Citation Nr: 18142353 Decision Date: 10/15/18 Archive Date: 10/15/18 DOCKET NO. 14-09 170A DATE: October 15, 2018 ORDER Service connection for an acquired psychiatric disorder is denied. A rating in excess of 10 percent for a traumatic brain injury (TBI) is denied. A rating in excess of 30 percent for posttraumatic headaches is denied. FINDINGS OF FACT 1. An acquired psychiatric disorder is not shown to be causally or etiologically related to any disease, injury, or incident during service, and is not caused or aggravated by service-connected TBI or posttraumatic headaches. 2. For the entire appeal period, the Veteran’s TBI is rated, at most, as “1” in one facet. 3. For the entire appeal period, the Veteran’s posttraumatic headaches are manifested by characteristic prostrating attacks occurring on an average once a month over several months, without more severe symptomatology more nearly approximating very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. CONCLUSIONS OF LAW 1. The criteria for service connection for an acquired psychiatric disorder are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 2. The criteria for a rating in excess of 10 percent for a TBI are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.124a, Diagnostic Code 8045. 3. The criteria for a rating in excess of 30 percent for posttraumatic headaches are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.124a, Diagnostic Code 8100. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1997 to December 2001. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from August 2013 and July 2015 rating decisions issued by Department of Veterans Affairs (VA) Regional Offices. Service Connection Claim Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Direct service connection may not be granted without evidence of a current disability; in-service incurrence or aggravation of a disease or injury; and a nexus between the claimed in-service disease or injury and the present disease or injury. Id.; see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff’d, 78 F.3d 604 (Fed. Cir. 1996) [(table)]. Service connection for posttraumatic stress disorder (PTSD) requires medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a), a link, established by medical evidence between current symptoms and an in-service stressor, and credible supporting evidence that the claimed in-service stressor occurred. 38 C.F.R. § 3.304(f). Service connection may also be established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). Further, service connection may not be awarded on the basis of aggravation without establishing a pre-aggravation baseline level of disability and comparing it to the current level of disability. 38 C.F.R. § 3.310(b). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). 1. Entitlement to service connection for an acquired psychiatric disorder, to include as secondary to service-connected TBI or posttraumatic headaches. The Veteran is seeking service connection for an acquired psychiatric disorder. He contends that he experiences depression, mood impairment, and anxiety, which he has attributed to PTSD resultant from his in-service TBI, in which he was struck by a tent pole, or his service in Kuwait. As an initial matter, the Board notes that the record reflects a current diagnosis of an acquired psychiatric disorder. In this regard, although a March 2012 VA examination diagnosed the Veteran with a “phobia of going under man-made objects,” this diagnosis is reflected nowhere else in the medical record, and was subsequently clarified by a June 2013 VA examination, which reflected no symptoms suggestive of a specific phobia. Accordingly, the Board finds that the Veteran does not have a diagnosis of phobia of going under man-made objects. Further, while a March 2010 VA examination found that the Veteran had no diagnosed psychiatric disorder, his VA treatment records reflect diagnoses of adjustment reaction with mixed emotion; depression, not otherwise specified; and anxiety disorder. Additionally, at June 2013 and February 2017 VA examinations, alcohol use disorder and anxiety disorder, with symptoms of depression, were diagnosed. No diagnosis of PTSD was rendered. In this regard, the latter examiner specifically determined that the diagnostic criteria for PTSD was not met based on the Veteran’s claimed stressors of being hit with a tent pole in the head or due to fear of hostile military or terrorist activity during his service in Kuwait. Nonetheless, as the Veteran has a diagnosed acquired psychiatric disorder, the first element of service connection, a current disability, is satisfied. Furthermore, the record reflects that the Veteran was hit in the head with a tent pole in September 2001, and served in Kuwait during his military service. Additionally, he is currently service-connected for TBI