Citation Nr: 1322514 Decision Date: 07/15/13 Archive Date: 07/24/13 DOCKET NO. 03-34 262A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUES 1. Entitlement to service connection for an allergy to fermented products (manifested by nasal congestion, flushing, and infrequent fainting), claimed as a residual of in-service immunizations against anthrax, tularemia, and botulism. 2. Entitlement to an initial compensable rating for migraine headaches. REPRESENTATION Appellant represented by: The American Legion WITNESSES AT HEARINGS ON APPEAL Appellant and his spouse ATTORNEY FOR THE BOARD N. T. Werner, Counsel INTRODUCTION The Veteran served on active duty from August 1959 to August 1961. This case comes before the Board of Veterans' Appeals (Board) on appeal from September 2002 and March 2011 decisions by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida. This appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2012). 38 U.S.C.A. § 7107(a)(2) (West 2002). In July 2006 and May 2012 the Veteran and his spouse testified at hearings before the undersigned Veterans Law Judge (VLJ). Transcripts of the hearings are of record. In October 2006, December 2009, and July 2011 the Board remanded the appeal for further development and adjudicative action. Following the issuance of the September 2012 supplemental statement of the case (SSOC) as to the claim of service connection for allergies and the issuance of the December 2012 SSOC as to the claim for a compensable rating for migraine headaches, additional VA treatment records were added to the virtual VA record. Nonetheless, the Board finds these records are cumulative, duplicative, and/or not relevant to the issue. Accordingly, there is no prejudice by consideration of the claim at this time. See Bernard v. Brown, 4 Vet. App. 384, 394 (1993). FINDINGS OF FACT 1. The most probative evidence shows that the Veteran's claimed allergy to fermented products (manifested by nasal congestion, flushing, and infrequent fainting), claimed as a residual of in-service immunizations against anthrax, tularemia, and botulism, is not related to service. 2. The credible and probative evidence fails to show characteristic prostrating attacks of migraine headaches at least once every two months. CONCLUSIONS OF LAW 1. The requirements for establishing service connection for allergy to fermented products (manifested by nasal congestion, flushing, and infrequent fainting), have not been met. 38 U.S.C.A. §§ 1131, 5107 (West 2002 & Supp. 2012); 38 C.F.R. § 3.303 (2012). 2. The criteria for compensable rating for migraine headaches have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 2002); 38 C.F.R. § 4.124a, Diagnostic Code 8100 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veterans Claims Assistance Act of 2000 (VCAA) The Veterans Claims Assistance Act of 2000 (VCAA), Pub. L. No. 106-475, 114 Stat. 2096 (Nov. 9, 2000) (codified at 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5106, 5107, and 5126 (West 2002)) redefined VA's duty to assist a claimant in the development of a claim. VA regulations for the implementation of the VCAA were codified as amended at 38 C.F.R. §§ 3.102, 3.156(a), 3.159, and 3.326(a) (2012). The notice requirements of the VCAA require VA to notify a claimant of what information or evidence is necessary to substantiate the claim; what subset of the necessary information or evidence, if any, the claimant is to provide; and what subset of the necessary information or evidence, if any, the VA will attempt to obtain. 38 C.F.R. § 3.159(b) (2012). The requirements apply to all five elements of a service connection claim: veteran status, existence of a disability, a connection between a veteran's service and the disability, degree of disability, and effective date of the disability. Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). VCAA notice must be provided to a claimant before the initial unfavorable decision on a claim for VA benefits by the agency of original jurisdiction (in this case, the RO). Id; see also Pelegrini v. Principi, 18 Vet. App. 112 (2004). However, insufficiency in the timing or content of VCAA notice is harmless if the errors are not prejudicial to the claimant. Conway v. Principi, 353 F.3d 1369, 1374 (Fed. Cir. 2004) (VCAA notice errors are reviewed under a prejudicial error rule). As to the service connection claim, the Board finds that letters dated in July 2002, and May 2006 provided the Veteran with notice that fulfills the provisions of 38 U.S.C.A. § 5103(a). These letters advised the Veteran regarding what information and evidence is needed to substantiate his claim, as well as what information and evidence must be submitted by the Veteran and what information and evidence will be obtained by VA. He was also advised of how disability evaluations and effective dates are assigned, and the type of evidence which impacts those determinations. The case was last adjudicated