Citation Nr: 18155175 Decision Date: 12/04/18 Archive Date: 12/03/18 DOCKET NO. 16-47 691 DATE: December 4, 2018 ORDER Entitlement to service connection for a disability manifested by recurrent muscle pain is denied. Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), is denied. Entitlement to service connection for periodontal disease, for compensation purposes, is denied. Entitlement to a 30 percent disability evaluation for allergic rhinitis with hay fever is granted. Entitlement to a rating greater than 10 percent for recurrent athlete's foot for the period prior to June 1, 2017, is denied. Entitlement to a 10 percent rating for recurrent athlete’s foot, for the period beginning on June 1, 2017, is granted. Entitlement to an initial 10 percent disability evaluation for recurrent generalized headaches for the period prior to June 1, 2017, is granted. Entitlement to a compensable rating for recurrent generalized headaches for the period beginning on June 1, 2017, is denied. FINDINGS OF FACT 1. The Veteran does not have a disability manifested by recurrent muscle pain as his reported muscle pain does not cause functional impairment. 2. The Veteran he did not have service in the SouthWest Asia Theater of Operations. 3. There is no valid diagnosis of PTSD. 4. An acquired psychiatric disorder was not manifest in service and is not attributable to service. 5. The Veteran does not have a dental disability for which compensation can be authorized. 6. The Veteran’s allergic rhinitis with hay fever is manifested by nasal polyps and occasional nasal blockage. 7. The Veteran’s recurrent athlete’s foot affects less than 5 percent of the entire body; constant or near constant use of topical medication is required, but no more than intermittent use of systematic therapy or immunosuppressive drugs were required during the prior 12-month period. 8. For the period prior to June 1, 2017, the Veteran’s recurrent generalized headaches were manifested by prostrating attacks lasting 1-2 days when his allergies worsened, approximately in the spring and fall. 9. For the period beginning on June 1, 2017, the Veteran’s headaches were manifested by nonprostrating attacks lasting 2-4 hours, occurring 3-4 times a week. CONCLUSIONS OF LAW 1. The criteria for service connection of a disorder manifested by recurrent muscle pain have not been met. 38 U.S.C. §§ 1101, 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303 (2018). 2. The criteria for service connection for PTSD have not been met. 38 U.S.C. §§ 1101, 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304 (2018). 3. The criteria for service connection of an acquired psychiatric disorder have not been met. 38 U.S.C. §§ 1101, 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303 (2018). 4. The criteria for establishing service connection for a dental disability for compensation purposes have not been met. 38 U.S.C. §§ 1110, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.381, 4.150 (2018). 5. The criteria for a disability rating of 30 percent for allergic rhinitis with hay fever have been met. 38 U.S.C. §§ 1155, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.97, Diagnostic Code 6522 (2018). 6. The criteria for the assignment of a rating of a 10 percent rating for recurrent athlete’s foot has been met for the rating period since June 1, 2017. 38 U.S.C. §§ 1155, 5103A, 5107; 38 C.F.R. §§ 4.7, 4.118, Diagnostic Codes 7820-7806 (2018). 7. The criteria for the assignment of a rating in excess of 10 percent for recurrent athlete’s foot has not been met for any part of the appeal period. 38 U.S.C. §§ 1155, 5103A, 5107; 38 C.F.R. §§ 4.7, 4.118, Diagnostic Codes 7820-7806 (2018). 8. The criteria for an initial 10 percent disability rating, but no higher, for headaches, for the period prior to June 1, 2017, have been met. 38 U.S.C. §§ 1155, 5103A, 5107; 38 C.F.R. §§ 3.159, 3.321, 4.124a, Diagnostic Code 8100 (2018). 9. The criteria for a compensable disability rating for headaches, for the period beginning on June 1, 2017, have not been met. 38 U.S.C. §§ 1155, 5103A, 5107; 38 C.F.R. §§ 3.159, 3.321, 4.124a, Diagnostic Code 8100 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the U.S. Air Force from January 2011 to January 2015. These matters come before the Board of Veterans’ Appeals (Board) on appeal of May 2015 and March 2016 rating decisions of the Regional Office (RO) of the Department of Veterans Affairs (VA) in Milwaukee, Wisconsin. A claim of service connection for a dental disability is also a claim for VA outpatient dental treatment under 38 C.F.R. § 3.381. Mays v. Brown, 5 Vet. App. 302 (1993). In dental claims, the RO adjudicates the claim of service connection for compensation benefits and the VA Medical Center (VAMC) adjudicates the claim for outpatient treatment. As this matter stems from an adverse determination by the RO, the appeal is limited to the issue of service connection for periodontal disease for the purpose of compensation. The claim of service connection for periodontal disease for the purpose of obtaining VA outpatient dental treatment is referred to the RO for additional referral to the appropriate VAMC. See 38 C.F.R. § 17.161. In a June 2018 letter from the RO, the Veteran was provided an opportunity to participate in VA's Rapid Appeals Modernization Program (RAMP). On June 25, 2018, the Veteran elected to participate in RAMP, selecting the option for “Supplemental Claim.” However, appeals that have been activated by the Board are not eligible for RAMP processing. The issues listed at the beginning of this decision were activated by the Board prior to the Veteran’s participation in RAMP. Therefore, the Board will continue with their adjudication pursuant to current appeals procedures. The Veteran has another appeal, not currently before the Board, including entitlement to an increased disability rating for asthma, and as noted in a November 2018 letter, this claim has been accepted for RAMP processing. VA will continue to work this claim under the RAMP guidelines. Duties to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA) imposes obligations on VA to provide claimants with notice and assistance. 38 U.S.C. §§ 5102, 5103, 5103A, 5107, 5126; Honoring America's Veterans and Caring for Camp Lejeune Families Act of 2012, Pub. L. No. 112-154, §§ 504, 505, 126 Stat. 1165, 1191-93; 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2018). The VCAA requires VA to assist a claimant at the time that he or she files a claim for benefits. As part of this assistance, VA is required to notify claimants of the evidence that is necessary in substantiating their claims, and provide notice that a disability rating and an effective date for the award of benefits will be assigned if service connection is awarded. 38 U.S.C. § 5103(a); 38 C.F.R. § 3.159(b)(1); Quartuccio v. Principi, 16 Vet. App. 183, 187 (2002); Dingess v. Nicholson, 19 Vet. App. 473, 486 (2006). In this case, the agency of original jurisdiction (AOJ) issued a notice letter to the Veteran. The letter explained the evidence necessary to substantiate the Veteran’s claims of entitlement to service connection, as well as the legal criteria for entitlement to such benefits. The claims for increased disability ratings are downstream from grants of service connection. The letter also informed him of his and VA’s respective duties for obtaining evidence. The AOJ decision that is the basis of this appeal was decided after the issuance of an initial, appropriate VCAA notice. As such, there was no defect with respect to timing of the VCAA notice. See Pelegrini v. Principi, 18 Vet. App. 112 (2004). VA also has a duty to assist a veteran with the development of facts pertinent to the appeal. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159(c). This duty includes the obtaining of “relevant” records in the custody of a Federal department or agency under 38 C.F.R. § 3.159(c)(2), as well as records not in Federal custody (e.g., private medical records) under 38 C.F.R. § 3.159(c)(1). VA will also provide a medical examination if such examination is determined to be “necessary” to decide the claim. 38 C.F.R. § 3.159(c)(4). The claims file contains the Veteran’s available service treatment records, reports of post-service treatment, and the Veteran’s own statements in support of his claims. The Veteran was afforded VA examinations responsive to the claims for service connection for an acquired psychiatric disorder, to include PTSD, and recurrent muscle pain; the Veteran was also afforded VA examinations responsive to the claims for increased disability ratings for headaches, athlete’s foot, and allergic rhinitis. These opinions were conducted by a medical professional, following thorough examination of the Veteran, solicitation of history, and review of the claims file. The examination reports contain all the findings needed to assess the Veteran’s claims on appeal, including history and clinical evaluation. See 38 C.F.R. § 3.327(a) (2018); Palczewski v. Nicholson, 21 Vet. App. 174, 182-83 (2007). As will be discussed below, the weight of the evidence demonstrates that the Veteran does not have a dental disorder related to his service. As such, a remand to provide the Veteran with medical examinations and/or to obtain medical opinions as to the issue of entitlement to service connection for periodontal disease is not necessary. See Bardwell v. Shinseki, 24 Vet. App. 36 (2010). The Board has reviewed the Veteran’s statements and medical evidence of record and concludes that there is no outstanding evidence with respect to the Veteran’s claims. For these reasons, the Board finds that the VCAA duties to notify and assist have been met. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a) (2018). To establish a right to compensation for a present disability, a Veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service—the so-called “nexus” requirement. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Service connection may be granted for any disease initially diagnosed after service 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). For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. For chronic diseases, if chronicity in service is not established, a showing of continuity of symptoms after discharge is required to support the claim. 38 C.F.R. §§ 3.303(b), 3.309; Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). At the outset, the Board notes that Veteran does not claim, and the evidence does not reflect, that his claim is the result of combat with the enemy. Therefore, the combat provisions of 38 U.S.C. § 1154 are not applicable. 1. Entitlement to service connection for recurrent muscle pain The Board finds that the weight of the evidence is against the existence of a disability manifested by recurrent muscle pain. The record does not reflect that the Veteran has a currently diagnosed disability related to his complaints of muscle pain for which service connection may be granted. The evidence of record reflects his complaints of muscle pain. However, the Board notes that pain, by itself, is not a disability for which service connection may be granted by VA. See Sanchez-Benitez v. West, 13 Vet. App. 282, 285 (1999). VA recognizes pain as a disability where there is also functional impairment. See Saunders v. Wilkie, ___ F. 3d ___, No. 2017-1466 (Fed. Cir. April 3, 2018). However, the record does not reflect that the Veteran’s muscle pain has resulted in functional impairment. While the January 2015 General Medical Examination indicated that his muscle pain impacted his ability to work, the pain was reported to only occur in the upper back and thighs with heavy fitness and exercise and resolved with motrin. Given these facts, although the examiner checked the box indicated an impact on the ability to work, the Board does not find the limited nature of the pain, occurring only with heavy fitness exercise, to cause functional impairment. As such, a current diagnosis is not established. Lacking a current diagnosis, service connection cannot be established, and the claim must be denied. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992) (a current disability is the cornerstone of a service connection claim). Thus, the claim for service connection for a disability manifested by recurrent muscle pain must be denied. 2. Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD) There are particular requirements for establishing PTSD in 38 C.F.R. § 3.304(f) that are separate from those for establishing service connection generally. Arzio v. Shinseki, 602 F.3d 1343, 1347 (Fed. Cir. 2010). Service connection for 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) and 38 C.F.R. § 4.125 (requiring PTSD diagnoses to conform to the DSM-IV/V). If the evidence establishes that the Veteran engaged in combat with the enemy and the claimed stressor is related to that combat, in the absence of clear and convincing evidence to the contrary, and provided that the claimed stressor is consistent with the circumstances, conditions, or hardships of the Veteran's service, the Veteran's lay testimony alone may establish the occurrence of the claimed in-service stressor. 38 C.F.R. § 3.304(f)(1). See also 38 U.S.C. § 1154(b) and 38 C.F.R. § 3.304(d) (pertaining to combat Veterans). A finding that the Veteran engaged in combat with the enemy, however, requires that the Veteran participated in events constituting an actual fight or encounter with a military foe or hostile unit or instrumentality, and does not apply to veterans who served in a general “combat area” or “combat zone” but did not themselves engage in combat with the enemy. See VAOPGCPREC 12-99 (October 18, 1999). Effective July 13, 2010, 38 C.F.R. § 3.304(f) was amended to reduce the evidentiary burden of establishing a stressor when it is related to a fear of hostile military or terrorist activity. See 75 Fed. Reg. 39843-01 (July 13, 2010), codified at 38 C.F.R. § 3.304(f)(3). The amendment provides that, if a stressor claimed by a veteran is related to the veteran's fear of hostile military activity, and a VA psychiatrist or psychologist confirms that the claimed stressor is adequate to support a diagnosis of PTSD, a veteran's lay testimony alone may establish the occurrence