Citation Nr: 9910383 Decision Date: 04/14/99 Archive Date: 04/29/99 DOCKET NO. 98-19 301 ) DATE ) ) On appeal from the Department of Veterans Affairs Medical and Regional Office Center in Wichita, Kansas THE ISSUES (1) Entitlement to an evaluation in excess of 10 percent for constipation. (2) Entitlement to an increased (compensable) evaluation for migraine headaches. (3) Entitlement to an increased (compensable) evaluation for vulvar dermatomycosis. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD Carole R. Kammel, Associate Counsel INTRODUCTION The veteran served on active duty from October 1995 to October 1997. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 1998 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Wichita, Kansas, which granted service connection for constipation and assigned a 10 percent disability evaluation. In that same decision, the RO also granted service connection for migraine headaches and vulvar dermatomycosis and assigned noncompensable evaluations to each disability. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of this appeal has been obtained. 2. Current manifestations of the veteran's service-connected constipation include complaints of constipation without evidence of any diarrhea or ascertained constant abdominal distress. 3. The veteran is not shown by competent medical evidence to manifest chronic migraine headaches with characteristic prostrating attacks averaging one in 2 months over the last several months. 4. The veteran's service-connected vulvar dermatomycosis is manifested by subjective complaints of vaginal itching, claimed as "lichen," with no objective evidence of any abnormal gynecological findings. CONCLUSIONS OF LAW 1. The schedular criteria for a rating in excess of 10 percent for constipation have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.114, Diagnostic Code 7319 (1998). 2. The schedular criteria for a compensable rating for migraine headaches have not been met. 38 U.S.C.A. §§ 1155, 5107(a) (West 1991); 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.124a, Diagnostic Code 8100 (1998). 3. The schedular criteria for a compensable rating for vulvar dermatomycosis have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.116, Diagnostic Code 7612 (1998). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Applicable laws and Regulations The Board finds that all three issues listed on the title page are well grounded within the meaning of 38 U.S.C.A. § 5107(a). That is, the Board finds that these claims are plausible. The Board is also satisfied that all relevant facts have been properly developed, and that no further assistance to the veteran with respect to her claims is required to comply with 38 U.S.C.A. § 5107(a). Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule), found in 38 C.F.R. Part 4 (1998). The Board attempts to determine the extent to which the veteran's service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, and the assigned rating is based, as far as practicable, upon the average impairment of earning capacity in civil occupations. 38 U.S.C.A. § 1155; 38 C.F.R. §§ 4.1, 4.10 (1998). Service connection is in effect for constipation, for which the RO has assigned a 10 percent rating under Diagnostic Code 7319 of the Rating Schedule; and for migraine headaches and vulvar dermatomycosis, both rated as noncompensably disabling pursuant to Diagnostic Codes 8100 and 7612, respectively. In accordance with 38 C.F.R. §§ 4.1, 4.2, 4.41 and 4.42 (1998), and Schafrath v. Derwinski, 1 Vet. App. 589 (1991), the Board has reviewed all evidence of record pertaining to the history of each of the aforementioned disabilities for which entitlement to an increased rating is asserted. The Board has found nothing in the historical record which would lead it to conclude that the current evidence of record is not adequate for rating purposes. Moreover, the Board is of the opinion that this case presents no evidentiary considerations which would warrant an exposition of the remote clinical histories and findings pertaining to such disabilities. A. Constipation Pursuant to Diagnostic Code 7319, a 10 percent rating is warranted for "moderate" irritable colon syndrome (spastic colitis, mucous colitis, etc), manifested by frequent episodes of bowel disturbance with abdominal distress; a 30 percent rating is warranted for "severe" irritable colon syndrome, manifested by diarrhea, or alternating diarrhea and constipation, with more or less constant abdominal distress. VA medical records, dating from April to October 1998, reflect that the veteran had a history of constipation. April 1998 VA General Medical and Intestine examination reports reflect that the examiners had reviewed the veteran's claims file prior to the examinations. An April 1998 VA Intestine examination report reflects that the veteran did complain of having any rectal pain, bleeding, nausea or vomiting but that she had had some discomfort in the periumbilical area of her abdomen. The veteran reported that her discomfort was not related to her periods or bowel movements and that if she took a Dulcolax tablet, she would have a bowel movement the next day. However, she related that if she did not take any medication, she would only have a bowel movement about every four days. The veteran felt that her constipation problems had increased since service. On examination of the abdomen, there was no evidence of any masses, tenderness, organomegaly or costovertebral angle tenderness. On rectal examination, the veteran had normal sphincter tone with no abnormality in the wall of the bowl. An occult blood test was negative. The veteran was diagnosed as having constipation which responded to one Dulcolax tablet with no evidence of any rectal bleeding. In considering the veteran's claim for an increased rating for his service-connected constipation, the Board finds that an evaluation in excess of 10 percent is not warranted. In reaching such conclusion, the Board emphasize that while the veteran complained of some discomfort in the periumbilical region of the abdomen, the clinical findings noted above are absent for any complaints of diarrhea, nausea, vomiting or constant abdominal distress. In addition, while the veteran complained of constipation, it was found to have been relieved with medication. Therefore, as there is no evidence of diarrhea, or alternating diarrhea and constipation with more or less constant abdominal distress, the above findings would not be characteristic of disability warranting a 30 percent rating pursuant to Diagnostic Code 7319. In light of the foregoing observations, the Board concludes that a rating in excess of 10 percent for the veteran's