Citation Nr: 21073912 Decision Date: 12/13/21 Archive Date: 12/13/21 DOCKET NO. 17-52 745 DATE: December 13, 2021 ORDER Entitlement to an initial rating in excess of 10 percent prior to July 24, 2017, and to a rating in excess of 30 percent since that date for posttraumatic stress disorder (PTSD) is denied. Entitlement to an initial rating of 30 percent for migraine headaches prior to July 31, 2017, is granted. Entitlement to a rating in excess of 30 percent for migraine headaches since July 31, 2017, is denied. Entitlement to an initial compensable rating prior to July 31, 2017, and to a rating in excess of 10 percent since that date for hypertension is denied. FINDINGS OF FACT 1. Prior to July 24, 2017, the occupational and social impairment from the Veteran's PTSD was manifested by mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress. 2. Since July 24, 2017, the occupational and social impairment from the Veteran's PTSD was manifested by occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks although generally functioning satisfactorily with routine behavior, self-care, and normal conversation. 3. For the entire appeal period, the Veteran's migraine headaches were manifested by characteristic prostrating attacks occurring on an average of once a month over the last several months. 4. Prior to July 31, 2017, the Veteran's service-connected hypertension has not resulted in diastolic pressure predominantly 100 or more; or, systolic pressure predominantly 160 or more; nor did she have a history of diastolic pressure predominantly 100 or more, which required continuous medication for control 5. Since July 31, 2017, the Veteran's service-connected hypertension has not resulted in diastolic pressure predominantly 110 or more; or, systolic pressure predominantly 200 or more. CONCLUSIONS OF LAW 1. Prior to July 24, 2017, the criteria for an initial rating in excess 10 percent for PTSD have not been met. 38 U.S.C. §§ 1155, 5107 (2018); 38 C.F.R. §§ 4.7, 4.130, Diagnostic Code 9411 (2020). 2. Since July 24, 2017, the criteria for an initial rating in excess 30 percent for PTSD have not been met. 38 U.S.C. §§ 1155, 5107 (2018); 38 C.F.R. §§ 4.7, 4.130, Diagnostic Code 9411 (2020). 3. Prior to July 31, 2017, the criteria for an initial 30 percent rating for migraine headaches have been met. 38 U.S.C. § 1155 (2018); 38 C.F.R. §§ 4.7, 4.124a, Diagnostic Code 8100 (2020). 4. Since July 31, 2017, the criteria for an initial 30 percent rating for migraine headaches have not been met. 38 U.S.C. § 1155 (2018); 38 C.F.R. §§ 4.7, 4.124a, Diagnostic Code 8100 (2020). 5. Prior to July 31, 2017, the criteria for an initial compensable rating for hypertension have not been met. 38 U.S.C. § 1155 (2018); 38 C.F.R. §§ 4.7, 4.104, Diagnostic Code 7101 (2020). 6. Since July 31, 2017, the criteria for an initial rating in excess of 10 percent for hypertension have not been met. 38 U.S.C. § 1155 (2018); 38 C.F.R. §§ 4.7, 4.104, Diagnostic Code 7101 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active military service from April 2006 to December 2010. These matters come before the Board of Veterans' Appeals (Board) on appeal from a September 2013 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran requested a hearing before the Board when she submitted her VA Form 9 (Substantive Appeal) in October 2017. In correspondence dated in August 2021, the Veteran was advised that she was scheduled for a hearing in October 2021. In September 2021, the Veteran withdrew her request for a hearing. Increased Rating PTSD The Veteran contends that her service-connected PTSD warrants higher ratings. As an initial matter, the Board notes that the Veteran was initially granted service connection and assigned a 10 percent rating effective July 9, 2012. In an August 2017 rating decision, the rating assigned was increased to 30 percent effective July 24, 2017. Post-service treatment reports dated from July 2011 to August 2017 reveal that the Veteran did not have anxiety, depression, or sleep impairment. Her affect was normal, and her mood was euthymic. She denied homicidal and suicidal thoughts, and was not taking medication for a psychiatric disorder. At a September 2013 VA examination, the Veteran reported that she was married and had four children. She endorsed good family relationships and friendships, good social interaction, appropriate activities, and her social skills were intact. She indicated that she was not working but she was taking college courses and caring for her children aged nine years to six months. She denied being in treatment or taking medication for a psychiatric disability. The Veteran's psychiatric symptoms included suspiciousness and mild memory loss such as forgetting names, directions, or recent events. The examiner diagnosed mild PTSD and indicated that a mental condition had been diagnosed but the Veteran's symptoms were not severe enough to interfere with occupational and social functioning or to require continuous medication. At a July 2017 VA examination, the Veteran reported that she had been married since 2003 and had four children. She indicated that she had a very good marriage and that she had a very good relationship with her children. She attended school events and wanted to engage more. She had recently returned from South Korea and was working on getting connected to the community. She had two friends and attended church. She reported that she had completed her MBA (Masters of Business Administration) and volunteered with the Red Cross in South Korea and with her church youth group. The Veteran denied any treatment for her psychiatric disability and indicated that she did not take medication for PTSD. Her mood was normal; she denied homicidal and suicidal ideations, plans, or intentions; and she denied mania, psychosis, and panic attacks. Her psychiatric symptoms included suspiciousness; mild memory loss such as forgetting names, directions, or recent events; and difficulty in adapting to stressful circumstances, including work or a work-like setting. The examiner diagnosed PTSD and indicated that a mental condition had been diagnosed, but the Veteran's symptoms were not severe enough to interfere with occupational and social functioning or to require continuous medication. Prior to July 24, 2017, the Board finds that an initial rating in excess of 10 percent is not warranted. In this regard, the Veteran has not demonstrated occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. Although the Veteran endorsed mild memory loss (such as forgetting names, directions, recent events), she did not have depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), or chronic sleep impairment. Moreover, she had a good relationship with her husband and children, she had social relationships, she was taking college courses, and she took care of her children. Additionally, there is no indication from the record that the Veteran experienced issues with thought processes, speech, impulse control, or delusions or hallucinations. As such, when the Veteran's psychiatric disability picture is considered as a whole, a higher rating is not warranted for PTSD prior to July 24, 2017. 