Citation Nr: 18143055 Decision Date: 10/18/18 Archive Date: 10/17/18 DOCKET NO. 16-35 479A DATE: October 18, 2018 ORDER An initial 30 percent evaluation, but no higher, for posttraumatic headaches throughout the appeal period is granted. FINDING OF FACT Throughout the appeal period, the Veteran’s headache disability more closely approximates characteristic prostrating attacks occurring on an average once a month over last several months, but does not approximate a headache disability productive of severe economic inadaptability. CONCLUSION OF LAW The criteria for an initial 30 percent evaluation, but no higher, for posttraumatic headaches throughout the appeal period are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.124a, Diagnostic Code 8100. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active duty service from November 2003 through June 2010. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a June 2015 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). Disability ratings are determined by applying the criteria set forth in the VA’s Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The basis of disability evaluations is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10. In determining the severity of a disability, the Board is required to consider the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the Veteran, as well as the entire history of the Veteran’s disability. 38 C.F.R. §§ 4.1, 4.2; Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991). If the disability more closely approximates the criteria for the higher of two ratings, the higher rating will be assigned; otherwise, the lower rating is assigned. 38 C.F.R. § 4.7. It is not expected that all cases will show all the findings specified; however, findings sufficiently characteristic to identify the disease and the disability therefrom and coordination of rating with impairment of function will be expected in all instances. 38 C.F.R. § 4.21. In deciding this appeal, the Board has considered whether separate ratings for different periods of time, based on the facts found, are warranted, a practice of assigning ratings referred to as “staging the ratings.” See Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2008). The Veteran filed his claim for service connection for headaches on February 18, 2015, and he has been awarded service connection for posttraumatic headaches since that date; a noncompensable evaluation has been assigned for that disability under Diagnostic Code 8100 throughout the appeal period. Under Diagnostic Code 8100, migraine headaches with less frequent attacks than the criteria for a 10 percent rating are rated as noncompensable (0 percent). Migraine headaches with characteristic prostrating attacks averaging one in 2 months over the last several months are rated 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. See 38 C.F.R. § 4.124a, Diagnostic Code 8100. The Veteran underwent a VA examination in April 2015, at which time he was diagnosed with posttraumatic headaches. He reported that he had occasional headaches, which he described as mild with a “steady sharp pain over the top of his head on the left side and across the forehead.” He did not have any triggers or auras; his headaches lasted 30 minutes to an hour. The examiner indicated that his headaches were not prostrating. On examination, the Veteran was noted to have constant head pain, pain localized to one side of the head, and pain on both sides of his head; his headache pain lasted less than a day and was located either on the left side or both sides of his head. The Veteran denied any non-headache symptoms, such as aura. The examiner indicated that the Veteran did not have characteristic prostrating attacks of migraine or non-migraine headache pain. Finally, the examiner found that the Veteran’s headache disability did not impact his ability to work. A treatment record from Dr. P.W. in July 2015 noted that the Veteran was seen with complaints of a headache for three weeks; his headaches were described as stabbing and pulsating pain, sometimes with nausea. He was diagnosed with chronic headaches. In a follow-up record with Dr. A.M.B. in August 2015, his condition was essentially stable. In another follow-up record with Dr. F.H.D. in September 2015, the Veteran was noted to have occasional tension headaches. The Veteran additionally underwent an August 2015 private neurological examination with Dr. A.M.B., during which he reported having daily headaches, mostly located in the left temporal area but which can move around his head. He described them as a “throbbing pain,” with associated dizziness and at times nausea, but no vomiting. He also was noted to have photo- and phonophobia during his headaches. Dr. A.M.B. described the headaches as moderate to severe almost every day of the month and may last up to several hours each day; head movement did not worsen the pain. The Veteran also reported having blurred vision during headaches, although there was no visual scotoma or scintillations. He also denied any sensory, motor, or language symptoms; autonomic symptoms such as ptosis, conjunctival injection, nasal congestion, or lacrimation; or, teeth clenching or snoring. After physical examination, Dr. A.M.B. noted that the history described by the Veteran was consistent with a chronic posttraumatic headache disability, as well as a diagnosis of chronic migraine given his history of having 15 headache-days per month for more than 3 months with migraine features on at least 8 days of the month, including unilateral throbbing quality with moderate to severe pain along with photophobia and nausea. In his September 2015 notice of disagreement, the Veteran indicated that that his headache pain continued to bother him while working or doing something; he indicated that he had chronic headaches and migraines, sharp pain, and forehead pain. In November 2015 private treatment records with Dr. A.M.B., noted that the Veteran’s headaches had increased in frequency of 15 days a month. The Veteran underwent another VA examination in November 2016, at which time he was diagnosed with posttraumatic headaches. The Veteran reported headaches three times a week, usually affecting the left side of his head but sometimes both sides of his are affected; his pain was described as stabbing pain with associated photo- and phonophobia, but without nausea or vomiting. On examination, the Veteran was noted to have constant head pain, pain localized to one side of the head, pain on both sides of his head, and sensitivity to light and sound; his headache pain lasted less than a day and was located either on the left side or both sides of his head. The examiner indicated that the Veteran did not have characteristic prostrating attacks of migraine or non-migraine headache pain. The examiner also found that the Veteran’s headache disability did not impact his ability to work. The examiner finally noted that the Veteran did not have any objective evidence of debilitating headaches in the last 12 months, noting no evidence of emergency room visits or prescribed bedrest. The Veteran was also examined by a VA examiner in December 2016, at which time he was diagnosed with migraine or migraine-variant headaches. The Veteran reported almost daily left temporal area headaches that lasted 30 to 45 minutes; occasionally they also occurred in the right temporal area as well. On examination, the Veteran was noted to have constant head pain, pain localized to one side of the head, pain on both sides of his head, pain that worsened with physical activity, nausea, vomiting, sensory changes such as feelings of pins and needles in his extremities, and sensitivity to sound; his headache pain lasted less than a day and was located either on the left side of his head. The examiner indicated that the Veteran had less frequent attacks of characteristic prostrating attacks of migraine or non-migraine headache pain, although such episodes were not productive of severe economic inadaptability. The examiner finally indicated that the Veteran’s headache disability impacted his occupational functioning by decreasing his ability to concentrate. Finally, subsequent VA treatment records demonstrate continued treatment for migraine headaches with complaints that are generally substantially similar to those noted above. Based on the foregoing evidence, the Board finds that description of the Veteran’s headaches throughout the appeal period is more closely approximate to characteristic prostrating attacks occurring on an average of once a month for the last several months. The evidence demonstrates that the Veteran has almost daily headaches and moderate to severe headaches approximately 3 times a week, although for fairly short periods of time; his more severe headaches are shown to be accompanied by nausea, vomiting, photo and/or phonophobia, or some combination of those symptoms. However, the Veteran’s headaches are not shown throughout the appeal period to be productive of severe economic inadaptability; throughout the appeal period, the Veteran is shown to be working in a job overseas. Moreover, the December 2016 VA examiner specifically found that the Veteran’s headaches are not productive of severe economic inadaptability. That finding is not refuted by any other evidence of record and is the most probative evidence of record in this case.   Accordingly, by resolving reasonable doubt in the Veteran’s favor, the Board finds that the above disability picture is commensurate with a 30 percent evaluation, but no higher, throughout the appeal period based on the evidence of record in this case. See 38 C.F.R. §§ 4.7, 4.124a, Diagnostic Code 8100. In so reaching that conclusion, the Board has appropriately applied the benefit of the doubt doctrine in this case. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. JAMES G. REINHART Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Peters, Counsel