Citation Nr: 21064475 Decision Date: 10/20/21 Archive Date: 10/20/21 DOCKET NO. 12-23 609 DATE: October 20, 2021 ORDER Entitlement to a rating in excess of 10 percent for a traumatic brain injury (TBI) is denied. FINDINGS OF FACT 1. The service-connected TBI has demonstrated residuals of headaches and mild memory loss as a result of his service-connected TBI. 2. The most severe facet of the TBI has been assigned a "1," and there is no evidence of impaired consciousness. CONCLUSION OF LAW The criteria for a disability rating in excess of 10 percent for TBI have not been met. 38 U.S.C. §§ 1155, 5110 (2012); 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.124a, Diagnostic Code 8045 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty from August 1966 to August 1968. This matter comes before the Board of Veterans' Appeals (Board) from a September 2016 rating decision of a Department of Veterans Affairs (VA) Regional Office, the agency of original jurisdiction (AOJ). In May 2017, the Veteran testified in a videoconference hearing before the undersigned Veterans Law Judge. A copy of the hearing transcript is of record and has been reviewed. As pertinent here, in a September 2016 rating decision, the AOJ reduced the Veteran's disability rating for service-connected TBI with residual skull depression and non-disfiguring scar from 10 percent to noncompensable based on perceived improvements in his symptoms reflected in a September 2016 VA TBI examination. In December 2017, the Board restored the 10 percent rating for TBI residuals effective September 17, 2017, concluding that improvement in the Veteran's symptoms had not been shown by a preponderance of the evidence. 38 C.F.R. §§ 3.105, 4.124a, Diagnostic Code 8045. The Board then remanded the Veteran's claim for a rating in excess of 10 percent for TBI as well as his claim for entitlement to service connection for a lung disability. See Board Decision and Remand dated December 1, 2017. Subsequent to the December 2017 remand, VA granted service connection for the Veteran's lung disability, specifically chronic obstructive pulmonary disease (COPD). VA's March 2020 grant of service connection for COPD is considered a full grant of the benefits on appeal for that claim. As such, the issue of service connection for a lung disability is no longer before the Board for appellate consideration. A.B. v. Brown, 6 Vet. App. 35 (1993). Preliminary Matter The Board has limited the discussion below to the relevant evidence required to support its findings of fact and conclusion of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016). Increased Ratings Applicable Laws and Regulations Generally, disability ratings are determined by applying the rating criteria set forth in VA's Schedule for Rating Disabilities (Rating Schedule) and represent the average impairment of earning capacity. 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 compensation, as well as the whole recorded history of the Veteran's disability. 38 C.F.R. §§ 4.1, 4.2; see generally Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Where there is a question of which of two evaluations shall be applied, the higher evaluation will be assigned if the disability more closely approximates the criteria for that rating. 38 C.F.R. § 4.7. Otherwise, the lower rating is assigned. Id. In general, all disabilities, including those arising from a single disease entity, are rated separately, and all disability ratings are then combined in accordance with 38 C.F.R. § 4.25. Pyramiding, the rating of the same disability, or the same manifestation of a disability, under different diagnostic codes (DC or DCs), is to be avoided when rating a veteran's service-connected disabilities. 38 C.F.R. § 4.14. It is possible for a veteran to have separate and distinct manifestations from the same injury which would permit rating under several DCs; however, the critical element in permitting the assignment of several ratings under various DCs is that none of the symptomatology for any one of the conditions is duplicative or overlapping with the symptomatology of the other condition. Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994). When an unlisted condition is encountered it will be permissible to rate under a closely related disease or injury in which not only the functions affected, but the anatomical localization and symptomatology are closely analogous. Conjectural analogies will be avoided, as will the use of analogous ratings for conditions of doubtful diagnosis, or for those not fully supported by clinical and laboratory findings. Nor will ratings assigned to organic diseases and injuries be assigned by analogy to conditions of functional origin. 38 C.F.R. § 4.20. Hyphenated codes are used when a rating under one DC requires use of an additional DC to identify the specific basis for the evaluation assigned. The additional DC is shown after a hyphen. 38 C.F.R. § 4.27. Where an increase in the level of a service-connected disability is at issue, the primary concern is the present level of disability. See Francisco v. Brown, 7 Vet. App. 55 (1994). Staged ratings are appropriate for any initial rating claim when the factual findings show distinct time periods during the appeal period where the service-connected disability exhibits symptoms that would warrant different ratings. Fenderson v. West, 12 Vet. App. 119, 126 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive and provide the reasons for its rejection of any material favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). A veteran is competent to report symptoms because this requires only personal knowledge, not medical expertise, as it comes to him or her through their senses. See Layno v. Brown, 6 Vet. App. 465 (1994). Lay testimony is competent to establish the presence of observable symptomatology, where the determination is not medical in nature and is capable of lay observation. Barr v. Nicholson, 21 Vet. App. 303 (2007). In evaluating the probative value of a medical opinion, the Board will assess whether (1) the medical opinion is based on sufficient facts and data, (2) the medical opinion is the product of reliable principles and methods, and (3) the medical expert has applied the principles and methods reliably to the case. Nieves-Rodriguez, 22 Vet. App. at 302. Specifically, the Board will determine whether the medical expert was aware of the critical medical facts in the Veteran's medical history and whether the expert provided the sort of factually accurate, fully articulated, and sound reasoning for the opinion that allows the Board to assess whether the expert applied valid medical analysis to the facts of the particular case. Id. at 303-05. When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with a veteran prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. A claimant bears the burden of presenting and supporting his or her claim for benefits. See 38 U.S.C. § 5107(a). Traumatic Brain Injury with Residual Depression and Scar In March 2009, the AOJ granted service connection for the Veteran's TBI with residual skull depression and non-disfiguring scar, and assigned a 10 percent rating under DC 8045, effective March 27, 2009, based on deficits in memory, attention, concentration, and executive functions. See Rating Decision dated September 8, 2010. As discussed above, the Board restored a rating reduction in 2017. See Board decision dated December 1, 2017. Rating Criteria DC 8045 provides evaluation for three main areas of dysfunction that may result from traumatic brain injury and have profound effects on functioning: Cognitive (which is common in varying degrees after a traumatic brain injury), emotional/behavioral, and physical. Each of these areas of dysfunction may require evaluation. 38 C.F.R. § 4.124a, DC 8045. Cognitive impairment is defined as decreased memory, concentration, attention, and executive functions of the brain. Executive functions are goal setting, speed of information processing, planning, organizing, prioritizing, self-monitoring, problem solving, judgment, decision making, spontaneity, and flexibility in changing actions when they are not productive. Not all of these brain functions may be affected in a given individual with cognitive impairment, and some functions may be affected more severely than others. In a given individual, symptoms may fluctuate in severity from day to day. Cognitive impairment is to be evaluated under the table titled "Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified." Id. Emotional/behavioral dysfunction is to be evaluated under § 4.130 (Schedule of ratings--mental disorders) when there is a diagnosis of a mental disorder. When there is no diagnosis of a mental disorder, evaluate emotional/behavioral symptoms under the criteria in the table titled "Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified." Id. Subjective symptoms may be the only residual of traumatic brain injury or may be associated with cognitive impairment or other areas of dysfunction. Subjective symptoms that are residuals of traumatic brain injury are evaluated, whether or not they are part of cognitive impairment, under the subjective symptoms facet in the table titled "Evaluation of Cognitive Impairment and Other Residuals of Traumatic Brain Injury Not Otherwise Classified." However, any residual with a distinct diagnosis that may be evaluated under another DC, such as migraine headache or Meniere's disease, may be separately evaluated even if that diagnosis is based on subjective symptoms, rather than under the "Evaluation of Cognitive Impairment and Other Residuals of Traumatic Brain Injury Not Otherwise Classified" table. Physical (including neurological) dysfunction is to be evaluated based on the following list, under an appropriate DC: Motor and sensory dysfunction, including pain, of the extremities and face; visual impairment; hearing loss and tinnitus; loss of sense of smell and taste; seizures; gait, coordination, and balance problems; speech and other communication difficulties, including aphasia and related disorders, and dysarthria; neurogenic bladder; neurogenic bowel; cranial nerve dysfunctions; autonomic nerve dysfunctions; and endocrine dysfunctions. Id. The preceding list of types of physical dysfunction does not encompass all possible residuals of TBI. For residuals not listed here that are reported on an examination, evaluate under the most appropriate DC. Each condition should be evaluated separately as long as the same signs and symptoms are not used to support more than one evaluation and combine under § 4.25 the evaluations for each separately rated condition. The evaluation assigned based on the "Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified" table will be considered the evaluation for a single condition for purposes of combining with other disability evaluations. Id. The need for special monthly compensation for such problems as loss of use of an extremity, certain sensory impairments, erectile dysfunction, the need for aid and attendance (including for protection from hazards or dangers incident to the daily environment due to cognitive impairment), being housebound, etc. should also be considered. Id. Under DC 8045, the table titled "Evaluation of Cognitive Impairment and Other Residuals of Traumatic Brain Injury Not Otherwise Classified" contains 10 important facets of traumatic brain injury related to cognitive impairment and subjective symptoms. It provides criteria for levels of impairment for each facet, as appropriate, ranging from 0 to 3, and a 4th level, the highest level of impairment, labeled "total." A 100 percent evaluation will be assigned it "total" is the level of evaluation for one or more facets. If no facet is evaluated at "total," the overall evaluation is based on the level of the highest facet as follows: 0 = 0 percent; 1 = 10 percent; 2 = 40 percent; and, 3 = 70 percent. However, not every facet has every level of severity. The "subjective symptoms" facet, for example, provides for an impairment level of 0, 1, or 2, which corresponds to 0 percent; 10 percent; and 40 percent, respectively. Notes are included with DC 8045. Note (1): There may be an overlap of manifestations of conditions evaluated under the table titled "Evaluation of Cognitive Impairment and Other Residuals of Traumatic Brain Injury Not Otherwise Classified" with manifestations of a combined mental or neurologic or other physical disorder that can be separately evaluated under another DC. In such cases, more than one evaluation is not to be assigned based on the same manifestations. If the manifestations of two or more conditions cannot be clearly separated, a single evaluation under whichever set of diagnostic criteria allows the better assessment of overall impaired functioning due to both conditions is to be assigned. However, if the manifestations are clearly separable, a separate evaluation for each condition will be assigned. Note (2): Symptoms listed as examples at certain evaluation levels in the table are only examples and are not symptoms that must be present in order to assign a particular evaluation. Note (3): "Instrumental activities of daily living" refers to activities other than self-care that are needed for independent living, such as meal preparation, doing housework and other chores, shopping, traveling, doing laundry, being responsible for one's own medications, and using a telephone. These activities are distinguished from "Activities of daily living," which refers to basic self-care and includes bathing or showering, dressing, eating, getting in or out of bed or a chair, and using the toilet. Note (4): The terms "mild," "moderate," and "severe" traumatic brain injury, which may appear in medical records, refer to a classification of traumatic brain injury made at, or close to, the time of injury rather than to the current level of functioning. This classification does not affect the rating assigned under DC 8045. Rating Analysis Turning to the evidence for the rating period on appeal, July 2015 VA outpatient treatment notes show that a depression screening was negative. During a neurological/psychiatric assessment, the Veteran was alert and oriented to person, place, and time, and his mood and affect were described as "alert." Except for back pain, a neurological assessment was normal. A July 2015 VA dermatology examination noted a number of scars above the Veteran's waste but makes no reference to a scar associated with the Veteran's head trauma. A July 2015 VA nursing outpatient note shows that the Veteran denied headaches. January 2016 VA treatment notes reflect that the Veteran denied headaches. An April 2016 VA dermatology note identifying scars made no reference to a scar associated with the Veteran's head trauma. An August 2016 VA outpatient treatment record reflects that a depression screening was negative. The Veteran underwent a VA TBI examination in September 2016. The VA examiner noted diagnoses of TBI and headaches attributable to the TBI. The Veteran described being struck in the head with a brick in September 1966 while he was in service. He reported that he has had headaches ever since. The Veteran reported that he retired ten years earlier after working for four years diving for mussels in a river, and prior to that he worked at different jobs after separation from service. At the time of the examination, the Veteran said he was retired, but "does odd repairs round the house." The examiner noted that the Veteran "is not functionally impaired due to [his TBI] and was very functional, and despite retirement does outside tasks and in house chores." On examination, it was noted that the Veteran was negative for impairment of memory, attention, concentration, and executive functions. His judgment was normal, and his social interaction was routinely appropriate. He was always oriented to person, time, place, and situation. Motor activity and visual spatial orientation were normal. The Veteran's subjective symptoms (headaches and migraine headaches) did not interfere with work; instrumental activities of daily living; or work, family, or other close relationships. The Veteran was negative for neurobehavioral effects. The Veteran was able to communicate by spoken and written language (expressive communication) and to comprehend spoken and written language. The Veteran's consciousness was normal. The examiner identified a "small, depressed area high [on the right] parietal skull" associated with the Veteran's TBI but noted that the Veteran had no scars associated with treatment of his TBI. Additionally, the examiner noted that a 2004 head CT revealed microangiopathy. The examiner concluded that the Veteran's TBI residuals did not impact his ability to work. See VA TBI examination dated September 17, 2016. The Veteran underwent a VA headaches examination in September 2016. The diagnosis was posttraumatic headaches. The Veteran noted that he had experienced headaches since his in-service head injury. The Veteran described symptoms of generalized throbbing headache pain that lasted less than one day. He denied non-headache symptoms such as an aura prior to the onset of headache pain. He denied experiencing prostrating attacks of headache pain. The Veteran reported that his headaches had improved, and that medication he was taking for arthritis symptoms, Meloxicam and aspirin, seemed to relieve headache symptoms; however, he told the examiner if he was not on Meloxicam, he "would have low level [headaches] constantly." The Veteran reported that he worked until his retirement, the examiner noting that despite his headaches, the Veteran "has been functional and working [until] retirement" and that his headaches did not impact his ability to work. See VA headaches examination dated September 17, 2016. VA outpatient notes from February 2017 reflect that neurological and psychiatric assessments were normal. In his February 2017 appeal to the Board, the Veteran said he had experienced blurred left eye vision since being struck in the head during service. During the Veteran's May 2017 videoconference Board hearing, he stated that because of his TBI residuals, he has trouble comprehending reading material, necessitating his reading the material over and over to understand it. See Board hearing transcript dated May 23, 2017 at pg. 3. He asserted that he has problems making unfamiliar decisions and is unable to identify, understand, or weigh possible alternatives or understand the consequences of his choices, resulting in bad decisions, although he was unable to provide any examples. Id. at pg. 4. Additionally, the Veteran said his TBI residuals have resulted in his forgetting the names of his grandchildren at times, yet he acknowledged that they live in a different state and he didn't see them very often. Id. Notably, the Veteran said he believes his TBI residuals caused his left eye blurred vision. Id. at pg. 6. February 2018 VA outpatient notes reflect that the Veteran denied any impediments to taking care of his health. Neurological and psychiatric assessments were normal. During a VA outpatient appointment in September 2018, the Veteran arrived alone for the appointment. He denied impediments to taking care of his health. On examination by a VA nurse, the Veteran was alert and oriented, and the nurse noted that there were no concerns regarding the Veteran's physical or cognitive abilities. During an August 2019 VA outpatient appointment, the Veteran denied headache, dizziness, and lightheadedness. He denied suicidal and homicidal ideation. On examination, his cranial nerves II-XII were grossly intact. His gait was steady. In October 2019, the Veteran reported having "memory issues." A January 2020 VA pharmacy note reflects that the pharmacist identified no barriers to the Veteran learning or understanding information relevant to prescribed medications and that he was negative for emotional and psychological factors that might impede his ability to understand information about his medication. The Veteran underwent a VA eye conditions examination in January 2020. The examiner noted diagnoses of bilateral nuclear sclerotic cataracts, and focal scars in the left eye macula attributed to LASER treatment for his prior macular edema due to branch retinal vein occlusion (BRVO). See VA eye conditions examination dated January 20, 2020. The examiner opined that the Veteran's left eye disorder is less likely than not a residual of his service-connected TBI residuals, explaining that the Veteran's macular edema due to BRVO had resolved and was stable, and that it is "unrelated to any TBI the Veteran had." The examiner added, "the Veteran shows no visual manifestations related to the TBI." As to the Veteran's bilateral cataracts, the examiner concluded that "[t]hese are age related and not connected to the TBI." See VA medical opinion dated January 20, 2020. The Veteran underwent a VA TBI examination in February 2020. The VA examiner noted a diagnosis of TBI. The Veteran reported that since his in-service head trauma he has had recurrent headaches. The examiner noted, "It is well within the natural history of traumatic brain injury recurrent headaches may result." The Veteran also endorsed photosensitivity, which he said required that he avoid sunlight when possible. He said he managed by taking acetaminophen as needed. The Veteran noted that over the course of time his headaches had not changed in severity. On examination, regarding impairment of memory, attention, concentration, and executive functions, the Veteran endorsed short term memory difficulty such as recalling recent events, and he said his memory had been declining over the past several years. His judgment was normal, and his social interaction was routinely appropriate. He was always oriented to person, time, place, and situation. His motor activity was normal. The Veteran's visual spatial orientation was mildly impaired in that he found it hard to navigate in unfamiliar places and buildings, however he said he was generally able to navigate with the use of a map. The Veteran's subjective symptoms (recurrent headaches and photophobia) did not interfere with work; instrumental activities of daily living; or work, family, or other close relationships. The Veteran was negative for neurobehavioral effects. The Veteran was able to communicate by spoken and written language (expressive communication) and to comprehend spoken and written language. The Veteran's consciousness was normal. The examiner identified a "small depression of soft tissue on the right parietal scalp" associated with the Veteran's TBI, but noted that the scar was not measurable, and that the Veteran had no scars associated with treatment of his TBI. The examiner concluded that the Veteran's TBI residuals impacted his ability to work in that the Veteran experienced difficulty completing tasks due to "an inefficient manner due to significant loss." See VA TBI examination dated February 11, 2020. The Veteran underwent a VA headaches examination in February 2020. The diagnosis was posttraumatic headaches. The Veteran noted that he had experienced recurrent headaches since his in-service head injury. The Veteran described symptoms of pulsating or throbbing head pain on both sides of his head lasting less than a day, but which worsened with physical activity, and occurred less frequently than once every two months. He described symptoms of nausea, vomiting and sensitivity to light and sound. He took acetaminophen to treat his headache symptoms. He endorsed less frequent characteristic prostrating attacks of migraine and non-migraine headache pain, but which were not productive of severe economic inadaptability. The examiner noted that the Veteran's headaches did not impact his ability to work. See VA headaches examination dated February 11, 2020. In March 2020, a VA nurse contacted the Veteran to follow up on a recent hospital admission for bradycardia, and while on the telephone the Veteran reported he did not feel well and that his head felt funny, and then was disconnected. The VA nurse called to have an ambulance dispatched to the Veteran's home, and ambulance personnel said the Veteran reported nausea, problems walking straight, lightheadedness, and dizziness. His blood pressure was elevated. Ambulance personnel reported that the power to the Veteran's home had gone out and that he was stable. There is no indication the Veteran was transported by ambulance at that time. See VA nursing telephone note and addendum dated March 11, 2020. May 2020 VA treatment records reflect that a depression screening was negative. VA treatment notes dated September 2020 note that the Veteran said he was "having issues with short-term memory." He denied depression, anxiety, hallucinations and delusions. He also denied difficulties with instrumental activities of daily living, and said he was performing housework and shopping with his sister's assistance as needed. He noted he was managing his own finances such as maintaining his checkbook and paying his own bills, although he noted his sister assisted in paying medical bills. A mental status examination reflected that the Veteran was alert and oriented to person, place, and time. During a November 2020 VA neurologic/psychiatric assessment, the Veteran was oriented to person, place, and time. His mood and affect were described as alert, and neurologically he was grossly intact. He denied depressed mood and suicidal ideation. The Veteran denied new onset of headaches, nausea, and vomiting. In October 2020, the Veteran denied lightheadedness and dizziness during a VA care coordination telehealth appointment. During a VA outpatient appointment in November 2020, the Veteran denied new onset of headaches, loss of taste, or smell during a COVID-19 screening. During VA outpatient appointments in December 2020 the Veteran said his sisters checked on him daily. The Veteran denied lightheadedness and dizziness. However, the following week, the Veteran endorsed being lightheaded and dizzy after nebulizer treatments. March 2021 VA treatment records reflect that the Veteran reported increased back pain, lightheadedness and dizziness. On examination, he denied depression, anxiety, hallucinations, and delusions. The Veteran indicated that he lived alone, had no unpaid caregiver, and had no one he relied upon for any type of support, although he noted that he was unable to drive, and his sister drove him to all of his appointments. It was noted that the Veteran has problems or deficits in three or more activities of daily living, but that the complexity of the Veteran's care needs is not greater than VA home telehealth services alone can provide. Additionally, VA direct care staff did not think the Veteran was capable of increased independence in activities of daily living or mobility. In April 2021, the Veteran denied lightheadedness and dizziness. Additionally, an assessment during an April 2021 VA outpatient appointment noted normal neurological functioning. Upon review of the evidence of record, both lay and medical, the Board finds that the Veteran's memory, attention, concentration, and executive functions facet is assigned level "1" severity based on the Veteran's memory loss, described as short term memory difficulty such as recalling recent events, as reflected in the February 2020 VA TBI examination report. Thus, with regards to the specific criteria facets under DC 8045, Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Specified, the Board finds the following: (1) Memory, Attention, Concentration, Executive Functioning: The Veteran's memory, attention, concentration, and executive functions facet is assigned level "1" severity based on the Veteran's memory loss, described as short term memory difficulty such as recalling recent events, as reflected in the February 2020 VA TBI examination report, and which is consistent with other objective medical evidence of record, including the March 2021 VA treatment notes reflecting difficulty remembering medication dosages and times. Although the Veteran is competent to describe memory and cognitive symptoms, he has personally experienced, see Layno, supra, he has not been shown to be competent to objectively diagnose memory deficiencies, cognitive dysfunctions, or impairment of executive functions. The Board finds the objective evaluations by VA clinicians to be the most probative evidence of record in this regard. Accordingly, the Board finds that the evidence of record warrants a "1" for this TBI facet. (2) Judgment: A level of severity of "0" has been assigned for the judgment facet based on the Veteran's judgment being normal throughout the rating period. A higher level of severity of "1" is not warranted unless the evidence demonstrates mildly impaired judgment for complex or unfamiliar decisions, occasionally unable to identify or understand, and weigh the alternatives, understand the consequences of choices, and make a reasonable decision. Although the Veteran generally asserted during the May 2017 Board hearing that he experienced the precise symptoms reflected in the rating criteria for a higher facet, the Veteran and his representative were unable to provide any examples of impaired judgment, and none are indicated in the treatment records. Notably, the Veteran's judgment was assessed as normal during the September 2016 and February 2020 VA TBI examinations, and impaired judgment was not identified as a symptom of the Veteran's psychiatric disorders during a February 2020 VA mental disorders examination. Thus, the Board is unable to assign a higher level of severity for this facet. (3) Social Interaction: A level of severity of "0" is also assigned for the social interaction facet based on the examiner's finding that the Veteran's social functioning was routinely appropriate. A higher level of severity of "1" is not warranted unless the Veteran demonstrates social interaction that is occasionally inappropriate. At no time throughout the appeal period is the Veteran deemed to be even slightly inappropriate in his social interactions by any treating physician or examiner; nor does the Veteran assert that he has any inappropriate behavior during the appeal period. The Board is therefore unable to assign a higher level of severity for this facet. (4) Orientation: A level of severity of "0" has been assigned for the orientation facet as the Veteran was noted to be always oriented to person, time, place, and situation. A higher level of severity of "1" is not warranted unless there is evidence of being occasionally disoriented to one of the four aspects (person, time, place, and situation) of orientation. At no time throughout the rating period on appeal is the Veteran deemed to have been occasionally disoriented to one of the four aspects of orientation. Thus, the Board cannot assign a higher level of severity for this facet. (5) Motor Activity: A level of severity of "0" is assigned for the motor activity facet based on normal motor activity. A higher level of severity of "1" is not warranted unless the evidence demonstrates that his motor activity is mostly normal, but mildly slowed at times due to apraxia. The evidence does not indicate that the Veteran's motor activity throughout the appeal period has met this facet. Thus, the Board is unable to assign a higher level of severity for this facet. (6) Visual Spatial Orientation: A level of severity of "1" is assigned for the visual spatial orientation facet based on the February 2020 VA TBI examiner's finding that the Veteran's visual spatial orientation is mildly impaired. The Board finds the objective evaluations by VA clinicians to be the most probative evidence of record in this regard. A higher level of severity of "2" is not warranted unless the evidence demonstrates moderate impairment, such as usually getting lost in unfamiliar surroundings, has difficulty reading maps or following directions, and is unable to use assistive devices such as GPS. The above record does not support a finding that the Veteran has been moderately impaired in his visual spatial orientation. Thus, the Board is unable to assign a higher level of severity for this facet. (7) Subjective Symptoms: A level of severity of "1" is assigned for the subjective symptoms facet for the Veteran's subjective reports of headaches. The Board finds that the Veteran's subjective symptoms do not interfere with work, instrumental activities of daily living, or work, family or other close relationships throughout the appeal period, as demonstrated in the above evidence. A higher level of severity of "2" is not warranted unless there are three or more subjective symptoms that moderately interfere with those areas of the Veteran's functioning, examples being marked fatigability, blurred or double vision, and headaches requiring rest periods during most days. See 38 C.F.R. § 4.124a, DC 8045. The September 2016 VA and February 2020 TBI examination reports list the Veteran's subjective symptoms as headaches and headaches with photophobia, respectively. However, in both instances, the symptoms were determined not to interfere with the Veteran's work, instrumental activities of daily living, or work, family or other close relationships. During the September 2016 VA headaches examination, it was determined that the Veteran's headaches did not impact his ability to work, and during the February 2020 VA headaches examination, he denied headache pain resulting in severe economic adaptability, and the examiner concluded that headaches resulted in no functional impact. Additionally, during the January 2020 VA eye conditions examination, the VA examiner opined that "the Veteran shows no visual manifestations related to the TBI." Moreover, the examiner determined that the Veteran's left eye blurred vision was a residual of LASER surgery for macular edema and his bilateral cataracts were age-related. No evidence of record weighs against these findings. The Board is therefore unable to assign a higher level of severity for this facet. (8) Neurobehavioral Effects: A level of severity of "0" has also been assigned for the neurobehavioral effects facet because no neurobehavioral effects were noted. A higher level of severity of "1" is not warranted unless the Veteran has one or more neurobehavioral effects that occasionally interfere with workplace interaction, social interaction, or both, but do not preclude them. At no time throughout the appeal period has the Veteran demonstrated one or more neurobehavioral effects. Thus, the Board is unable to assign a higher level of severity for this facet. (9) Communication: A level of severity of "0" is assigned for the communication facet based on the Veteran's ability to communicate by spoken and written language, and to comprehend spoken and written language. A higher level of severity of "1" is not warranted unless comprehension or expression, or both, of either spoken or written language is occasionally impaired, and the Veteran is generally able to communicate complex ideas. The Board recognizes that the February 2020 VA mental disorders examiner suggested that the Veteran was essentially unable to communicate without the assistance of his sister, who accompanied him to the examination. However, the mental disorders examination is inconsistent with the VA TBI examination conducted the same day and treatment records the post-date the February 2020 examinations, which reflect no impairment in either spoken or written language, in either comprehension or expression, or an inability to communicate complex ideas. Thus, the Board is unable to assign a higher level of severity for this facet. (10) Consciousness: A level of severity of "0" is assigned for the consciousness facet as the record reflects that the Veteran's consciousness is normal throughout the appeal period, as demonstrated in the above evidence. A higher level of severity of "Total" is not warranted unless there is evidence of persistently altered state of consciousness, such as a vegetative state, minimally responsive state, or coma. The evidence of record demonstrates that the Veteran is not in a persistently altered state of consciousness throughout the appeal period. Thus, the Board is unable to assign a higher level of severity for this facet. In short, the Veteran has been assigned a "1" as the highest severity level with regard to any of the ten facets, as discussed above. Such an evaluation is commensurate to a 10 percent rating under DC 8045. See 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.10, 4.124a, DC 8045. Consequently, regarding the overall rating the benefit-of-the-doubt rule does not apply, and an evaluation in excess of 10 percent for the Veteran's TBI residuals under DC 8045 is not warranted. See 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3; Gilbert, 1 Vet. App. at 55. Nevertheless, the Board must also consider whether the Veteran is entitled to a rating under any other potentially applicable DC. See Schafrath v. Derwinski, 1 Vet. App. 589, 593 (1991) (regardless of the precise basis of a veteran's disability rating, the Board has a duty to acknowledge and consider all regulations and DC s that are potentially applicable). Separate disability ratings may be assigned for distinct disabilities resulting from the same injury so long as none of the symptomatology for one condition is "duplicative of or overlapping with the symptomatology" of the other disability. See Esteban, 6 Vet. App. at 262. The Veteran has been assigned a 100 percent disability rating for his service-connected depressive disorder with anxiety disorder associated with TBI residuals, effective July 19, 2016, the date of commencement of the rating period on appeal. See Rating Decision dated March 9, 2020; 38 C.F.R. § 4.130. Accordingly, there is no higher disability rating which may be granted for the Veteran's depressive disorder with anxiety disorder. The Veteran's TBI disability includes a "non-disfiguring scar." There are several diagnostic codes that pertain to scars. Diagnostic Code 7801 applies to burn scars or scars due to other causes, not of the head, face, or neck, that are deep and nonlinear. 38 C.F.R. § 4.118, DC 7801. A deep scar is one that is associated with underlying soft tissue damage. Id. at Note 1. Diagnostic Code 7802 allows for a 10 percent rating for burn scars or scars due to other causes, not of the head, face, or neck, that are superficial and nonlinear, and that cover an area of 929 square centimeters or more. 38 C.F.R. § 4.118, DC 7802. A superficial scar is one that is not associated with underlying soft tissue damage. Id. at Note 1. Diagnostic Code 7804 allows for compensable ratings for unstable or painful scars. 