Citation Nr: 18158879 Decision Date: 12/18/18 Archive Date: 12/18/18 DOCKET NO. 17-04 750 DATE: December 18, 2018 ORDER Entitlement to a rating of 30 percent for post-traumatic headaches residual of traumatic brain injury, effective April 16, 2014 is granted. FINDING OF FACT Resolving reasonable doubt in his favor, the Veteran has had headaches with characteristic prostrating attacks occurring on average at least once a month during the period on appeal. CONCLUSION OF LAW The criteria for a 30 percent rating for headaches have been met since April 16, 2014. 38 U.S.C. § 1155; 38 C.F.R. § 4.124a, Diagnostic Code 8100. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from January 1982 to January 1986. This matter is before the Board of Veterans’ Appeals (Board) on appeal from an April 2015 rating decision. Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities and are intended to represent the average impairment of earning capacity resulting from disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. When there is a question as to which of two ratings apply, VA will assign the higher of the two where the disability picture more nearly approximates the criteria for the next higher rating. 38 C.F.R. § 4.7. Otherwise, the lower rating will be assigned. Id. Where service connection has been granted and the assignment of an initial evaluation is disputed, separate evaluations may be assigned for different periods of time based on the facts found. Fenderson v. West, 12 Vet. App. 119, 125-26 (1999). Disabilities must be viewed in relation to their entire history. 38 C.F.R. § 4.1. VA is required to interpret reports of examination in light of the whole recorded history, reconciling the various reports into a consistent picture so that the current rating may accurately reflect the elements of disability. 38 C.F.R. § 4.2. VA is also required to evaluate functional impairment on the basis of lack of usefulness and the effects of the disabilities upon the claimant’s ordinary activity. 38 C.F.R. § 4.10. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3. The Veteran’s headaches are rated under Diagnostic Code 8100. Under this criteria, a 10 percent rating is assigned for migraines with characteristic prostrating attacks averaging one in two months over the last several months. See 38 C.F.R. § 4.124a, Diagnostic Code 8100. A 30 percent rating is granted for migraines with characteristic prostrating attacks occurring on an average once a month over the last several months. Id. The highest schedular rating available, 50 percent, is warranted for migraines with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. Id. The rating criteria do not define “prostrating,” and the courts have not undertaken to define “prostrating” for purposes of Diagnostic Code 8100. See Fenderson, 12 Vet. App. at 119. 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.” The Court has determined “productive of severe economic inadaptability” can be read as having either the meaning of “producing” or “capable of producing.” Pierce v. Principi, 18 Vet. App. 440, 445 (2004). Yet, “severe economic inadaptability” remains undefined, but nothing in Diagnostic Code 8100 requires that the claimant be completely unable to work in order to qualify for a 50 percent rating. Id. at 445-46. In this case, the Veteran has consistently reported headaches related to his multiple head trauma injuries from service for many years. His initial May 2006 VA examination reported frequent headaches characterized by pain to the front and sides that would sometimes result in nausea and vomiting. The Veteran reported regular treatment with Excedrin for migraines. Flare-ups of these headaches, aggravated by exertion and described as occurring two to three times per week and lasting two to three hours, would include pain, weakness, fatigue, and function loss requiring him to lie down. The Board notes the diagnostic criteria for residuals of brain injuries in effect in December 2006 did not allow for rating headaches due to head trauma under Diagnostic Code 8100; therefore, the examiner was not asked to report prostrating attacks related to the Veteran’s headaches. See 38 C.F.R. § 4.124a, Diagnostic Code 8045 (2006). A March 2015 VA examination report describes similar headaches characterized by constant head pain, pulsating or throbbing, on both sides of head and worsened with physical activity. These headaches result in nausea and vomiting. The examiner provided no response to questions about prostrating attacks, and frequency of headaches was not provided. The examiner notes continued treatment with Excedrin for migraines. A subsequent December 2016 VA examination describes these headaches in similar terms to prior exams. The Veteran reported his head pain had not improved since the previous examination. He continued to experience frontal headaches, which he managed with Excedrin. Pain was again noted on both sides of his head, as well as nausea. The examiner indicated no presence of prostrating attacks, though he remarked that the Veteran reported his chronic pain from headaches, fibromyalgia, and chronic back issues rendered him unable to work. The examiners’ reports are competent and credible, as the reports were based on reviews of the Veteran’s medical records and in-person examinations of the Veteran, and are therefore entitled to significant probative weight. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The Veteran has reported in lay statements both during and before the period on appeal that his headaches have been consistent since service and occur almost daily. These reports of severe headaches since service have been corroborated by a doctor who knew the Veteran in service. Taken together, the evidence shows the Veteran has experienced frequent, severe headaches with flares that produce nausea, vomiting, weakness, fatigue, and functional impairment. Though the most recent VA examiner states the Veteran does not experience prostrating attacks, the symptoms characterized across multiple VA examinations and described by the Veteran indicate a consistent pattern of severe headaches productive of functional impairment rising to the level of prostrating attacks. Granting the Veteran the benefit of reasonable doubt, the Board finds the evidence is in at least relative equipoise as to whether the Veteran has experienced headaches with characteristic prostrating attacks occurring on average at least once a month during the period on appeal. Accordingly, a rating of 30 percent for post-traumatic headaches is warranted since April 16, 2014. The Board finds a higher rating of 50 percent is not warranted during the period on appeal, as the evidence fails to show the Veteran has experienced prolonged prostrating attacks productive of economic inadaptability. The evidence generally shows flares of the Veteran’s headaches last one to three hours and are managed with medication. Furthermore, though the Board observes the Veteran has previously been granted a total disability rating based on individual unemployability (TDIU) for the combined effects of his various service-connected conditions, the evidence of record does not show his headache symptoms result in economic inadaptability or are severe enough to significantly interfere to with his occupational functioning when viewed in isolation. M. HYLAND Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD D. Pitman, Associate Counsel