Citation Nr: 18160012 Decision Date: 12/20/18 Archive Date: 12/20/18 DOCKET NO. 14-09 401 DATE: December 20, 2018 ORDER Entitlement to an initial compensable rating for residual scar, left wrist ganglion, is denied. Entitlement to an initial rating in excess of 30 percent for migraine headaches is denied. FINDINGS OF FACT 1. The Veteran’s residual scar, left wrist ganglion, measures 4.5 centimeters by 0.1 centimeters, is not painful or unstable, and does not result in any disabling effects. 2. The Veteran’s headaches have not been shown to be manifested with prostrating and prolonged attacks productive of severe economic inadaptability. CONCLUSIONS OF LAW 1. The criteria for an initial compensable rating for residual scar, left wrist ganglion scar, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.7, 4.118, Diagnostic Codes 7804, 7805. 2. The criteria for an initial rating in excess of 30 percent for migraine headaches have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.7, 4.124a, Diagnostic Code 8100. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the U.S. Navy from November 1983 to November 1987 and from January 1991 to January 2011. In January 2018, these matters were remanded by the Board for additional development. The Board’s January 2018 remand included the issues of entitlement to service connection for a right shoulder disability, right knee disability, and status-post septoplasty. As service connection for these three issues was granted by the Regional Office in a September 2018 rating decision, these issues are no longer before the Board. The Board notes that a March 2018 examination of the Veteran’s left wrist scar, residual of ganglion cyst excision, found a recurrence of ganglion cyst. The current issue before the Board is an increased rating of the residual scar caused by the removal of a prior ganglion cyst. If the Veteran believes his current ganglion cyst condition is related to service, he may file a claim of service connection for this condition. Increased Rating Disability evaluations are determined by the application of VA’s Schedule for Rating Disabilities, which assigns ratings based on average impairment of earning capacity resulting from a service-connected disability. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 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. When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. See Gilbert, 1 Vet. App. at 53; see also 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 1. Entitlement to an initial compensable rating for residual scar, left wrist ganglion The Veteran’s service-connected scar on his left wrist, residual to a ganglion cyst excision, is rated as non-compensable as of February 1, 2011 under Diagnostic Code 7804-7805. The Veteran contends that he entitled to an initial compensable rating. Under the provisions of 38 C.F.R. § 4.118, Diagnostic Codes 7801 and 7802, a 10 percent evaluation is warranted for: “scars, other than head, face, or neck,” that inter alia cover an area or areas exceeding 6 square inches (39 sq. cm.), but less than 12 square inches (77 sq. cm.). A 20 percent rating is warranted for scars covering an area or areas covering at least 12 square inches (77 sq. cm.), but less than 72 square inches (465 sq. cm.). Under the provisions of Diagnostic Code 7804, a 10 percent evaluation is warranted for one or two superficial scars that are painful or unstable. For a 20 percent rating, there must be three or four scars that are painful or unstable. Under Diagnostic Code 7805, scars may be rated on limitation of function of the affected part. The relevant notes pertaining to these regulations (re-numbered) are shown below: (1) A deep scar is one associated with underlying soft tissue damage. (2) A superficial scar is one not associated with underlying soft tissue damage. (3) An unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. The Veteran was afforded a VA general medical examination as part of his initial claim for service connection in October 2010. The Veteran reported the residuals of his ganglion cyst excision cause occasional pain but no current symptoms. The examiner found no pathology to render a diagnosis. In January 2018 the Board remanded this matter, finding the prior VA examination outdated and considering the Veteran’s statement that the prior examination was inadequate. The Veteran was provided a new VA examination in March 2018 to determine the severity of his left wrist scar. As discussed above, the examiner noted a recurrence of the ganglion cyst, which was the cause of current left wrist symptoms. The examiner found that the surgical incision site where the ganglionic cysts were resected is well-healed. The examiner found a scar on the volar surface of the left wrist, measuring 4.5 centimeters by 0.1 centimeters. The examiner did not find objective evidence that the scar was painful, unstable, or had a total area equal to or greater than 39 square centimeters. Based on the evidence of record, and after resolving all doubt in the Veteran’s favor, the Board finds that the Veteran is not entitled to a compensable rating for his left wrist ganglion cyst excision residual scar. The medical evidence of record does not show that the scar exceeds 6 square inches or 39 square centimeters. Furthermore, the VA examinations did not find the scar to be unstable or painful. As noted by the January 2018 examiner, any limitation of motion of the left wrist is caused by a recurrence of the ganglion cyst rather than a residual scar. The January 2018 VA examiner specifically noted that the scar did not cause any additional functional impairment. Therefore, a compensable rating for the parotid mass excision residual scar is not warranted. 