of the claimed in-service stressor, as long as the claimed stressor is consistent with the places, types, and circumstances of the veteran's service and there is no clear and convincing evidence to the contrary. Id. “Fear of hostile military activity” is defined to mean that a veteran experienced, witnessed, or was confronted with an event or circumstance that involved actual or threatened death or serious injury, or a threat to the physical integrity of the veteran or others, and the veteran's response to the event or circumstance involved a psychological or psycho-physiological state of fear, helplessness, or horror. Id. The list of examples of such an event or circumstance specifically includes attack upon friendly military aircraft, vehicle-imbedded explosive devices, and incoming artillery, rocket, or mortar fire. In Patton v. West, 12 Vet. App. 272 (1999), the United States Court of Appeals for Veterans Claims (Court) held that special consideration must be given to claims for service connection for PTSD based on personal assault. In particular, the Court held that the provisions in VA’s Adjudication Manual which addressed PTSD claims based on personal assault are substantive rules which are the equivalent of VA regulations and must be considered. See also YR v. West, 11 Vet. App. 393, 398-99 (1998). Moreover, evidence other than the Veteran’s service records can corroborate the occurrence of a claimed in-service stressor based on personal assault. See 38 C.F.R. § 3.304(f)(5). Examples of such evidence include evidence of behavior changes following the claimed assault. Examples of behavior changes that may constitute credible evidence of a stressor include deterioration in work performance and episodes of depression, panic attacks, or anxiety without an identifiable cause, or unexplained economic or social behavioral changes. 38 C.F.R. § 3.304(f)(5) also provides that VA may submit any evidence that it receives to an appropriate medical or mental health professional for an opinion as to whether it indicates that a personal assault occurred. In Menegassi v. Shinseki, 628 F.3d 1379 (Fed. Cir. 2011), the Federal Circuit held that under 38 C.F.R. § 3.304(f)(5), medical opinion evidence may be submitted for use in determining whether there was occurrence of a claimed stressor, and such opinion evidence should be weighed along with the other evidence of record in making this determination. The Veteran contends that he has an acquired psychiatric disorder, to include PTSD, related to his experiences during his military service. The Veteran alleges that he has PTSD related to denial of a promotion in service and related workplace stress, and due to being involved in a motor vehicle accident as a passenger when he was on leave. The Board notes that the Veteran was treated from April 2013 to June 2013 for work stress related to his supervisor. In April 2013, he was diagnosed with an adjustment disorder with depressed mood. Counseling notes and clinical records indicate that the Veteran was “displaying a normative stress reaction to occupational demands” and noted follow-up visits and adherence to treatment recommendations for coping with occupational stress and depressed mood. Cognitive-behavioral strategies to reduce anxiety were recommended, and the Veteran was noted as adapting his work performance; no behavioral health concerns were noted. A November 2014 Report of Medical Assessment does not reflect any psychiatric complaints. VA treatment records indicate that the Veteran was seen for preventative medicine contact in June 2015. Depression and PTSD screening were negative. The Veteran was afforded VA examinations in January 2016 and June 2017. The VA examiner at each examination found that the motor vehicle accident involving the Veteran met the A criterion for a diagnosis of PTSD. The January 2016 VA examiner also noted that the Veteran was asked about PTSD symptoms, that were rated by the examiner, and the Veteran endorsed mild symptoms that met the criterion B and E for a diagnosis of PTSD. However, the VA examiner found that the Veteran’s symptoms are too mild or infrequent to meet criteria C, D, and G of PTSD in the relevant diagnostic criteria. Likewise, the January 2016 VA examiner found that the Veteran did not meet the diagnostic criteria for any other psychiatric diagnosis. The VA examiner noted that the Veteran was treated in service for emotional issues related to occupational stress, and that he had post-service issues with his current supervisor, but nonetheless found that the Veteran’s symptoms do not rise to the level of a formal psychiatric diagnosis. The VA examiner noted that the Veteran likely had a personal disorder that impacts his work and social functioning, but