and posttraumatic headaches. Therefore, the second element of service connection, an in-service event or a service-connected disability, is satisfied. However, the Board finds that there is no nexus between the Veteran’s current acquired psychiatric disorder and either his active duty service or his service-connected TBI or posttraumatic headaches, and thus the third element of service connection is not satisfied. In this regard, the June 2013 examiner opined that the Veteran’s psychiatric disorder was not related to his in-service TBI since his psychiatric symptoms did not present until seven years after the injury, and they appeared to have been precipitated by the onset of increasing alcohol use. The examiner noted that the Veteran’s symptoms of anxiety and depression first appeared shortly after he began to drink heavily in 2006. The February 2017 examiner also found that the Veteran’s psychiatric disorder was not related to his military service, or his service-connected TBI or headaches. Specifically, he opined that it was less likely as not that such disorder is the result of an in-service stressor related event. In this regard, the examiner noted that the Veteran did not report persistent reexperiencing of his past stressor events at the examination. The examiner further observed that the Veteran had drank alcohol heavily since 2006, which has resulted in legal issues as well as increased anxiety and social isolation. In this regard, the Veteran, as well as VA treatment records, noted that his symptoms of anxiety were related to work stress and the lack of a close romantic relationship. The VA examiner further opined that it was less likely than not that the Veteran’s psychiatric disorder was proximately due to or the result of, or aggravated by, his TBI and/or posttraumatic headaches. In this regard, he noted that TBIs are typically not progressive in nature. The examiner cited research showing that TBI symptoms “follow a natural trajectory of improvement, with most symptoms . . . resolving within the first year. . . Individuals with a history of [mild] TBI do not typically have lasting neuropsychological consequences and any subjective complaints are more likely associated with . . . psychiatric conditions.” In addition, the examiner observed that the Veteran himself attributed his psychiatric symptoms to work stress and the lack of a close romantic relationship. The examiner noted that the Veteran had made similar reports to other VA clinicians, citing treatment records from December 2007, February 2015, and January 2017. The examiner concluded that “the Veteran’s alcohol use onset started in 2006, and his anxiety issues began in 2011 after his divorce from his wife. His anxiety worsened with the onset of panic attacks in 2014, related to ‘work stress.’” He further opined that the Veteran’s psychiatric disorder was not aggravated by his TBI or headaches since his psychiatric disorder did not present until at least five years after the onset of these service-connected conditions and were fully explained by the other factors discussed above. The Board affords great probative weight to the VA opinions rendered in June 2013 and February 2017 as they are predicated on a review of the record, to include the Veteran’s service and post-service VA treatment records, and consideration of his statements. Further, the examiners provided a complete rationale, relying on and citing to the records reviewed, and offered clear conclusions with supporting data as well as reasoned medical explanations connecting the two. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (“[A]medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions”). There is no medical opinion to the contrary. The Board has also considered the Veteran’s statements in support of his claim. While he is competent to report his in-service experiences, as well as his current psychiatric symptoms, the Board finds he is not competent to offer an opinion as to whether his acquired psychiatric disorder is related to any instance of his service, or a service-connected disability, since he does not possess the requisite medical knowledge to offer such an opinion. Specifically, the etiology of such disorder involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship. Therefore, as such is a complex medical question, the Veteran is not competent to offer an opinion as to the etiology his acquired psychiatric disorder, and, consequently, his opinion on such matter is afforded no probative weight. Woehlaert v. Nicholson, 21 Vet. App. 456 (2007) (although the claimant is competent in certain situations to provide a diagnosis of a simple condition such as a broken leg or varicose veins, the claimant is not competent to provide evidence as to more complex medical questions). Therefore, the Board finds that an acquired psychiatric disorder is not shown to be causally or etiologically related to any disease, injury, or incident during service, and is not caused or aggravated by service-connected TBI or posttraumatic headaches. Consequently, service connection for such disorder is not warranted. In reaching such decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, the preponderance of the evidence is against the Veteran’s claim for entitlement to service connection for an acquired psychiatric disorder. As such, that doctrine is not applicable in the instant appeal, and his claim must be denied. 