38 C.F.R. § 4.118, Diagnostic Codes 7804, 7805. 2. Entitlement to a disability rating in excess of 30 percent for migraine headaches The Veteran’s service-connected migraine headaches are rated 30 percent disabling under Diagnostic code 8100, with an effective date of February 1, 2011. The Veteran contends he is entitled to a higher initial rating. Under Diagnostic Code 8100, migraines with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability warrant a 50 percent rating. Migraines with characteristic prostrating attacks occurring on an average once a month over the last several months warrant a 30 percent rating. Migraines with characteristic prostrating attacks averaging one in two months over the last several months warrant a 10 percent rating. Migraines with less frequent attacks warrant a noncompensable rating. 38 C.F.R. § 4.124a. For general medical purposes, “prostration” is defined as “extreme exhaustion or powerlessness.” See Dorland’s Illustrated Medical Dictionary 1554 (31st ed. 2007). “Completely” is defined as “total, absolute.” See Merriam-Webster.com 2018. https://www.merriam-webster.com (20 December 2018). The use of “completely” in the criteria for the 50 percent rating indicates a level of prostration greater than that contemplated by the 30 percent rating. “Frequent” is defined as “happening at short intervals” and “returning regularly or often.” Id. “Prolonged” is defined as “lengthened in extent, scope or range.” Id. The phrase “productive of severe economic inadaptability” encompasses conditions that cause severe economic inadaptability as well as those that are merely capable of producing severe economic inadaptability. Pierce v. Principi, 18 Vet. App. 440, 445-46 (2004). “Severe economic inadaptability” does not require a showing of an inability to work. Id. at 446. The rating criteria for headaches are successive, and all the requirements must be met to attain the higher rating. Johnson v. Wilkie, 2018 U.S. App. Vet. Claims LEXIS 1253 (September 19, 2018). Therefore, based on the entirety of the above definitions, the 50 percent rating for headaches requires attacks occurring very often or at short intervals, resulting in total powerlessness for lengthy periods, and which can produce severe economic inadaptability. The Veteran was afforded a VA general medical examination as part of his initial claim for service connection in October 2010. The Veteran reported headaches which caused pain to one side of the head, light sensitivity, and having to stay in bed. The Veteran reported headaches on average of one time per month lasting for two days. In August 2011, the Veteran’s employer wrote a letter indicating that the Veteran has missed work or left work due to the severity of his migraines. However, the employer did not indicate the frequency of absences. The employer also did not state that the Veteran was unable to fulfill his work duties or that headaches otherwise affected his on-the-job performance. In January 2018 the Board remanded this matter, finding the prior VA examination outdated and considering the Veteran’s statement that the prior examination was inadequate. The Veteran was provided a new VA examination in March 2018 to determine the severity of his migraine headaches. At the examination, the Veteran reported experiencing headaches three times per week. He takes medication when he feels a headache coming on, but symptoms may last until the next day. The Veteran reported going to the emergency room three times in the last year. The examiner found that the Veteran had prostrating attacks of migraines once every month, but these headaches were not productive of severe economic inadaptability. The examiner further found that the Veteran’s headache condition does not impact his ability to work. Based on the evidence of record, and after resolving all doubt in the Veteran’s favor, the Board finds that the Veteran’s headaches more nearly approximate the criteria for a 30 percent rating. The evidence, including the letter from his employer, shows that the Veteran experienced headaches that occasionally required him to miss work, but does not show a level of occupational impairment consistent with “severe economic inadaptability” in the form of incomplete duties or other deficiencies. Notably, the assigned 30 percent rating is considered adequate to compensate the Veteran for a considerable loss of his working time. 38 C.F.R. § 4.1. The findings of the October 2010 and March 2018 examinations are consistent with characteristic prostrating attacks occurring on an average once a month. Neither the medical nor lay evidence indicates that the Veteran suffers from migraines occurring very often or at short intervals and resulting in total powerlessness for lengthy periods to warrant the 50 percent rating. Thus, the Board finds that the Veteran’s level of impairment is consistent with no more than a 30 percent rating. Shamil Patel Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C. Casey, Associate Counsel