38 C.F.R. § 4.130, Diagnostic Code 9411. Since July 24, 2017, the Board finds that a rating in excess of 30 percent is not warranted. In this regard, the Veteran has not demonstrated occupational and social impairment with reduced reliability and productivity. The Veteran's PTSD has not been manifested by flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; or difficulty in establishing and maintaining effective work and social relationships. The Veteran endorsed suspiciousness, mild memory loss such as forgetting names, directions, or recent events, and difficulty in adapting to stressful circumstances, including work or a work-like setting. However, those symptoms were not noted to be significant in nature, and the examiner specifically noted that they did not impact the Veteran's ability to work. Additionally, the Veteran has reported that she has a good marital relationship, and a good relationship with her children. She had recently completed her MBA, had several friendships, and she attended church. Further, she reported that she had volunteered in the community and was an active member of her church. As such, a higher rating is not warranted for PTSD since July 24, 2017. 38 C.F.R. § 4.130, Diagnostic Code 9411. In sum, the Board finds that the Veteran's symptomatology is consistent with a 10 percent rating prior to July 24, 2017, and a 30 percent rating since that date and higher ratings are not warranted. 38 C.F.R. § 4.130, Diagnostic Code 9411. Increased Rating Migraine Headaches The Veteran contends that her service-connected migraine headaches warrant higher initial ratings. As an initial matter, the Board notes that the Veteran was initially granted service connection for migraine headaches and assigned a 10 percent rating effective July 9, 2012. In an August 2017 rating decision, the rating assigned was increased to 30 percent effective July 31, 2017. Post-service treatment reports reveal a diagnosis of frequent headaches for which the Veteran was treated with various medications. At a September 2013 VA headache examination, the Veteran reported that she used Topamax to treat her headaches. She reported tension headaches and migraine headaches. The Veteran endorsed characteristic prostrating attacks of migraine headache pain less than once every two months. The Veteran denied very frequent prostrating and prolonged attacks of migraine headache pain. She endorsed prostrating attacks of non-migraine headache pain more than once per month and very frequent prostrating and prolonged attacks of non-migraine headache pain. The Veteran reported that her headaches impacted her employment in that she had difficulty thinking during headaches and her pain increased when she bent over to pick things up. At a July 2017 VA headache examination, the Veteran reported characteristic prostrating attacks of migraine/non-migraine headache pain once a month. The Veteran denied very prostrating and prolonged attacks of migraines/non-migraine pain productive of severe economic inadaptability. The examiner indicated that the Veteran reported one prostrating attack of headaches each month. The Veteran reported that she was unable to participate in any work activities during bouts of severe migraine headaches which typically lasted less than one day. The Board finds that an initial rating of 30 percent, but not higher, is warranted for the relevant period on appeal. In this regard, the medical and lay evidence of record support that the Veteran had characteristic prostrating headaches on average once a month. The Board acknowledges that the Veteran reported that she was unable to work during bouts of severe migraine headaches. However, there is no indication from the record that such episodes happen regularly. Accordingly, the Board finds that an initial rating of 30 percent, but not higher, for migraine headaches is warranted. 38 C.F.R. § 4.124a, Diagnostic Code 8100. Increased Rating Hypertension The Veteran contends that her service-connected hypertension warrants higher initial ratings. As an initial matter, the Board notes that the Veteran was initially granted service connection for hypertension and assigned a noncompensable percent rating effective July 9, 2012. In an August 2017 rating decision, the rating assigned was increased to 10 percent effective July 31, 2017. At a September 2013 VA hypertension examination, the Veteran's blood pressure readings were 129/90, 120/89, and 120/90. The examiner indicated that the Veteran was diagnosed with hypertension in 2010. The Veteran required the use of continuous medication to treat her hypertension. Post-service treatment reports dated from July 2011 to April 2017 reveal systolic pressure no higher than 149 on two occasions and diastolic pressure no higher than 111 in March 2013 and 101 in October 2013; on one occasion the Veteran's diastolic pressure was 100 and on all other occasions the Veteran's diastolic pressure was under 100. At a July 2017 VA hypertension examination, the Veteran's blood pressure readings were 149/100, 139/105, and 140/107. The Veteran required the use of continuous medication to treat her hypertension. Prior to July 31, 2017, the Veteran's service-connected hypertension has not resulted in diastolic pressure predominantly 100 or more; or systolic pressure predominantly 160 or more; nor did she have a history of diastolic pressure predominantly 100 or more, which required continuous medication for control. 38 C.F.R. § 4.104, Diagnostic Code 7101. Therefore, the Board finds that a compensable rating for hypertension is not warranted for the relevant period on appeal. Since July 31, 2017, the Veteran's service-connected hypertension has not resulted in diastolic pressure predominantly 110 or more; or systolic pressure predominantly 200 or more. 38 C.F.R. § 4.104, Diagnostic Code 7101. Therefore, the Board finds that a rating in excess of 10 percent for hypertension is not warranted for the relevant period on appeal. In sum, the Board finds that the Veteran's symptomatology is consistent with a noncompensable rating prior to July 31, 2017, and a 10 percent rating since that date and higher ratings are not warranted. 38 C.F.R. § 4.104, Diagnostic Code 7101. Kristin Haddock Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Cryan, 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.