Citation Nr: 0814375 Decision Date: 05/01/08 Archive Date: 05/12/08 DOCKET NO. 06-13 139 ) DATE ) ) Received from the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUES 1. Entitlement to an initial rating in excess of 10 percent for left knee patellofemoral pain syndrome. 2. Entitlement to an initial rating in excess of 10 percent for right knee patellofemoral pain syndrome. 3. Entitlement to an initial rating in excess of 10 percent for plantar fasciitis. 4. Entitlement to an initial compensable rating for migraine headaches. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL The veteran ATTORNEY FOR THE BOARD A. Cryan, Associate Counsel INTRODUCTION The veteran served on active duty from September 2001 to June 2005. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a June 2005 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Waco, Texas. After the decision was entered, the case was transferred to the jurisdiction of the RO in St. Petersburg, Florida. The veteran testified at a Travel Board hearing before the undersigned Veterans Law Judge (VLJ) in June 2007. The Board notes that the veteran also appealed the issue of entitlement to an initial compensable rating for pseudofolliculitis barbae. However, at the time of the Travel Board hearing the veteran submitted a written request to withdraw the issue of entitlement to an initial compensable rating for compensable rating for pseudofolliculitis barbae. Consequently, the Board will only adjudicate the issues listed on the first page of this decision. The veteran also submitted two lay statements with a waiver of the agency of original jurisdiction at the time of the Travel Board hearing. Consequently, the veteran is not prejudiced by the Board's adjudication of his claims. FINDINGS OF FACT 1. The veteran's left knee disability is manifested by crepitus and pain on extension; range of motion is full. 2. The veteran's right knee disability is manifested by crepitus and pain on extension; range of motion is full. 3. The veteran's bilateral plantar fasciitis is manifested by complaints of pain and objective evidence of tenderness; his condition is not manifested by marked deformity, callosities, or marked inward displacement and severe spasm of the tendo achillis on manipulation, and is no more than "moderate" in degree. 4. The veteran's migraine headache disability is manifested by attacks occurring from one to three times per month which are prostrating. CONCLUSIONS OF LAW 1. The criteria for an initial rating in excess of 10 percent for left knee patellofemoral pain syndrome have not been met. 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. §§ 4.1, 4.7, 4.40, 4.45, 4.71a, Diagnostic Codes 5099-5014 (2007). 2. The criteria for an initial rating in excess of 10 percent for right knee patellofemoral pain syndrome have not been met. 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. §§ 4.1, 4.7, 4.40, 4.45, 4.123, 4.71a, Diagnostic Codes 5099-5014 (2007). 3. The criteria for the assignment of an initial rating in excess of 10 percent for bilateral plantar fasciitis have not been met. 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. §§ 4.1, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5276 (2007). 4. The criteria for a 30 percent rating for migraine headaches have been met. 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. §§ 4.1, 4.7, 4.124a, Diagnostic Code 8100 (2007). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Preliminary Matters The Veterans Claims Assistance Act of 2000 (VCAA), Public Law No. 106-475, 114 Stat. 2096 (2000), substantially amended the provisions of chapter 51 of title 38 of the United States Code, concerning the notice and assistance to be afforded to claimants in substantiating their claims. VCAA § 3(a), 114 Stat. 2096, 2096-97 (2000) (now codified as amended at 38 U.S.C.A. §§ 5103, 5103A (West 2002 & Supp. 2007)). In addition, VA published regulations, which were created for the purpose of implementing many of the provisions of VCAA. See 66 Fed. Reg. 45,620 (Aug. 29, 2001) (now codified, in pertinent part, at 38 C.F.R. § 3.159 (2007)). The notice requirements of the VCAA require VA to notify the veteran of any evidence that is necessary to substantiate his claim, as well as the evidence VA will attempt to obtain and which evidence he is responsible for providing. Quartuccio v. Principi, 16 Vet. App. 183 (2002). The requirements apply to all five elements of a service connection claim: veteran status, existence of a disability, a connection between the veteran's service and the disability, degree of disability, and effective date of the disability. See Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006), aff'd, Hartman v. Nicholson, 483 F.3d 1311 (Fed. Cir. 2007). Such notice must be provided to a claimant before the initial unfavorable decision on a claim for VA benefits by the agency of original jurisdiction. Id; see also Pelegrini v. Principi, 18 Vet. App. 112 (2004). The Board finds that the notification requirements of VCAA have been satisfied in this case. In this regard, the Board notes an evidence development letter dated in May 2005, in which the RO advised the veteran of the evidence needed to substantiate his claims of service connection for the issues on appeal. The veteran