working with, we just say, oh man, that smells really getting to me, I need to get away from it. Then we'll separate ourselves and then self-treat with ibuprofen or Tylenol and it's not until it becomes a recurrent issue that we seek clinical care.

Bethanie Spangenberg: 11:13

So a lot of times the limitation with veterans getting a direct to service connection is that they don't seek treatment while in service. It's one of those things that they push off. On the secondary side of things, yes, they can be related to chemicals. Yes, they can be related to mental health stress. They can be related to anything that affects the balance in the brain system and chemicals the brain system and chemicals.

Bethanie Spangenberg: 11:48

So the idea, you know, they don't know from the medical side of things exactly why headaches occur, but the theory is is that there is a threshold for the body and so if we start out our day up here and let's say, you know we, we didn't sleep well, so that threshold that bar lowers, and then maybe we forgot our thyroid medication that day, that can lower the threshold. And you know what, my neck is really bothering me today because I just I slept wrong and I was triggered my neck condition and then it lowers that threshold to where a headache is triggered. So there's a lot of things in our bodies or in our environment that can trigger the headaches. And from the medical expert side of things, when we write these nexus letters, we really have to understand the veteran's full history. You know what kind of medical conditions are at play. What are they suffering with or experiencing 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 realize that if you're doing this and you're doing an exam for somebody and you realize that, okay, this guy has got headaches, say the guy did have a pretty severe neck injury in the service, plus he probably had, say he had severe high blood pressure, okay, and say he kept going to sick, call he's had several headaches in service over this issue. So it makes your job easier. But now do you have to pinpoint as to which condition actually caused the headaches, or can you do a general relate to both of them?

Bethanie Spangenberg: 13:20

Often we try to throw everything at it because that's the way the condition, that's the way migraines occur. It's not typically one thing. It's typically mental health and sleep apnea, or it's mental health and a musculoskeletal condition.

J Basser: 13:50

So we try to use everything to support that, to show that those play a role in causing or contributing to the onset of the headache condition. Good, because when you get done with the DBQ, I want to go through and I want to give our listeners, I want to give them some great advice on what to do and I don't feel good. Stay tuned, folks, you're not going 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 and it has to do with prostrating attacks of the headache condition. The term prostrating is an older term that we don't use in today's medicine. When we hear that term, if a clinician hears that term and they're familiar with the VA disability, they get a red flag and they're like, oh, they're familiar with the VA disability. They get a red flag and they're like, oh, they're either looking for VA disability or discussing VA disability or that's a trigger word for the clinician to kind of understand the direction of where the veteran's going For their VA rating. Prostrating is the word that they lean on for your rating. Now the M21 defines the word prostrating as causing extreme exhaustion, powerlessness, debilitation or incapacitation, with substantial inability to engage in ordinary activities. A lot of times what we hear with veterans when they experience a prostrating headache it's that they get a headache that is so severe that they have to excuse themselves from whatever they're doing, go into a dark room, turn the lights off and just kind of get away from the stimulus, overload, the sensory overload and take medication typically. So when we think of prostrating. That's the first thing that comes to my mind of it's so bad. I need to get out of this environment and kind of separate myself to get everything to settle down, separate myself to get everything to settle down.

Bethanie Spangenberg: 16:10

Question 4A it says does the veteran have characteristic prostrating attacks of the headache pain? The first option for the examiner to document or to mark is with less frequent attacks and that's kind of based on a scale, the M21, I know I keep referencing the M21, but it really is the most helpful and kind of trying to understand how the VA works with this. The 38 CFR, which is the rating schedule for the migraines, is not very helpful in trying to understand how these things are rated. So the M21 says less frequent is characteristic prostrating attacks on average are more than two months apart over the last several months. So that's what they mean by being less frequent the last several months. So that's what they mean by being less frequent and that you can understand a little bit better when you look at the next option for the examiner to document. The next option is they have these prostrating attacks once in two months. That gets the veteran a 10% rating If the veteran experiences one prostrating attack every month, that's a 30% rating. The last option is greater than once per month.

Bethanie Spangenberg: 17:35

Question 4B talks about completely prostrating and prolonged attacks of the migraine or non-migraine headache pain, and those options are the same. So if they have less frequent attacks, that's 0%. If they have it once in two months, that's 10%. Once every month, that's 30%. And the last one for the completely prostrating and prolonged attacks greater than once per month is a 50% rating, and that's typically some of the more 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 specifically says with very frequent completely prostrating and prolonged attacks so, and then it goes on to say productive of severe economic inadaptability, the attacks, productive of severe economic inadaptability. That kind of goes hand in hand if you have these completely prostrating and prolonged attacks.