in a September 2012 supplemental statement of the case. As to the rating claim, the Veteran is challenging the initial evaluation assigned following the grant of service connection for his migraine headaches. In Dingess, supra, the Court also held that in cases where service connection has been granted and an initial disability evaluation has been assigned, the service connection claim has been more than substantiated, it has been proven, thereby rendering § 5103(a) notice no longer required because the purpose that the notice is intended to serve has been fulfilled. Id, at 490-91; see also Hartman v. Nicholson, 483 F.3d 1311 (Fed. Cir. 2007); Dunlap v. Nicholson, 21 Vet. App. 112 (2007). Therefore, regardless of whether the notice that the Veteran was provided with before service connection was granted was legally sufficient, the Board finds that VA's duty to notify in this case has been satisfied. The record also reflects that VA has made reasonable efforts to obtain relevant records adequately identified by the Veteran including service treatment records, post service treatment records, VA examination reports, hearing testimony, and lay statements. In addition, records and VA medical opinions requested on remand have been obtained. Accordingly, the Board finds that there has been substantial compliance with the prior remand instructions. See D'Aries v. Peake, 22 Vet. App. 97 (2008) (holding that only substantial, and not strict, compliance with the terms of a Board remand is required pursuant to Stegall v. West, 11 Vet. App. 268 (1998)). The Veteran has repeatedly claimed that the Army Medical Research and Development Command in Fort Detrick, Maryland, the Army Medical Research Institute of Chemical Defense at Aberdeen Proving Ground in Maryland, and Walter Reed Army Medical Center had additional medical records of his. Moreover, all of the Board's remands have requested that additional steps be taken to attempt to obtain these records. However, despite these numerous attempts, no such records have been obtained. Specifically, the record shows that in April 2007 Walter Reed Army Medical Center notified VA that it did not have any records of the Veteran. Similarly, in February 2010 a negative response was received from the Kirk U.S. Army Health Clinic at Aberdeen Proving Ground. Likewise, in March 2010 the AMC received a response from the Army Medical Research and Development Command in Fort Detrick, stating that "Records not at this facility." Furthermore, in May 2013 the Veteran testified that he also received negative replies to his requests for his medical records from the Army Medical Research and Development Command in Fort Detrick, Maryland, the Army Medical Research Institute of Chemical Defense at Aberdeen Proving Ground in Maryland, and Walter Reed Army Medical Center. Thus, the Board finds that the Remand directives have been substantially complied with. Regardless, the Board finds that the Veteran's account of receiving immunizations against anthrax, as well as botulism and tularemia, is credible and plausible based on the evidence of record, and no further action is required with respect to documenting immunizations for anthrax, botulism, or tularemia. As to the service connection claim, the Veteran, in writings to VA as well as at his personal hearing, alleges that the medical opinions obtained by VA were inadequate because the opinions were not provided after he was afforded an examination. In this regard, the record shows that the Veteran was provided an examination in connection with his appeal in January 2009. Moreover, the Board remanded the appeal in December 2009 to obtain a clearer opinion as to the origins of the Veteran's allergies and in July 2011 to obtain a medical basis for the opinion provided by the April 2010 examiner. Neither remand directed that the Veteran be provided with an examination to obtain the requested medical opinion. Thereafter, a medical opinion was obtained in April 2010 and addendums, which included the medical bases for the April 2010 opinion, were obtained by VA in November 2011 and February 2012. Accordingly, the Board finds that the January 2009 VA examination, the April 2010 VA opinion, along with the November 2011 and February 2012 addendums substantially comply with the Board's remand directives. Id. The Board also finds that the Veteran was not prejudiced by not being provided with yet another physical examination while the appeal was in remand status because such examination was not needed to obtain the medical basis for the earlier VA opinion. The Veteran has been afforded two hearings before a VLJ in which he presented oral argument in support of the claims. In Bryant v. Shinseki, 23 Vet. App. 488 (2010), the Court held that 38 C.F.R. § 3.103(c)(2) requires the VLJ who chairs a hearing fully explain the issues and suggest the submission of evidence that may have been overlooked. Here, the VLJ identified the issues to the claimant and asked specific questions directed at identifying whether the Veteran met the criteria for service connection as well as for at least a compensable rating for his migraine headaches. Additionally, the Veteran and his wife volunteered his treatment history and symptoms since service. Neither the Veteran nor his representative have asserted that VA failed to comply with 38 C.F.R. § 3.103(c)(2), nor have they identified any prejudice in the conduct of the Board hearings. The hearings focused on the elements necessary to substantiate the claims, and the Veteran and his spouse provided testimony relevant to those elements. As such, the Board finds that no further action pursuant to Bryant is necessary. As discussed above, the VCAA provisions have been considered and complied with. The Veteran was notified and aware of the evidence needed to substantiate the claims, the avenues through which he might obtain such evidence, and the allocation of responsibilities between the Veteran and VA in obtaining such evidence. The Veteran was an active participant in the claims process by submitting evidence and argument. Therefore, he was provided with a meaningful opportunity to participate in the claims process and has done so. Any error in the sequence of events or content of the notice is not shown to have affected the essential fairness of the adjudication or to cause injury to the Veteran. See Pelegrini, 18 Vet. App. at 121. Therefore, any such error is harmless and does not prohibit consideration of this matter on the merits. See Conway, 353 F.3d at 1374; Dingess, 19 Vet. App. 473; see also ATD Corp. v. Lydall, Inc., 159 F.3d 534, 549 (Fed. Cir. 1998). The Board has reviewed all the evidence in the record including the evidence found in the virtual VA claims file. Although the Board has an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that all the evidence submitted by the appellant or obtained on his behalf be discussed in detail. Rather, the Board's analysis below will focus specifically on what evidence is needed to substantiate the claims and what the evidence in the claims file shows, or fails to show, with respect to the claims. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) and Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000). The Service Connection Claim The Veteran claims that he suffers from allergies to fermented products (manifested by symptoms other than headaches such as nasal congestion, flushing, and infrequent fainting) as a result of his vaccines to anthrax, botulism, and tularemia in service. The Board notes that the Veteran initially included headaches as a manifestation of his allergies, but service connection for migraine headaches has since been established. Specifically, the Veteran claims that during the course of his work at Fort Detrick doing research with anthrax, tularemia, and botulism, he received immunizations against these agents and subsequently developed allergies, particularly to fermented foods, as a result. He believed that the immunizations were administered by a branch of the Walter Reed Hospital, but in a February 2010 letter, which was associated with the claims file in June 2010, he clarified that a branch of Walter Reed Hospital at Fort Detrick administered the immunizations, and he believed that Aberdeen Proving Ground may be the depository for Fort Detrick records. Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. § 1131; 38 C.F.R. § 3.303. Regulations also provide that service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303(d). Generally, in order to prove service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. See, e.g., Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999). With the above criteria in mind, the Board notes that service personnel records reflect that the Veteran earned a bachelor's degree in biology in 1958 prior to military service and subsequently worked at a company on the Nike-Hercules [Missile] program until entering military service. A secret security clearance was completed in February 1960. Service records place him at the U.S. Biological Laboratories at Fort Detrick from October 1959 until separation from service, and specifically at the Biological Warfare Lab at Fort Detrick from October 1959 until June 1960. His military occupational specialty was medical lab specialist, and the related civilian occupation was bacteriologist. Also, in correspondence dated in June 2006, M. G., Ph.D., stated that he worked in the same research laboratory at Fort Detrick as the Veteran from October 1959 to August 1961 and that the Veteran performed "research on the anthrax organism and received immunizations against this disease, as well as for botulism and tularemia, organisms which were also in the laboratory." His service treatment records, which on review appear to be complete, document immunizations for smallpox, typhoid, tetanus, polio, and