Citation Nr: 21075260 Decision Date: 12/20/21 Archive Date: 12/20/21 DOCKET NO. 19-06 287A DATE: December 20, 2021 ORDER Entitlement to a compensable evaluation for headaches prior to January 28, 2020 is denied. Entitlement to a 50 percent rating, but no higher, for headaches, from January 28, 2020, is granted. Entitlement to service connection for a left knee disability is granted. FINDINGS OF FACT 1. Prior to January 28, 2020, the Veteran experienced headaches with less frequent attacks. Her migraines did not manifest in characteristic prostrating attacks averaging one in 2 months over the last several months. 2. From January 28, 2020, the Veteran experienced headaches with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. 3. The Veteran's left knee disability, to include arthritis, manifested to a compensable degree within one year of her separation from service and is not attributable to intercurrent causes. CONCLUSIONS OF LAW 1. Prior to January 28, 2020, the criteria for a compensable rating for headaches have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8100. 2. Since January 28, 2020, the criteria for a 50 percent rating, but no higher, for headaches have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8100. 3. The criteria for entitlement to service connection for a left knee disability, to include arthritis, are met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the Coast Guard from November 24, 1986 to May 31, 1997; from September 25, 2001, to April 18, 2002; and from April 19, 2002 to July 31, 2014. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an October 2017 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In February 2021, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing has been associated with the claims file. 1. Entitlement to a compensable evaluation for headaches prior to January 28, 2020 2. Entitlement to a 50 percent rating, but no higher, for headaches, from January 28, 2020 The Veteran contends that she is entitled to a 50 percent evaluation for her headaches. Tension headaches are rated by analogy pursuant to 38 C.F.R. § 4.124a, Diagnostic Code (DC) 8100, for migraine. Under DC 8100, a noncompensable rating is warranted for migraines with less frequent attacks. A 10 percent rating is warranted for migraines with characteristic prostrating attacks averaging one in 2 months over the last several months. A 30 percent rating is warranted for migraines with characteristic prostrating attacks occurring on an average once a month over the last several months. A 50 percent rating is warranted for migraines with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. A 50 percent rating is the highest schedular rating under DC 8100. The rating criteria of DC 8100 are considered successive, meaning that a claimant cannot fulfill the criteria of the higher rating without fulfilling those of the next lower rating. Johnson v. Wilkie, 30 Vet. App. 245, 252 (2018). This renders 38 C.F.R. §§ 4.7 and 4.21 inapplicable. Johnson, 30 Vet. App. at 252. The phrase "characteristic prostrating attacks" is used in the criteria corresponding to 10 percent and 30 percent ratings under DC 8100 to describe the nature and severity of migraines, but it is not defined in the regulation. Pursuant to Dorland's Illustrated Medical Dictionary 1531 (32d ed. 2012), prostration is defined as "extreme exhaustion or powerlessness." Thus, the phrase "characteristic prostrating attacks" is understood to describe migraine attacks that typically produce extreme exhaustion or powerlessness. The rating criteria for a 50 percent rating contain several undefined phrases. The descriptive phrase "very frequent" connotes a frequency at least greater than once a month, as is required by the rating criteria corresponding to a lesser 30 percent rating. Johnson, 30 Vet. App. at 253. The phrase "completely prostrating" generally means that the migraines attack must render the veteran entirely powerless. Id. The completely prostrating attacks must also be "prolonged," which is defined as "to lengthen in time: extend duration: draw out: continue, protract." Id. (internal citation omitted). Lastly, the 50 percent rating criteria requires that the very frequent completely prostrating and prolonged attacks be "productive of severe economic inadaptability." Productive can be read as having either the meaning of "producing" or "capable of producing," and, with regard to severe economic inadaptability, nothing in DC 8100 requires that the claimant be completely unable to work in order to qualify for a 50 percent rating. Pierce v. Principi, 18 Vet. App. 440, 445-46 (2004). The Board concludes that prior to January 28, 2020, the Veteran had headaches, but did not have characteristic prostrating attacks, corresponding to a noncompensable rating under DC 8100. Since January 28, 2020, the Veteran has had headaches with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability, corresponding to the criteria for a 50 percent rating under DC 8100. In September 2017, the Veteran underwent an initial VA examination for her headaches. The examiner diagnosed the Veteran with tension headaches. The examiner noted that the Veteran's headaches are related to her neck problems. The examiner indicated the Veteran had headache pain on both sides of the head, but that she did not experience non-headache symptoms. The examiner noted the Veteran reported her head pain was always there, but of varying intensity. The examiner noted her headache pain was mostly posterior, occipital, and in the neck. The examiner indicated the Veteran did not experience characteristic prostrating attacks of headache pain. The examiner also indicated the Veteran's headaches would not impact her ability to work. In January 2020, the Veteran received an updated examination of her tension headaches. The examiner noted the Veteran was first diagnosed in 2008, during the Veteran's service. The Veteran described symptoms of pulsing or throbbing head pain, pain on both sides of the head, and pain that worsens with physical activity. The Veteran also reported related symptoms of sensitivity to light and sound as well as sensory changes. The Veteran indicated she typically has headaches lasting 1-2 days on both sides of the head. The examiner indicated the Veteran has prostrating attacks of non-migraine headache pain more frequently than once per month, also noted to be very frequent prostrating and prolonged attacks of non-migraine headache pain. The examiner noted the Veteran had comorbid diagnoses of cervical spine strain, degenerative disc disease, and IVDS of the neck that interacted with her headaches. The examiner described the migraines as debilitating and render the Veteran incapacitated. The examiner opined the Veteran cannot work for function during these headaches, cannot look at a computer, cannot talk on the phone, be in bright lights, or in noisy environments. The Veteran's VA medical records indicate that due to her cervical spine disability, the Veteran is unable to look up without experiencing a headache. The Veteran is competent to report her readily observable symptoms. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The Veteran's credibility is not at issue. Considering all relevant evidence of record, the Board finds the September 2017 and January 2020 examiner's medical opinions probative. Accordingly, the Board concludes that the Veteran had headaches with no characteristic prostrating attacks prior to January 28, 2020, corresponding with a noncompensable rating under DC 8100. Beginning on January 28, 2020, the Veteran has had headaches with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability, corresponding to the criteria for a 50 percent rating under DC 8100. No higher schedular evaluation is available for headache pain. Entitlement to service connection for a left knee disability The Veteran contends that her left knee disability manifested as arthritis documented in imaging studies with pain within a year from her separation from service. Certain chronic diseases will be presumed related to service if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service, with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). The Veteran has a current diagnosis of bilateral joint space narrowing, or left knee arthritis, as evidenced by April 2015 bilateral knee x-rays. Mild narrowing of all 3 joint compartments of both knees or osteoarthritis of the left knee, is an enumerated condition under 38 C.F.R. § 3.309(a); Walker, 708 F.3d 1331. The Veteran's DD 214 shows that the Veteran had active service from April 19, 2002 to July 31, 2014. Post-service treatment records dated April 2015 show that the Veteran's left knee disability (arthritis) with pain manifested to a compensable degree within one year. DC 5003-5260. As a chronic condition, any subsequent manifestations are service connected unless attributable to intercurrent causes. No intercurrent causes have been shown in this case and therefore the Veteran's left knee disability is attributable to service. L. M. BARNARD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M.D. Taylor, Associate 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.