Citation Nr: 21003826 Decision Date: 01/22/21 Archive Date: 01/22/21 DOCKET NO. 12-20 069 DATE: January 22, 2021 ORDER A rating in excess of 20 percent for a right shoulder disability is denied. A rating in excess of 10 percent for folliculitis is denied. A 50 percent rating for migraine headaches prior to August 16, 2019, is granted. FINDINGS OF FACT 1. The Veteran’s right shoulder disability is manifested by limitation of motion at the shoulder level of the major extremity. 2. The Veteran’s folliculitis is manifested by no more than topical therapy required over the past 12-month period and characteristic lesions involving less than 5 percent of the entire body affected. 3. Prior to August 16, 2019, the Veteran experienced migraines with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 20 percent for a right shoulder disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5201. 2. The criteria for a rating in excess of 10 percent for folliculitis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.118, Diagnostic Code 7806. 3. The criteria for a 50 percent rating, but no higher, for migraine headaches prior to August 16, 2019, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8100. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran, who is the appellant in this case, had service from February 1988 to December 1997, including service in Southwest Asia. He received the Combat Action Ribbon, among other decorations, for this service. The Board previously considered this appeal in March 2019, and remanded these issues for additional development. After the development was completed, the case returned to the Board for further appellate review. Subsequently, a December 2019 rating decision granted service connection for a cervical spine disability and a right hand disability. As a result, these two issues are no longer before the Board. Increased Ratings Disability ratings are determined by applying the criteria set forth in the VA’s Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate Diagnostic Codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The basis of disability evaluations is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10. In determining the severity of a disability, the Board is required to consider the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the Veteran, as well as the entire history of the Veteran’s disability. 38 C.F.R. § 4.1, 4.2; Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991). If the disability more closely approximates the criteria for the higher of two ratings, the higher rating will be assigned; otherwise, the lower rating is assigned. 38 C.F.R. § 4.7. When after careful consideration 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. Additionally, the evaluation of the same disability under several Diagnostic Codes, known as pyramiding, must be avoided. Separate ratings may be assigned for distinct disabilities resulting from the same injury so long as the symptomatology for one condition is not duplicative of or overlapping with the symptomatology of the other condition. 38 C.F.R. § 4.14; Esteban v. Brown, 6 Vet. App. 259, 262 (1994). 1. A rating in excess of 20 percent for a right shoulder disability. The Veteran contends that he is entitled to a higher rating because his right shoulder disability symptoms have increased in severity since his initial rating was assigned. Where, as here, an increase in the level of a disability is at issue, the primary concern is the present level of disability. Francisco v. Brown, 7 Vet. App. 55 (1994). Where the evidence contains factual findings that demonstrate distinct time periods in which the service-connected disability exhibits symptoms that would warrant different evaluations during the course of the appeal, the assignment of staged ratings is appropriate. See Hart v. Mansfield, 21 Vet. App. 505 (2007). The Veteran’s right shoulder disability is rated under 38 C.F.R. § 4.71a, Diagnostic Code 5202, for other impairment of the humerus. Under Diagnostic Code 5202, malunion of the humerus with moderate deformity warrants a 20 percent rating for both the major and minor extremity. Malunion of the humerus with marked deformity warrants a 20 percent rating for the minor extremity and a 30 percent rating for the major extremity. Recurrent dislocation of the humerus at scapulohumeral joint with infrequent episodes and guarding of movement only at shoulder level warrants a 20 percent rating for both the major and minor extremity. Recurrent dislocation of the humerus at scapulohumeral joint with frequent episodes and guarding of all arm movements warrants a 20 percent rating in the minor extremity and a 30 percent rating in the major extremity. Fibrous union of the humerus warrants a 40 percent rating in the minor extremity and a 50 percent rating in the major extremity. Nonunion of the humerus (false fail joint) warrants a 50 percent rating in the minor extremity and a 60 percent rating in the major extremity. Loss of head of the humerus (flail shoulder) warrants a maximum 70 percent rating for the minor extremity and a maximum 80 percent rating for the major extremity. 38 C.F.R. § 4.71a, Diagnostic Code 5202. According to MERRIAM WEBSTER, “moderate” means “tending toward the mean or average amount or dimension”. See www.merriam-webster.com/dictionary/moderate. “Marked” means “having a distinctive or emphasized character”. See www.merriam-webster.com/dictionary/marked. Under Diagnostic Code 5201, limitation of motion of the arm at shoulder level warrants a 20 percent rating for both the major and minor extremity. Limitation of motion of the arm midway between side and shoulder warrants a 20 percent rating for the minor extremity and a 30 percent rating for the major extremity. Limitation of motion of the arm to 25 degrees from side warrants a maximum 30 percent rating for the minor joint and a maximum 40 percent rating for the major joint. 38 C.F.R. § 4.71a, Diagnostic Code 5201. According to 38 C.F.R. § 4.71, Plate I, normal forward elevation (flexion) and abduction of the shoulder is from 0 to 180 degrees. Normal internal and external rotation are from 0 to 90 degrees. 38 C.F.R. § 4.71a. Diagnostic Code 5201 “does not provide separate ratings for limitation of motion in the flexion and abduction planes, but rather is addressed generically to limitation of motion of the arm.” Yonek v. Shinseki, 722 F.3d 1355, 1358 (Fed. Cir. 2013). When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) (“[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran’s disability, after which a rating is determined based on the § 4.71a criteria.”). Under 38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis; however, 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. See Burton v. Shinseki, 25 Vet. App. 1 (2011). In Correia v. McDonald, 28 Vet. App. 158 (2016), the Court held that the final sentence of 38 C.F.R. § 4.59 requires that the examiner record the results of range of motion testing “for pain on both active and passive motion [and] in weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint.” In Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court held that VA examiners must obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment of flares from the veterans themselves, when a flare-up is not observable at the time of examination. The Board finds that the preponderance of the evidence is against a rating in excess of 20 percent for a right shoulder disability. The evidence of record shows that the Veteran is right-handed as noted on the August 2019 VA examination. The Veteran was afforded examinations in 2010, 2016 and 2019. During the April 2010 examination, the Veteran described progressively worse pain on the anterior and posterior aspects of the shoulder, associated with weakness and stiffness. Flare ups occurred several times a week and lasted 30 minutes to one hour until medications worked. He treated with medication and physical therapy and a TENS unit. He denied having injections or surgery. He did not use an assistive device or sling. He indicated he was right-handed. There was no evidence of atrophy. Range of motion was flexion to 150 degrees, abduction from 0 to 120, external rotation 0 to 80 and internal rotation 0 to 65 degrees. Repetitive motion caused increased pain. He had a positive Hawkins test. Yergason’s test was negative. The February 2016 VA examination reflected progressive pain, stiffness and weakness. The Veteran denied interval trauma, surgery or articular injection. Treatment included medication, activity modification and physical therapy. Flare-ups involved pain, stiffness and weakness and functional loss involved limited overhead activities, throwing, lifting and carrying. Flexion was found from 0 to 165 degrees, abduction was 0 to 165, external and internal rotation were from 0 to 70 degrees. There was pain with weight bearing and evidence of mild tenderness to palpation AC joint and evidence of crepitus. There was no additional functional loss after repetitive testing. The examiner also indicated pain, weakness, fatigability or incoordination did not significantly limit functional ability with repeated use. There was no ankylosis. There was dislocation and AC joint arthritis of the clavicle which affected range of motion and resulted in tenderness on palpation. Cross-body adduction test was positive. There was no impairment of the humerus. The August 2019 VA examination noted the Veteran described the shoulder was worse and he could not lift it over his head and had to use his left arm for everything. He reported he was right hand dominant. He described daily flare-ups that were moderate and can last 6 hours. It was precipitated by pulling arm, lifting and was alleviated by rest or medication. Flexion was from 0 to 110 degrees, abduction was from 0 to 90 degrees and external and internal rotation were from 0 to 90 degrees. There was pain with flexion and abduction and evidence of tenderness to palpation in the posterior superior location of mild severity. There was no change in range of motion after repetitive testing. There was no ankylosis. Hawkins test was positive but empty-can test, external rotation/infraspinatus strength test and lift-off subscapularis test were negative. He had instability, dislocation or labral pathology. Crank apprehension and relocation test was negative. There was clavicle dislocation which affected motion and resulted in tenderness to palpation and cross body adduction test was positive. There was no evidence of an impairment of the humerus. The Board acknowledges the Veteran’s lay reports of symptoms and that there was functional loss due to daily pain, weakened movement, excess fatigability, repetitive use, pain during flare-ups, and pain during repetitive use over time. However, even considering the Veteran’s lay reports of symptoms and noted functional loss, the degree of additional limitation reflected by the statements that he has daily, moderate to severe flare-ups would not result in symptoms more nearly approximating malunion of the humerus with marked deformity of the major joint, recurrent dislocation of the humerus at scapulohumeral joint with frequent episodes and guarding of all movements of the major joint, fibrous union of the humerus, nonunion of the humerus, or loss of head of the humerus. Moreover, the Veteran’s lay reports of symptoms and noted functional loss would not result in symptoms more nearly approximating limitation of motion of the arm midway between side and shoulder level of the major extremity or limitation of motion of the arm to 25 degrees from the