influenza and that he reported a reaction to the influenza vaccine one day after receiving it in October 1960. The nature of the reaction, however, was not reported. Nonetheless, given the above in-service history, the Board finds that the Veteran's account of receiving immunizations against anthrax, as well as botulism and tularemia, is credible and plausible based on the evidence of record. However, service treatment records are negative for complaints, diagnoses, or treatment for any reaction to a vaccine other than his documented problem after receiving his influenza vaccine in October 1960. In fact, in his May 1961 separation report of medical history, he denied any reaction to serum, drug, or medicine. Furthermore, the Veteran testified in May 2013 that his only documented in-service reaction to a vaccine was the one incident documented in October 1960 regarding the influenza vaccine. Post-service, private and VA treatment records reflect complaints of headaches associated with food and alcohol. In June 1964, the Veteran described fatigue, headaches, and vertigo especially after lunch for the past two weeks. The assessment was sinusitis. He returned the same day with complaints of feeling itchy with chills. The assessment was possible allergy to penicillin. In a January 1979 headache history form he described three types of headaches in three locations that began a year and a half ago; the most severe type included associated symptoms of nausea, photophobia, nasal congestion, and vertigo. He reported an allergy to penicillin, no known food allergies, and headaches aggravated by excessive alcohol intake. He stated that he worked in biological warfare during military service and was exposed to many weekly immunizations. In subsequent private treatment records in the 1980s, the Veteran identified severe headaches triggered by wine, beer, and fermented foods such as cheese. In February 1988 the assessment was allergies to fermented products, cheese, beer, and wine. A January 1995 report from a private otolaryngologist, R. A., M.D., noted the Veteran's reported history of chronic sinusitis, facial pain, and a history of allergies to anything that is fermented. In a private treatment record from an ear, nose, and throat specialist dated in May 2001, the Veteran complained of problems with postnasal drip and an earache with cough for the past three weeks. He listed an allergy to penicillin, and other notations regarding allergies included "tetracycline; biological warfare exposure; migraines: wine, beer, cheese." The assessment included rhinitis (stuffy nose). In subsequent records dated in 2001, he continued to report migraines associated with wine, beer, cheese, and pickles, and stated that his allergies bothered him after nuts, chocolate, and caffeine. In a June 2005 VA allergy progress note the diagnosis included the following: rhinitis/conjunctivitis skin testing was negative; food sensitivities including migraines with chocolate, flushing with peanuts, and reactions of red dye-flushing, headache, and nasal congestion; and possible tyramine sensitivity or syndrome. The Board reiterates that a March 2011 rating decision granted service connection for a migraine headache disability effective May 13, 2002, based on a medical opinion linking the Veteran's headaches to his headaches in service. Thus, the question remaining for purposes of service connection is whether the Veteran also suffers from allergies to fermented products (manifested by symptoms other than headaches such as nasal congestion, flushing, and infrequent fainting) as a result of his vaccines to anthrax, botulism, and tularemia in service. As to the origins or etiology of the Veteran's allergy to fermented products, the December 2009 remand instructions directed a VA physician specializing in allergies and immunology to provide a medical opinion as to whether any chronic headache disorder or any current allergies were the result of vaccinations for anthrax, botulism, and tularemia during service and to support the opinion with a rationale. In an April 2010 opinion, a VA physician Board Certified in Allergy, Asthma, and Immunology, indicated that she reviewed the claims file and records and that it was less likely that allergies were caused by the vaccines he received during service. Unfortunately, the examiner did not provide any medical rationale for her opinion. Therefore, the claims file was returned to obtain the reasoning behind her conclusion. In the November 2011 addendum by a physician (but not one specializing in allergies and immunology), it was opined after a review of the record on appeal and controlling medical literature that it was less likely than not that the Veteran's allergy to fermented products was incurred in or caused by his vaccination to anthrax, botulism, and tularemia in service because there is no evidence in the medical literature to support his claim