Bethanie Spangenberg: 19:07

So that basically what you have to do to get the 50% is you really have to lay out how this affects your job, how this affects your function in completing your work tasks and we'll talk a little bit more about that later on in the DBQ, about that later on in the DBQ. Section five is a place for the examiner to put other pertinent findings regarding the headaches. 5b asks about scars related to the headaches. I've seen a few of these with the head trauma. They'll have a scar on their head somewhere Not very common. Section six is diagnostic testing. Testing and it asks are there any other significant diagnostic test findings or results?

Bethanie Spangenberg: 19:59

And for me when I complete these dbqs, if you are, if I look at what we expect to happen in the clinic versus what the veteran is saying for their disability, I want those things to align. I want them to be clinically consistent. So if a veteran is telling me in the clinic that they are having completely prostrating and prolonged attacks of their headaches, that I'm going to put every tool out there to figure out why these are happening In the clinic. I'm going to do lab work, I'm going to do some type of imaging, a CT scan typically and I may refer them to a specialist. A lot of times what I see is I have these veterans that will say they have completely prostrating attacks and they occur once a week and for me I want to see that they've had testing done, that they've been referred to a neurologist. That's also a red flag. If they haven't so when I complete these DBQs I will put in there.

Bethanie Spangenberg: 21:08

The veteran was encouraged to seek workup for their headache condition based on the symptoms provided, because there can be something wrong anatomically in the brain or in the body that is causing these headaches and if they're not worked up then there can be consequences for those untreated health conditions. So for Section 6, for diagnostic testing, if they're telling me that their headaches are prostrating, I want to see that they've had testing done. I feel that the other VA C&P examiners are along the same thinking, because if they have to write a nexus letter or they have to make a medical opinion, then they're going to want to believe that veteran and what they're experiencing. And if they've brought that history and those complaints to the VA for benefits, then they should be seeking clinical care as well. That is the typical thinking and as a clinical mindset, so I guess the better way to say it is. It makes your report of symptoms believable. It makes it look like you're telling the truth if you have sought care for your headaches that are this severe.

Bethanie Spangenberg: 22:29

Does that make sense.

J Basser: 22:32

Yeah, it does. I tell you, though, if you've got bad migraines like that I mean you know, I can guarantee you from a personal standpoint, if you've had them for a very long time then your medical evidence is going to be off the chart, because I mean, I know, certain times when you get them bad enough, you go straight to the emergency room and you show up in your file with the VA and the examiner looks at the PC's 30 pages or 40 visits to the emergency room with a veteran with a migraine, or a guy getting shot up his birth set and pentagon, and you know so I mean that helps you out a whole lot 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 can really lean on that, as you know. Hey, it's not because they have a foreign um, you know, some type of nodule or tumor disease in the brain that's causing these headaches, and so I can really lean on that workup to support the nexus. Here for the last page of the DBQ, looking at section seven, this is the functional impact. This is what I wanted to really stress. The question asks does the veteran's headache condition impact his or her ability to work? When I do these DBQs, I want to know a specific example. Tell me a time that your headache affected your job duty. Tell me the story. I know it's probably happened a ton, but I want to know that example. Tell me what you're experiencing. What are you doing? Who's around? I want to really be able to paint a picture in my report of what is happening when you get these 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 at a headache journal, like I mentioned earlier, and it actually says they want your headache journal to say the headache frequency, want your headache journal to say the headache frequency, the symptoms, including whether or not they're prostrating, and what type of work limitations you have. So if you are building a headache journal, you need to make sure that you put those things in there as evidence to support your claim. The work limitations from your headache journal will also go to support that functional impact and will go to support a 50% disability rating, because you're showing that it's contributing to an economic issue.