was also advised of his and VA's responsibilities under VCAA, to include what evidence should be provided by him and what evidence should be provided by VA. The veteran was further advised to inform the RO if there was any other evidence or information that he believes pertains to his claim. The veteran appealed the initial evaluation assigned for his patellofemoral syndrome of the bilateral knees, plantar fasciitis, and migraines and he was subsequently informed, by way of a July 2005 letter, that the evidence must show that his service-connected disabilities had increased in severity. Additionally, while notice was not provided as to the criteria for rating low back disabilities or with respect to award of effective dates, see Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006), aff'd, Hartman v. Nicholson, 483 F.3d 1311 (Fed. Cir. 2007), the Board does not have jurisdiction over such issues. Consequently, a remand of the claims is not required. The Board has considered the recent case of Vazquez-Flores v. Peake, 22 Vet. App. 37 (2008), wherein the Court held that, for an increased-compensation claim, section 5103(a) compliant notice must meet the following four part test: (1) that the Secretary notify the claimant that, to substantiate a claim, the claimant must provide, or ask the Secretary to obtain, medical or lay evidence demonstrating a worsening or increase in severity of the disability and the effect that worsening has on the claimant's employment and daily life; (2) if the Diagnostic Code under which the claimant is rated contains criteria necessary for entitlement to a higher disability rating that would not be satisfied by the claimant demonstrating a noticeable worsening or increase in severity of the disability and the effect of that worsening has on the claimant's employment and daily life (such as a specific measurement or test result), the Secretary must provide at least general notice of that requirement to the claimant; (3) the claimant must be notified that, should an increase in disability be found, a disability rating will be determined by applying relevant Diagnostic Codes, which typically provide for a range in severity of a particular disability from noncompensable to as much as 100 percent (depending on the disability involved), based on the nature of the symptoms of the condition for which disability compensation is being sought, their severity and duration, and their impact upon employment and daily life; (4) the notice must also provide examples of the types of medical and lay evidence that the claimant may submit (or ask the Secretary to obtain) that are relevant to establishing entitlement to increased compensation, e.g., competent lay statements describing symptoms, medical and hospitalization records, medical statements, employer statements, job application rejections, and any other evidence showing an increase in the disability or exceptional circumstances relating to the disability. Vazquez-Flores v. Peake, 22 Vet. App. 37 (2008). To the extent that this holding applies to appeals of initial ratings, the Board finds that any defects with regard to the Vazquez-Flores test are non-prejudicial. While notification of the specific rating criteria was provided in the statement of the case (SOC), and not a specific preadjudicative notice letter, no useful purpose would be served in remanding this matter for yet more development. As to the remaining elements identified in that holding, the veteran was questioned about his employment and daily life during the course of VA examination, and during his personal hearing. The veteran provided statements in which he detailed the impact of his disability on his daily life. The Board finds that the notice given, the questions directly asked, and the responses provided by the veteran show that he knew that the evidence needed to show that his disabilities had worsened and what impact that had on his employment and daily life. As the Board finds the veteran had actual knowledge of the requirement, any failure to provide him with adequate notice is not prejudicial. Sanders v. Nicholson, 487 F.3d 881 (2007). Such a remand would result in unnecessarily imposing additional burdens on VA, with no additional benefit flowing to the veteran. The Court has held that such remands are to be avoided. The Board further finds that the duty to assist requirements of VCAA have also been satisfied in this case. Specifically, the Board finds that all obtainable evidence identified by the veteran relative to the issues on appeal has been obtained and associated with the claims folder. In particular, the Board notes that the RO has obtained the veteran's service medical records and VA treatment records. The veteran did not identify any private treatment records. The RO also arranged for him to undergo a VA examination. In short, the Board finds that VA has satisfied its duty to assist to the extent possible under the circumstances by obtaining evidence relevant to his claims. 