of having adverse reactions to anthrax, botulism, and tularemia vaccines including long term allergies to fermented food. Thereafter, in a February 2012 addendum by a VA physician specializing in allergies and immunology, it was opined after a review of the record on appeal that based on a diligent review of the medical literature, there is no current reasonable support for the theory that long term allergies to fermented food occur as a consequence of the receipt of anthrax, botulism, and tularemia vaccines. It was next opined that the likelihood of the Veteran developing an allergic reaction to fermented foods as a consequence of receiving anthrax, botulism, and tularemia vaccines does not meet the as likely as not standard. Lastly, it was opined that such an association is unlikely and conjectural. In support of his opinion, the examiner attached copies of six medical studies regarding the long term health consequences of the anthrax vaccine. The VA opinions included consideration of the examination findings and claims file review, and the 2011 and 2012 physicians considered medical literature in formulating their opinions. The opinions also referenced information in the claim file and are consistent with the in-service and post-service medical evidence of record. Moreover, two of the opinions were provided by VA physicians specializing in allergies and immunology. Therefore, the Board finds these opinions are highly probative. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008) (holding that it is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes to the probative value of a medical opinion). Moreover, although the Veteran is competent to state that he experienced symptoms of an allergy to fermented products such as nasal congestion, flushing, and occasional fainting, there is no indication that he has specialized training in diagnosing allergies or determining their etiology. The diagnosis and etiology of allergies requires medical testing and medical expertise to determine. Thus, the Veteran's contention as to diagnosis and etiology of his allergy is not a competent medical opinion. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis). Moreover, whether the symptoms the Veteran claims to have experienced in service or following service are in any way related to his current allergy is a matter that requires medical expertise to determine. See Clyburn v. West, 12 Vet. App. 296, 301 (1999) ("Although the veteran is competent to testify to the pain he has experienced since his tour in the Persian Gulf, he is not competent to testify to the fact that what he experienced in service and since service is the same condition he is currently diagnosed with."). Thus, the Board finds the opinion of the VA examiners to be significantly more probative than the Veteran's lay assertion. The appellant has also submitted medical treatise evidence in support of his claim. In this regard, medical article or treatise evidence that contains a degree of certainty may be uses to meet the requirement for a medical nexus. Wallin v. West, 11 Vet. App. 509 (1998). However, an attempt to establish a medical nexus between service and a disease or injury solely by generic information in a medical journal or treatise "is too general and inclusive." Sacks v. West, 11 Vet. App. 314, 317 (1998) (a medical article that contained a generic statement regarding a possible link between a service-incurred mouth blister and a present pemphigus vulgaris condition did not satisfy the nexus element). Still, medical treatise evidence can provide important support when combined with an opinion of a medical professional. Mattern v. West, 12 Vet. App. 222, 228 (1999). See Rucker v. Brown, 10 Vet. App. 67, 73-74 (1997) (holding that evidence from scientific journal combined with doctor's statements was "adequate to meet the threshold test of plausibility"). The treatise information submitted by the appellant only contains generic information on long term health problems that may be caused by the anthrax vaccine. It does not relate the Veteran's allergies to the vaccinations he received in service Therefore, the Board finds that it is entitled to minimal, if any, probative value, as it is not supported by any probative medical opinions. In summary, even in light of this additional evidence, the most probative evidence of record reflects that there is no relationship between the Veteran's allergy to fermented products and the vaccines to anthrax, botulism, and tularemia he received in service. For the reasons set forth above, the Board finds the most probative evidence is against a finding that the Veteran's allergy to fermented products is related to service. Accordingly, the Board finds that entitlement to service connection for allergy to fermented products (manifested by nasal congestion, flushing, and infrequent fainting) is not warranted. 