Citation Nr: 20044081 Decision Date: 06/30/20 Archive Date: 06/30/20 DOCKET NO. 17-36 838 DATE: June 30, 2020 ORDER Entitlement to service connection for a gastric ulcer is denied. Entitlement to service connection for memory loss is denied. Entitlement to service connection for insomnia is denied. Entitlement to an initial rating of 50 percent for migraine headaches is granted. FINDINGS OF FACT 1. The Veteran had a gastric ulcer in November 2012 that resolved without residuals; there is no evidence that he has had a recurrence of a gastric ulcer at any time during the appeal. 2. The Veteran’s memory loss and insomnia are symptoms associated with nonservice-connected and service-connected disabilities; they are not independently diagnosed disorders or undiagnosed illnesses related to his Persian Gulf service. 3. The Veteran’s migraine headaches more nearly approximate very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a gastric ulcer have not been met. 38 U.S.C. §§ 1101, 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 2. The criteria for entitlement to service connection for memory loss have not been met. 38 U.S.C. §§ 1101, 1110, 1131, 1117, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310, 3.317. 3. The criteria for entitlement to service connection for insomnia have not been met. 38 U.S.C. §§ 1101, 1110, 1131, 1117, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310, 3.317. 4. The criteria for entitlement to an initial rating of 50 percent for migraine headaches have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.124a, Diagnostic Code 8100. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from March 1986 to September 1999. This appeal to the Board of Veterans’ Appeals (Board) is from June 2016 and June 2017 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO). A timely substantive appeal was received in July 2017 that limited the appeal to the issue involving gastric ulcers. The November 2017 substantive appeal was only timely for the issue involving the Veteran’s headaches; it was untimely for service connection for insomnia and memory loss since the rating decision that denied these claims was in June 2016 and the statement of the case was in June 2017. However, the Board has accepted jurisdiction of these issues and addressed them in the March 2020 Travel Board hearing. A transcript of this hearing is of record. In June 2017, the Veteran was contacted to verify the issues on appeal. At that time, the Veteran stated that he was not looking to raise a claim for total rating based on individual unemployability (TDIU). See June 2017 Report of General Information. During the hearing, the Veteran was again asked if he was claiming a TDIU due to his service-connected disabilities. His representative did not respond yes or no, only that the Veteran’s disabilities would have a combined 100 percent rating if his headaches were increased to 50 percent. See March 2020 Hearing Transcript. Since the Veteran is employed and would not confirm he is seeking a TDIU, the Board finds that he has not raised a TDIU claim in connection with the claims on appeal. Service Connection VA compensation may be granted for disability resulting from disease or injury incurred in or aggravated by active duty. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. To establish compensation for a present disability, a veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may be granted on a secondary basis for a disability that is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310. The evidence must show: (1) that a current disability exists; and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. See Allen v. Brown, 7 Vet. App. 439, 448-49 (1995). Service connection may be awarded on a presumptive basis to a Persian Gulf veteran who (1) exhibits objective indications; (2) of a chronic disability such as those listed in paragraph (b) of 38 C.F.R. § 3.317; (3) which became manifest either during active military, naval, or air service in the Southwest Asia theater of operations during the Persian Gulf War, or to a degree of 10 percent or more not later than December 31, 2021; and (4) such symptomatology by history, physical examination, and laboratory tests cannot be attributed to any known clinical diagnosis. Gutierrez v. Principi, 19 Vet. App. 1, 7 (2004); 38 U.S.C. § 1117; 38 C.F.R. § 3.317. Objective indications of a chronic disability include both ‘signs,’ in the medical sense of objective evidence perceptible to an examining physician, and other, non-medical indicators that are capable of independent verification. Disabilities that have existed for six months or more and disabilities that exhibit intermittent episodes of improvement and worsening over a six-month period will be considered chronic. The six-month period of chronicity will be measured from the earliest date on which the pertinent evidence establishes that the signs or symptoms of the disability first became manifest. A chronic disability resulting from an undiagnosed illness referred to in this section shall be rated using evaluation criteria from the VA’s Schedule for Rating Disabilities for a disease or injury in which the functions affected, anatomical localization, or symptomatology are similar. A disability referred to in this section shall be considered service-connected for the purposes of all laws in the United States. 38 C.F.R. § 3.317(a)(3-5). Signs or symptoms which may be manifestations of an undiagnosed illness include, but are not limited to, fatigue, signs or symptoms involving the skin, headaches, muscle pain, joint pain, neurologic signs or symptoms, neuropsychological signs or symptoms, signs or symptoms involving the respiratory system (upper or lower), sleep disturbances, gastrointestinal signs or symptoms, cardiovascular signs or symptoms, abnormal weight loss, or menstrual disorders. 38 C.F.R. § 3.317(b). In addition to certain chronic disabilities from undiagnosed illness, service connection may also be given for medically unexplained chronic multisymptom illness (such as chronic fatigue syndrome, fibromyalgia, and irritable bowel syndrome) that is defined by a cluster of signs and symptoms, as well as for any diagnosed illness that the VA Secretary determines by regulation warrants a presumption of service connection. 38 C.F.R. § 3.317(a)(2)(i)(B). Compensation shall not be paid under this section if there is affirmative evidence that an undiagnosed illness was not incurred during active military, naval, or air service in the Southwest Asia theater of operations during the Persian Gulf War; or if there is affirmative evidence that an undiagnosed illness was caused by a supervening condition or event that occurred between the Veteran’s most recent departure from active duty in the Southwest Asia theater of operations during the Persian Gulf War and the onset of the illness; or if there is affirmative evidence that the illness is the result of the Veteran’s own willful misconduct or the abuse of alcohol or drugs. 38 C.F.R. § 3.317(c). The term “Persian Gulf Veteran” means a veteran who served on active military, naval, or air service in the Southwest Asia Theater of operations during the Persian Gulf War. The Southwest Asia Theater of operations includes Iraq, Kuwait, Saudi Arabia, the neutral zone between Iraq and Saudi Arabia, Bahrain, Qatar, the United Arab Emirates, Oman, the Gulf of Aden, the Gulf of Oman, the Persian Gulf, the Arabian Sea, the Red Sea, and the airspace above these locations. 38 C.F.R. § 3.317(d). In determining whether service connection may be granted for a disability, 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 the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the claimant is afforded the benefit of the doubt. 1. Entitlement to service connection for a gastric ulcer. The Veteran contends he has gastric ulcers secondary to medications for pain associated with service-connected disabilities and fibromyalgia. See March 2020 Hearing Transcript. He also objected that his claim was denied on the basis there was no current disability. He stated that he had two “scopes” that diagnosed ulcers and that since then he has been treated for the disorder and has had continued pain. See October 2016 NOD. Service connection is currently in effect for a mood disorder, fibromyalgia, a right hip disability, migraines, irritable bowel syndrome (IBS), right shoulder and right knee disabilities, tinnitus, hemorrhoids, and a right hip scar. See May 2019 Rating Decision – Codesheet. The Veteran raised his current claim for service connection in April 2016 after raising a previous claim in December 2012 that he later withdrew in March 2013 before it was adjudicated. The record shows that a November 2012 EDG revealed an ulcer in the antrum. See October 2017 CAPRI records. February and March 2016 statements from Dr. L. Jensen noted that the Veteran had a history of NSAID induced ulcers and that as a result he could not take NSAIDS for his service-connected disabilities. See October 2017 CAPRI records. A follow-up EDG in January 2013 was negative for the previously diagnosed gastric ulcer and the stomach was normal. See October 2017 CAPRI records. An April 2016 VA examination confirmed that the November 2012 gastric ulcer had resolved and opined that it was less likely than not caused by or a result of prescribed medication. The clinician noted that there are many factors that contribute to the development of gastric ulcers, overuse of NSAID is one; Helicobacter pylori is a significant factor and present in 50-70 percent of patients with gastric ulcer. Other significant factors are tobacco and alcohol use and a family history. The clinician noted that the Veteran did not take continuous medication for a gastric ulcer and he did not have any pertinent findings, complications, conditions, signs, or symptoms related to gastric ulcers. There were no current gastric ulcer symptoms and the Veteran’s current symptoms were more attributed to gastroesophageal reflux disease (GERD). See October 2017 CAPRI records. Although an October 2017 treatment record notes complaints of recent gastrointestinal distress and the Veteran reported that it felt like his ulcers were “acting up” he was not diagnosed with any active ulcers. See October 2017 CAPRI records. In August 2018, he also complained of having pain similar to ulcers but worse; however, an October 2018 EDG was negative for an ulcer and instead it only revealed gastritis. See March 2019 CAPRI records. Even though the records from Dr. L. Jensen indicate there was a correlation between NSAIDs that had been taken for service-connected disabilities and gastric ulcers, the ulcer in 2012 resolved and April and May 2017 treatment records show the Veteran no longer took NSAIDs secondary to ulcers. See October 2017 CAPRI records. Thus, while the Veteran was found to have a gastric ulcer three years before his claim it is shown to have resolved without residuals and he no longer took the medications that induced the ulcer. The Veteran’s assertion that he still gets ulcers is noted but it is not supported by the evidence. The Veteran is not competent to link his current symptoms with the claimed disability, particularly when he is shown to have other disorders, such as gastritis, that has similar symptoms. As for direct service connection, peptic ulcer disease was suspected in a January 1997 service treatment record, but he has not had the diagnosis since then. See January 2012 STR – Medical. A December 2005 VA treatment record contains a GI assessment that specifically states he did not have peptic ulcer disease (PUD). See February 2006 Medical Treatment Record – Government Facility. In the absence of proof of a current disability, there can be no valid claim for service connection. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). The Board finds it significant that in his correspondence and during his hearing testimony that the Veteran was clear that he was seeking service connection for ulcers. As discussed, there were no findings of ulcers during the appeal period. With regard to the findings of gastritis and GERD during the appeal period, the evidence does not demonstrate that either finding is related to the Veteran’s military service or to a service-connected disorder. Therefore, the claim is denied. 2. Entitlement to service connection for memory loss. 3. Entitlement to service connection for insomnia. The Veteran is seeking service connection for memory loss and insomnia, although he acknowledges they could be symptoms of other things. See March 2020 Hearing Transcript. He also believes they are related to his Gulf War service. See October 2016 NOD. Based on the evidence, the Board finds that the Veteran’s memory loss and insomnia are symptoms of nonservice-connected and service-connected disabilities and they are not shown to be separate disorders to include undiagnosed illnesses. The Veteran testified that his insomnia started within one year after service, but he did not seek treatment for a while. See March 2020 Hearing Transcript. The Veteran’s service treatment records are silent for complaints or findings of memory loss or insomnia, to include August 1985 and April 1986 medical history reports. See August 1985 STR – Medical. Private treatment records in August 2001 first noted complaints of sleeping difficulties. See August 2009 Medical Treatment Record – Non-Government Facility. In December 2005, he asked for medication to help him sleep. See February 2006 Medical Treatment Record – Government Facility. The record shows he continues to be on prescribed medication for sleep impairment during the appeal. See October 2017 and May 2019 CAPRI records Reports of the Veteran’s memory loss have been inconsistent. Records in November 2009, November 2010, May 2011, October 2012, September 2014, May 2015, June 2015, December 2018, and February 2019 show his memory was intact and that there were no deficits, whereas records in December 2009, November 2010, January 2011, January 2015, May 2015, and February 2018 note his complaints of memory problems. See January 2010 CAPRI records, July 2011 Medical Treatment Record – Government Facility, October 2017 CAPRI records, and May 2019 CAPRI records. A July 2017 statement from his wife notes they have been married for the past 18 years and indicates he has had noticeable forgetfulness over the past couple of years. See July 2017 Buddy/Lay Statement. There are also records that address the etiology of the Veteran’s memory loss and sleep impairment. A December 2005 treatment record shows that he reported that his pain pills gave him insomnia. The assessment was insomnia secondary to Percocet and pain. See February 2006 Medical Treatment Record – Government Facility. In November 2009, the Veteran reported that he did not remember answering a work related call received when he was asleep. He asked for a note to be written for his boss advising him of potential memory impairment when awakened during the night due to medication (zolpidem). This medication is taken for sleep. See January 2010 CAPRI records. A March 2016 statement from Dr. L. Jensen states that the Veteran has fibromyalgia and that this is also associated with insomnia. The Veteran also reported memory disturbances since service. The physician stated that the Veteran’s conditions started after service in the Gulf War. He does not have any other disorders that would link all his conditions together after his time in service other than consideration of Gulf War Syndrome. She refers to a government source that identifies conditions that apply to the Veteran. It notes that chronic fatigue syndrome includes symptoms such as insomnia and memory problems. See April 2016 Medical Treatment Record – Government Facility. The Board noes that the Veteran is not service connected for chronic fatigue syndrome. On a May 2016 mental health VA examination, the clinician stated that the Veteran’s chronic sleep impairment and mild memory impairment were associated with his psychiatric disability. See May 2016 C&P Exam. A May 2016 VA opinion addressed whether the Veteran’s insomnia and memory loss were secondary to chronic fatigue syndrome, but since chronic fatigue syndrome is not service connected the opinions are of no relevance. The clinician indicated it would be speculative to offer an opinion about memory loss without a neuropsychological evaluation, but did note, however, that subjective memory problems are not uncommon for individuals with chronic pain or with chronic depression. Regarding sleep, insomnia can be caused by most mental health disorders, along with many medical disorders. Since the Veteran presents with significant depressive symptoms, it is at least as likely as not that the sleep problems are due in part to service-connected depression. See October 2017 CAPRI records. The Veteran had several VA examinations in June 2016. The clinician who examined him for fibromyalgia and chronic fatigue syndrome stated that the Veteran’s sleep disturbance and memory complaints are attributed to his fibromyalgia and mood disorders. The same clinician also performed a Gulf War VA examination. She noted that the Veteran has fibromyalgia and irritable bowel syndrome (IBS) and indicated that he does not report any additional signs and/or symptoms not addressed through the completion of DBQs previously identified. He did not have additional signs and/or symptoms that may present an “undiagnosed illness” or “diagnosed medically unexplained chronic multisymptom illness.” See June 2016 C&P Exams. On June 2017 mental health VA examination, the clinician noted that the Veteran’s sleep problems are not listed in the diagnostic formulation as an independent disorder. His sleep symptoms appear to result from multiple sources including sleep apnea, depressive disorder, fibromyalgia, and pain complaints. In a similar manner, his memory concern is not seen as a separate, independent diagnosis such as a neurocognitive disorder. Memory concerns are a common complaint related to sleep apnea, depressive disorder, fibromyalgia, pain complaints, and side effects from medications. See June 2017 VA Examination. In February 2018, the Veteran had a neuropsychological evaluation for his complaints of memory loss. He reported frequent difficulties with memory, attention, language, and executive functions. He explained that he often misplaced things, repeated himself, entered a room and forgot his purpose for doing so, had difficulty concentrating, was easily distractible/impulsive, was often preoccupied/daydreamed, had difficulty finding words to express his ideas, and had “trouble making a decision . . . with planning, it’s hard to think of everything you need to do.” The Veteran stated that his neurocognitive problems began four or five years ago, and he described an insidious onset of neurocognitive symptoms. He believed that his cognitive concerns have been gradually declining since that time, but also acknowledged that these problems seemed to fluctuate over the course of the day/week, stating “sometimes they’re there, sometimes they’re not.” The Veteran was given neuropsychological tests and the summary and impression were as follows: Neuropsychological test findings are significant for high average range intelligence and generally intact neurocognitive functions. The Veteran’s scores on tests of attention/working memory, processing speed, language, verbal memory, visual memory, visuospatial functions, and executive functions were generally within normal limits (i.e. average or better). He demonstrated clear neurocognitive strengths on tests of perceptual reasoning (superior range), semantic verbal fluency (superior range), and verbal learning/memory of unstructured information (high average). The Veteran exhibited a weakness on one test of mental flexibility, though this was in the low average range when compared to his same aged and highly educated peers and his performance across other executive measures was within normal limits. The clinician found that the results are not consistent with a neurocognitive disorder. Given his profile, his perceived neurocognitive problems are most reasonably attributable to a combination of psychiatric interference (depression), chronic pain issues, and the fatigue often associated with these conditions. This is consistent with Veteran's report that his neurocognitive problems seem to fluctuate over the course of the day/week, such that sometimes his neurocognitive symptoms are present and at others they are absent. However, the effects of both prescribed and illicit substances may also be contributing to his experience of memory and attention problems. In particular, the Veteran reported that he smoked cannabis once daily for pain control, which is known to result in difficulties in recent memory that resolve with sustained sobriety. See May 2019 CAPRI records. The evidence tends to show that the Veteran’s memory loss and insomnia have multiple causes, some are service-connected disabilities and include medication and others are nonservice-connected disabilities. However, despite the association with service-connected disabilities and their medications, the VA clinicians have indicated the insomnia and memory loss are symptoms rather than independent disorders. Furthermore, the Gulf War examination did not identify them as undiagnosed illness. Thus, the Board finds there is no basis to grant service connection for separate disabilities. Although a preponderance of the evidence is against the claims for service connection, the Board notes that the Veteran is already compensated for memory loss in the 50 percent rating for his service-connected depressive disorder and sleep impairment in the 40 percent rating for service-connected fibromyalgia as these symptoms are contemplated in the rating criteria for these disabilities. See 38 C.F.R. § 4.71a, Diagnostic Code 5025 and 38 C.F.R. § 4.130, Diagnostic Code 9434-9435. Increased Rating The Veteran’s migraines are rated 30 percent disabling, but he contends that a 50 percent rating should be assigned. A disability rating is determined by the application of VA’s Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual conditions in civil occupations. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The Board will consider whether separate ratings may be assigned for separate periods of time based on facts found, a practice known as “staged ratings,” whether it is an initial rating case or not. Fenderson v. West, 12 Vet. App. 119, 126-27 (1999). Under Diagnostic Code 8100, headaches are assigned a 30 percent rating for characteristic prostrating attacks occurring on an average once a month over the last several months. A 50 percent rating is warranted for very frequent, completely prostrating and prolonged attacks, productive of severe economic inadaptability. 38 C.F.R. § 4.124a, Diagnostic Code 8100. The rating criteria do not define “prostrating,” nor has the Court. By way of reference, the Board notes that, according to Dorland’s Illustrated Medical Dictionary 1523 (32nd ed. 2012), “prostration” is defined as “extreme exhaustion or powerlessness.” The rating criteria also do not define “severe economic inadaptability;” however, nothing in the applicable diagnostic code requires the claimant to be completely unable to work in order to qualify for a 50 percent rating. See Pierce v. Principi, 18 Vet. App. 440 (2004). The Board may not deny entitlement to a higher rating on the basis of relief provided by medication when those effects are not specifically contemplated by the rating criteria. Jones v. Shinseki, 26 Vet. App. 56, 63 (2012). 4. Entitlement to an initial rating in excess of 30 percent for migraine headaches. Having reviewed the evidence, the Board finds that throughout the appeal, the Veteran’s migraines more nearly approximate the criteria for a 50 percent rating. On April 2016 VA examination, the Veteran reported that his migraine headaches included nausea, vomiting, and sensitivity to light and sound. His headaches typically lasted one to two days and had characteristic prostrating attacks once a month. He did not have very prostrating and prolonged attacks of migraines productive of severe economic inadaptability. The clinician indicated that the headaches did not impair the Veteran’s ability to work. See April 2016 C&P Exam. On May 2016 mental health VA examination, the Veteran reported that he had headaches “all the time” and he has had some Botox injections, as well as oral medications. See May 2016 C&P Exam. In June 2016, he reported having a four day history of migraine headaches with light sensitivity and nausea. He was seen two months later in August 2016 with a two day history of headaches that also included nausea and light sensitivity. In September 2016 he was still struggling with headaches and associated nausea and vomiting. See October 2017 CAPRI records. In October 2016, he reported being treated for migraines more than 10 times a month. He takes medication and usually stays in a darkened room where he sleeps to get rid of the headache, which can often take the entire day. The impact is so severe he is no longer secure in his employment. See October 2016 NOD. An October 2016 treatment record shows he reported having a headache for two and a half days. He had attempted to work through the migraine with usual home treatments but found himself crying uncontrollably. His emotions restored about three to four hours later. He reported that his work product was suffering. During the evaluation he was more comfortable with the lights dim in the room due to the migraine effect. His work stress level was high and triggered the onset of the migraine. He was presented with FMLA paperwork. See October 2017 CAPRI records. In a March 2017 statement from his wife, she reported that the Veteran routinely had migraines to the point where he needed to sleep for a few hours before feeling better and that this happened once or twice a week. See July 2017 Buddy/Lay Statement. Episodes of headaches were also reported in June 2017 and they were without aura and status migrainosis. In July 2017, he reported having a three day history of recurrent migraine headaches that had not responded to his usual medication, so he requested a shot. The clinician indicated that during the examination the Veteran reported that he preferred to lie down in a dark room. He reported significant improvement after the shot. See September 2017 CAPRI records. A July 2017 note from Dr. L. Rankin states that the Veteran has intractable chronic migraines 15 or more days per month. At least half of these are migraines or respond to migraine medication. He also had nausea, light sensitivity and a foggy head with headaches that worsen with activity. See July 2017 Medical Treatment Record – non-Government Facility. In a July 2017 statement from his employer, D. G., reported that the Veteran suffered from a significant number of migraines and that he often went home early due to the severity of his headaches. He uses sick time, vacation time, and makes up some of the hours, but he still misses a significant amount of work time, which has impacted his productivity. See July 2017 Buddy/Lay Statement. A November 2017 record indicates the Veteran had been missing a lot of work due to his headaches. See March 2019 CAPRI records. In January 2018, he had a headache with nausea and photophobia that he rated 10/10 in severity. See May 2019 CAPRI records. In June 2018, he reported having headaches with nausea and vomiting that had begun two weeks earlier. He indicated there was an increase in frequency of the headaches and requested a shot. See March 2019 CAPRI records. He was seen in September 2018 with a three day history of headaches with associated nausea and light sensitivity that he rated 7/10 in severity. The lights were dimmed to allow him a period of rest. The Veteran reported that the headaches began at work and the headaches had not resolved with his usual medications. See May 2019 CAPRI records. In a February 2020 statement from Dr. L. Rankin, who is a former VA neurologist who has known the Veteran since 2010, the physician stated that the Veteran had longstanding intractable chronic migraines and at that time he had migraines over half of the days of the month and was in the ER frequently. He has had numerous failed trials of oral medications. Quarterly Botox started in 2014 has helped but he still has several debilitating attacks per month which require rest in a dark quiet room. He has very frequent completely prostrating and prolonged attacks of severe economic inadaptability. He used a great deal of his work leave and vacation time for migraine related absences. See March 2020 Medical Treatment Record – Non-Government Facility. During his March 2020 hearing, the Veteran testified that he had missed quite a bit of work due to migraines. He had to use FMLA because he was using all his paid leave. He has not worked since November, but this is mainly due to his anxiety. He could not recall a single week when he did not miss time from work due to migraines (at least once or twice a week). See March 20202 Hearing Transcript. A March 2020 statement from his fiancé says that he gets migraines several times a week and often they are severe enough that even after taking multiple doses of medication he is incapacitated and stays in bed. Sometimes they last for longer than one day. His headaches are the most impactful. See March 2020 Buddy/Lay Statement. Despite the findings on the April 2016 VA examination, the lay statements, medical records, and statements from Dr. L. Rankin and his employer all suggest the disability is more severe than what is contemplated in a 30 percent rating. Instead, the frequency, duration, and severity of his migraines more nearly approximate a level of disability that produces severe economic inadaptability. Thus, a 50 percent rating is assigned. This is the maximum schedular rating for migraine headaches. Thus, a 50 percent rating is warranted throughout the appeal. S. HENEKS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Bredehorst 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.