pointed out that personality disorders are considered congenital or developmental defects. The June 2017 VA examiner also found that the Veteran did not have PTSD or other psychiatric disorder. According to the June 2017 VA examiner, Veteran’s symptoms do not meet the diagnostic criteria for PTSD under DSM-5 criteria and the Veteran does not have a mental disorder that conforms with DSM-5 criteria. The VA examiner noted that the Veteran had mental health symptoms in service including anger, depression, stress, and anxiety, and that he was diagnosed with an adjustment disorder with depressed mood. The VA examiner noted that private treatment records from Gunderson Health System show that the Veteran was treated with psychiatric medication for anxiety and insomnia in November 2015, and that VA treatment records indicate that depressive disorder was to be added to the Veteran’s problem list based on a June 2016 letter from a private medical provider. The VA examiner found that, although the Veteran met criteria A for a diagnosis of PTSD, he did not meet criterion B, C, D, E, F, G, H, or I; the VA examiner also noted that the Veteran did not meet the criterion for any other diagnosable mental disorder. The VA examiner explained that the Veteran primarily reported occupational stress related to balancing his work with young children, and that he does not “have any problems” on days that he does not work. The VA examiner noted that the Veteran’s “presenting concerns are consistent with stress and effects of stress, but not consistent with a mental disorder.” A February 2018 VA mental health treatment record reflects diagnoses of PTSD, brief psychotic disorder, panic disorder, agoraphobia, and major depression. The treating provider noted psychosocial factors of significance including living alone, employment, and paranoia related to work and a potential privacy breach. The Veteran denied depression and mental status examination was normal. Based on the evidence of record, the Veteran’s claims of service connection for an acquired psychiatric disorder and/or PTSD must be denied. The Board acknowledges that the Veteran has a confirmed stressor event, a motor vehicle accident, and that the Veteran was treated for an adjustment disorder due to occupational stress in service. Thus, he has established this aspect of service connection. However, the most probative evidence of record does not indicate the presence of a valid PTSD diagnosis, or a link between any other diagnoses and his events in service. The Board notes that there is a reported diagnosis of PTSD in February 2018 treatment records; however, there is no indication as to the basis for this diagnosis. As noted, the January 2016 and June 2017 VA examiners found that the Veteran did not meet the criteria for a diagnosis of PTSD and provided a thorough rationale for the basis of their conclusions. The Board notes that the opinions of the VA examiners are also consistent with the medical evidence of record. See Prejean v. West, 13 Vet. App. 444, 448-49 (2000). Moreover, the February 2018 VA treatment record reflecting a diagnosis of PTSD lacks sufficient detail, including the symptoms to support a diagnosis. See Madden v. Gober, 125 F.3d 1477, 1481 (1997) (in evaluating the evidence and rendering a decision on the merits, the Board is required to assess the credibility and probative value of proffered evidence in the context of the record as a whole). Accordingly, the Board finds the two VA examiners assessments to be more probative than the February 2018 notation, and the Veteran’s claim for service connection for PTSD must fail based on the absence of a valid PTSD diagnosis. With regard to psychiatric diagnoses other than PTSD, the Board also finds the VA examiners determinations to be the most probative evidence of record. The January 2016 and June 2017 VA examiners found that the Veteran did not meet the diagnostic criteria for any psychiatric disorder. In both instances, the VA examiner noted that the Veteran experienced occupational stress, but nonetheless found that the Veteran’s symptoms do not rise to the level of a formal psychiatric diagnosis. The Board recognizes the February 2018 diagnoses, but finds that these notations fail to provide any rationale for the basis of the diagnoses. Thus, the findings are less probative as diagnoses. Nonetheless, even assuming that the February 2018 diagnoses of brief psychotic disorder, panic disorder, agoraphobia, and major depression, are valid diagnoses, there is no evidence of a connection between these conditions and the Veteran’s active service. In fact, the treating provider attributed these conditions to the Veteran’s living alone, employment, and paranoia related to work and a potential privacy breach, not to any event related to service. To the extent that the January 2016 VA examiner found that the Veteran’s symptoms were likely related to a personality disorder, personality disorders are characterized by developmental defects or pathological trends in the personality structure manifested by a lifelong pattern of action or behavior. Congenital or developmental defects such as personality disorders are not diseases or injuries within the meaning of applicable legislation. 