Citation Nr: 18141733 Decision Date: 10/11/18 Archive Date: 10/11/18 DOCKET NO. 16-31 888 DATE: October 11, 2018 ORDER Entitlement to an initial 50 percent rating for migraine headaches is granted. FINDING OF FACT Resolving reasonable doubt in favor of the Veteran, throughout the appeal period the Veteran’s migraine headaches more nearly approximate very frequent prostrating and prolonged attacks that are capable of producing severe economic inadaptability. CONCLUSION OF LAW The criteria for a 50 percent disability rating for migraine headaches have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.124a, Diagnostic Code 8100 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from June 1998 to May 2004. This matter comes from a before the Board of Veterans’ Appeals (Board) on appeal from a March 2016 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). 1. Entitlement to an initial 50 percent rating for migraine headaches A disability rating is determined by the application of VA’s Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual conditions in civil occupations. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The Board will consider whether separate ratings may be assigned for separate periods of time based on facts found, a practice known as “staged ratings,” whether it is an initial rating case or not. Fenderson v. West, 12 Vet. App. 119, 126-27 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Migraine headaches are rated under Diagnostic Code 8100. 38 C.F.R. § 4.124a. Migraine headaches with less frequent attacks warrant a non-compensable rating. Migraine headaches with characteristic prostrating attacks averaging one in 2 months over last several months are rated at 10 percent disabling. Migraine headaches with characteristic prostrating attacks occurring on an average once a month over last several months are rated 30 percent disabling. Migraine headaches with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability are rated 50 percent disabling. 38 C.F.R. § 4.124a, Diagnostic Code 8100. The term “prostrating attack” is not defined in regulation or case law, but can be defined as extreme exhaustion or powerlessness. Cf. Fenderson, 12 Vet. App. at 126-27 (quoting Diagnostic Code 8100 verbatim but not specifically addressing the definition of a prostrating attack); DORLAND’S ILLUSTRATED MEDICAL DICTIONARY 1531 (32d ed. 2012). “Inadaptability” is also not defined in Diagnostic Code 8100, nor can a definition be found elsewhere in Title 38 of the Code of Federal Regulations. See Pierce v. Principi, 18 Vet. App. 440, 446 (2004). It has been held that nothing in Diagnostic Code 8100 requires that the claimant be completely unable to work to qualify for a 50 percent rating. Id. Based upon a review of the totality of the evidence of record, the Board affords the Veteran the benefit of all reasonable doubt and finds that her service-connected migraine headaches more nearly approximate very frequent prostrating and prolonged attacks that are capable of producing severe economic inadaptability throughout the appeal period, warranting an initial 50 percent disability rating. A March 2016 VA examiner gave the Veteran a diagnosis of migraines including migraine variant. The examiner noted the Veteran treated her migraines with Imitrex and Motrin. The examiner described the Veteran’s headaches as prostrating attacks once every month, lasting more than 2 days. It was noted that the Veteran experienced pulsating or throbbing head pain, pain localized to one side of the head, and that her pain worsened with physical activity. The examiner also noted that the Veteran experienced nausea and sensitivity to light and sound. The examiner also noted that the Veteran’s headache condition impacts her ability to work, stating that the Veteran may have to miss a day or two of work/school due to the condition. See March 2016 VA examination. Thereafter, the Veteran reported that she experiences prostrating headaches 3 times a month that can last up to 3 days with nausea, lightheadedness and the inability to function physically. She stated that she is often unable to get out of bed due to dizziness caused by her migraines. The Veteran also stated that without taking medication she would not be able to function or work due to light and sound sensitivity. See April 2016 NOD; June 2016 Form 9; May 2018 IHP. First, the Veteran is competent and credible to report on what she feels, such as the severity of headache-related pain. Accordingly, the Board finds that the Veteran’s statements are credible as to the matter of frequency and severity of her headaches, and she is competent to attest whether her headaches are prostrating in nature. See Layno v. Brown, 6 Vet. App. 465, 469 (1994); 38 C.F.R. § 3.159(a)(2). The Veteran has consistently reported that her migraine headaches are severe in nature, last as long as three days, and impact her ability to function and work, to include needing to lie down. The Board finds that the Veteran’s competent reports are sufficient to demonstrate that her headache attacks are “prostrating” in nature. The Board finds the Veteran’s competent reports indicating her migraine headaches are prostrating throughout the appeal period are also supported by the medical evidence of record. Although the March 2016 VA examiner stated the Veteran did not experience frequent prostrating and prolonged attacks, the examiner noted the Veteran has prostrating attacks once every month that last more than 2 days. Further, the Veteran noted that the Veteran’s migraines involved symptoms beyond headache pain such as sensitivity to light and sound, and noted the Veteran may have to miss a day or two of work due to her symptoms. Based upon the totality of the lay and medical evidence of record and resolving reasonable doubt in favor of the Veteran, the Board finds the Veteran’s migraine headaches more nearly approximate very frequent and prolonged attacks that are capable of producing severe economic inadaptability. Accordingly, given the totality of the evidence of record, the Board finds the criteria for an initial 50 percent disability rating for migraine headaches have been met, and the Veteran is awarded the maximum schedular rating throughout the appeal period. DONNIE R. HACHEY Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD K. Brandt