Citation Nr: 18155948 Decision Date: 12/06/18 Archive Date: 12/06/18 DOCKET NO. 16-47 680 DATE: December 6, 2018 ORDER A 30 percent evaluation for service-connected migraines is granted. FINDING OF FACT The Veteran’s service-connected migraine disability has caused prostrating attacks occurring on an average once a month over last several months. CONCLUSION OF LAW The criteria for a 30 percent evaluation, but no greater, for migraine headaches have been met. 38 U.S.C. § 1155, 5107 (2012); 38 C.F.R. §§ 3.321, 4.1, 4.124a, Diagnostic Code 8100 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from July 1999 to November 2003. He received the Combat Medical Badge, among other decorations, for this service. This matter is before the Board of Veterans’ Appeals (Board) on appeal from an October 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran requested a hearing in connection with this appeal, but withdrew his request for a hearing in writing in November 2016. Disability evaluations are determined by evaluating the extent to which a Veteran’s service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities. The percentage ratings represent as far as can practicably be determined the average impairment in earning capacity resulting from such diseases and injuries and the residual conditions in civilian occupations. Generally, the degree of disabilities specified are considered adequate to compensate for considerable loss of working time from exacerbation or illness proportionate to the severity of the several grades of disability. 38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.1 (2017). Separate diagnostic codes identify the various disabilities and the criteria for specific ratings. If two disability evaluations are potentially applicable, the higher evaluation will be assigned to the disability picture that more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (2017). Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. 38 C.F.R. § 4.3 (2017). However, the evaluation of the same disability under various diagnoses, known as pyramiding, is to be avoided. 38 C.F.R. § 4.14 (2017). 1. Entitlement to an increased disability rating for service-connected migraines The RO initially granted service connection for recurrent mixed type of headaches in an October 2014 rating decision. A noncompensable evaluation was assigned under Diagnostic Code 8100. 38 C.F.R. § 4.124a (2017). Under the Schedule of Ratings for neurological conditions and convulsive disorders, a 10 percent evaluation is warranted for migraine headaches with characteristic prostrating attacks averaging one in 2 months over the last several months. A 30 percent evaluation is warranted for migraine headaches with characteristic prostrating attacks occurring on an average once a month over the last several months. A 50 percent evaluation is warranted for migraine headaches with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. 38 C.F.R. § 4.124a, Diagnostic Code 8100 (2017). The Board finds that the Veteran’s headache disability warrants a 30 percent rating. At a June 2014 VA examination, the Veteran reported that he started experiencing Migraine headaches in 2002 which cause pulsating or throbbing pain behind his right eye and experiences light and noise sensitivity. The VA examiner noted no characteristic prostrating headache or migraine attacks. The VA examiner further noted that the Veteran’s headaches did not have a significant impact on his ability to work. At a January 2016 VA examination, the Veteran described having pulsating and throbbing pain and pain from the back of his head to his right eye. The Veteran also described experiencing nausea and sensitivity to light and sound related to his migraine headaches. The Veteran reported less than one headache per day that lasts several hours. The VA examiner noted that the Veteran experiences prostrating migraine headaches with less frequent attacks over the last several months. The VA examiner further noted that the Veteran’s headaches did not have a significant impact on his ability to work. The Veteran submitted evidence from his private physician showing that he experiences headaches up to four times per week. The Veteran has also indicated that he suffers from characteristic prostrating attacks occurring on an average once a month over the last several months and that he uses sick leave when he experiences the prostrating headaches and is unable to work. The Board notes that the Veteran is employed as a physician. The Veteran submitted time and attendance records from his job showing that he has used sick leave at least once per month over the last several months. The Board finds the Veteran is entitled to a 30 percent rating for his migraine headache disability, as the record reflects a worsening of the Veteran’s headaches such that they meet the criteria of completely prostrating and occurring on average at least monthly. The evidence does not reflect that he has very prostrating and prolonged attacks of headache pain productive of severe economic inadaptability. Rather, the nature and severity of his headaches is contemplated by the 30 percent rating assigned. Furthermore, the Board notes that in his Notice of Disagreement the Veteran specifically indicated he sought a 30 percent evaluation. Additionally, by his own statements and time and attendance sheets, his headaches averaged about once a month. The records further reflects he continues to work as a physician and as such, while the headaches clearly impact his ability to work, they do not result in severe economic inadaptability. Therefore, the Board finds that the evidence supports a 30 percent evaluation, but does not support a rating in excess of 30 percent. H. SEESEL Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Boal, Associate Counsel