38 C.F.R. § 3.303. In reaching the above conclusions, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran's claim, that doctrine is not applicable in the instant appeal. See 38 U.S.C.A. § 5107(b) (West 2002); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990). The Initial Rating Claim Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule) and are intended to represent the average impairment of earning capacity resulting from disability. 38 U.S.C.A. § 1155; 38 C.F.R. § 4.1. Disabilities must be reviewed in relation to their history. 38 C.F.R. § 4.1. Other applicable, general policy considerations are: interpreting reports of examination in light of the whole recorded history, reconciling the various reports into a consistent picture so that the current rating may accurately reflect the elements of disability, 38 C.F.R. § 4.2; resolving any reasonable doubt regarding the degree of disability in favor of the claimant, 38 C.F.R. § 4.3; where there is a question as to which of two evaluations apply, assigning a higher of the two where the disability picture more nearly approximates the criteria for the next higher rating, 38 C.F.R. § 4.7; and, evaluating functional impairment on the basis of lack of usefulness, and the effects of the disabilities upon the person's ordinary activity, 38 C.F.R. § 4.10. See Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Where the appellant has expressed dissatisfaction with the assignment of an initial rating following an initial award of service connection for that disability, separate ratings can be assigned for separate periods of time based on the facts found - a practice known as "staged" ratings. Fenderson v. West, 12 Vet. App. 119 (1999). The March 2011 rating decision granted service connection for migraine headaches and assigned a noncompensable rating under 38 C.F.R. § 4.124a, Diagnostic Code 8100, effective from May 13, 2002. Under 38 C.F.R. § 4.124a, Diagnostic Code 8100, migraine headaches with characteristic prostrating attacks averaging one in two months over the last several months warrants a 10 percent disability rating. Characteristic prostrating attacks occurring on an average once a month over last several months warrants a 30 percent disability rating. Very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability warrants a 50 percent disability rating. With the above criteria in mind, the Board notes that at the January 2009 VA examination the Veteran complained of migraine headaches approximately once a month which last from twenty minutes to two hours but rarely a whole day. The migraine headaches start in the back of the head and travel to the side as well as behind the eyes on occasion and are sharp in nature. He also complained that they are occasionally accompanied by photophobia and nausea. He further reported that he treated his migraine headaches with two medications which had reduced the frequency of his headaches. At the subsequent October 2012 VA examination, the Veteran complained of migraine headaches induced 99 percent of the time by fermented food that occurred two to three times a month on the right side of his head, with photophobia and nasal congestion, lasting one to three hours, as well as severe headaches two to three times a month. The Veteran reported that he treats his migraine headaches with four medications. On examination, the examiner noted that the Veteran had headache pain, the pain was sharp, it lasted less than one day, and it was on the right side of the head. The examiner opined that the migraine headaches did not cause characteristic prostrating attacks. It was also opined that the migraine headaches did not have any occupational effect. VA treatment records dating since February 2003 document the Veteran's report of experiencing migraine headaches. In February 2003 he presented to the VA clinic to transfer care and noted a history of migraine headaches. In October 2006, October 2007 and October 2008 yearly visits, he denied headaches. Treatment records from 2009 do not mention headaches or include headaches in the chronic medical problems list. In October 2010 and November 2011, he reported that he had no headache episodes recently. The November 2011 entry noted the headaches were well controlled on Metoprolol. In November 2012, the Veteran was seen for an annual visit. He reported headache and neck pain that was a level 5 out of 10. At the Veteran's first hearing before the undersigned in 2006, he alleged having up to three migraines a week depending on what he eats and that they last up to 24 hours. At his hearing in May 2013 he complained that he had migraine headaches two to three times a month which lasted approximately three to four hours as well as a prostrating attacks at least once a month. He also reported that when he was working he lost over ten days a year of work because of his migraine headaches. He also testified that he treated his migraine headaches with a beta blocker and antihistamines, and