8 U.S.C. 5107; 38 C.F.R. 3.102; Gilbert, supra. Increased Rating Claims The Veteran’s residuals of an in-service TBI and posttraumatic headaches are currently rated as 10 percent and 30 percent disabling, respectively. He contends that these ratings do not accurately reflect the severity of his disabilities. Specifically, he asserts that he experiences migraine headaches multiple times per day for hours at a time, with symptoms of sensitivity to light and sound, dizziness, and insomnia. He asserts that his headaches impair his ability to concentrate and force him to take breaks at work. Disability ratings are determined by applying a schedule of ratings that is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R., Part 4. Each disability must be viewed in relation to its history and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of the veteran working or seeking work. 38 C.F.R. § 4.2. All reasonable doubt will be resolved in the claimant’s favor. 38 C.F.R. § 4.3. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7. 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); Hart v. Mansfield, 21 Vet. App. 505 (2007). Staged ratings are appropriate whenever the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. Id. Neither the Veteran nor his representative have raised any other issues, nor have any other issues been reasonably raised by the record, with regard to the increased rating claims adjudicated herein. See Doucette v. Shulkin, 28 Vet. App. 366 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). 2. Entitlement to a rating in excess of 10 percent for a TBI. The Veteran’s claim for an increased rating for his TBI was received in April 2013. Such disability is currently rated as 10 percent disabling under Diagnostic Code 8045. 38 C.F.R. § 4.124a. Diagnostic Code 8045 states that there are three main areas of dysfunction that may result from a TBI and have profound effects on functioning: cognitive (which is common in varying degrees after a traumatic brain injury), emotional/behavioral, and physical. Each of these areas of dysfunction may require evaluation. Cognitive impairment is defined as decreased memory, concentration, attention, and executive functions of the brain. Executive functions include goal setting, speed of information processing, planning, organizing, prioritizing, self-monitoring, problem solving, judgment, decision making, spontaneity, and flexibility in changing actions when they are not productive. Not all of these brain functions may be affected in a given individual with cognitive impairment, and some functions may be affected more severely than others. In a given individual, symptoms may fluctuate in severity from day to day. VA is to evaluate cognitive impairment under the table titled “Evaluation of Cognitive Impairment and Other Residuals of a Traumatic Brain Injury Not Otherwise Classified.” Subjective symptoms may be the only residual of a TBI or may be associated with cognitive impairment or other areas of dysfunction. Subjective symptoms that are residuals of a TBI, whether or not they are part of cognitive impairment, should be evaluated under the subjective symptoms facet in the table titled “Evaluation of Cognitive Impairment and Other Residuals of a Traumatic Brain Injury Not Otherwise Classified.” However, VA is to separately evaluate any residual with a distinct diagnosis that may be evaluated under another Diagnostic Code, such as migraine headache or Meniere’s disease, even if that diagnosis is based on subjective symptoms, rather than under the “Evaluation of Cognitive Impairment and Other Residuals of a Traumatic Brain Injury Not Otherwise Classified” table. VA is to evaluate emotional/behavioral dysfunction under 38 C.F.R. § 4.130 (Schedule of ratings-mental disorders) when there is a diagnosis of a mental disorder. When there is no diagnosis of a mental disorder, evaluate emotional/behavioral symptoms under the criteria in the table titled “Evaluation of Cognitive Impairment and Other Residuals of Traumatic Brain Injury Not Otherwise Classified.” Here, the Veteran is separately service-connected for PTSD, which has been directly linked to his service, rather than as secondary to his service-connected TBI residuals. VA is to evaluate physical (including neurological) dysfunction based on the following list, under an appropriate diagnostic code: Motor and sensory dysfunction, including pain, of the extremities and face; visual impairment; hearing loss and tinnitus; loss of sense of smell and taste; seizures; gait, coordination, and balance problems; speech and other communication difficulties, including aphasia and related disorders, and dysarthria; neurogenic bladder; neurogenic bowel; cranial nerve dysfunctions; autonomic nerve dysfunctions; and endocrine dysfunctions. The preceding list of types of physical dysfunction does not encompass all possible residuals of a TBI. For residuals not listed in 38 C.F.R. § 4.124a, Diagnostic Code 8045, that are reported on an examination, VA is to evaluate under the most appropriate Diagnostic Code. Each condition is to be evaluated separately, as long as the same signs and symptoms are not used to support more than one evaluation, and combine under 38 C.F.R. § 4.25 the evaluations for each separately rated condition. The evaluation assigned based on the “Evaluation of Cognitive Impairment and Other Residuals of a Traumatic Brain Injury Not Otherwise Classified” table will be considered the evaluation for a single condition for purposes of combining with other disability evaluations. The table titled “Evaluation of Cognitive Impairment and Other Residuals of a Traumatic Brain Injury Not Otherwise Classified” addresses 10 facets of a TBI related to cognitive impairment and subjective symptoms. It provides criteria for levels of impairment for each facet, as appropriate, ranging from 0 to 3, and a 5th level, the highest level of impairment, labeled “total.” Not every facet has every level of severity. The consciousness facet, for example, does not provide for an impairment level other than “total,” since any level of impaired consciousness would be totally disabling. A 100 percent evaluation is assigned if “total” is the level of evaluation for one or more facets. If no facet is evaluated as “total,” the overall percentage evaluation is assigned based on the level of the highest facet as follows: 0 = 0 percent; 1 = 10 percent; 2 = 40 percent; and 3 = 70 percent. For example, a 70 percent evaluation is assigned if 3 is the highest level of evaluation for any facet. Diagnostic Code 8045 contains the following notes: Note (1): There may be an overlap of manifestations of conditions evaluated under the table titled “Evaluation of Cognitive Impairment and Other Residuals of a Traumatic Brain Injury Not Otherwise Classified” with manifestations of a comorbid mental or neurologic or other physical disorder that can be separately evaluated under another diagnostic code. In such cases, do not assign more than one evaluation based on the same manifestations. If the manifestations of two or more conditions cannot be clearly separated, assign a single evaluation under whichever set of diagnostic criteria allows the better assessment of overall impaired functioning due to both conditions. However, if the manifestations are clearly separable, assign a separate evaluation for each condition. Note (2): Symptoms listed as examples at certain evaluation levels in the table are only examples and are not symptoms that must be present in order to assign a particular evaluation. Note (3): “Instrumental activities of daily living” refers to activities other than self-care that are needed for independent living, such as meal preparation, doing housework and other chores, shopping, traveling, doing laundry, being responsible for one’s own medications, and using a telephone. These activities are distinguished from “Activities of daily living,” which refers to basic self-care and includes bathing or showering, dressing, eating, getting in or out of bed or a chair, and using the toilet. Note (4): The terms “mild,” “moderate,” and “severe” traumatic brain injury, which may appear in medical records, refer to a classification of a traumatic brain injury made at, or close to, the time of injury rather than to the current level of functioning. This classification does not affect the rating assigned under Diagnostic Code 8045. Note (5): A veteran whose residuals of a traumatic brain injury are rated under a version of 38 C.F.R. § 4.124a, Diagnostic Code 8045, in effect before October 23, 2008 may request review under Diagnostic Code 8045, irrespective of whether his disability has worsened since the last review. VA will review that Veteran’s disability rating to determine whether the Veteran may be entitled to a higher disability rating under Diagnostic Code 8045. A request for review pursuant to this note will be treated as a claim for an increased rating for purposes of determining the effective date of an increased rating awarded as a result of such review; however, in no case will the award be effective before October 23, 2008. For the purposes of determining the effective date of an increased rating awarded as a result of such review, VA will apply 38 C.F.R. § 3.114, if applicable. 