38 U.S.C.A. §§ 5103 and 5103A. II. Factual Background The veteran claims that his service-connected disabilities warrant higher initial ratings. The veteran's service medical records (SMRs) reveal that the veteran reported treatment for headaches in an emergency room prior to service and an examiner also noted the same. The veteran reported daily headaches in October 2001. He denied photophobia, nausea, vomiting, and scotomoas at that time. Also in October 2001 the veteran was noted to have chronic migraine headaches. The examiner noted that the veteran's headaches existed prior to service. He was noted to have had a migraine in June 2001 in which he had pain in his eyelid and all around his head characterized by severe pain and occasional vomiting. The veteran was diagnosed with plantar fasciitis in 2002 and treated during service with inserts, steroid injections, and shockwave therapy. He was noted to have little improvement with conservative treatment (profile, inserts, and injections). The veteran reported right knee pain in January 2002. The Board notes that the veteran's separation examination was not included with the SMRs but the RO indicated on the rating decision that the veteran was diagnosed with patellofemoral syndrome of the bilateral knees at that time. The veteran was afforded a VA examination in May 2005. The veteran reported that his plantar fasciitis began in service. He said he gets pain on the bottom of his feet with standing and walking. He said he was treated with supports, physical therapy, local steroid shots, and shockwave therapy but that nothing really helped the pain and that the shockwave therapy made the pain worse. The examiner reported that on examination the veteran had tenderness on the plantar fascia especially on the middle one-third of his foot and on the posterior aspect of both heels. No callosities were found and no neurovascular deficits were reported and his posture and gait were normal. His feet were otherwise normal to examination. With regard to the veteran's knees, the veteran reported pain in his knees. On examination of the knees, there was no effusion or swelling. There was some tenderness to pressure on the patella. The range of motion was full and flexion was 140/140. There was some crepitus and pain on extension of both knees. Both knees were stable and McMurray and drawer test were negative. The veteran said he had pain in both knees with prolonged walking but his day to day activities were not affected by his knees. No change in motion was reported with repeated testing. With regard to the veteran's migraines, the veteran stated that the migraines started during basic training. He said he had an episode of severe headaches during service in which he was taken to the emergency room and placed in a dark area. Since then he reported migraine headaches once per week which last for a half hour up to four hours associated with photophobia, phonophobia, nausea, and vomiting. He said he took Aleve for his headaches. The examiner said the veteran had one prostrating episode which required an emergency room visit and pain shots and since then he had not had any prostrating episodes. The examiner indicated that the veteran lost about one to two days of work in the last year due to the headaches. The examiner diagnosed the veteran with bilateral plantar fasciitis, migraine headaches, and bilateral patellofemoral syndrome of the knees. Associated with the claims file are VA outpatient treatment reports dated from May 2007 to June 2007. In May 2007 the veteran reported that his last migraine was five months prior and that he had been having headaches weekly with phonophobia, photophobia, scotomas, nausea, and emesis. He said he uses Excedrin migraine without improvement and usually goes to bed and the headache is resolved when he wakes up. The veteran indicated that his plantar fasciitis is tolerable and that he uses arch supports, stretches, and naproxen. With regard to his knees, the veteran reported that the pain is constant and aggravated by walking and sitting. He said he takes naproxen which doesn't help the knee pain but that the knee pain is tolerable. The veteran provided testimony at a Travel Board hearing in June 2007. He testified that he was treated for his service- connected disabilities at VA. He reported that he wakes up with stiff knees daily. He said he works as a mail carrier and does other various jobs for the postal service and that he is able to get on with his day once he gets going in the morning which is the hardest part of his day. The veteran indicated that his knees have given way on several occasions while walking. He stated that he has a large tuberosity at the bottom of his right kneecap. He indicated that he is not restricted in terms of his ability to walk. With regard to his plantar fasciitis, the veteran reported that he has excruciating pain in his feet upon waking up in the morning. He stated that the pain was mostly in his middle of his feet to the heels. He said he is able to walk a mile and that he has not missed any work due to his feet. The veteran reported that he got heel supports, steroid shots, and shock wave therapy on his feet while in service. With regard to the veteran's migraines, the veteran testified that he takes Excedrin Migraine for his headaches. He said he last had a migraine the week before the hearing. He said when he gets migraines he has to have the lights off and have no noise in the room. He said he puts a pillow or the covers over his head and he puts a black sheet over his windows. He