Citation Nr: 18148936 Decision Date: 11/08/18 Archive Date: 11/08/18 DOCKET NO. 16-40 208 DATE: November 8, 2018 ORDER Entitlement to a 50 percent rating, but no higher, for migraines is granted. FINDING OF FACT Resolving all reasonable doubt in favor of the Veteran, his migraines more closely approximate very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. CONCLUSION OF LAW The criteria for a 50 percent rating for migraines have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.10, 4.124a, Diagnostic Code (DC) 8100. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from October 1979 to October 1983. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a February 2016 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Louisville, Kentucky. Entitlement to an evaluation in excess of 30 percent for migraines. Disability ratings are determined by application of the criteria set forth in VA's Schedule for Rating Disabilities, which is based on average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. When a question arises as to which of two ratings applies under a particular Diagnostic Code, the higher rating is assigned if the disability more closely approximates the criteria for the higher rating. Otherwise, the lower rating applies. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 C.F.R. § 4.3. 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. Francisco v. Brown, 7 Vet. App. 55 (1994). Nevertheless, the Board acknowledges that a claimant may experience multiple distinct degrees of disability that might result in different levels of compensation from the time the increased rating claim was filed until a final decision is made. Hart v. Mansfield, 21 Vet. App. 505 (2007). The Board will summarize the relevant evidence. The analysis below will focus specifically on what the evidence shows, or fails to show, as to the claim. Gonzales v. West, 218 F.3d 1378 (Fed. Cir. 2000). In November 2015, the Veteran requested a reevaluation of his headache rating. In February 2016, the Veteran's migraine headaches were assigned a 30 percent rating pursuant to 38 C.F.R. § 4.124a, DC 8100. Under DC 8100, a 30 percent rating is warranted for migraine headaches with characteristic prostrating attacks occurring on an average of once a month over the last several months. A 50 percent rating is warranted for migraine headaches with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. See Pierce v. Principi, 18 Vet. App. 440, 445 (2004) (finding rating criteria do not define "severe economic inadaptability," but nothing in DC 8100 requires that Veteran be completely unable to work to qualify for 50 percent rating; "productive of economic inadaptability" can be read as either "producing" or "capable of producing."). Although DC 8100 does not provide a definition for "prostrating," prostration is defined as "extreme exhaustion or powerlessness." See Dorland's Illustrated Medical Dictionary 1531 (32nd ed. 2012). In an August 2016 VAMC record, the Veteran reported having migraine headaches 3-4 times per week. In a March 2016 VAMC record, the Veteran reported having chronic, daily migraine headaches. In March 2016, the Veteran’s spouse provided a statement in support of the Veteran’s increased rating claim. The Veteran’s spouse reported that the Veteran suffers from extremely bad headaches 4-5 times per week. The Veteran’s spouse also reported that the Veteran’s medications for his headaches makes him sleepy. The Veteran’s spouse stated that the Veteran has lost quite a few jobs due to his headaches. The Veteran was afforded a VA examination in January 2016 for his migraine headaches. At the VA examination, the Veteran reported that he has chronic headaches that affect his sleep. The headaches cause him not to sleep for days. The Veteran also reported having to stop his headache medications due to the interaction with his Parkinson’s medication. At the January 2016 VA examination, the Veteran reported headache pain characterized as constant head pain on both sides of his head. The Veteran also reported sensitivity to light and sound. The Veteran stated that the typical duration of his headache pain was more than two days. The Veteran was found to have characteristic prostrating attacks of migraine headache pain once every month, but was not found to have prostrating and prolonged attacks of migraine pain productive of severe economic inadaptability. The Veteran reported that when he has a headache and takes his medication, he cannot stay awake at work. In a January 2015 VAMC record, the Veteran reported that he has a mild headache that is constant and daily, with pain being a 4-5/10. However, 4-5 days per week, the pain is a 9/10. A March 2016 VA cardiology note reflects that the has chronic headaches. An August 2016 VA mental health record reflects that the Veteran complained of headaches three to four times per week. Based on the foregoing, and resolving all reasonable doubt in favor of the Veteran, the Board finds that the Veteran's migraines warrant a 50 percent evaluation under DC 8100 for the entire period on appeal. Though the January 2016 VA examiner did not find that the Veteran's migraines were productive of severe economic inadaptability, the Board finds that the totality of the evidence supports such a finding. The Veteran has repeatedly, and throughout the course of the appeal, indicated that he has chronic, daily headaches. The Veteran loses sleep for days, which affects his work. The Veteran has consistently reported that he suffers from headaches 4-5 times per week which were 9/10 on the pain scale and lasted longer than two days. Additionally, the Veteran has consistently reported that he suffered from some form of headaches daily. The Veteran, throughout the course of the appeal, demonstrated headache frequency, severity, and reported a consistent impact of his headaches upon his economic adaptability. The Board notes that the January 2016 VA examiner did not address the Veteran's long and well-documented VA medical care regarding his headaches. Despite the fact that the January 2016 VA examiner found the Veteran's headaches did not rise to the level of causing severe economic inadaptability, the Board resolves all doubt in the Veteran's favor and concludes his headaches were manifested by frequent, prolonged prostrating headaches productive of severe economic inadaptability. See 38 U.S.C § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49, 53-56(1990). LESLEY A. REIN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C. Mahaffey, Associate Counsel