38 C.F.R. § 4.124a, Diagnostic Code 8045 (2016). During the pendency of the Veteran’s claim, he was afforded VA examinations in June 2013 and February 2017 to evaluate the current nature and severity of his service-connected TBI. At the June 2013 VA examination, the examiner noted the Veteran’s report of an increase in TBI symptoms in regard to poor sleep, poor concentration, and depression. It was further observed that the Veteran was separately service-connected for posttraumatic headaches. At the February 2017 VA examination, the Veteran reported headaches and some memory issues. With regard to the assessment of facets of TBI-related cognitive impairment, the June 2013 VA examiner found objective evidence on testing of mild impairment of memory, attention, concentration, or executive functions resulting in mild functional impairment, which equates to a level of “2” in the facet of memory, attention, concentration, and executive functions. In this regard, the Board notes that the examiner based such assessment on the Veteran’s report that he used sticky notes at work so he will not forget what he needs to do. Mini mental state examination revealed a score of 29/30, which is the normal range, but it was noted that the Veteran missed 1/3 in the five minute recall portion. Furthermore, at the February 2017 VA examination, the examiner found a complaint of mild loss of memory (such as having difficulty following a conversation, recalling recent conversations, remembering names of new acquaintances, or finding words, or often misplacing items”, attention, concentration, or executive functions, but without objective evidence on testing, which equates to a level of “1” in the facet of memory, attention, concentration, and executive functions. Consequently, based on the totality of the evidence, the Board finds that the Veteran’s impairment in the facet of memory, attention, concentration, and executive function most nearly approximates level “1.” Both VA examiners found that the Veteran’s judgment was normal, his social interaction is routinely appropriate, and he was oriented to person, time, place, and situation, which equates to a level of “0” in the facets of judgment, social interaction, and orientation, respectively. Similarly, the Veteran’s motor activity was normal and his visual spatial orientation was normal, which equates to a level of “0” in motor activity and visual spatial orientation, respectively. With regard to subjective symptoms, the June 2013 VA examiner found none (other than the Veteran’s separately service-connected posttraumatic headaches), but the February 2017 VA examiner found subjective symptoms that do not interfere with work; instrumental activities of daily living; or work, family, or other close relationships, identified as headaches, which equates to a level “0” in subjective symptoms. Furthermore, at both examinations, the Veteran had no neurobehavioral effects, and was able to communicate by spoken and written language, and his consciousness was normal, which equates to a level of “0” in neurobehavioral effects, communication, and consciousness, respectively. The examiners further determined that the Veteran’s TBI and residuals did not impact his ability to work. A review of the Veteran’s VA treatment records likewise reflects complaints related to his headaches, memory issues, and psychiatric disorders. However, as noted in the preceding section, as the Veteran’s acquired psychiatric disorder has not been found to be related to his TBI, the Board may not consider the resulting functional impairment of such disorder in the evaluation of his TBI. Further, as will be discussed in the next section, the Veteran is separately service-connected for his posttraumatic headaches and, consequently, such may not be used to support a higher rating for his TBI as such would be tantamount to pyramiding. 38 C.F.R. § 4.14; Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994). Based on the foregoing, the Board finds that, for the entire appeal period, the Veteran’s TBI is rated, at most, as “1” in one facet. Consequently, a rating in excess of 10 percent for TBI is not warranted. In reaching this decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, the preponderance of the evidence is against the Veteran’s claim of entitlement to a rating in excess of 10 percent for TBI. As such, that doctrine is not applicable in the instant appeal, and such must be denied. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. 3. Entitlement to a rating in excess of 30 percent for posttraumatic headaches. The Veteran’s claim for an increased rating for his posttraumatic headaches was received in July 2015. Such disability is currently rated as 30 percent disabling under Diagnostic Code 8100. 