side of the major extremity. The objective medical evidence of record does not show the Veteran’s range of motion was less than at shoulder level during initial or repetitive use testing. All examinations reflect range of flexion and abduction far greater than 45 degrees and rotation greater than 45 degrees. The examiners also conducted repetitive testing and found no change in the motion after repetition. The August 2019 VA examiner also found that the Veteran’s right shoulder pain, weakness, fatigability, or incoordination did not significantly limit functional ability with flare-ups. In addition, the VA examiner did not find the Veteran had a history of recurrent right shoulder dislocation the glenohumeral joint, but the Veteran did have dislocation of the acromioclavicular separation or sternoclavicular dislocation with tenderness that affected range of motion. There was no other impairment of the humerus, to include loss of head, nonunion, or fibrous union or moderate or marked deformity. The humerus condition did not affect range of motion of the right shoulder joint. The Board has considered whether any other Diagnostic Codes related to disabilities of the shoulder would provide for a higher disability rating. However, the evidence does not reflect that the symptoms would warrant a higher rating under a different Diagnostic Code. See 38 C.F.R. § 4.71a. The evidence does not show the Veteran has ankylosis, and to the extent there is impairment of the humerus, clavicle, or scapula, the evidence does not show that a higher rating than the current 20 percent evaluation is warranted. In conclusion, the Board finds that the preponderance of the evidence is against the Veteran’s appeal for a rating in excess of 20 percent for a right shoulder disability. All evidence has been considered and there is no doubt to be resolved. See 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7. Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). 2. A rating in excess of 10 percent for folliculitis. The Veteran asserts that he is entitled to a higher rating because his condition has worsened and he experiences more frequent flare-ups. Where, as here, an increase in the level of a disability is at issue, the primary concern is the present level of disability. Francisco v. Brown, 7 Vet. App. 55 (1994). Where the evidence contains factual findings that demonstrate distinct time periods in which the service-connected disability exhibits symptoms that would warrant different evaluations during the course of the appeal, the assignment of staged ratings is appropriate. See Hart v. Mansfield, 21 Vet. App. 505 (2007). The Veteran’s folliculitis is rated under Diagnostic Code 7806, for dermatitis or eczema. VA amended the criteria for rating skin disabilities effective from August 13, 2018. These new regulations apply to all applications for benefits received by VA or that are pending before the agency of original jurisdiction on or after August 13, 2018. Claims pending prior to the effective date will be considered under both old and new rating criteria, and whatever criteria is more favorable to the veteran will be applied. The Board may not apply a current regulation prior to its effective date, unless the regulation explicitly provides otherwise. Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). However, the Board is not precluded from applying prior versions of the applicable regulation to the period on or after the effective dates of the new regulation if the prior version was in effect during the pendency of the appeal. Prior to August 13, 2018, under Diagnostic Code 7806, a noncompensable rating is assigned for less than 5 percent of the entire body or less than 5 percent of exposed areas affected, and; no more than topical therapy required during the past 12 months. A 10 percent rating is assigned for at least 5 percent, but less than 20 percent, of the entire body, or at least 5 percent, but less than 20 percent, of exposed areas affected, or; intermittent systemic therapy such as corticosteroids or other immunosuppressive drugs required for a total duration of less than six weeks during the past 12-month period. A 30 percent rating is assigned for 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected, or; systemic therapy such as corticosteroids or other immunosuppressive drugs required for a total duration of six weeks or more, but not constantly during the past 12-month period. A 60 percent rating is assigned for more than 40 percent of the entire body or more than 40 percent of exposed areas affected, or; constant or near- constant systemic therapy such as corticosteroids or other immunosuppressive drugs required during the past 12- month period. Or rate as disfigurement of the head, face, or neck (DC 7800) or scars (DC’s 7801, 7802, 7803, 7804, or 7805), depending on the predominant disability. 38 C.F.R. § 4.118, Diagnostic Code 7806. For claims filed prior to August 13, 2018, the Court held that a systematic therapy is one that that affects the entire body in its treatment of the condition at issue, and that the Board must determine (1) whether a topical treatment affects the body as a whole in treating a veteran’s skin condition; and (2) whether the given treatment is “like” a corticosteroid or other immunosuppressive drug.” Burton v. Wilkie, 30 Vet. App. 286 (2018). Only the second question need be addressed if the treatment is clearly systemic. Id. Effective August 13, 2018, VA regulations explicitly state that systemic therapy is treatment that is administered through any route other than the skin, and topical therapy is treatment that is administered through the skin. 38 C.F.R. § 4.118(a). Additionally, effective August 13, 2018, a new General Rating Formula for the Skin applies to Diagnostic Codes 7806, 7809, 7813 to 7816, 7820 to 7822, and 7824. See 38 C.F.R. § 4.118. Under this formula, a noncompensable rating is assigned for no more than topical therapy required over the past 12-month period and at least one of the following: characteristic lesions involving less than 5 percent of the entire body affected; or characteristic lesions involving less than 5 percent of exposed areas affected. A 10 percent rating is assigned for at least one of the following: characteristic lesions involving at least 5 percent, but less than 20 percent, of the entire body affected; or at least 5 percent, but less than 20 percent, of exposed areas affected; or intermittent systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required for a total duration of less than 6 weeks over the past 12- month period. A 30 percent rating is assigned at least one of the following: characteristic lesions involving more than 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected; or systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required for a total duration of 6 weeks or more, but not constantly, over the past 12-month period. A 60 percent rating is assigned for at least one of the following: characteristic lesions involving more than 40 percent of the entire body or more than 40 percent of exposed areas affected; or constant or near-constant systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, psoralen with long-wave ultraviolet-A light (PUVA), or other immunosuppressive drugs required over the past 12-month period. Or rate as disfigurement of the head, face, or neck (DC 7800) or scars (DC’s 7801, 7802, 7803, 7804, or 7805), depending on the predominant disability. 38 C.F.R. § 4.118, General Rating for the Skin for DCs 7806, 7809, 7813-7816, 7820-7822, and 7824. Here, the evidence of record demonstrates that the predominant disability is folliculitis as shown by the March 2016 VA examination. The Board finds that the preponderance of the evidence is against the assignment of a rating in excess of 10 percent under the pre-August 13, 2018, regulations because the Veteran’s folliculitis does not more nearly approximate 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected, or; systemic therapy such as corticosteroids or other immunosuppressive drugs required for a total duration of six weeks or more, but not constantly during the past 12-month period. The objective medical evidence including the 2010 and 2016 examinations, does not show the Veteran uses systemic therapy or other immunosuppressive drugs to treat his folliculitis. Furthermore, he does not have symptoms in his exposed body surface areas and his total body area affected is less than five percent. Rather, the 2016 examination reported a total body surface area of 1 % and exposed body surface area of 0%. The June 2010 examination estimated hyperpigmentation and inflamed follicles occupy less than perhaps 10 % of total body skin area and 0% of exposed body skin area. The Board finds that the preponderance of the evidence is against the assignment of a rating in excess of 10 percent under the August 13, 2018, regulations because the Veteran’s folliculitis does not more nearly approximate characteristic lesions involving more than 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected; or systemic therapy required for a total duration of 6 weeks or more, but not constantly, over the past 12-month period. The June 2019 VA addendum examination clarified that there is no objective evidence showing the Veteran’s use of systemic corticosteroids or immunosuppressive medication for folliculitis. The Board acknowledges that the Veteran believes that the disability on appeal has been more severe than the assigned disability rating reflects. Moreover, the Veteran is competent to report observable symptoms, to include flare-ups during hot and humid weather and also underneath clothing areas, and his reports are credible. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). However, medical treatment records do not show that the Veteran’s disability more nearly approximates the criteria in the next higher rating. The Board has considered whether any other Diagnostic Codes related to disabilities of the skin would provide for a higher disability evaluation. However, the evidence does not reflect that he would warrant a higher rating under a different diagnostic code. See 38 C.F.R. § 4.118. The March 2016 VA examiner reported the Veteran’s scars due to folliculitis were not painful or unstable. Moreover, the scars did not measure at least six square inches or more and are not located on the head, face, or neck. In conclusion, the Board finds that the preponderance of the evidence is against the Veteran’s claim of a rating in excess of 10 percent for folliculitis. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). 3. An initial compensable rating for migraine headaches prior to August 16, 2019. The Veteran contends that he is entitled to a higher rating prior to August 16, 2019, because his migraine headache symptoms are more severe than the noncompensable rating assigned. Where, as here, the appeal for a higher rating for migraine headaches arises from the original assignment of a disability evaluation following an award of service connection, the severity of the disability at issue is to be considered during the entire period from the initial assignment of the disability rating to the present time. Where the evidence contains factual findings that demonstrate distinct time periods in which the service-connected disability exhibits symptoms that would warrant different evaluations during the course of the appeal, the assignment of staged ratings is appropriate. See Fenderson v. West, 12 Vet. App. 119 (1999). Migraine headaches are rated pursuant to 38 C.F.R. § 4.124a, Diagnostic Code (DC) 