said the migraines were excruciating and incapacitating. He reported that he also occasionally throws up. The veteran indicated that he gets the migraines between one and three times per month. He said he missed work two times in three months of employment due to his migraines. He also reported that he has two to three minor headaches per week. The veteran submitted statements from his mother and girlfriend. The veteran's girlfriend indicated that the veteran had foot pain and migraines on a regular basis. She said he takes pain pills and that his attitude was affected by the pain. She said the veteran has to stay in a dark room with no sound and throws up when he has migraines. The veteran's mother said that the veteran had foot pain and numerous migraines. III. Legal Analysis Disability evaluations are determined by the application of a schedule of ratings that is based on the average impairment of earning capacity. 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. § Part 4. Separate diagnostic codes identify the various disabilities. The governing regulations provide that the higher of two evaluations will be assigned if the disability more closely approximates the criteria for that rating. Otherwise, the lower rating is assigned. 38 C.F.R. § 4.7. The veteran's entire history is reviewed when making disability evaluations. See generally 38 C.F.R. 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). Where entitlement to compensation already has been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, in Fenderson v. West, 12 Vet. App. 119 (1999), it was held that evidence to be considered in the appeal of an initial assignment of a rating disability was not limited to that reflecting the then current severity of the disorder. In Fenderson, the United States Court of Appeals for Veterans Claims (Court) also discussed the concept of the "staging" of ratings, finding that, in cases where an initially assigned disability evaluation has been disagreed with, it was possible for a veteran to be awarded separate percentage evaluations for separate periods based on the facts found during the appeal. A. Knees Disabilities of the musculoskeletal system can result in anatomical damage, functional loss, with evidence of disuse, and/or abnormal excursion of movements. Evaluations of disabilities of the knee are made utilizing Diagnostic Codes 5256 through 5263, inclusive. In determining disability evaluations of the knees, consideration is given to impairment of function manifested by findings of ankylosis, limitation of motion, nonunion, the severity and frequency of dislocation or lateral instability and/or painful motion. 38 C.F.R. §§ 4.40, 4.45, 4.59 (2007). The veteran was awarded service connection for his bilateral patellofemoral pain syndrome and each knee was assigned a 10 percent disability rating for painful or limited motion under 38 C.F.R. § 4.71a, Diagnostic Code 5099-5014, as analogous to osteomalacia. Diagnostic Code 5014 states that osteomalacia will be rated on limitation of motion of the affected parts, as arthritis, degenerative. 38 C.F.R. § 4.71a, Diagnostic Code 5014. Diagnostic Code 5003 specifies that degenerative arthritis established by x-ray findings will be rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved. When however, the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate diagnostic codes, a rating of 10 percent is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under Diagnostic Code 5003. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. The veteran's current 10 percent ratings were assigned under these criteria for limited or painful motion of a major joint group. The Board must also consider factors such as lack of normal endurance, functional loss due to pain, and pain on use, including pain during flare-ups. See also 38 C.F.R. §§ 4.40, 4.45; DeLuca v. Brown, 8 Vet. App. 202 (1995). The Board has considered all pertinent sections of 38 C.F.R. Parts 3 and 4, as required by the Court of Appeals for Veterans Claims (Court) in Schafrath, supra. In that regard, consideration has been given to whether any other applicable diagnostic code under the regulations provides a basis for a higher evaluation for the service-connected knee disabilities. Knee impairment with recurrent subluxation or lateral instability is rated 10 percent when slight, 20 percent when moderate, and 30 percent when severe. 38 C.F.R. § 4.71a, Diagnostic Code 5257. The evidence does not reveal that the veteran has recurrent subluxation or lateral instability. Knee impairment with dislocated semilunar cartilage, with frequent episodes of locking, pain, and effusion into the joint has one rating of 20 percent. 38 C.F.R. § 4.71a, Diagnostic Code 5258. There is no evidence of dislocated semilunar cartilage with frequent episodes of locking, pain, and effusion into the joint. Diagnostic Codes 5256 (ankylosis of the knee), 5258 (dislocation of semilunar cartilage), 5259 (removal of semilunar cartilage), 5262 (impairment of the tibia and fibula), and 5263 (genu recurvatum) are not applicable in this instance, as the competent medical evidence does not show that the veteran has any of these conditions. Accordingly, Diagnostic Codes 5256, 5258, 5259, 5262, and 5263 cannot serve as a basis for an increased rating in this case. Diagnostic Codes 5260 and 5261 contemplate limitation of leg flexion and extension, respectively. Under Diagnostic Code 5260, a noncompensable rating is warranted for flexion limited to 60 degrees; a 10 percent rating is warranted for flexion limited to 45 degrees; a 20 percent rating is warranted for flexion limited to 30 degrees; and a 30 percent rating is warranted for flexion limited to 15 degrees. 