38 C.F.R. § 4.124a. Diagnostic Code 8100 provides that migraine headaches with characteristic prostrating attacks occurring on an average once a month over last several months are rated at 30 percent. Migraine headaches with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability are rated at 50 percent. The rating criteria do not define “prostrating;” nor has the United States Court of Appeals for Veterans Claims (Court). Cf. Fenderson, supra (in which the Court quotes Diagnostic Code 8100 verbatim but does not specifically address the matter of what is a prostrating attack). By way of reference, the Board notes that, according to Webster’s New World Dictionary of American English, Third College Edition (1986), p. 1080, “prostration” is defined as “utter physical exhaustion or helplessness.” A very similar definition is found in Dorland’s Illustrated Medical Dictionary 1367 (28th Ed. 1994), in which “prostration” is defined as “extreme exhaustion or powerlessness.” Johnson v. Wilkie, No. 16-3808 (September 19, 2018). Further, the Court has explained that “productive of” for purposes of Diagnostic Code 8100 can either mean producing, or capable of producing. See Pierce v. Principi, 18 Vet. App. 440, 445 (2004). Thus, migraine headaches need not actually produce severe economic inadaptability to warrant a 50 percent rating under DC 8100. Id. At 445-46. Similarly, “economic inadaptability” does not equate to unemployability, as such would undermine the purpose of regulations pertaining to a TDIU. Id. At 446; see also 38 C.F.R. § 4.16. The Board notes, however, that the migraine headaches must be, at a minimum, capable of producing severe economic inadaptability in order to meet the 50 percent criteria. During the course of the appeal, the Veteran underwent VA examinations in July 2015 and February 2017. At the July 2015 VA examination, the Veteran reported having bifrontal headaches that occur approximately five days out of the week in varying degrees. In this regard, such will commonly occur upon waking, and he had associated photophobia and sometimes nausea. It was also observed that he missed seven days of work in the current year due to his headaches, and had the flexibility to go into work late if he wakes with a bad headache. At the February 2017 VA examination, it was noted that the Veteran reported headaches occurring three to four times a week. Upon examination, the July 2015 VA examiner noted that the Veteran experienced headache pain with associated nausea and sensitivity to light that lasted for one to two days, while the February 2017 VA examiner noted that his headache pain was accompanied by sensitivity to light and sounds, but lasted less than a day. The July 2015 VA examiner further indicated that he had characteristic prostrating attacks of headache pain that occurred once a month over the last several months, while the February 2017 VA examiner found no evidence of characteristic prostrating attacks of headache pain. Further, both VA examiners found that the Veteran did not have very prostrating and prolonged attacks of headache pain productive of severe economic inadaptability. In this regard, while the July 2015 VA examiner noted that the Veteran worked doing administrative work with computers and office paperwork and, due to his chronic headaches, he will have to miss work or come in late because the computer greatly aggravates his headaches, the February 2017 VA examiner found that the Veteran’s headaches did not impact his ability to work. In this regard, the Board notes that the record reflects that the Veteran has worked full-time throughout the appeal period. VA treatment records dated during the appeal period do not reflect any complaints or treatment for the Veteran’s headaches. In fact, such reveal that his last complaint of a headache occurred in August 2012. Based on the foregoing, the Board finds that, for the entire appeal period, the Veteran’s posttraumatic headaches are manifested by characteristic prostrating attacks occurring on an average once a month over several months, without more severe symptomatology more nearly approximating very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. Consequently, a rating in excess of 30 percent for posttraumatic headaches is not warranted. In reaching this decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, the preponderance of the evidence is against the Veteran’s claim of entitlement to a rating in excess of 30 percent for posttraumatic headaches. As such, that doctrine is not applicable in the instant appeal, and such must be denied. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. A. JAEGER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD P. Timmerman, Associate Counsel