Citation Nr: 20042555 Decision Date: 06/24/20 Archive Date: 06/24/20 DOCKET NO. 17-07 112 DATE: June 24, 2020 ORDER An initial rating of 50 percent for tension headaches is granted, subject to the laws and regulations governing the award of monetary benefits. FINDING OF FACT The Veteran’s tension headaches disability is manifested by symptomatology that more closely approximates very frequent, completely prostrating and prolonged attacks productive of severe economic inadaptability. CONCLUSION OF LAW The criteria for a 50 percent an initial rating of tension headaches have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.3, 4.7, 4.124a Diagnostic Code 8100. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from August 1977 to November 1977. He had reserve service from June 1977 to May 1986. This matter is before the Board of Veterans’ Appeals (Board) on appeal of a January 2015 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran’s appeal initially included a claim for an increased rating of his bilateral hearing loss. However, the claim was not named in the VA Form 9, Appeal to Board of Veterans Appeals, filed in February 2017 to perfect the appeal. Therefore, entitlement to an increased rating of bilateral hearing loss is not before the Board. Entitlement to an initial rating of 50 percent for tension headaches is granted. Disability evaluations are determined by comparing the manifestations of a disability with the criteria set forth in the Diagnostic Codes of the Schedule for Rating Disabilities (Rating Schedule). 38 U.S.C. § 1155; 38 C.F.R. § Part 4. The percentage ratings represent, as far as can practicably be determined, the average impairment in earning capacity (in civilian occupations) resulting from service-connected disability. 38 C.F.R. § 4.1. Impairment of earning capacity is central to every rating. The ultimate significance of a percentage rating in any given case is the degree to which the disability has impaired the veteran’s ability to work. 38 C.F.R. § 4.1. Relevant regulations do not require that all cases show all findings specified by the Rating Schedule; however, findings enough to identify the disease and the resulting disability and, above all, coordination of the rating with impairment of function will be expected in all cases. 38 C.F.R. §§ 4.7, 4.21. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA will give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b). When after careful consideration by VA of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability, such doubt will be resolved in favor of the claimant. 38 C.F.R. § 4.3. When there is a question which of two evaluations is to be applied, the higher evaluation will be assigned unless the veteran’s disability picture more closely approximates the criteria for the lower rating. Otherwise, the lower evaluation will be assigned. See 38 C.F.R. § 4.7. The evaluation of a disability accounts for competent lay evidence. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that a lay person can be observed and described. 38 C.F.R. § 3.159(a)(2). A lay claimant is competent to report physical and mental symptoms as the claimant has experienced them. See 38 C.F.R. § 3.159(a)(2). A January 2015 rating decision granted service connection for tension headaches, with a rating of 30 percent, effective October 1, 2014. The Veteran maintains that he is entitled to an initial higher schedular rating of his headaches. The Veteran’s tension headaches are rated under Diagnostic Code 8100 on criteria applying specifically to migraines. Diagnostic Code 8100 assigns the following ratings: noncompensable for migraines with less frequent attacks, 10 percent for migraines with characteristic prostrating attacks averaging one in 2 months over last several months, a 30 percent rating for migraines with characteristic prostrating attacks occurring on an average once a month over the last several months, and a maximum 50 percent for migraines with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. 38 C.F.R. § 4.124a, Diagnostic Code 8100. The term “prostrating attack” is not defined in regulation or case law. See Fenderson v. West, 12 Vet. App. 119, 126-27 (1999) (quoting Diagnostic Code 8100 but not specifically addressing the definition of a prostrating attack). However, prostration can be defined as “extreme exhaustion or powerlessness.” See Dorland’s Illustrated Medical Dictionary 1531 (32nd ed. 2012). The Veteran underwent a VA Headaches in December 2014. The diagnosis presented in the examination report was tension headaches; migraine headaches were not diagnosed. The examiner confirmed that the Veteran experienced non-migraine pain more frequently than once a month and that those attacks were very frequent, prostrating, and prolonged. His symptoms included pulsating or throbbing pain, pain on both sides of the head, worsening pain with physical activity, and sensitivity to light. The examiner noted that the Veteran was not taking any prescribed medicine for his headaches, only over-the-counter medicine (such as aspirin and brand ibuprofen). There were no other physical findings relevant to headaches. The examiner described the functional impact of the condition as impaired concentration and cognitive acuity when the Veteran had a headache. In November 2016, the Veteran underwent another examination to assess his headaches. At that time, the Veteran’ reported having both recurrent tension headaches and chronic migraines. The examination confirmed that the Veteran had a diagnosis of tension headaches but not a diagnosis of migraines. The Veteran described having bilateral headaches at least once a week that would last all day and were a 7/10 for the degree of pain severity. The Veteran also reported having prostrating attacks monthly, described as a 10/10 for the degree of pain severity, and that at those times, he would try stay home from work. His headaches were reportedly associated with photophobia and “sonophobia.” He used prescription medication to treat his headaches. The examiner concluded that the Veteran had characteristic prostrating attacks of headache pain once every month but did not have very prostrating and prolonged attacks of migraine or non-migraine pain productive of severe economic inadaptability. The examiner confirmed that the headache condition adversely affected the Veteran’s ability to work in that he had limited capacity for prolonged concentration and focusing during a headache, although he was still able to perform general activities without significant restrictions. The VA and private medical evidence reflect reported symptomatology that is consistent with that noted on the VA examinations. Resolving all doubt in favor of the Veteran, the Board finds that a 50 percent rating is warranted for the Veteran’s headaches for the entire period on appeal. The December 2014 VA revealed that the Veteran’s headache episodes are frequent, prostrating, and prolonged. Although the November 2016 examiner described the Veteran’s prostrating attacks of headache pain as occurring once every month, the examiner noted that the Veteran had had limited capacity for prolonged concentrating and focusing during a headache episode, which would include any episodes that occur while at work. The Board finds that the functional limitations identified by the examiner in November 2016 tend to support a definition of severe economic inadaptability for rating and adjudication purposes. The Veteran’s own reports of trying to take off work when he experiences prostrating headaches (which by his own account occur at least once month), further supports this conclusion. The Veteran’s account of his symptomatology is competent evidence on the question of the severity of his headache disability and, being relevant evidence, is probative. The Veteran’s account, when considered with the medical evidence, presents a disability picture that is more consistent with a rating of 50 percent under the Diagnostic Code. In reaching this determination, the Board considered the Veteran’s statements regarding the nature and severity of his headaches. In the May 2017 written brief from his representative and on his September 2017 VA Form 9, the Veteran disagreed with the characterization of his disability as tension headaches and asserted that actually suffers from migraine headaches. As noted above, both the December 2014 and November 2016 examinations failed to diagnose migraine headaches. Nevertheless, to the extent that the Veteran claims the November 2016 VA examination is inadequate in this regard or other medical evidence shows that he has migraine headaches, his tension headaches is currently rated under Diagnostic Code 8100, which pertain to migraines. Thus, the same rating criteria apply and the Veteran’s service-connected headache disability. There is no evidence suggesting, nor does the Veteran allege, that separate ratings for separate headache diagnoses is warranted in this case, which would amount to impermissible pyramiding of overlapping symptomatology. See 38 C.F.R. § 4.14. (Continued on next page) The Board will grant a rating of 50 percent for the Veteran’s tension headaches. Any reasonable doubt is resolved in favor of the claim. 38 C.F.R. §§ 4.3, 4.7. DELYVONNE M. WHITEHEAD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Pitts 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.