38 C.F.R. § 4.71a. Under Diagnostic Code 5261, a noncompensable rating is warranted for extension limited to 5 degrees; a 10 percent rating is warranted for extension limited to 10 degrees; a 20 percent rating is warranted for extension limited to 15 degrees; a 30 percent rating is warranted for extension limited to 20 degrees; a 40 percent rating is warranted for extension limited to 30 degrees; and a 50 percent rating is warranted for extension limited to 45 degrees. 38 C.F.R. § 4.71a. The examiner said the veteran had full range of motion with pain and crepitus on extension. Based on a thorough review of the record, the Board finds the weight of the evidence is against disability ratings in excess of 10 percent each for the veteran's right and left knee disabilities. In this regard, the Board notes that the May 2005 VA examination revealed that the veteran had full range of motion and could flex both knees to 140 degrees. There was some crepitus and pain on extension of both knees. There was no effusion or swelling and some tenderness to pressure on the patella. Testing revealed both knees to be stable and there was no change in motion with repeated testing of the knees. There was also no objective evidence of fatigability or incoordination. VA outpatient treatment reports dated in May 2007 revealed that the veteran reported constant pain in his knees aggravated with walking and sitting. The veteran testified that he wakes up with stiff knees daily. He said he works as a mail carrier and does other various jobs for the postal service and that he is able to get on with his day once he gets going in the morning which is the hardest part of his day. The veteran indicated that his knees have given way on several occasions while walking. He stated that he has a large tuberosity at the bottom of his right kneecap. He indicated that he is not restricted in terms of his ability to walk. The Board has considered the veteran's complaints; however, the 10 percent currently assigned Diagnostic Code 5014 contemplates otherwise noncompensable degree limitation of motion accompanied by symptoms such as painful motion. Therefore, the Board finds that the degree of pain, weakness, and other symptoms resulting in functional loss are already contemplated by the 10 percent rating currently assigned. See Deluca, supra. The Board also concludes that there is no period since the award of service connection that a rating greater than 10 percent for either knee is warranted. Fenderson, supra. B. Plantar Fasciitis The veteran's plantar fasciitis has been rated under Diagnostic Code 5276 which pertains to acquired flatfoot. 38 C.F.R. § 4.71a, Diagnostic Code 5276 (2007). Under Diagnostic Code 5276, a 10 percent evaluation is for application when there is moderate disability evidenced by weight-bearing line over or medial to the great toe, inward bowing of the tendo achillis, and pain on manipulation and use of the feet bilaterally or unilaterally. A 30 percent evaluation is for application when there is severe bilateral disability evidenced by marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, and characteristic callosities. A 50 percent evaluation is for application when there is pronounced bilateral disability evidenced by marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo achillis on manipulation, which is not improved by orthopedic shoes or appliances. In the present case, the record shows that the veteran was found to have plantar fasciitis during service. In May 2005, when the veteran was examined for VA compensation purposes, he complained of pain. On examination, tenderness was noted on the plantar fascia objectively. There were no callosities or neurovascular deficits in the feet. His feet were otherwise normal to examination. It was noted that he had a normal gait and posture. VA outpatient treatment reports indicate that in May 2007 the veteran reported that his plantar fasciitis is tolerable and that he uses arch supports, stretches, and naproxen. The veteran testified that the pain in his feet is excruciating but that he is not restricted in terms of his ability to walk. He said he is able to walk a mile and that he has not missed any work due to his feet. Based on a review of the relevant evidence, and the applicable law and regulations, it is the Board's conclusion that the preponderance of the evidence is against the assignment of a schedular rating in excess of 10 percent for bilateral plantar fasciitis. Although the veteran has consistently described experiencing pain and there is objective evidence of tenderness on the plantar fascia, the record does not show that his condition is manifested by objective evidence of marked deformity. Indeed, as noted above, examination in May 2005 revealed that aside from the tenderness on the plantar fascia, the examination of the