38 C.F.R. § 3.303(b); Beno v. Principi, 3 Vet. App. 434 (1992). For the foregoing reasons, the preponderance of the evidence is against the claims for entitlement to service connection for PTSD or an acquired psychiatric disorder other than PTSD, and the benefit-of-the-doubt doctrine is not for application. 3. Entitlement to service connection for periodontal disease, for VA compensation purposes Under current VA regulations, compensation is only available for certain types of dental and oral conditions listed under 38 C.F.R. § 4.150, such as impairment of the mandible, loss of a portion of the ramus, and loss of a portion of the maxilla. Compensation is available for loss of teeth only if such is due to loss of substance of body of maxilla or mandible due to trauma or disease such as osteomyelitis, but not periodontal disease. Otherwise, a Veteran may be entitled to service connection for dental conditions including treatable carious teeth, replaceable missing teeth, dental or alveolar abscesses, and periodontal disease, for the sole purposes of receiving VA outpatient dental services and treatment, if certain criteria are met. 38 U.S.C. § 1712; 38 C.F.R. §§ 3.381, 17.161; Simington v. West, 11 Vet. App. 41, 44 (noting the distinction between replaceable missing teeth which can be service connected for treatment purposes only and teeth lost “as a result of 'loss of substance of body of maxilla and mandible' which can be assigned ratings anywhere from 0 to 100 % for compensation purposes”). The Board acknowledges that the Veteran was treated for periodontal disease during service. Nevertheless, the Board notes that the Veteran does not allege, and the evidence does not demonstrate, impairment of the mandible, loss of substance of the maxilla or mandible, osteomyelitis, or loss of teeth due to trauma during his service. The Veteran does not have any dental or oral condition for which service connection for compensation purposes can be awarded. See 38 C.F.R. § 4.150, Diagnostic Codes 9900 – 9916. Accordingly, as the Veteran does not have loss of the substance of the body of the maxilla or the mandible, service connection for compensation purposes must be denied. In so finding, the Board makes no determination with respect to whether the Veteran may be entitled to service connection for dental conditions for outpatient treatment purposes, which, as indicated above, is not subject of the current appeal. Increased Rating Disability evaluations are determined by application of the criteria set forth in the VA’s Schedule for Rating Disabilities, which is based on average impairment in earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. An evaluation of the level of disability present must also include consideration of the functional impairment of the Veteran's ability to engage in ordinary activities, including employment. 38 C.F.R. § 4.10. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 C.F.R. § 4.3. Separate evaluations may be assigned for separate periods of time based on the facts found. In other words, the evaluations may be staged. Staged ratings are appropriate for any rating claim when the factual findings show distinct time periods during the appeal period where the service-connected disability exhibits symptoms that would warrant different ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Here, the service-connected disability on appeal has not materially changed and a uniform evaluation is warranted for the rating period on appeal. 4. Entitlement to an initial compensable disability evaluation for allergic rhinitis with hay fever The Veteran is currently assigned a noncompensable (i.e., 0 percent) disability rating for allergic rhinitis with hay fever pursuant to 38 C.F.R. § 4.97, Diagnostic Code 6522. According to Diagnostic Code 6522, the minimum compensable rating of 10 percent is warranted for allergic rhinitis without polyps but with greater than 50 percent obstruction of the nasal passage on both sides or complete obstruction on one side. A 30 percent disability evaluation requires polyps. See 38 C.F.R. § 4.97, Diagnostic Code 6522 (2018). Upon reviewing these rating criteria in relation to the evidence for consideration, the Board finds that the disability picture for the Veteran’s service-connected allergic rhinitis with hay fever is most consistent with a 30 percent disability rating, which is the highest rating available, for the entire rating period on appeal. The Board acknowledges that the objective clinical evidence of record does not show that the Veteran experiences at least 50 percent obstruction of either nasal passage, but the January 2016 VA examination report reflects that the Veteran has nasal polyps. Likewise, the VA examination reports indicate that the Veteran experiences congestion resulting in temporary obstruction of the nasal passages. The Board acknowledges that the January 2015, January 2016, and June 2017 VA examinations were negative for granulomatous conditions and rhinoscleroma. Therefore, his symptomatology specifically attributable to the allergic rhinitis most closely fits within the criteria for a 30 percent disability evaluation. 5. Entitlement to an increased disability evaluation for recurrent athlete's foot, initially rated as 10 percent disabling, The Veteran’s recurrent athlete’s foot is currently evaluated as 10 percent disabling prior to June 1, 2017 and as noncompensable from June 1, 2017 pursuant to 38 C.F.R. § 4.118, Diagnostic Codes 7820 – 7806. See 38 C.F.R. § 4.20. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the evaluation assigned. 38 C.F.R. § 4.27 (2018). The Board finds that a 10 percent rating, but no higher, is warranted for the entire appeal period. Diagnostic Code 7820 requires infections of the skin (including bacterial, fungal, viral, treponemal, and parasitic diseases) to be rated as disfigurement of the head, face, or neck, scars, or dermatitis, depending on the predominant disability. As such, the Veteran’s service-connected recurrent athlete’s foot is rated under Diagnostic Code 7806. See 38 C.F.R. § 4.20 (2018). Diagnostic Code 7806 provides a noncompensable disability evaluation for dermatitis or eczema of less than 5 percent of the entire body or less than 5 percent of exposed areas affected and no more than topical therapy required during the past 12-month period. A10 percent disability evaluation is assigned for dermatitis or eczema of at least 5 percent of the entire body, but less than 20 percent of the entire body, or at least 5 percent, but less than 20 percent of the exposed affected areas, or intermittent systemic therapy, such as corticosteroids or other immunosuppressive drugs were required for a total duration of less than six weeks during the prior 12-month period. See 38 C.F.R. § 4.118, Diagnostic Code 7806. For the next higher 30 percent disability evaluation, there must be dermatitis or eczema over 20 to 40 percent of the body or 20 to 40 percent of the exposed areas affected, or systemic therapy, such as corticosteroids or other immunosuppressive drugs required for a total duration of six weeks or more, but not constantly during the prior 12-month period. For the next higher 60 percent disability evaluation, there must be dermatitis or eczema over more than 40 percent of the entire body or more than 40 percent of the exposed areas affected, or; constant or near-constant systemic therapy such as corticosteroids or other immunosuppressive drugs for the past 12-month period. Id. Following a review of the evidence, the Board finds that the Veteran’s recurrent athlete’s foot more nearly approximates the criteria for a 10 percent disability evaluation under Diagnostic Code 7806 for the entire rating period on appeal (since January 12, 2015). The evidence shows that the Veteran does not have athlete’s foot over at least 5 percent of his entire body. Indeed, the medical evidence, including the January 2015 and June 2017 VA examination reports, indicates that the Veteran has recurrent athlete’s foot over less than 5 percent of his entire body. However, the Board acknowledges that the January 2015 and June 2017 VA examinations indicate that the Veteran treats his recurrent athlete’s foot with topical corticosteroids on a daily basis. While this treatment is not systemic therapy as required for the regulation, the Board finds that given the percentage of exposure and his daily use of the creams, his athlete’s foot more nearly approximates the criteria for a 10 percent rating for the entire appeal period. A higher rating is not warranted as he does no come close to having 20 percent of his entire body affected, and as noted, his topical corticosteroid use does not equate to systemic therapy of corticosteroids or other immunosuppressive drugs given that topical treatment is not characteristic of a systemic (oral) corticosteroid as required for a higher rating. Therefore, the Veteran’s athlete’s foot does not warrant a rating in excess of 10 percent at any time during the appeal period. Accordingly, a 10 percent rating is assigned as of June 1, 2017, and a rating greater than 10 percent for the entire appeal period, beginning on January 12, 2015, is denied. 6. Entitlement to an initial compensable disability evaluation for recurrent generalized headaches The Veteran’s recurrent generalized headaches are rated as noncompensable for the initial rating period pursuant to 38 C.F.R. § 4.124a, Diagnostic Code 8100. A noncompensable disability evaluation is for assignment where there are characteristic prostrating attacks less frequent than one every two months. A 10 percent disability evaluation is assigned for prostrating attacks averaging one in 2 months over the last several months. For the next higher 30 percent disability evaluation, there must be characteristic prostrating attacks occurring on average once a month over the last several months. For a higher, 50 percent disability evaluation to be warranted, there must be migraines with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. 38 C.F.R. § 4.124a, Diagnostic Code 8100. Neither the rating criteria nor the Court has defined the term “prostrating.” According to WEBSTER’S NEW WORLD DICTIONARY OF AMERICAN ENGLISH, THIRD COLLEGE EDITION 1080 (1986), “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.” Further, “inadaptability” is also not defined under 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). In addition, it has been held that nothing in diagnostic Code 8100 requires that the claimant be completely unable to work in order to qualify for a 50 percent rating. Pierce, 18 Vet. App. at 446. In this regard it was explained by the Court that if “economic inadaptability” were read to import unemployability, the appellant, should he or she meet the economic-inadaptability criterion, would then be eligible for a rating of total disability based on individual unemployability resulting from a service-connected disability (TDIU) rather than just a 50 percent rating. Id., citing 38 C.F.R. § 4.16. In the Pierce case, the Court discussed the notion that consideration must also be given as to whether the disability is capable of producing severe economic inadaptability, regardless of whether the condition is actually causing such inadaptability. See Pierce, 18 Vet. App. at 445-46. In this regard, the decision mentions that, VA conceded that the words, “productive of” could be read to mean either “producing” or “capable of producing.” Id. at 446-47. After a review of the evidence, the Board finds that the Veteran’s recurrent generalized headaches most closely approximate the criteria for a 10 percent disability evaluation for the period prior to June 1, 2017, and a noncompensable rating thereafter. In a January 2015 General Medical Examination, the examiner noted that the Veteran had headaches twice a week when his allergies were bad and that he treated them with over the counter medications. The examiner noted that these headaches were prostrating and had associated dizziness, and could last 1-2 days. No indication of any impact on economic adaptability was noted. On June 1, 2017, the Veteran was provided with another examination, the examiner noted the Veteran’s report of tension headaches 3 to 4 times a week which last 2 to 4 hours each, with dizziness treated with over the counter medication. The examiner reported that they were not prostrating and did not impact his ability to work. Reviewing the evidence, the Veteran’s headaches prior to June 1, 2017, more nearly approximate the criteria for a 10 percent evaluation. Although it is not clear that they occurred once in 2 months over the past several months, they did occur when his allergies worsened which he reported occurred in spring and fall, and they were prostrating; thus, the Board finds that they equate most closely with the 10 percent criteria. However, in the absence of any evidence that they occurred more frequently, a higher rating of 30 percent is not warranted. With regard to the period beginning on June 1, 2017, while the Veteran’s headaches appear to have increased in frequency, they also were noted to have decreased in severity. They only lasted 2 to 4 hours and were not deemed prostrating. Accordingly, as of this date, they no longer approximate the criteria for a 10 percent rating, and thus, the Board finds that a noncompensable rating is appropriate for this stage of the rating period. In sum, the preponderance of the evidence supports staged ratings for the Veteran’s headache condition. For the period prior to June 1, 2017, a 10 percent rating is warranted, and for the period beginning on June 1, 2017, a noncompensable rating is appropriate. GAYLE STROMMEN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Hallie E. Brokowsky, Counsel