service-connected constipation is not warranted. B. Migraine Headaches The RO has assigned the veteran's service-connected migraine headaches a noncompensable evaluation pursuant to 38 C.F.R. § 4.124a, Diagnostic Code 8100. Under that code, a noncompensable evaluation is warranted for migraine headaches with less frequent attacks. A 10 percent evaluation requires characteristic prostrating attacks averaging one in two months over the last several months. A 30 percent evaluation requires characteristic prostrating attacks occurring on an average of once per month over the last several months. VA medical records, dating from April to October 1998, reflect that the veteran had a history of migraine headaches. An April 1998 VA Neurological examination report reflects that the examiner reviewed the claims folder prior to the examination. The veteran stated that she took different medications for her headaches, which would typically occur about once or twice a month. She reported that she would go about a month without a headache. Her typical headache was reported to have been associated with some visual symptoms, such as spots, sparkles or tunnel vision, which were followed by a throbbing headache which lasted for a couple of hours. The veteran had some nausea with the headaches but that she would rarely vomit. She related that when she would get a headache, she would have to lay down in a quiet dark room or go to sleep. The veteran had a normal neurological examination and was diagnosed as having migraine headaches. The examiner further indicated that the symptoms experienced by the veteran, such as visual scotoma, tunnel vision, throbbing headache with nausea and occasional vomiting with photophobia were typical of vascular migraine headaches. The examiner noted that the veteran might have had some tension headaches in the past when she was under stress. Although the Board finds that the veteran's statements as to the frequency, duration and intensity of headaches to be credible, the evidence does not support a finding of characteristic prostrating attacks averaging one in two months over the last several months to warrant a 10 percent evaluation pursuant to Diagnostic Code 8100. Indeed, as noted above, on recent VA examination, the veteran's headaches were not found to have been incapacitating and to have improved with medication; a neurological examination was normal. Clearly, the veteran has not demonstrated that she meets the criteria needed to justify a compensable evaluation for the service-connected migraine headaches pursuant to 38 C.F.R. § 4.124(a), Diagnostic Code 8100. C. Vulvar Dermatomycosis The RO has assigned a noncompensable disability evaluation to the veteran's service-connected vulvar dermatomycosis pursuant to 38 C.F.R. § 4.116, Diagnostic Code 7612. Under that code, a zero percent evaluation will be assigned for symptoms that do not require continuous treatment. A 10 percent rating is assigned for symptoms that require continuous treatment, and a 30 percent evaluation is warranted for symptoms not controlled by continuous treatment. VA medical records dating from April to October 1998, reveal that the veteran had a history of lichen simplex. During an April 1998 VA gynecological examination, the veteran's claims file was made available to the examiner for review. The examiner noted the veteran's in-service history and related that in 1996, the veteran was diagnosed as having " lichens" of the vulva and was given an ointment, which she still used. It was reported that in March 1997, the veteran had a vulvar biopsy which revealed dermatomycosis compatible with candida. The veteran complained that she had experienced dysmenorrhea for the first two days of her period for the previous four to five months. She noted that her periods were every 28 days and would last three to four days with heavy bleeding during the first two days. The veteran denied having any clots. In addition, the veteran continued to complain of occasional episodes of vaginal itching. She claimed that she had been given an ointment for what she claimed was "lichen." On examination, there was no evidence of any lesions compatible with lichen and her external genitalia, Bartholin, urethral and Skene's glands were all found to have been within normal limits. Her vagina was moist and pink without any lesions. The veteran's cervix was nulliparous and clear without any evidence of any lesions. Her adnex was clear with no masses noted. The veteran was diagnosed as having a history of abnormal pap smears with no dysplasia identified, a history of "lichen" and vulvar dermatomycosis compatible with candida. The Board observes that the during the recent VA examination, the veteran complained of occasional vaginal itching for which she took medication. However, a gynelogical examination was negative for any abnormalities, to include lesions compatible with "lichen." In light of the paucity of clinical findings noted above, the Board is of the opinion that an compensable evaluation for the veteran's service- connected vulvar dermatomycosis is not warranted pursuant to 38 C.F.R. § 4.116, Diagnostic Code 7612. II. 38 C.F.R. § 3.321(b)(1) According to 38 C.F.R. § 3.321(b)(1) (1998), ratings are to be based as far as practicable upon the average impairment of earning capacity. However, in those exceptional cases where the schedular evaluations are found to be inadequate, an extraschedular evaluation can be provided commensurate with the average earning capacity impairment due exclusively to the service-connected disabilities. The governing norm in these exceptional cases is: A finding that the case represents such an exceptional or unusual disability picture with such related factors as marked interference with employment or frequent periods of hospitalization as to render impractical the application of the regular schedular standards. Although the veteran indicated during the April 1998 VA General Medical examination that she was unemployed, the record contains no indication that it was a result of the service-connected constipation, migraine headaches or vulvar dermatomycosis, or that such disabilities markedly interfered with her employment nor is there any suggestion that she has been frequently hospitalized as a result of such disabilities. Therefore, there is no basis upon which to grant an increase in compensation on an extraschedular basis. ORDER An evaluation in excess of 10 percent for constipation is denied. An increased (compensable) evaluation for migraine headaches is denied. An increased (compensable) evaluation for vulvar dermatomycosis is denied. F. JUDGE FLOWERS Member, Board of Veterans' Appeals Department of Veterans Affairs