Bethanie Spangenberg: 25:21

Right, section 8 is the remark section. Section eight is the remark section. It's just a blank section for the examiner to put any other details that they want regarding the headache condition. Normally what I do is I will ask the veteran, you know, is there anything else that you want me to know about your headaches that we haven't talked about today? These DBQs are designed for rating schedules and not necessarily for clinical issues and 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 are valuable into that section. The last section is Section 9, and it is the examiner, certification and signature. Typically this DBQ, if it's done over the phone, takes 10 to 15 minutes. If it's done in person, maybe 15 to 20 minutes. So there's no physical exam, there's no prompting for a physical exam. They're purely looking at the symptom 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 there thinking I mean here's a problem I have. I think I would imagine I've only had a total of maybe three headaches in my entire life, um and so therefore this is all brand new to me. I mean, I say that now I've heard people say I've had a migraine, I've had my grandson that he gets them and he has to do what she was saying go lay down in a dark room and close all the curtains and block out as much sound as he can and try to go to sleep.

Ray Cobb: 27:29

So you know, that's been kind of my experience is hearing what others have said, uh, I can't relate to it to say, oh, I know what you're talking about, because I really don't. It would be hard for me to that's when I'm going to have to turn a veteran over to you or somebody else, because I have a hard time understanding the pain factor, although I've seen people. Just actually in my work I had an individual that it got so bad that, like you were saying earlier, she actually threw up and you know they sent her home for the rest of the day. But you know, for my personal experience I've had none of that, nor has any of my immediate family had any of them. This is really all new to me.

Ray Cobb: 28:19

Before it's just been kind of a hearsay situation. You hear about it but you know you don't actually see it. You don't actually see it. I'm assuming that most individuals when they come on they go to a quiet place or they stay at home or they don't get out and try to move around because they don't feel like it. That's what I'm assuming from what I've gathered here tonight.

Bethanie Spangenberg: 28:49

Severity will vary from person to person. Um, a lot of times we have patients that will get what they call an aura, or they'll get like uh, like blurred vision, or they'll get symptoms before the head pain actually occurs, and so when they develop that aura, they can take ibuprofen or their medication to kind of abort the headache symptoms. So for me personally, when I get 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 I grab three or four ibuprofen and within hour I get no pain and that vision has returned. So you're you're lucky that you don't experience the headaches or the migraines, because they are very common and they're actually one of the top disabilities in the world, for, you know, across across the world as far as limitations and occupational impairment, it's not 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, and it just creeps up to me, and the time it gets to a certain point is too late, no matter what I take. And so when I was, you know, I just basically I'd lay down until I got bad enough and then I'd have to take a blood pressure, because a lot of times during the headache the blood pressure would go extremely, extremely high. I'm talking 215, 220, high over 180. And so there I'd go off to the emergency room and I'd be getting all these fancy medications and I'd come home and sleep for hours upon end because of the pentagram and the other medication.

J Basser: 30:34

And so in the past probably 10 or 12 years, I stopped taking the medication. I stopped saying, okay, here's what you know, I don't want to take this no more. After this stuff is making me loopy, I found out there's one medication that works better on you. If you've got a migraine, go to the ER, get a Toradol shot. That works better than any stinking narcotic. Plus, you're not loopy and you can return to function pretty quickly after the fight.

Bethanie Spangenberg: 31:03

When I covered the urgent care clinic. We would have patients come in just for Toradol for their migraines.

J Basser: 31:09

It works. But now I've been to every specialist known to mankind. I've been to several different types of neurologists. I've had CTs, mris. I've had all the workups done. I've had the Pocomaxes and the Chocomaxes and the what do you call them? The ones you've got to take 20,000 milligrams of that stinking pill. I can't stand it. It's Neurontin, it is Neurological Rotten. I've had it all. I've had every psych. It's psych meds, more or less right.

Bethanie Spangenberg: 31:49

It does it affects your brain. Some of it's used for psych reasons. There are psych meds more or less right. It does it affects your brain. Some of it's used for psych reasons. They're old meds and they just honestly, 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 to push this for migraines to see if it helps somebody else. I mean, there's really no true science behind it.

J Basser: 32:07

It's trial and error all the medications. I was like the dude that had an IQ of 10 in college. I failed them all, but I've got some good advice for it. I mean it's difficult. So if you're doing an exam for an initial service connection, you really have to dig and see, because you've got to be the one related to the service there has to be enough evidence to show it or related to a condition that's already service connected, like hypertension and sleep apnea and things like that. That's probably one of the hardest 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 issue to which it's got to be proven right. If a person is 30 and wouldn't go to 50, you've got to prove that his migraines have become very prostrating or severe economic impact for his working ability. You know it's a catch-22 in my opinion, but it all depends on 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 headache diary. I guess they changed it to journal over the last few years. You need to write that down Every time you get a migraine. You's called a headache diary. I guess they changed it to journal over the last few years. You need to write that down Every time you get a migraine. You need to write it down. Today's technology you don't need to write a thing down. If you've got an iPhone, you can say Siri, make a note. Then you can combine those notes. 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 and you pop it open and it will ask you what symptoms you're experiencing and the date and the time. What you think triggered it. And even that's helpful for me when I write an access letter, if, if you kind of give me feedback on what's you know. What do you think triggered it? You know what you know because you know what?

Bethanie Spangenberg: 34:07

you know, because you know your body the best. And so if you can tell me well, you know I got yelled at at work or I got a nasty email at work, or you know that that stress component can help me to kind 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 big factor, big factor in headache, I don't care what people tell you, it's a very big factor. If you're in high stressful conditions and jobs and things like that. Say, okay, you're a. Say like Joey Jones, your job is to disarm bombs, that's pretty dang impressive. Say, if you're in quality control and your job is to keep an assembly line going, manufacturer automobiles. Say your company makes a defect. Next thing you know you're going to stop the line. When you stop the line it's so many thousand dollars a minute until you get it fixed. You know that's stressful. Where you sit there making million-dollar decisions in about 30 seconds, that's stressful. They can cause migraine. If I tell you something else causes migraine, the people will get mad at me for saying it. A lot of migraine-conditioned folks are hereditary.

Bethanie Spangenberg: 35:12

Yeah, when we do consider those, when we write our nexus letter, we like to look to see that family history component and then at that point we look okay, well, is this condition now aggravating, you know, or is it aggravated by a service-connected condition? So you know, that plays a part in the nexus as well.

J Basser: 35:33

It does. It does. You know it's crazy, though I mean it's not fun, but you know they do say and I haven't seen this personally yet but they say the older you get, the less you really become and eventually it might go away. But what I have noticed too is when you get up in your 50s, pushing the big six zero excuse my French you still have the aura and you still have the migraine, but you've had so many that the neurological system in your head, where it's aching, is not as much as pounding. Because usually if you have that bad, every time your heart beats it's a thump, but over a period of time it's more of a numbness than it is a thumping.

J Basser: 36:21

That's my personal note. That's kind of something to look forward to folks. I mean it's serious, I hate to say it, but it don't matter what. It takes rid of the pain and it works. So you know, I mean it's just my own personal experience. I mean I hate to see anybody suffer through. You know I hate to see it, but when you get knocked in the back of the head at a young age, it does 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 another show what not to do in the military. What not to do how to stay alive 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 told me some stories about you when you were younger, so I figured your 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 how to raise kids. It's a pretty sad situation. We didn't raise ourselves. They were good to us, we had food 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 to knock on. I think we done. Still here, we're not dead yet. Let's have a piece of wood to knock 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 said earlier, I was fortunate the way I grew up too. I'm kind of one of the lucky ones. I had an older sister that watched out for me and my parents.

Ray Cobb: 38:22

I was fortunate the way I grew up too, I'm kind of one of the lucky ones. I had an older sister that watched out for me and my parents was always. You know. I definitely didn't have any problems. My biggest thing was putting a guy in the trunk of the car, putting ketchup on his leg and driving up to a red-ace service station asking if I could borrow his shovel. That was the biggest trouble I got 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 with a corpse in the back of my trunk. We only had done that when we were deer hunting. We put our shovels in the back of the toolbox and we'd drive around to our deer hunting spot and see these protesters and we'd get the shovels out. They didn't hang around very long.

Ray Cobb: 39:06

Laughter, laughter our biggest thing was back when I grew up here in middle Tennessee. You know August was really a great month to be a young man and you know in your early teens and mid-teens these watermelon patches. They're an awful lot of fun to go into at night and get you two or three watermelons and take them out to your girlfriend's house and leave them on the porch and you made a lot of brownie points that way, you know.

J Basser: 39:38

Well, you learned a lot of footballie points that way, you know. Well, you learned a lot of football moves too, didn't you? Yeah, no, but listen, I'm gonna take this. Um, folks, migraines are serious business. It really doesn't matter what cause that you're going to suffer through it because you know you're the victim of it, because it's going to hit, you don't suffer. You know, if your service connected in the va regardless of what percentage, I mean, you know, especially if you're supposed to take for headaches, especially and you don't live too far away from the va it's got a virtue room, you get a migraine, go to merchant, get a tour doll shot, because that's your best way of building this issue up, because one day, you know, it gets bad enough, you're going to need an increase and you've got to build it. It's kind of like making fire on a survivor you don't build it right and the other guy's going to win and another point to that.

Ray Cobb: 40:30

you know, john, I was thinking a moment ago.

Ray Cobb: 40:32

Something you said, or something Bethany said, popped into my mind.

Ray Cobb: 40:36

You know, if you're at work and you have a migraine, don't just sit back and suffer with it or just shrug it off.

Ray Cobb: 40:44

You make sure that your manager or your supervisor or someone above you knows that you're having a migraine.

Ray Cobb: 40:52

That's okay if you keep working, if you keep working.

Ray Cobb: 40:55

But the purpose of that is, at some point down the line, if you file a claim for a migraine, if that individual, that supervisor, could say, yes, he had migraines quite often at work, that's just going to strengthen the case to which frequency and how it affects your ability for an income could show up, like Bethany was talking about earlier, that they look for when she does it, so that you know that's a very important guys. You know, go to the ER, get treatment, get that record on your or get that information on your records, get the information with your employer that you're having them, even if you don't have to go home, but if it may cause a slowdown in your work. But if anything else, it might allow him to take some of the pressure off of you instead of pushing you to get something completed by the end of that day, knowing that that might make it worse. Or, if you make a mistake, it would at least be a reason as to why you made the mistake, not because 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 a migraine or if you get any condition, it's not going to fall a claim on you. You may not even know it's claimable right now. But my best advice for you if you get out of service and you've got to get a copy of your military medical record, your military service records, and when you get out of service, anytime you go to the hospital, doctor or whatever I don't care if you get bit by a spider or get in a car wreck you make sure that everything you do, you get all the copies of that visit and you put in your house. It's somewhere in a fireproof safe. No matter what, every document you can get your hands on. You're going to need that later down the road.

J Basser: 42:42

And if you file a claim with the VA and the Veterans Claim Assistance Act of 2000 gave the onus on the VA to actually obtain the documents that are in possession of the United States government. So they kind of get the onus on them to do that of the United States government. So they kind of get the onus on them to do that. It says they will attempt to reach out and contact your private treatment places to get your civilian records or your private medical records. Okay, the key word here is attempt. You know, if I attempt to win the powerball it doesn't mean I'm going to right I like that example.

J Basser: 43:19

I'm serious, you get your records and you keep them on you because you make this little lady's job a lot easier. She can write you a stone cold, stiglossian opinion that she can come off the top rope and she can elbow that claim right through the mat and you're ready to go. And that's a fact. Evidence wins claim. Only problem is you're the carpenter. You got to have your evidence, you got to build it. If not, and these people are not 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't changed 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 one thing, I did and I think others have done it too. You know, if you have a situation, and especially if it's not at the VA, you know you're outside doctors or whatever. It's your responsibility to see that it's gotten doctors or whatever. It's your responsibility to see that it's gotten. Highlight whatever it is that helps prove your case. Make a copy of it and get it turned in and send it to end with your claim.

Ray Cobb: 44:47

Now you cannot anymore. You cannot go to your doctor and say, would you put this in my medical records? They're not allowed to do that anymore. I don't know if you guys have heard that or not in the last two or three years, but what they do, they say, well, did they send you to that person for community care? And you say, no, well, that's not acceptable for us, we can't put it in your records. Well, that means that you have to turn that information, those reports, those exams. It's up to you then to turn them in with your claim so that a proper decision can be made. I found out personally. I went down and found out when I gave an outside report to my podiatrist and he said, yeah, I'll get it turned in. I checked two weeks later. It wasn it turned in. I checked two weeks later it wasn't turned in. I called the records. They said oh well, we're not allowed to accept that. I said well, what happened to the report? Oh, it probably ended up in the trash.

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 spinal cord stuff and I had a lot of information that we had to go through and they had to look at it all because it's kind of a, you know, it's very comprehensive and the doctor actually bypassed all those rules and got it in there because basically it's for, you know, a certain condition. So I mean, I guess it all depends. I mean, look, personally, I think the courts are too lazy to do it. But you know, like, just my opinion, probably, yeah, and you know, it's just, I don't know what do you think Bethany? Do you think they do their jobs or do you think they need help?

Bethanie Spangenberg: 46:34

I don't think we have enough time to go into this discussion.

Bethanie Spangenberg: 46:51

I just to me. I think you know we've had this discussion many a times, but I think it's all a numbers game and so they'll they deny everything or they'll give you a lot of veterans who will get our DBQs and they'll submit our DBQs and they'll be like well, based off of what you reported, I should be getting this percentage, but they only gave me this lower percentage. And then you know, we tell them, based off the DBQ, you're correct, you should be getting this percentage. You need to appeal it, you need to talk to a representative, you need to fight that disability rating that they gave you, and so that's probably, when it comes to migraines, that's a very common report that we get and it just supports the idea that they make you work for anything you get, make you fight.

J Basser: 47:42

Well, in your world, you know I mean veterans will call us I've been lowballed, you know, and lowball means they underrate you. I see it every day and I'm sure you see it more than we do. As far as that and your day-to-dayday activities, and Ray sees it all the time, you know, and just like migraine, you know guys get 0% from migraines and you look up yeah well, he didn't have a prostrating thing on here and it looks in the medical record that shows what he's going through and yeah, it's prostrating. All right, you know, he might as well write it down. You know, somebody didn't write it down. So you know that's a magic word. It is a magic word. I mean, no matter what everybody talks about migraine, this is your magic word prostrating. And that doesn't mean if the prostrate you got prostate disease, okay, that's a different word altogether. So if you tell a doctor you got prostrating condition, he says you tear your roll and you better look out.

Bethanie Spangenberg: 48:43

Yeah, if the exam is the wrong area, make sure you clarify Up here, up here.

J Basser: 48:55

We've got to keep it fun and light, though. We've been through a whole lot of 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 about the 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 many oars in the water here. We try to keep the boat going straight. It's hard to keep it going straight, you know. You try to cut your arm off. You can be going around the circuit. We'll figure it out. On Tuesday, guys Ray's got his show on WZYX in McCown Tennessee.

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 Betts Roadmap, small letters B-E-T-S-R-O-A-D-M-A-Pcom. You can look it up and I've got Bethany. Matter of fact, I put a connection to your page on there and I got one to you, john, and got one to James Cripps and one to Alex Graham and then, I'm going to be putting up a little more.

Ray Cobb: 50:26

I got a blog about myself and my journey with the VA and I've got I've got ready to put up a couple more photos and a list that you provided concerning good agents, that if they need to try to find an agent, it has their 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 scrapbooks from the photographs you've taken over the years. Man, that's pretty cool. I mean I'm serious. I mean you know you lived a pretty good life'm serious, I mean you know, I mean there you've uh, um, you lived a pretty, pretty good life doing this stuff. You know, and you're really good at what you did and that was your livelihood well, it was.

J Basser: 51:07

I mean, that's how I made a living, yeah anytime you can photograph atlanta brave the players, 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 men would love to live. I mean, you know, when you're down at a Super Bowl and you're close enough to the players that you can hear all those dirty words they're saying to each other, there's a lot of guys that would like to be at that position to watch the game that close, or bowl games, or playoff games. I had the privilege and honor of attending the first ncaa college football playoff between tennessee and florida state, and so you know I've been very fortunate, even though my I was actually fortunate in the military too. I mean, you know, I've followed generals around and took pictures of them putting medals on and shaking hands, and that's not much of a military life to have to go through. But at the same time, because I was the only military photographer at Fort McCallum, I got exposed to Agent Orange because I had to go into a place where they were about to spray it and they did spray it. So you know, kind of interesting.

J Basser: 52:30

It is. That's pretty cool. I bet you didn't know that about you, did you?

Bethanie Spangenberg: 52:37

But actually maybe on your website there can be like like a little button 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 All right?

Ray Cobb: 52:47

Well, I have a book that I probably should have published that goes back into my military time and there's 120 photos in it and I had it made into a coffee table type book and I got them from Germany and London.

Bethanie Spangenberg: 53:05

I got the.

Ray Cobb: 53:05

Super Bowls, playoffs, NASCAR. Matter of fact, I got one of the last known photographs made of Dale Earnhardt before he was killed in Daytona, so you know, things like that have been very fortunate.

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 being you, because every time you come on we learn something, and we're going to learn a whole lot more. You know, but we'll keep you glued in. I mean, you're going to have a hard time leaving now. You're invested. 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 back on and we'll start something new or whatever. We'll let her decide and give her time to think about it and relax a little bit. She spends a lot of time on this stuff, guys, and we think what she does. And, ray, we'll be hollering at you, man, because I'm going to be on your show Tuesday and we'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 to that. We're going to let people know what'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 for now.