Citation Nr: 20002274 Decision Date: 01/10/20 Archive Date: 01/09/20 DOCKET NO. 16-58 709 DATE: January 10, 2020 REMANDED Entitlement to a rating in excess of 0 percent for migraine headaches is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Navy from June 1979 to June 1999. This appeal comes before the Board of Veterans’ Appeals (Board) from a March 2015 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO) in Muskogee, Oklahoma, which granted service connection for migraine headaches at a 0 percent rating. In August 2019, the Veteran testified at a video conference hearing in the Saint Petersburg, Florida, RO before the undersigned Veterans Law Judge sitting at the Central Office in Washington, D.C. A transcript of the hearing is available in the record. Entitlement to a rating in excess of 0 percent for migraine headaches is remanded. The Veteran seeks an increased rating above an initial 0 percent grant of service connection for his migraine headache disability. The Veteran’s service-connected migraine headaches are currently rated as noncompensable for the entire appeal period under 38 C.F.R. § 4.12a, Diagnostic Code (DC) 8100. Under DC 8100, a noncompensable rating is warranted for less frequent attacks than the following: a 10 percent disability rating is warranted for migraines with characteristic prostrating attacks occurring on an average of once in two months over the last several months; a 30 percent disability rating is warranted for migraines with characteristic prostrating attacks occurring on an average of once a month over the last several months; a 50 percent rating is warranted for migraines with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. A 50 percent rating is the maximum rating provided under DC 8100. 38 C.F.R. § 4.12a. The issue therefore turns on the frequency of characteristic prostrating headache attacks experienced by the Veteran during the appeal period. Governing case law and regulations have not defined “prostrating.” For reference, the Board notes that “prostration” is defined as “extreme exhaustion or powerlessness.” See DORLAND’S ILLUSTRATED MEDICAL DICTIONARY 1531 (32. Ed. 2012). Also, the Board notes that “migraine” is commonly associated with irritability, nausea, vomiting, constipation or diarrhea, and often with photophobia. Attacks are preceded by constriction of the cranial arteries, often with resultant prodromal sensory (especially ocular) symptoms. Id. at 1166. The Veteran has argued that he experiences headaches as much as 3 to 4 times per week, for up to half a day in duration. He must take sick days up to 4 or 5 times per month as a result of his attacks. See August 2019 Hearing Transcript. The Veteran has noted that he is usually able to swap hours with other workers, or to work overtime to make up for lost time in his career as a truck driver. Id. The Veteran has stated that he is unable to work during his attacks, and in some instances he either blacks out, or must isolate himself because he cannot do anything. Id. Medical records indicate that the Veteran has previously reported experiencing 3 migraines per week, at the end of 2016. See November 2016 VA Medical Treatment Record. In December 2014, the Veteran had similarly reported having 2-3 migraines per week, which lasted 15 minutes to an hour, with no aura reported. The medical evidence of record generally corroborates the Veteran’s accounts. Two incidents of hospitalization for dizziness or fainting have been documented within a 4-year timeframe. The Veteran’s reports of the frequency of his headaches has been fairly consistent, though the severity of the headaches has not been well documented. However, the medical opinions of record are highly conflicting. Two incidents of hospitalization have been documented. Medical records from November 2014 show the Veteran nearly passed out (follow-up treatment records state that he actually did pass out) while watching television. The Veteran also subsequently reported dizziness and a migraine concurrent with this episode. However, records from the date of the attack indicate no headache, no pain, and no altered level of consciousness other than dizziness. See November-December 2014 Medical Treatment Record – Non-Government Facility. Medical records from June 2018 indicate the Veteran was doing yard work when he felt dizzy and experienced a severe headache, and then passed out. When he awoke he was en route to the emergency room. Records show no problems with the Veteran’s vision, and no gastrointestinal, respiratory, or psychiatric problems at that time. See July 2018 Medical Treatment Record – Non-Government Facility. In February 2015, a VA examining neurologist evaluated the Veteran’s headache condition, and documented reports of approximately 3 headaches per month, which would last for hours. The examiner checked a block indicating these were not, however, characteristic prostrating attacks of migraine pain. See February 2015 C&P Exam. The examination report did not directly address the November 2014 event, and the report pre-dated the June 2018 event. The examination report did not explain why the examiner did not consider the Veteran’s headaches to be characteristic prostrating attacks. The Veteran has also provided a Disability Benefits Questionnaire (DBQ) filled out by a private treating neurologist in June 2018. That report included a box checked to indicate that the Veteran experienced characteristic prostrating attacks more frequently than once per month. The examiner noted the Veteran’s reports of frequent head pain 3-4 times per week, in varying duration from 30 minutes to 3 hours. The report documented rare syncope (fainting) episodes in 2014 and June 2018. The report did not explain which of the Veteran’s attacks were considered characteristic prostrating attacks, nor how frequently those attacks occurred. See July 2018 VA Examination. The Board finds further development is necessary. The medical evidence as noted above, is significantly conflicting, and the opinions are insufficient for the Board to reach a decision on the increased rating claim. Both the VA examination from February 2015 and the private DBQ examination in June 2018 are conclusory in nature, as neither describes whether the Veteran’s two hospitalization events were characteristic prostrating migraine attacks. Similarly, neither report describes whether the Veteran’s more regular and frequent headaches, which have been reported anywhere between 3 times per month and 4 times per week, are characteristic prostrating attacks. As the frequency and severity of the Veteran’s headaches are the primary concern in this case, the Board finds the disparity between the two conclusory opinions required the need for an additional examination. The matters are REMANDED for the following action: 1. Obtain any updated VA treatment records and associate them with the claims file. 2. Thereafter, schedule the Veteran for an examination to determine the frequency and severity of his characteristic prostrating migraine attacks. The examiner should review the entire claims file, and answer the following questions: How frequently does the Veteran experience characteristic prostrating migraine attacks? Are the Veteran’s headaches which occur as frequently as 3 to 4 times per week “characteristic prostrating attacks?” Does the Veteran have migraines with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability? The examiner’s attention is invited to the Veteran’s lay testimony at the hearing, that some of these attacks have required the Veteran to isolate himself, or to take time off work. The examiner’s attention is also invited to the VA medical opinion from February 2015 which found the Veteran did not experience characteristic prostrating attacks, as well as the private medical opinion from June 2018 which found the Veteran did experience characteristic prostrating attacks, more frequently than once per month. The examiner’s opinion should directly address the Veteran’s two instances of hospitalization for fainting, and should discuss whether those events were characteristic prostrating attacks. The examiner should also directly address the Veteran’s reports of other recurrent headaches which have not required hospitalization, and discuss whether they are characteristic prostrating attacks. K. J. ALIBRANDO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Hermsdorfer, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.