these medications had helped reduced the frequency of the headaches. The Veteran's wife also testified regarding how often the appellant had migraine headaches and how long they lasted, although she noted they are now under control unless he accidently eats something that triggers it. She stated he still gets them but they are not as bad as they were because he takes the medication regularly. Upon review of the record, the Board finds that a compensable evaluation is not warranted. While the Veteran reported weekly headaches during his July 2006 hearing, during that same hearing he seemed to clarify that he only had a few migraine headaches because he is taking medication. However, at his 2009 VA examination he stated he had migraine headaches approximately once a month which last from twenty minutes to two hours but rarely a whole day. At the October 2012 VA examination, the Veteran complained of migraine headaches induced 99 percent of the time by fermented food that occurred two to three times a month on the right side of his head, with photophobia and nasal congestion, lasting one to three hours, as well as severe headaches two to three times a month. However, review of the Veteran's VA treatment records do not support the frequency described by the Veteran. In this regard, a history of migraine headaches was noted in some of these records, but no complaints of such or visits for specific treatment of such were made. Indeed, in the annual physicals in 2006, 2007, and 2008, he denied headaches. In 2009 there was no mention of headaches, and in 2010 and 2011 he denied any recent headache episodes. It was noted that his headaches were well controlled with Metoprolol, a medication also prescribed for his hypertension. Had the Veteran been suffering from headaches at least 2 to 3 times per month, it is highly likely that he would have at least mentioned such to his treatment providers, rather than actually denying the presence of headaches. The Board finds the Veteran's reports to VA treating clinicians more persuasive and probative than his allegations made during his claim for compensation benefits. See Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) (VA cannot ignore a veteran's testimony simply because the veteran is an interested party; personal interest may, however, affect the credibility of the evidence). Moreover, the 2012 VA examiner has opined that the Veteran does not have characteristic prostrating attacks of migraine headache pain. The examiner considered the Veteran's treatment records in providing this opinion, and the Board finds this opinion is consistent with the other evidence, including the Veteran's report as to the duration of the headaches being 20 minutes to a few hours. Thus, although a November 2012 VA treatment report noted the Veteran reported headache and neck pain at a level of 5 out of 10, no treatment was rendered for his headaches at that time and such does not suggest a prostrating attack of migraine headache pain. In summary, the Board finds the credible and probative evidence reflects that the Veteran's migraine headaches are not characteristically prostrating with a frequency to support a compensable evaluation. Accordingly, the preponderance of the evidence is against the claim and a compensable evaluation for migraine headaches is denied for the entire period of the claim. The Board has also considered whether the Veteran's disability presents an exceptional or unusual disability picture as to render impractical the application of the regular schedular standards such that referral to the appropriate officials for consideration of extra-schedular ratings is warranted. See 38 C.F.R. § 3.321(b)(1) (2012); Bagwell v. Brown, 9 Vet. App. 337, 338-39 (1996). The threshold factor for extraschedular consideration is a finding that the evidence before VA presents such an exceptional disability picture that the available schedular evaluations for that service-connected disability are inadequate. See Fisher v. Principi, 4 Vet. App. 57, 60 (1993) ("[R]ating schedule will apply unless there are 'exceptional or unusual' factors which render application of the schedule impractical."). Here, the rating criteria reasonably describe the Veteran's disability level and symptomatology and provides for additional or more severe symptoms than currently shown by the evidence; thus, his disability picture is contemplated by the rating schedule, and the assigned schedular evaluation is, therefore, adequate. See Thun v. Peake, 22 Vet. App. 111, 115 (2008). Consequently, referral for extraschedular consideration is not warranted. ORDER Service connection for an allergy to fermented products (manifested by nasal congestion, flushing, and infrequent fainting) is denied. A compensable rating for migraine headaches is denied. ____________________________________________ K. A. BANFIELD Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs