Citation Nr: 21002596 Decision Date: 01/14/21 Archive Date: 01/14/21 DOCKET NO. 16-41 704 DATE: January 14, 2021 ORDER A 30 percent rating as of April 13, 2016 for migraines is granted. REMANDED Service connection for a right elbow condition is remanded. Service connection for a left knee condition is remanded. Service connection for a right ankle condition is remanded. Service connection for a left ankle condition is remanded. Service connection for a left wrist condition, to include ulnar neuritis, is remanded. Service connection for a right wrist condition, to include ulnar neuritis, is remanded. FINDING OF FACT As of April 13, 2016, the evidence of record shows the Veteran’s migraines were characterized by symptoms similar to characteristic prostrating attacks and occurring on an average once every month over several months. CONCLUSION OF LAW The criteria for a 30 percent rating for migraine headaches as of April 13, 2016, but no earlier, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.124a, Diagnostic Code (DC) 8100. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from August 1991 to September 1996. The Veteran and her husband testified before the undersigned Veterans’ Law Judge in June 2019; a copy of the transcript is a part of the record. An August 2020 rating decision granted service connection for a traumatic brain injury (TBI). As this represents a full grant of benefits sought with respect to this claim the issue of service connection for a TBI is no longer on appeal. Increased Ratings Disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities. 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 required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability is resolved in favor of the Veteran. 38 C.F.R. § 4.3. Migraines The Veteran’s migraines were assigned a noncompensable (0%) rating as of her March 2014 grant of service connection under DC 8100. Under Code 8100, migraine headaches resulting in characteristic prostrating attacks averaging one in two months over the last several months warrant a 10 percent rating. Migraine headaches resulting in characteristic prostrating attacks occurring on an average once a month over the last several months warrant a 30 percent rating. Migraines with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability warrant a 50 percent rating. 38 C.F.R. § 4.124a. The rating criteria does not define “prostrating;” nor has the Court. By way of reference, the Board notes that 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.” A very similar definition is found in DORLAND’S ILLUSTRATED MEDICAL DICTIONARY 1367 (28th Ed. 1994), in which “prostration” is defined as “extreme exhaustion or powerlessness.” After review of the record, the Board finds that the evidence of record does not support a compensable rating for the Veteran’s headaches until VA received a lay statement from her husband on April 13, 2016. Prior to that date, the evidence of record does not show that the Veteran was having headaches with frequency of at least one every two months or more. In August 2015, the Veteran underwent a VA examination regarding her migraine headaches. The examination report stated that she suffered from migraines 3 times per year on average and that the headaches lasted less than 4 hours. The Veteran reported light and sound sensitivity. The examiner found that the Veteran did not have any prostrating attacks of headache or non-headache pain, but that her symptoms were pain on both sides of her head and sensitivity to light and sound. In her June 2019 hearing testimony, the Veteran stated that she did not recall reporting her headaches only occurred three times a year. However, private medical records submitted by the Veteran which document medical treatment from 2014 through 2015 show that the Veteran did not have complaint of or treatment for headaches and did not report taking any medication for treatment of headaches during that time. Thus, the objective medical evidence of record does not support a finding that the Veteran’s headaches occurred at least one every two months or more prior to April 13, 2016, which is a necessary finding to support a compensable rating under DC 8100. However, on April 13, 2016, VA received a lay statement from the Veteran’s husband which reported that the Veteran suffered from headaches once or twice a month which required the Veteran to retire to bed, with a pillow over her head, along with ice packs. He stated the headaches forced her to stay in her room for up to two days until her headache resolved. In her June 2019 hearing testimony, the Veteran reported that her headaches occur every 1-2 weeks and that when she is suffering from a headache she had to go into a dark room, have silence, and be alone for 2-3 hours. A 2019 VA examination reported that the Veteran’s headaches caused nausea, sensitivity to light and sound and caused pulsating or throbbing head pain which occurred on both sides of her head. Based on these findings and the lay testimony of the Veteran and her husband, as well as resolving any reasonable doubt in favor of the Veteran, the Board finds that her headaches warrant a 30 percent rating as of her husband’s April 13, 2016, statement. At that time, the evidence of record showed that the Veteran’s headaches were occurring on an average once a month over the last several months. Though the Veteran’s VA examination did not find that the Veteran’s headaches qualified as “prostrating attacks” the Board notes the aforementioned definitions and finds that the Veteran’s headaches meet such a criteria. The Veteran’s headaches render her helpless – as she has to go into a dark and quiet room for extended periods of time. Resolving reasonable doubt in favor of the Veteran, the Board finds that the evidence of record supports a rating of 30 percent for her headaches. However, there is no evidence which supports a finding that the Veteran’s headaches cause severe economic inadaptability and the Veteran, and her representative have not identified or introduced any such evidence in the record. REASONS FOR REMAND Right Elbow, Left Knee, Right Ankle, Left Ankle, Left Wrist, and Right Wrist The Veteran has sought service connection for the above listed conditions. VA examinations in 2019, however, are inadequate for adjudication purpose. The Board regrets additional delay, however, finds that new examinations are warranted. The Veteran has submitted medical records from her treating chiropractor which has diagnosed disorders of her right elbow, left knee, and bilateral ankles and wrists. However, the 2019 VA examinations did not address these diagnoses in rendering of the opinions that no such diagnoses disorders existed. Specifically, the examination of the Veteran’s bilateral wrists indicated that no nerve condition of the Veteran’s wrists existed but stated the Veteran did have symptoms attributable to a peripheral nerve condition. As such, the Board finds that new examinations are warranted. The matters are REMANDED for the following action: Schedule the Veteran for an appropriate VA examination, with a physician (M.D.), to evaluate the nature and etiology of her claimed disabilities. The claims file should be made available to the examiner(s) and reviewed in conjunction with the examinations(s). All diagnostic testing deemed necessary should be conducted. The examiner is asked to identify any and all diagnosed disabilities of the Veteran’s right elbow, left knee, bilateral ankles, and bilateral wrists. In doing so, the examiner is asked to review and address the medical records of Natural Choice Chiropractic which appears to have diagnosed disorders of the Veteran’s right elbow, left knee, bilateral ankles, and bilateral wrists. (Continued on the next page)   For all diagnosed disabilities of the Veteran’s right elbow, left knee, bilateral ankles, and bilateral wrists, the examiner is asked to opine whether it is at least as likely as not (50 percent or greater probability) that any such disability was incurred in, or due to, the Veteran’s service. The lay statements of record, including the Veteran and her husband’s June 2019 hearing testimony should be recorded and considered. JOHN Z. JONES Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Parrish, 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.