8100, for migraine. Under DC 8100, a noncompensable rating is warranted for migraines with less frequent attacks. A 10 percent rating is warranted for migraines with characteristic prostrating attacks averaging one in 2 months over the last several months. The rating criteria of DC 8100 are considered successive, meaning that a claimant cannot fulfill the criteria of the higher rating without fulfilling those of the next lower rating. Johnson v. Wilkie, 30 Vet. App. 245, 252 (2018). This renders 38 C.F.R. §§ 4.7 and 4.21 inapplicable. Johnson, 30 Vet. App. at 252. The phrase “characteristic prostrating attacks” is used in the criteria corresponding to 10 percent and 30 percent ratings under DC 8100 to describe the nature and severity of migraines, but it is not defined in the regulation. Pursuant to Dorland’s Illustrated Medical Dictionary 1531 (32d ed. 2012), prostration is defined as “extreme exhaustion or powerlessness.” Thus, the phrase “characteristic prostrating attacks” is understood to describe migraine attacks that typically produce extreme exhaustion or powerlessness. Considering all relevant evidence of record, and resolving reasonable doubt in favor of the Veteran, the Board finds that prior to August 16, 2019, the Veteran had migraine headaches with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability, corresponding to the criteria for a 50 percent rating under DC 8100. The March 2012 VA examination did not find the Veteran had characteristic prostrating attacks averaging one in 2 months over the last several months. However, VA treatment records throughout the appeal period prior to August 16, 2019, show the Veteran’s migraines had increased in severity. Furthermore, he testified at a January 2016 Decision Review Officer hearing that his headaches caused him to stay home four to six times per month. He also explained that taking pain medication was the most helpful treatment to manage his migraine headache symptoms. The Veteran is competent to report his readily observable symptoms. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The March 2016 VA examination revealed the Veteran was prescribed Percocet and took aspirin to manage his migraine headache symptoms. He also received Marcaine injections twice per month at the base of his neck. The Veteran endorsed headaches two to three times per week that lasted for one to two hours. While the March 2016 VA examiner did not classify the Veteran's headaches as "prostrating," it is not clear whether he considered the ameliorative effect of the Veteran using over-the-counter and prescribed pain medications in making this assessment. A March 2018 private treatment record shows the Veteran was admitted for overnight observation due to sudden onset of a severe migraine that caused dizziness and vertigo. A March 2019 statement from the Veteran’s VA treating neurosurgeon notes that the Veteran was advised to avoid lifting and physical activities that bring on exertional headaches related to his service-connected migraine headaches. On VA examination in August 2019, the Veteran endorsed continued migraine headaches that occurred approximately three times per week and required him to lie down in a quiet, darkened room. He still experienced some nausea from his headaches. Bright lights and noises also aggravated this disability. The Veteran said typical migraine medications have not worked. The VA examiner noted the Veteran still took Percocet and Marcaine occipital nerve block injections for his migraines. The VA examiner was asked to assess the expected severity of his service-connected headaches, absent any ameliorative effects from his various medications over the years, pursuant to the pertinent rating criteria. After documenting the Veteran’s lengthy history of migraine symptoms, the VA examiner found he had characteristic prostrating attacks of migraines at least once every month with very frequent prostrating and prolonged attacks productive of severe economic inadaptability. Other findings included symptoms of dizziness, imbalance, nausea, photophobia, phonophobia, and numbness on the right side of his head. The VA examiner found the Veteran’s headaches impacted his ability to work because he suffers from prostrating episodes of post-traumatic headaches three times per week. Throughout the period on appeal, the Veteran has consistently reported having very frequent migraines that are both prostrating and prolonged. He also reported that he has multiple headaches every week. He consistently reported experiencing bouts of nausea, vomiting, and photosensitivity associated with his headaches. It is clear that management of the Veteran's headaches requires him to take medication, and they are not always effective in relieving his migraine pain. Notably, the Court has held that "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). As DC 8100 does not contemplate the effects of medication in alleviating the frequency and duration of the Veteran's headaches, the Board is precluded from considering the relief afforded by the Veteran's medication, if any, in evaluating the severity of his disability. Id. Moreover, after affording the Veteran the benefit of the doubt, the Board finds that the evidence of record demonstrates that his migraine headache symptoms and functional impairment would be worse absent the medication he takes multiple times a week for this condition. As noted above, 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, 26 Vet. App. at 63. All evidence has been considered and there is no doubt to be resolved. See 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7. Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). H. SEESEL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R. Connally, 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.