veteran's feet was otherwise normal. The record is devoid of any evidence of callosities, and there is no indication of marked inward displacement and severe spasm of the tendo achillis on manipulation. In the absence of manifestations required for a higher evaluation, the Board finds that the weight of the evidence is against the assignment of a higher schedular evaluation. C. Migraines The RO determined that the veteran's migraine headaches existed prior to service and permanently worsened as a result of service. In cases involving aggravation, the rating will reflect only the degree of disability over and above the degree existing prior to the aggravation. It is therefore necessary to deduct from the present degree of disability the degree, if ascertainable, of the disability existing prior to the aggravation, in terms of the rating schedule, except that if the disability is total (100 percent) no deduction will be made. If the degree of disability prior to the aggravation is not ascertainable in terms of the schedule, no deduction will be made. 38 C.F.R. § 4.22, see also 38 C.F.R. § 3.322. A disability rating for aggravation is derived by reducing the current rating of the disability by the amount of the disability (as it would have been rated) prior to the aggravation. See Hensley v. Brown, 5 Vet. App. 155, 161 (1993) (citing 38 C.F.R. § 4.22). As noted, the RO determined that the veteran's migraine headaches existed prior to service. However, the headaches were considered noncompensably disabling at the veteran's entrance into service. Consequently, no deduction is necessary in this case. The veteran's migraine headaches have been rated as 10 percent disabling under 38 C.F.R. § 4.124a, Diagnostic Code 8100. Diagnostic Code 8100 provides that a veteran will be rated as 10 percent disabled with characteristic prostrating attacks averaging 1 in 2 months over the last several months. Characteristic prostrating attacks occurring on an average of once a month over the last several months warrant a 30 percent rating, and very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability warrant a 50 percent rating. Diagnostic Code 8100. In evaluating the evidence of record the Board finds that the veteran's headache symptomatology more closely approximates the rating criteria for a 30 percent rating under Diagnostic Code 8100. The VA examination report indicates that the veteran reported migraine headaches once a week which last for one-half hour to four hours associated with photophobia, phonophobia, nausea, and vomiting. At the Travel Board hearing the veteran indicated that he had between one and three migraine headaches per month. He said the migraines are excruciating and incapacitating and he reported that he also occasionally throws up. The veteran noted that he missed work two times in three months of employment due to his migraines. He also reported that he has two to three minor headaches per week. The frequency of the headaches and their debilitating nature lead the Board to conclude that a 30 percent disability rating is in order. This is so because the problems the veteran experiences appear to be more akin to the level of disability contemplated by the criteria for a 30 percent rating. 38 C.F.R. § 4.7 (2007). There is no evidence of record to show that the veteran experiences very frequent and completely prostrating attacks warranting the assignment of a 50 percent rating. He has not been shown to have completely prostrating and prolonged attacks that are very frequent, or result in severe economic inadaptability. D. Extraschedular Considerations The Board finds that there is no showing that the veteran's service-connected bilateral knee disability, plantar fasciitis, or migraines have reflected so exceptional or so unusual a disability picture as to warrant the assignment of any higher evaluations on an extra-schedular basis. In this regard, the Board notes that none of these disabilities has been shown to markedly interfere with employment (i.e., beyond that contemplated in the assigned rating), to warrant frequent periods of hospitalization, or to otherwise render impractical the application of the regular schedular standards. While he has described missing work due to migraine attacks, and reported difficulty at work due to his knee and foot problems, it appears that he remains employed full-time, and that his absences are not of a frequency to suggest marked interference with employment. Hence, the criteria for invoking the procedures set forth in 38 C.F.R. § 3.321(b)(1) are not met. See Bagwell v. Brown, 9 Vet. App. 337, 338-9 (1996); Floyd v. Brown, 9 Vet. App. 88, 96 (1996); Shipwash v. Brown, 8 Vet. App. 218, 227 (1995). ORDER Entitlement to an initial rating in excess of 10 percent for left knee patellofemoral pain syndrome is denied. Entitlement to an initial rating in excess of 10 percent for right knee patellofemoral pain syndrome is denied. Entitlement to an initial rating in excess of 10 percent for plantar fasciitis is denied. Entitlement to a 30 percent rating for migraine headaches is granted, subject to the laws and regulations governing the payment of monetary benefits. ____________________________________________ MICHAEL LANE Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs