Citation Nr: 21070561 Decision Date: 11/24/21 Archive Date: 11/24/21 DOCKET NO. 19-04 258 DATE: November 24, 2021 ORDER Entitlement to service connection for a heart disorder, diagnosed as coronary artery disease, is granted. Entitlement to service connection for an acquired psychiatric disorder, to include major depression is denied. Entitlement to a total disability rating based on individual unemployability (TDIU) is granted. Entitlement to a 50 percent disability rating for headaches is granted. FINDINGS OF FACT 1. The most probative evidence of record shows that the Veteran's coronary artery disease was due to his active duty service. 2. The most probative evidence of record indicates the Veteran does not have PTSD, and his diagnosed major depressive disorder is unrelated to any aspect of active duty service. 3. The evidence of record reflects that the Veteran has been unable to secure and maintain gainful employment due to his service-connected migraine headaches. 4. The evidence is in equipoise as to whether the Veteran's headaches have been manifested by 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 heart disorder, diagnosed as coronary artery disease, have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for entitlement to service connection for an acquired psychiatric disorder have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for entitlement to a TDIU have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 4. The criteria for a 50 percent rating for headaches have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321(b)(1), 4.124a, Diagnostic Code 8100. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from July 1984 to May 1994, to include service in the Southwest Asia Theater of operations during the Persian Gulf War. This matter comes before the Board of Veterans' Appeals (Board) on appeal from rating decisions issued by a Department of Veterans Affairs (VA) Regional Office (RO). In connection with this appeal, the Veteran testified in a virtual hearing before the undersigned Veterans Law Judge in May 2020. However, the complete hearing transcript is unavailable due to an audio malfunction. A transcript of that hearing has been associated with the claims file. The Board acknowledges that a portion of the hearing transcript is unavailable due to a technical difficulty. As such, the Veteran was afforded the opportunity for another hearing in September 2020. In November 2020, the Veteran's representative stated that another hearing was not requested. Further, the Veteran's legal assistant also submitted her notes from the hearing, which the Board has thoroughly reviewed and considered. Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). To establish entitlement to service-connected compensation benefits, 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-the so-called "nexus" requirement." Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b). Service connection may also be established for certain disabilities under 38 C.F.R. § 3.317. Service connection may be warranted for a Persian Gulf Veteran who exhibits objective indications of a qualifying chronic disability that became manifest during active service in the Southwest Asia Theater of operations during the Persian Gulf War, or to a degree of 10 percent or more. 38 U.S.C. § 1117 (West 2014); 38 C.F.R. § 3.317(a)(1). The chronic disability must not be attributed to any known clinical disease by history, physical examination, or laboratory tests. 38 U.S.C. § 1117 (West 2014); 38 C.F.R. § 3.317(a), (b). Pursuant to 38 U.S.C. § 1117, the definition of qualifying chronic disability includes: (a) undiagnosed illness, (b) a medically unexplained chronic multisymptom illness (such as chronic fatigue syndrome, fibromyalgia, and irritable bowel syndrome) that is defined by a cluster of signs or symptoms, and (c) a diagnosed illness that the Secretary of VA determines in regulations prescribed under 38 U.S.C. § 1117(d) warrants a presumption of service-connection. 38 C.F.R. § 3.317(a)(2). 1. Entitlement to service connection for a heart disorder, diagnosed as coronary artery disease The Veteran contends that service connection is warranted for a heart disorder, diagnosed as coronary artery disease. More specifically, the Veteran has first asserted that service connection for a cardiovascular disability is warranted due to an undiagnosed illness. See May 2016 VA Form 21-526EZ. Here, however, the Board finds that the Veteran's current symptoms are attributable to a known clinical diagnosis of coronary artery disease. See September 2016 Gulf War Examination. Therefore, service connection for a cardiovascular disability cannot be granted due to an undiagnosed illness due to service in the Persian Gulf as the claimed disability is medically diagnosed. 38 C.F.R. § 3.317. Where the evidence does not warrant presumptive service connection, however, a veteran is not precluded from establishing service connection for a disability with proof of direct causation. Combee v. Brown, 34 F.3d 1039, 1041 (Fed. Cir. 1994). In this regard, as the claim is being granted on a direct basis, the Board will not further discuss the other provisions of 38 C.F.R. § 3.317 and entitlement upon a presumptive basis. As an initial matter, the Board notes that the Veteran's service treatment records do not contain complaints of, treatment for, or a diagnosis of a heart disorder. The Veteran underwent a Heart Conditions (Including Ischemic and Non-ischemic Heart Disease, Arrhythmias, Valvular Disease, and Cardiac Surgery) DBQ in September 2016. The examiner noted a diagnosis of coronary artery disease. Upon examination, the Veteran reported that he had intermittent, sharp chest pains for approximately two years which occurred primarily at rest, but also during non-strenuous activity. The examiner opined that it was not caused by or related to Gulf War environmental exposure or military service. The examiner also noted that the Veteran's condition onset over a decade following separation and that it was most likely caused by and related to multiple coronary artery disease factors including NSC Essential hypertension, hyperlipidemia, diabetes mellitus, obesity, family history, male gender, and natural age. The Veteran then submitted a private opinion in June 2020, at which time Dr. S.B. opined that it was at least as likely as not that the Veteran's coronary artery disease was related to service, and specifically attributed to his in-service exposure to paint and solvents. The clinician first acknowledged the Veteran's statements that he was exposed to paints and solvents during active military service. In support of the opinion, the examiner acknowledged the traditional risk factors for coronary artery disease, to include high cholesterol, high blood pressure, family history, diabetes, smoking, advanced age, and diabetes. Additionally, the clinician noted that there were new emerging studies showing that occupational hazards were an unspoken risk factor. Here, the clinician stated that the Veteran had exposure to multiple risk factors, including paint and solvents throughout his military career and that, notably, the Veteran was exposed to such paints and solvents well before the change of its contents to make them safer. The clinician then described how toxins and chemicals are metabolized and slowly eliminated in the body. Here, the clinician further described how benzene, contained in paints and solvents, are similar in structure and nature to Agent Orange, and the clinician linked the Veteran's exposure to benzene and other environmental pollutants to an increased risk for coronary artery disease, noting further that such compounds are retained in some body tissues for a long time (even decades). Additionally, the examiner cited to medical literature to further support his opinion. The Board finds that the most probative evidence of record shows that the Veteran's heart disorder is related to service. In this regard, the Veteran's DD Form 214 reflects that his MOS was that of an Inventory Management Specialist, which presumably includes various duties within the realm of logistics chain management, to include exposure to paint and other solvents. Notably, in a June 1993 service treatment record, the Veteran was assessed with TDI (Toluene diisocyanate) and solvent exposures, however, without objective adverse findings. In a November 1993 service treatment record, the Veteran reported to painting one to hours per week, wearing only a grey filter face mask. Also, in an August 1994 VA General Examination (conducted a mere four months following discharge), the Veteran reported that he was responsible for stripping a waxed floor of a warehouse over the course of several months. The Board acknowledges the VA opinion provided in September 2016, but little probative weight is afforded to it. Here, the examiner partly relied on the lack of contemporaneous documentation of symptoms following service. Further, this examiner identified various risk factors that could have contributed or caused the Veteran's heart disorder but did not clearly identify why chemical exposure during military service was not a more likely etiology. Of probative weight, however, is the June 2020 private opinion. Here, the private physician considered the Veteran's lay statements, medical history, and provided a well-reasoned medical opinion based on medical principles, medical literature, and medical knowledge, skills, and experience. Thus, the Board finds that the most probative evidence of record reveals that the Veteran's heart disorder, diagnosed as coronary artery disease, is related to service. Thus, the claim for a heart disorder, diagnosed as coronary artery disease, is granted. 2. Entitlement to service connection for an acquired psychiatric disorder The Veteran contends that he has an acquired psychiatric disorder, to include PTSD, that is related to his military service. First, the Board will determine whether the Veteran has a current acquired psychiatric disorder. On this question, the Board notes that the Veteran claims to have PTSD. The medical evidence of record also notes a diagnosis of major depressive disorder. Turning to the evidence of record, in an April 1994 General Medical Examination, the examiner noted that the Veteran denied having, in relevant part, anxiety or depression. The examiner also noted that as to the Veteran's social history, he was married with three children, was in good health, and did not drink or smoke. In a June 1994 VA Form 21-526, the Veteran, in relevant part, filed a claim for stress and sleep disturbances. In an August 1994 Mental Disorders Examination, an examiner noted that the Veteran denied any prior inpatient or outpatient psychiatric care and categorically denied any psychiatric problems at the time of the examination. Impressions revealed no psychiatric illnesses. VA PTSD screens in 2010 and 2015 were negative for PTSD. A February 2016 private psychological evaluation note (authored by Dr. T.M.) reveals that the Veteran had a "long-standing history of difficulty with stress, anxiety, and depression." At the time of treatment, the Veteran reported poor sleep with nightmares about killing people and often wakes and cannot get back to sleep. The Veteran also reported suicidal thinking with plan and intent in 1993 while stationed at Shaw AFB. Impressions revealed that the Veteran appeared to be suffering from long-standing and chronic PTSD with chronic symptoms of nightmares, anxious arousal, hypervigilance, and defensive avoidance. In addition, the physician noted that the Veteran was severely depressed. Diagnoses rendered included Major Depression, severe and PTSD, chronic, severe. Sleep apnea was ruled out. An April 2016 VA psychiatry note shows that the Veteran presented with complaints that he had PTSD and that he did not think that his medication was working. The clinician noted that the Veteran had been seen somewhat sporadically in mental health since leaving the service in 1994 for depression, anxiety, and complaints of cognitive problems. The clinician further stated that notes from that time were reviewed, at which time the Veteran was diagnosed with dysthymia and had several medication trials including Amitriptyline and Sertraline. The clinician further noted that the Veteran fell out of mental health treatment for a number of years until 2005 when he was again evaluated, diagnosed with dysthymia, and prescribed medication Citalopram. Upon examination, the clinician noted that the Veteran had a diagnosis of Depression NOS. The clinician also noted that although the Veteran's private psychologist diagnosed him with PTSD, a diagnosis of PTSD would not be made at the time of treatment, given the absence of index trauma. Notably, the clinician noted that given that the Veteran has "had similar complaints, including depression and anxiety since his initial visits in 1994, it would not be unreasonable to think that he developed some affective disorder while in the service; however how this might have been affected by his then alcohol abuse or other factors is not known. It is also not known whether any of these complaints may have preceded his service time." The examiner also reported that there was no reason to think that the Veteran was "not psychologically distressed although there may be some reason to question the diagnosis itself. This will need further evaluation." The Veteran was afforded an Initial PTSD DBQ in October 2016. The Veteran identified a stressor, to include that he had to wear chemical gear and that "one time they shot down a missile close to the base we were at." The examiner noted that the stressor did not meet Criterion A, although it was related to fear of hostile military or terrorist activity. Here, the examiner explained that the Veteran did not have exposure to actual or threatened death; serious injury; or sexual violence. Upon examination, the examiner noted that the Veteran's symptoms did not meet the diagnostic criteria for PTSD under the DSM-5 criteria. The examiner, however, noted that the Veteran met the diagnostic criteria for Unspecified Depressive Disorder. Yet, the VA examiner found no link between the Veteran's diagnosed medical condition and military service. Here, the examiner opined that the Veteran's diagnosis of Unspecified Depressive Disorder was less likely than not related to any in-service stressor. The examiner additionally reported that there was no objective evidence linking his experiences during the Gulf War and his current symptoms of depression to service, rather such symptoms were most likely related to current psychosocial stressors. Entitlement to Service Connection for PTSD Again, the Veteran contends that service connection is warranted for PTSD. More specifically, the Veteran has stated that while stationed in Bahrain, in 1991, he had to continually put on chemical gear and that there was a scud missile that blew up outside of the base. See May 2016 Statement in Support of Claim for Service Connection for Post-Traumatic Stress Disorder (PTSD). Regarding PTSD, as the Veteran's appeal was certified to the Board in August 2019, a diagnosis of PTSD must be established in accordance with the Fifth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Here, the Board finds that the most probative evidence of record shows that the Veteran does not have a diagnosis of PTSD that conforms to the DSM-5 criteria. Although the record contains a February 2016 private diagnosis of PTSD, here, the clinician did not indicate that the Veteran met the diagnostic criteria under DSM-5 criteria. Further, in an April 2016 VA treatment record, a VA clinician noted that even after considering the February 2016 private treatment note, a diagnosis of PTSD could not be rendered. And, notably, in an October 2016 DBQ, a VA examiner stated that the Veteran's symptoms did not meet Criterion A for PTSD under DSM-5 criteria. In this opinion, the examiner considered the Veteran's medical history and lay statements. The examiner also noted that the entire claims file was reviewed, and a thorough rationale supported the medical opinion. Here, the Board finds the October 2016 examination report to be the most probative evidence of record as to whether the Veteran has ever had PTSD. Factors for assessing the probative value of a medical opinion include the physician's access to the claims folder and the thoroughness and detail of the opinions. See Prejean v. West, 13 Vet. App. 444, 448-49 (2000) (stating that factors for assessing the probative value of a medical opinion are the physician's access to the claims folder and the thoroughness and detail of the opinion). In light of the determination by the VA examiner that no such diagnosis was warranted under the current DSM-5, the Board finds that the Veteran does not have a current valid diagnosis of PTSD for VA purposes. Absent a diagnosis of PTSD, service connection for PTSD is not warranted. Entitlement to service connection for an acquired psychiatric disorder other than PTSD As noted above, there is no dispute that the Veteran currently has a diagnosis of Depressive Disorder under DSM-5 criteria. See October 2016 VA examination. Here, the Veteran's service treatment records are silent as to a diagnosis of, complaints of, or treatment for an acquired psychiatric disorder, to include a depressive disorder. As to a nexus, the Board acknowledges the Veteran's assertions that he feels that his acquired psychiatric disorder, to specifically include depression is related to service. In this regard, the Veteran is competent to describe his symptoms. However, the Veteran does not possess the medical expertise to determine the etiology of his condition. The Board finds the October 2016 VA examiner's opinion to be the most probative evidence of record as to a nexus regarding his depression diagnosis. This opinion is thorough and reasoned and is based on an in-person evaluation of the Veteran, while taking into account his various lay statements of record and those made during the examination. This examiner additionally offered the more likely etiology for the Veteran's disorder. While the Board has carefully reviewed the record in depth, it has been unable to identify a basis upon which service connection for an acquired psychiatric disorder other than PTSD, to specifically include Major Depressive Disorder, may be granted. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, the private examiner does not provide an opinion or rationale as to whether the Veteran's depression is related to service, and thus, has little probative value as to nexus. As a result, the preponderance of the evidence is against the claim, and the benefit of the doubt doctrine is not applicable. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 57. TDIU VA will grant a total rating for compensation purposes based on unemployability when the evidence shows that a veteran is precluded, by reason of service-connected disability, from obtaining and maintaining any form of gainful employment consistent with his or her education and occupational experience. 38 C.F.R. §§ 3.340, 3.341, 4.16. Under the applicable regulations, benefits based on individual unemployability are granted only when it is established that the service-connected disability or disabilities are so severe, standing alone, as to prevent the retaining of gainful employment. Under 38 C.F.R. § 4.16, if there is only one such disability, it must be rated at least 60 percent disabling to qualify for benefits based on individual unemployability. If there are two or more such disabilities, there shall be at least one disability ratable at 40 percent or more, and sufficient additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. § 4.16(a). The Veteran claims that entitlement to TDIU, to include on an extraschedular basis is warranted. See March 2018 VA Form 21-526EZ. The Veteran has reported that he is incapable of securing and maintaining gainful employment due to service-connected disabilities, which include a left knee total replacement; headaches; a herniated disc L4-S1 with osteoarthritis; bilateral carpal tunnel syndrome; residuals fracture right fourth finger; cholecystectomy, gastroenteritis; sciatica, left lower extremity; and surgical scars, left knee. In considering the grant of an increased rating for headaches herein, the schedular requirements for a TDIU are met from at least March 2, 2018. In a May 2020 VA Form 21-8940, Veteran's Application for Increased Compensation Based on Unemployability, the Veteran stated that he last worked on a full-time basis in September 2015 and that his service-connected migraines prevented him from securing or following any substantially gainful employment. The Veteran further reported that he left his last job as a utility worker due to his disability and that he has tried to obtain employment since becoming too disabled to work. Additionally, the Veteran stated that he completed high school, as well as one year of college. He did not specify, however, whether he had any additional education or training. The Veteran was afforded a Headaches DBQ in April 2018. The examiner noted that the Veteran did not have characteristic prostrating attacks of migraine/non-migraine headache pain, concluding that the Veteran's headache condition did not impact his ability to work. In a June 2020 Headaches DBQ, an examiner stated that the Veteran's headache condition impacted his ability to work, noting that the Veteran stated that he is unable to function or concentrate with headaches. It was further noted that the Veteran worked as a repairman for sewer and water lines, and he cannot perform the job because of the noise from the pumps and the sunlight. The Veteran stated that he would have to leave work due to his headaches. He also mentioned that he previously worked at the post office, but he was unable to concentrate and focus on his deliveries due to his headaches. In a June 2020 Report of General Information, the Veteran clarified that he was last employed in 2015. He also denied having any part-time or intermittent jobs since that time. Additionally, he reported that he could not remember the address to his last employer. In a July 2020 QTC addendum, a VA examiner stated that the Veteran had been seen by a neurologist in the past (as documented in the medical records), but no information was noted on the impact on the Veteran's headaches as it relates to his occupation. The Board finds that the evidence is at least in equipoise as to whether the Veteran is unable to secure and follow substantially gainful employment due to his service-connected headaches. While the 2018 VA opinion reflects that the Veteran's service-connected headache disability would not impact his ability to work, the Board notes that it is reasonable to conclude that the Veteran's service-connected headaches prevents such. Specifically, the record evidence shows that the Veteran's migraine headaches include prostrating attacks occurring on an average of several times a month. This frequency pattern is not a practical limitation for someone engaging in gainful employment, particularly that of a utility worker that requires working in any weather condition, to include the bright sun, and one that is exposed to loud noises. Further, the record shows the Veteran last worked full-time, as a utility worker in 2015, where he worked for over five years. Here, although the Veteran has one year of college education, there is no indication that he has any other training or experience other than being a utility worker and postal courier. Given the above, coupled with the Veteran's employment history and education, the Board finds that he has been incapable of securing or maintaining gainful employment due to his service-connected headaches. Accordingly, entitlement to TDIU is granted. Increased Ratings Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule) and are intended to represent the average impairment of earning capacity resulting from disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. A veteran's entire history is reviewed when making disability evaluations. See generally Schafrath v. Derwinski, 1 Vet. App. 589 (1991); 38 C.F.R. § 4.1. Where the question for consideration is the propriety of the initial evaluation assigned, as it is here, consideration of the medical evidence since the effective date of the award of service connection and consideration of the appropriateness of a staged rating are required. See Fenderson v. West, 12 Vet. App. 119 (1999). If evidence obtained during the appeal period indicates that the degree of disability increased or decreased following the assignment of the initial rating, "staged" ratings may be assigned for separate periods of time based on facts found. Id. Entitlement to a rating in excess of 30 percent for migraine headaches The Veteran's headaches have been evaluated under 38 C.F.R. § 4.124, Diagnostic Code 8100. Under Diagnostic Code 8100, a 10 percent evaluation is warranted for characteristic prostrating attacks averaging one in two months over the last several months. A 30 percent disability evaluation is assigned where there are characteristic prostrating attacks occurring on average once a month over the last several months. For a higher, 50 percent disability evaluation to be warranted, there must be migraines with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. 38 C.F.R. § 4.124a, Diagnostic Code 8100. A 50 percent rating is the highest rating available under the Schedular criteria governing the evaluation of headaches. The Veteran contends that he is entitled to an increased rating for his headaches. See February 2018 VA 21-526EZ. The Veteran underwent a Headache DBQ in April 2018, at which time the examiner noted that the Veteran had a diagnosis of migraines, including migraine variants. The Veteran reported that his headaches start in the back of his head and go around to the front. He further noted that he will then go to bed, unable to do anything. He stated that his headaches occur two to three times per week. The Veteran noted that his treatment plan did not include medication. The examiner noted that the Veteran experienced headache pain, to include constant head pain. He did not experience non-headache symptoms associated with his headaches. His head pain typically lasted less than one day and was localized on both sides of his head. The examiner noted that the Veteran did not have characteristic prostrating attacks of migraine/non-migraine headache pain nor did he have very prostrating and prolonged attacks of migraines/non-migraine pain productive of severe economic inadaptability. There were no other pertinent physical findings, complications, conditions, signs, or symptoms related