38 C.F.R. § 4.118, DC 7804. An unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. Id. at Note 1. Under DC 7804, a 10 percent rating is warranted for one or two scars that are unstable (frequent loss of covering of the skin over the scar) or painful. Id. at Note (2). According to Diagnostic Code 7805, which applies to other scars (including linear scars) and other effects of scars evaluated under Diagnostic Codes 7800, 7801, 7802, and 7804, VA is to evaluate any disabling effect(s) not considered in a rating provided under such Diagnostic Codes under an appropriate diagnostic code. 38 C.F.R. § 4.118, DC 7805. Here, the record reflects that the scar associated with the Veteran's TBI has been characterized as non-existent, see VA headaches examination dated September 17, 2016, or "not measurable," see VA TBI examination dated February 11, 2020. The evidence does not reflect that what has been characterized as the Veteran's scar is painful or unstable, resulted from a burn, involves underlying soft tissue damage, is superficial and nonlinear, or that it covers an area of 929 square centimeters or more. There is no basis upon which to grant a separate and/or higher rating under any other applicable diagnostic code pertaining to scars. Moreover, the scar associated with the Veteran's TBI has not had any disabling effects. Accordingly, a separate rating for the scar is not warranted. The Veteran is service-connected for migraine-tension headaches associated with his TBI residuals, separately rated as 30 percent disabling under DC 8100. Under DC 8100, a 30 percent rating is assigned for migraines with characteristic prostrating attacks occurring on an average once a month over a several month period. A 50 percent rating, the maximum schedular rating allowed, is assigned for migraines with very frequent completely prostrating and prolonged attacks that are productive of severe economic inadaptability. 38 C.F.R. § 4.124a, DC 8100. Here, while January 2016 VA treatment notes reflect that the Veteran denied headaches, the September 2016 and February 2020 VA TBI and headaches examinations reflect that the Veteran reporting recurrent headaches throughout the rating period. The September 2016 VA headaches examination does not reflect the frequency of the headaches and the Veteran denied experiencing prostrating attacks of headache pain. However, during the February 2020 examination, the Veteran endorsed headaches occurring less frequently than every two months, including characteristic prostrating attacks of migraine and non-migraine headache pain, but which were not productive of severe economic inadaptability. The Board finds that these symptoms approximate the criteria for the currently assigned 30 percent rating. A higher rating of 50 percent is not warranted as the record does not reflect that the Veteran has "very frequent" completely prostrating and prolonged attacks of headache pain productive of severe economic inadaptability. 38 C.F.R. § 4.124a, DC 8100. The Board recognizes that the United States Court of Appeals for Veterans Claims has held that the receipt of a 100 percent schedular rating for a service-connected disability does not necessarily render moot any pending claim for a TDIU. Bradley v. Peake, 22 Vet. App. 280 (2008). Although no additional disability compensation may be paid when a total schedular disability rating is already in effect, the Court's decision in Bradley recognizes that a separate award of a TDIU predicated on a single disability may form the basis for an award of special monthly compensation (SMC). The Bradley case, however, is distinguishable from the instant case. In Bradley, the Court found that TDIU was warranted in addition to a schedular 100 percent evaluation where the TDIU had been granted for a disability other than the disability for which a 100 percent rating was in effect. Under those circumstances, there was no "duplicate counting of disabilities." Bradley, 22 Vet. App. at 293. Here, the February 2020 VA TBI examiner concluded that the Veteran "has difficulty with completing tasks in an inefficient manner due to significant loss," and the February 2020 VA mental disorders examiner emphasized that while the Veteran's TBI symptoms resulted in mild and occasional impairment, it was the Veteran's service-connected depression and anxiety disorders that caused total occupational and social impairment. See VA mental disorders examination dated February 20, 2020 at pg. 4. Furthermore, the record does not demonstrate that the Veteran's other service-connected disabilities preclude substantially gainful employment, and the Veteran does not so contend. Regarding special monthly compensation, VA granted SMC at the housebound rate on account of the Veteran's service-connected depressive disorder with anxiety disorder rated at 100 percent and additional service-connected disabilities of TBI with residual skull depression and non-disfiguring scar, migraine-tension headaches, and tinnitus, independently ratable at 60 percent disabling or more, effective July 19, 2016, the date of the Veteran's claim. See 38 U.S.C. § 1114(s); 38 C.F.R. § 3.350(i). Finally, 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, 69-70 (2017). S. B. MAYS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. Farrell 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.