to the Veteran's condition. The examiner also reported that the Veteran's headache condition did not impact his ability to work. In a May 2018 VA treatment record, the Veteran stated that he has had headaches for the last ten years, to include migraines over the last few months. He stated that he has visual disturbances prior to the migraine and usually lies down in a dark room. In another VA treatment record, dated May 2018, a clinician noted that his headaches were occipital, radiating to become holocranial. The headaches, which originally occurred two times a week and lasted for three days were described as lasting "a lot longer." The headaches were further described as sharp, steady, constant, and pounding. In a June 2019 VA treatment record, the Veteran presented with complaints of increased migraines that were managed well with prescription medication. The Veteran underwent a Headaches (Including Migraine Headaches) Disability DBQ in June 2020. In the examination, the Veteran reported that he had been diagnosed with migraine headaches four months prior and that his headaches had gotten worse. The examiner noted that the Veteran takes Tizanidine for treatment and that the Veteran has pulsating or throbbing head pain on both sides of his head. The examiner also noted symptoms of vomiting, and sensitivity to light and sound associated with his headaches. His headaches usually last less than one day, and his typical head pain is on both sides of the head. The examiner further noted that the Veteran experiences characteristic prostrating attacks of migraine/non-migraine headache pain, which occurs once every month. The examiner also reported that the Veteran did not have very prostrating and prolonged attacks of migraines/non-migraine pain productive of severe economic inadaptability. There were no other pertinent physical findings, complications, conditions, signs, or symptoms related to the Veteran's condition. The examiner stated that the Veteran's headache condition impacted his ability to work, noting that the Veteran stated that he is unable to function or concentrate with headaches. The examiner further noted that the Veteran worked as a repairman for sewer and water lines, and he cannot perform the job because of the noise from the pumps and the sunlight. The Veteran stated that he would have to leave work due to his headaches. He also mentioned that he previously worked at the post office as a postman, but he was unable to concentrate and focus on his deliveries due to his headaches. In considering the above and remaining evidence, the Board reiterates that a 50 percent rating is warranted when migraines are present with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. 38 C.F.R. § 4.124a, Diagnostic Code 8100. The Board notes that "very frequent" and "completely prostrating" are not defined by the regulations. However, because the criteria for a 30 percent rating requires prostrating attacks for an average of once a month, it can be presumed that "very frequent" must require at least 2 or more completely prostrating and prolonged attacks per month. Additionally, the Court of Appeals for Veterans Claims recently found that the phrase "characteristic prostrating attacks" means "attacks that typically produce powerlessness or a lack of vitality." Johnson v. Wilkie, 30 Vet. App. 245 (2018). The phrase "productive of severe economic inadaptability" has also not been clearly defined by regulations or by case law. The United States Court of Appeals for Veterans Claims (Court) has noted that "productive of" can either have the meaning of "producing" or "capable of producing." Pierce v. Principi, 18 Vet. App. 440, 445 (2004). Thus, migraines need not actually "produce" severe economic inadaptability to warrant the 50 percent rating. Id. at 445-46. Further, "economic inadaptability" does not mean unemployability, because it would undermine the purpose of regulations pertaining to a total disability rating based on individual unemployability (TDIU). Id. at 446; see also 38 C.F.R. § 4.16. The Board notes, however, that the migraines must be, at minimum, capable of producing "severe" economic inadaptability. Here, both the April 2018 and June 2020 examiners found that the Veteran's migraines were not prostrating and prolonged attacks productive of severe economic inadaptability. Yet, in the Functional Impact section of the June 2020 examination report, the Veteran thoroughly explained that his migraine headaches were prostrating in nature and required him to leave work upon onset. Additionally, during the May 2020 virtual hearing, the Veteran testified that he has prostrating attacks that last four to five hours and occur five days per week. In this regard, the Veteran is competent to report the severity and frequency of his headaches, and the Board affords great probative weight to his lay statements. Given the above, the Board finds the evidence is at least in equipoise as to whether the Veteran's migraine headaches include very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. As such, the Board resolves all doubt in favor of the Veteran. Accordingly, a 50 percent disability rating (the highest schedular rating) for service-connected migraines is granted. GAYLE STROMMEN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Hanson 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.