Citation Nr: 21006861 Decision Date: 02/05/21 Archive Date: 02/05/21 DOCKET NO. 13-33 204 DATE: February 5, 2021 ORDER Entitlement to an initial evaluation in excess of 10 percent for lumbar spine disability for the period from April 1, 2011 to March 13, 2017 is denied. Entitlement to an evaluation of 20 percent, but no higher, for lumbar spine disability for the period from March 14, 2017 to January 31, 2018 is granted. Entitlement to an evaluation in excess of 40 percent for lumbar spine disability for the period beginning February 1, 2018 is denied. Entitlement to an initial evaluation in excess of 10 percent for a cervical spine disability for the period from April 1, 2011 to April 30, 2013 is denied. Entitlement to an evaluation of 30 percent, but no higher, for a cervical spine disability for the period beginning May 1, 2013 is granted. Entitlement to an initial evaluation of 30 percent, but no higher, for migraine headaches, for the period beginning April 1, 2011 is granted. Entitlement to an initial compensable evaluation for hypertension for the period from April 1, 2011 to January 31, 2018 is denied. Entitlement to an evaluation in excess of 10 percent for hypertension for the period beginning February 1, 2018 is denied. Entitlement to an initial evaluation in excess of 10 percent for left upper extremity cubital tunnel syndrome for the period from April 1, 2011 to January 31, 2018 is denied. Entitlement to an evaluation in excess of 20 percent for left upper extremity cubital tunnel syndrome for the period beginning February 1, 2018 is denied. FINDINGS OF FACT 1. For the period prior to March 14, 2017, the evidence of record did not show that the Veteran’s lumbar spine disability resulted in functional impairment equivalent to forward flexion of the thoracolumbar spine greater than 30 degrees, but not greater than 60 degrees; or combined range of motion of the thoracolumbar spine not greater than 120 degrees; or muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour. 2. For the period from March 15, 2017 to January 31, 2018, resolving reasonable doubt in the Veteran’s favor, the Veteran’s lumbar spine disability resulted in functional impairment equivalent to muscle spasm or guarding severe enough to result in an abnormal gait. 3. The evidence of record does not show that the Veteran has had ankylosis of the thoracolumbar spine at any time during the period on appeal. 4. For the period from April 1, 2011 to April 30, 2013, the evidence of record does not show that the Veteran’s cervical spine disability resulted in forward flexion of the cervical spine greater than 15 degrees, but not greater than 30 degrees, or combined range of motion of the cervical spine not greater than 170 degrees. 5. Resolving reasonable doubt in the Veteran’s favor, for the period beginning May 1, 2013, the Veteran’s forward flexion of the cervical spine was limited to 15 degrees or less. However, he did not have unfavorable ankylosis of the entire cervical spine at any time during the period on appeal. 6. Resolving reasonable doubt in the Veteran’s favor, for the entire period on appeal, the evidence of record shows that the Veteran has been having migraine headaches with characteristic prostrating attacks occurring on an average once a month over last several months. 7. For the period from April 1, 2011 to January 31, 2018, the evidence of record does not show that the Veteran’s diastolic pressure was predominantly 100 or more or systolic pressure was predominantly 160 or more. 8. For the period beginning February 1, 2018, the evidence of record does not show that the Veteran has been having diastolic pressure predominantly 110 or more, or systolic pressure predominantly 200 or more. 9. For the period from April 1, 2011 to January 31, 2018, the Veteran’s symptoms of left upper extremity disability more approximate a mild level of incomplete paralysis, and no worse, involving the ulnar nerve. 10. For the period beginning February 1, 2018, the evidence of record does not show that the Veteran has been having severe incomplete paralysis involving the ulnar nerve due to his left upper extremity cubital tunnel syndrome. CONCLUSIONS OF LAW 1. The criteria for an initial evaluation in excess of 10 percent for a lumbar spine disability for the period from April 1, 2011 to March 13, 2017 have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.45, 4.59, 4.71a, Diagnostic Code 5237 (2019). 2. The criteria for an evaluation of 20 percent, but no higher, for a lumbar spine disability for the period from March 14, 2017 to January 31, 2018 have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.45, 4.59, 4.71a, Diagnostic Code 5237 (2019). 3. The criteria for an evaluation in excess of 40 percent for a lumbar spine disability for the period beginning February 1, 2018 have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.45, 4.59, 4.71a, Diagnostic Code 5237 (2019). 4. The criteria for an initial evaluation in excess of 10 percent for a cervical spine disability for the period from April 1, 2011 to April 30, 2013 have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.45, 4.59, 4.71a, Diagnostic Code 5242 (2019). 5. Resolving reasonable doubt in the Veteran’s favor, the criteria for an evaluation of 30 percent, but no higher, for a cervical spine disability for the period beginning May 1, 2013 have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.45, 4.59, 4.71a, Diagnostic Code 5242 (2019). 6. Resolving reasonable doubt in the Veteran’s favor, the criteria for an initial evaluation of 30 percent, but no higher, for migraine headaches for the period beginning April 1, 2011 have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.124a, Diagnostic Code 8100 (2019). 7. The criteria for an initial compensable evaluation for hypertension for the period from April 1, 2011 to January 31, 2018 have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.104, Diagnostic Code 7101 (2019). 8. The criteria for an evaluation in excess of 10 percent for hypertension for the period beginning February 1, 2018 have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.104, Diagnostic Code 7101 (2019). 9. The criteria for an initial evaluation in excess of 10 percent for left upper extremity cubital tunnel syndrome for the period from April 1, 2011 to January 31, 2018 have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.124a, Diagnostic Code 8516 (2019). 10. The criteria for an evaluation in excess of 20 percent for left upper extremity cubital tunnel syndrome for the period beginning February 1, 2018 have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.124a, Diagnostic Code 8516 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from March 1991 to March 2011. This case is before the Board of Veterans’ Appeals (Board) on appeal from a March 2012 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In March 2017, the Veteran testified at a Travel Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing has been associated with the electronic claims file. In November 2017, the Board remanded the matters for further development. Now the matters are returned to the Board. Initially, the Board notes that the RO increased the disability ratings for all disabilities on appeal since the November 2017 Board remand order. See August 2020 and September 2020 Rating Decisions. However, as the highest possible ratings for the disabilities have not been assigned, the appeal continues. See AB v. Brown, 6 Vet. App. 35 (1993). Increased Ratings A disability rating is determined by the application of VA’s Schedule for Rating Disabilities (Rating Schedule). See generally 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can practicably be determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual conditions in civil occupations. See 38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.1 (2019). Separate diagnostic codes identify the various disabilities. 38 C.F.R. § 4.27 (2019). Where service connection has already been established, and increase in the disability rating is at issue, it is the present level of the disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55 (1994). However, in Fenderson v. West, 12 Vet. App. 119 (1999), it was held that evidence to be considered in the appeal of an initial assignment of a disability rating was not limited to that reflecting the then current severity of the disorder. Also, in cases where an initially assigned disability evaluation has been disagreed with, it is possible for a veteran to be awarded separate percentage evaluations for separate periods based on the facts found during the appeal period. See also Hart v. Mansfield, 21 Vet. App. 505 (2008). Disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. 38 C.F.R. § 4.40 (2019). Functional loss may be due to pain, supported by adequate pathology and evidenced by the visible behavior in undertaking the motion. 38 C.F.R. § 4.59 (2019) (discussing facial expressions such as wincing, muscle spasm, crepitation, etc.). Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. Excess fatigability and incoordination should be taken into account in addition to more movement than normal, less movement than normal, and weakened movement. 38 C.F.R. § 4.45 (2019). VA has a duty to acknowledge and to consider all regulations that are potentially applicable through the assertions and issues raised in the record, and to explain the reasons and bases for its conclusions. See Schafrath v. Derwinski, 1 Vet. App. 589, 592-93 (1991). Where there is a question as to which of two ratings to apply, VA will assign the higher rating if the disability picture more nearly approximates the criteria for that rating. 38 C.F.R. § 4.7 (2019). Otherwise, it will assign the lower rating. Id. 1. Lumbar spine disability The Veteran is currently service-connected for lumbar strain with scoliosis of the thoracic spine with partial compression fractures of T7-T9. The Veteran was initially assigned a 10 percent evaluation, effective April 1, 2011, and it was increased to 40 percent, effective February 1, 2018. See August 2020 Rating Decision. Thus, the Board will examine whether the Veteran was entitled to an initial evaluation in excess of 10 percent for the period from April 1, 2011 to January 31, 2018, and is entitled to an evaluation in excess of 40 percent for the period beginning February 1, 2018. Pursuant to Diagnostic Code 5237, lumbosacral strain is evaluated under either the General Formula for Diseases and Injuries of the Spine (General Formula) or the Formula for Rating Intervertebral Disc Syndrome (IVDS) Based on Incapacitating Episodes, whichever method results in the higher rating. 38 C.F.R. § 4.71a (2019). Here, the evidence of record does not show that the Veteran has IVDS; therefore, his lumbar spine disability will be rated under the General Formula. Under the General Formula, in pertinent part, a 20 percent evaluation is warranted for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or combined range of motion of the thoracolumbar spine not greater than 120 degrees; or muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis; a 40 percent evaluation is warranted for forward flexion of the thoracolumbar spine 30 degrees or less; or favorable ankylosis of the entire thoracolumbar spine; a 50 percent evaluation is warranted for unfavorable ankylosis of the entire thoracolumbar spine; and a 100 percent evaluation is warranted for unfavorable ankylosis of entire spine. 38 C.F.R. § 4.71a, General Formula (2019). On December 2010 VA examination, the examiner noted the Veteran’s diagnoses of recurrent lumbar strain, minimal scoliosis in the thoracic spine, partial compression fractures of T7, T8 and T9. The Veteran reported moderate pain in the lower back which occurs once per month which lasts for two weeks. The Veteran provided that pain is exacerbated by physical activity and it comes and goes spontaneously. It was noted that the Veteran was able to function without medication when he experiences back pain. The examiner provided that the Veteran’s range of motion for thoracolumbar spine was within normal limits, but indicated that he had pain at 63 degrees for flexion and 24 degrees for extension. The examiner also noted that the Veteran was able to do repetitive range of motion testing and there was no additional degree of limitation afterwards. Further, the examiner noted that the Veteran’s lumbar spine X-ray findings were within normal limits, but thoracic spine X-ray report showed mild compression fractures of T7, T8 and T9 with age in etiology undetermined. Minimal scoliosis convexity to the left was also shown in the report. The examiner provided that muscle spasm was absent and there was no guarding of movement. The Veteran’s spinal contour was preserved although there was tenderness to palpation on bilateral lumbar paraspinal muscles. Based on above, the Board finds that the evidence of record prior to March 14, 2017, which is discussed below, did not show that the Veteran’s lumbar spine disability resulted in functional impairment equivalent to forward flexion of the thoracolumbar spine greater than 30 degrees, but not greater than 60 degrees; or combined range of motion of the thoracolumbar spine not greater than 120 degrees; or muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour. Consequently, the Board finds that the Veteran’s entitlement to an initial evaluation in excess of 10 percent for a lumbar spine disability for the period from April 1, 2011 to March 13, 2017 is not warranted. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.45, 4.59, 4.71a, Diagnostic Code 5237 (2019). During the hearing held on March 14, 2017, the Veteran testified that he had to visit an emergency room due to muscle spasm which he gets as often as twice per week. The Veteran described one incident of a flare-up where he had to call off the remainder of his work day when it happened, and he had to lie down on the floor for two days before he could even move and get into a car to go to an emergency room. He explained that he could not move, because the spasms would lock up his entire back once they started. The Veteran also testified that he uses a cane and walks slowly due to his back pain, and has to sit down on and off throughout the day because his back just gives out. In light of the Veteran’s competent and credible testimony on March 15, 2017, the Board resolves reasonable doubt in the Veteran’s favor and finds that the Veteran’s lumbar spine disability resulted in functional impairment equivalent to muscle spasm or guarding severe enough to result in an abnormal gait for the period from March 15, 2017 until the Veteran had a disability rating increase effective February 1, 2018. Thus, resolving reasonable doubt in the Veteran’s favor, the Board finds that the Veteran’s entitlement to an evaluation of 20 percent, but no higher, for a lumbar spine disability for the period from March 14, 2017 to January 31, 2018 is warranted. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.45, 4.59, 4.71a, Diagnostic Code 5237 (2019). As the evidence for this period does not show the Veteran’s lumbar spine disability resulting in forward flexion of the thoracolumbar spine 30 degrees or less or favorable ankylosis of the entire thoracolumbar spine, the next higher evaluation of 40 percent for the period is not warranted. 38 C.F.R. § 4.71a, Diagnostic Code 5237 (2019). On February 2018 VA examination, the Veteran reported daily flare-ups of the thoracolumbar spine with sharp pain and stiffness. The Veteran’s range of motion was measured at: forward flexion to 30 degrees; extension to 20 degrees; right lateral flexion to 20 degrees; left lateral flexion to 15 degrees; and both right and left lateral rotations to 15 degrees. The examiner provided that pain was noted on all range of motion, but it does not result in functional loss. The Veteran was able to perform repetitive-use testing with at least three repetitions, and there was no additional loss of function or range of motion afterwards. The examiner did not report any additional factors contributing to the Veteran’s lumbar spine disability. The Veteran did not have muscle atrophy or ankylosis of the spine. The examiner indicated that the Veteran does not have IVDS. The Veteran’s constant use of a cane was noted. As stated above, in order to warrant a next higher rating of 50 percent for the Veteran’s lumbar spine disability, the evidence must show that he has unfavorable ankylosis of the entire thoracolumbar spine. However, evidence does not show that the Veteran has had ankylosis of the thoracolumbar spine at any time during the entire period on appeal. Consequently, the Board finds that the Veteran’s entitlement to an evaluation in excess of 40 percent for a lumbar spine disability for the period beginning February 1, 2018 is not warranted. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.45, 4.59, 4.71a, Diagnostic Code 5237 (2019). 2. Cervical spine disability The Veteran is currently service-connected for cervical spine degenerative arthritis. The Veteran was initially assigned a noncompensable disability rating from April 1, 2011, but it was increased to 10 percent for the same period. See August 2020 Rating Decision. Further, a 20 percent evaluation was assigned from February 1, 2018. Cervical spine degenerative arthritis is evaluated under General Formula. 38 C.F.R. § 4.71a, Diagnostic Code 5242. In pertinent part, a 20 percent evaluation is warranted for forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees, or, combined range of motion of the cervical spine not greater than 170 degrees; a 30 percent evaluation is warranted for forward flexion of the cervical spine 15 degrees or less, or favorable ankylosis of the entire cervical spine; a 40 percent disability rating is assigned for unfavorable ankylosis of the entire cervical spine; and a maximum 100 percent evaluation is warranted for unfavorable ankylosis of entire spine. 38 C.F.R. § 4.71a, General Formula (2019). On December 2010 VA examination, the examiner provided the Veteran’s diagnosis of degenerative arthritis of the cervical spine. The examiner noted that there was no evidence of radiating pain on movement of the cervical spine, muscle spasm, tenderness, guarding, weakness, loss of tone, or atrophy of the limbs. The Veteran did not have ankylosis of the cervical spine. The range of motion of the Veteran’s cervical spine was within normal limits, and there was no additional degree of limitation of motion after a repetitive range of motion testing. The examiner also indicated that joint function of the cervical spine is not additionally limited by pain, fatigue, weakness, lack of endurance or incoordination after repetitive use. Until the Veteran’s private evaluation of the cervical spine on May 1, 2013, as discussed below, the evidence of record does not show that the Veteran’s cervical spine disability resulted in forward flexion of the cervical spine greater than 15 degrees, but not greater than 30 degrees, or combined range of motion of the cervical spine not greater than 170 degrees. Consequently, the Board finds that the Veteran’s entitlement to an initial evaluation in excess of 10 percent for a cervical spine disability for the period from April 1, 2011 to April 30, 2013 is not warranted. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.45, 4.59, 4.71a, Diagnostic Code 5242 (2019). Notably, the evidence shows that the Veteran had a private evaluation of his cervical spine on May 1, 2013. During the evaluation, the Veteran’s difficulty with activities of daily living, difficulty with turning head, being awakened by pain, weakness, loss of function, loss of motion due to stiffness, radicular pain, and headaches were noted. The Veteran reported stabbing and burning pain between the shoulder blades and back of the neck up to his forehead. He rated the pain from 6 to 8 out of 10. The examiner noted that she was unable to further assess cervical musculature due to increased sympathetic nervous system response and the Veteran had significant tenderness to suboccipital muscles. The Board notes that the range of motion of the Veteran’s cervical spine was recorded as percentages rather than degrees. As finder of fact, the Board may interpret these percentages and convert them to numerical data. The Veteran’s initial active range of motion was noted as 25 percent each for flexion, extension, right rotation, and left rotation. In this case, the Board finds that the percentages of range of motion are clear, and as such, these measurements will be considered in the evaluation of the Veteran’s claim. A 100 percent of cervical flexion, extension, and right and left lateral flexions are 45 degrees; and a 100 percent of right and left rotations are 80 degrees. 38 C.F.R. § 4.71a, Plate V (2019). Thus, the Board concludes that the Veteran’s cervical spine flexion was limited to 11 degrees and extension, right and left rotations were limited to 20 degrees. Based on above and resolving reasonable doubt in the Veteran’s favor, the Board finds that the Veteran’s cervical spine disability has been resulting in forward flexion of the cervical spine limited to 15 degrees or less for the period beginning May 1, 2013. As stated above, for the rating of 40 percent, the evidence must show that the Veteran’s cervical spine disability results in unfavorable ankylosis of the entire cervical spine. On February 2018 VA examination, the range of motion for cervical spine was measured at: forward flexion to 35 degrees; extension to 25 degrees; right and left lateral flexion to 20 degrees; and right and left lateral rotation to 15 degrees. Pain was noted during forward flexion, extension, right lateral flexion, and right lateral rotation range of motion testing. The Veteran was able to perform repetitive-use testing with at least three repetitions without additional loss of function or range of motion afterwards. There was objective evidence of localized tenderness of a moderate level in the cervical region. The examiner noted that the Veteran has localized tenderness, guarding, or muscle spasm of the cervical spine, but it does not result in abnormal spinal contour. The examiner reported that the Veteran does not have any ankylosis of the spine. On August 2020 VA examination, the range of motion of the cervical spine was measured at: forward flexion and extension to 30 degrees; right and left lateral flexions to 25 degrees; and right and left lateral rotation to 70 degrees. Pain was noted during all range of motion testing. The examiner provided that the Veteran’s range of motion itself contributes to a functional loss since it impacts his ability to lift things, especially above the head, and to turn and/or look up or down in a normal manner. The examiner noted that the Veteran does not have any ankylosis of the spine. Based on above, the Board finds that the Veteran did not have unfavorable ankylosis of the entire cervical spine at any time during the entire period on appeal. Consequently, resolving reasonable doubt in the Veteran’s favor, the Board finds that the Veteran’s entitlement of an evaluation of 30 percent, but no higher, for a cervical spine disability for the period beginning May 1, 2013 is warranted. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.45, 4.59, 4.71a, Diagnostic Code 5242 (2019). 3. Migraine headaches The Veteran is currently service-connected for migraine headaches and headache syndromes and was initially assigned a noncompensable evaluation (0 percent) from April 1, 2011. The evaluation was increased to 10 percent from February 1, 2018. See August 2020 Rating Decision. Migraine headaches are evaluated under Diagnostic Code 8100. In pertinent part, a 10 percent evaluation is warranted for migraine with characteristic prostrating attacks averaging one in two months over last several month; a 30 percent evaluation is warranted for migraine with characteristic prostrating attacks occurring on an average once a month over last several months; and a maximum 50 percent evaluation is warranted for migraine with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. 38 C.F.R. § 4.124a, Diagnostic Code 8100 (2019). On December 2010 VA examination, the Veteran described his headaches as intermittent, dull, frontal then temporal type of headache pain which causes nausea, vomiting, and sensitivities to light and noise. The Veteran reported that he is able to go to work when headaches occur, but a medication is required. The Veteran indicated headaches pain level of 8 on a scale from 1 to 10 with 10 being the highest level of pain. The Veteran stated that headaches flare-ups occur as often as twice a week with each lasting for 4 hours, and he is unable to perform daily functions during the flare-ups. The Veteran’s severe headaches were noted during a September 2012 cognitive impairment consult. The Veteran reported that headache triggers include smells, taste, light, and neck pain, and he experiences constant pressure with throbbing sensation in both temples which recurs three times a week lasting most of the day. Also, on a December 2012 therapy session, the Veteran reported that he experiences headaches one to two times a week. During a primary care visit in August 2014, the Veteran reported that he continues to have headaches twice weekly, and it starts at the back of the neck and radiates to the front of the head. He stated that he has photophobia when the headache is severe. During the March 2017 hearing, the Veteran testified that he has incapacitating migraine headache episodes or attacks about twice a week which last a day and a half. The Veteran provided that he has to take time off when he gets longer lasting migraine attacks, and had to take 30 to 33 days of sick leave in a six-month period due to migraine headaches. The Veteran testified that noise and florescent lights can increase the headache to the point where he just has to put his head down on the desk while covering it with a coat. On February 2019 VA examination, the examiner noted the Veteran’s headaches symptoms of constant head pain, pulsating or throbbing head pain, pain localized to one side of the head, and worsening of pain with physical activity. Other non-headaches symptoms of nausea, sensitivity to light and sound, and changes in vision were also noted. The examiner provided that the Veteran has characteristic prostrating attacks of migraine/non-migraine headache pain once every month. The examiner provided that the Veteran does not have very prostrating and prolonged attacks of migraines/non-migraine pain productive of severe economic inadaptability. The examiner stated that the Veteran’s headaches condition impacts his ability to work since he is not able to focus or perform job duties when the headaches occur. After a review of evidence of record, the Board notes that the Veteran’s reports of frequency of at least one to two migraine attacks or symptoms per week were consistent throughout the entire period on appeal. Thus, the Board resolves reasonable doubt in the Veteran’s favor and finds that the evidence of record shows that he has been having migraine headaches with characteristic prostrating attacks occurring on an average once a month over last several months for the entire period on appeal. Consequently, resolving reasonable doubt in the Veteran’s favor, the Board finds that the Veteran’s entitlement to an initial evaluation of 30 percent, but no higher, for migraine headaches, for the period beginning April 1, 2011 is warranted. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.124a, Diagnostic Code 8100 (2019). The next higher rating of 50 percent is not warranted here as the evidence does not show that the Veteran is having migraine headaches with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. 38 C.F.R. § 4.124a, Diagnostic Code 8100 (2019). 4. Hypertension The Veteran is currently service-connected for hypertension and was initially assigned a noncompensable evaluation (0 percent) from April 1, 2011. Later, the evaluation was increased to 10 percent from February 1, 2018. See August 2020 Rating Decision. Thus, the Board will examine whether the Veteran was entitled to an initial compensable evaluation for the period from April 1, 2011 to January 31, 2018, and is entitled to an evaluation in excess of 10 percent for the period beginning February 1, 2018. Hypertension is evaluated under Diagnostic Code 7101. A 10 percent evaluation is warranted for diastolic pressure predominantly 100 or more, or; systolic pressure predominantly 160 or more, or; minimum evaluation for an individual with a history of diastolic pressure predominantly 100 or more who requires continuous medication for control; a 20 percent evaluation is warranted for diastolic pressure predominantly 110 or more, or; systolic pressure predominantly 200 or more; a 40 percent evaluation is warranted for diastolic pressure predominantly 120 or more; and a maximum 60 percent is warranted for diastolic pressure predominantly 130 or more. 38 C.F.R. § 4.104, Diagnostic Code 7101 (2019). The term “predominant” is not defined in the rating criteria. Merriam-Webster defines predominant to mean “being most frequent or common.” See, e.g., “predominant,” Merriam-Webster.com Online Dictionary, https://www.merriam-webster.com/dictionary/predominant. The records from 2012 shows the Veteran’s blood pressure readings as the following: 149/97, 116/80, 138/78, 143/89, 145/89. See August 2012 H & P Outpatient Note, September 2012 PC Follow-up Note, October 2012 Urology Note, November 2012 Urology Procedure Note. In 2013, the blood pressure readings were as the following: 130/88, 128/86 (resting), 126/84, 140/86, 137/74, 127/76, 145/96, 115/81, and 136/93. See March, August and December 2013 PC Follow-up Notes, September 2013 Stress Test Consult, H & P Note, Nursing Procedure Note, and Cardiology Note. In July 2014, the Veteran reported that his blood pressure runs about 150/100s when he is having headaches, which happens every two to three weeks, and his blood pressure at home runs 130 to 150 (systolic) over 80 to 100 (diastolic). See July 2014 Cardiology Note. Other records from 2014 shows the blood pressure readings as the following: 134/90, 132/88, 137/85, 116/83, 135/89, and 125/81. See January 2014 Nurse Notes, April and August 2014 PC Follow-up Notes, and January and July 2014 Cardiology Notes. In February 2015, the Veteran reported that his blood pressure at home runs 130/80s and his blood pressure during the consultation was 132/86. See February 2015 Cardiology Note. The Board notes that this is the only blood pressure reading on record from 2015. October 2016 treatment records shows the blood pressure readings of 132/83 and 124/85. See October 2016 Treatment Records from CHI St. Luke’s Health. During the March 2017 hearing, the Veteran testified that he takes three different medications for hypertension. He stated that his blood pressure has been pretty steady since he has been on the medications and doing yoga to help with his blood pressure. Based on above, the Board finds that the evidence of record does not show that the Veteran’s diastolic pressure was predominantly 100 or more or systolic pressure was predominantly 160 or more for the period from April 1, 2011 to January 31, 2018. Consequently, the Board finds that the Veteran’s entitlement to an initial compensable evaluation for hypertension for the period from April 1, 2011 to January 31, 2018 is not warranted. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.104, Diagnostic Code 7101 (2019). As stated above, a higher 20 percent rating under DC 7101 is not warranted unless diastolic pressure is predominantly 110 or more, or systolic pressure is predominantly 200 or more. The Board notes that the three blood pressure readings recorded during a February 2018 VA examination were 189/109, 194/111, and 190/103. Also, 2018 records show the following blood pressure readings: 122/83, 137/85, 133/81, 124/81, and 133/81. See May 2018 Nursing Note and October 2018 Hematology Consult Note. Thus, the Board finds that the evidence of record does not show that the Veteran has been having diastolic pressure predominantly 110 or more, or systolic pressure predominantly 200 or more for the period beginning February 1, 2018. Consequently, the Board finds that the Veteran’s entitlement to an evaluation in excess of 10 percent for hypertension for the period beginning February 1, 2018 is not warranted. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.104, Diagnostic Code 7101 (2019). 5. Left upper extremity disability The Veteran is currently service-connected for left upper extremity cubital tunnel syndrome. The Veteran was initially assigned a noncompensable disability rating from April 1, 2011, but it was increased to 10 percent for the same period. See August 2020 Rating Decision. Further, a 20 percent evaluation was assigned from February 1, 2018. The record shows that the Veteran’s right hand is his dominant hand. Paralysis of the ulnar nerve is evaluated under Diagnostic Code 8516. Mild incomplete paralysis is rated as 10 percent for both the major and minor extremity; moderate incomplete paralysis is rated as 20 percent for the minor extremity, and severe incomplete paralysis is rated as 30 percent for the minor extremity. 38 C.F.R. § 4.124a, Diagnostic Code 8516 (2019). A maximum 50 percent rating for the minor extremity is warranted for complete paralysis with the griffin claw deformity due to flexor contraction of ring and little fingers, atrophy very marked in dorsal interspace and thenar and hypothenar eminences; loss of extension of ring and little fingers cannot spread the fingers (or reverse), cannot adduct the thumb; and flexion of wrist weakened. Id. The words “mild,” “moderate,” and “severe” as used in the various Diagnostic Codes are not defined in the Rating Schedule. Regulations provide that ratings for peripheral neurological disorders are to be assigned based the relative impairment of motor function, trophic changes, or sensory disturbance. 38 C.F.R. § 4.120 (2019). Consideration is also given for loss of reflexes, pain, and muscle atrophy. See 38 C.F.R. §§ 4.123, 4.124 (2019). The term “incomplete paralysis” indicates a degree of lost or impaired function substantially less than the type picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating is for the mild, or at most, the moderate degree. The disability ratings for the peripheral nerves are for unilateral involvement; when bilateral, the ratings combine with application of the bilateral factor. 38 C.F.R. § 4.124a (2019). On December 2010 VA examination, the examiner noted the Veteran’s history of left elbow ulnar nerve irritation. The Veteran reported tingling and numbness, pain, weakness, and paralysis. The examiner noted that the Veteran’s symptoms occur intermittently about twice a month which lasts one day. The Veteran was doing physical therapy four times a week and taking Motrin as needed. The Veteran reported that he is able to perform daily functions during flare-ups and does not experience overall functional impairment from this condition. During the March 2017 hearing, the Veteran testified that he experiences tingling and pain in the left ring finger and pinky finger, and the tingling has gotten worse over time. The Veteran described that his whole left hand is numb, and the tingling and pain run along the left side of the arm through the elbow. The Veteran also stated that he has lost considerable amount of strength in the left hand. Based on above, the Board finds that the Veteran’s symptoms of left upper extremity disability for period from April 1, 2011 to January 31, 2018 more approximates a mild level of incomplete paralysis, and no worse, involving the ulnar nerve. Thus, the Board finds that the Veteran’s entitlement to an initial evaluation in excess of 10 percent for left upper extremity cubital tunnel syndrome for the period from April 1, 2011 to January 31, 2018 is not warranted. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.124a, Diagnostic Code 8516 (2019). Now the Board will examine whether the Veteran is entitled to an evaluation higher than 20 percent for the period beginning February 1, 2018. On August 2020 VA examination for peripheral neuropathy conditions, the examiner noted the Veteran’s diagnosis of left upper extremity cubital tunnel syndrome. The examiner provided that there is no change in the Veteran’s service-connected diagnosis and no additional diagnoses have been rendered. The examiner noted the Veteran’s mild paresthesia and/or dysesthesias, and mild numbness affecting left upper extremity. The muscle strength testing was all normal for left upper extremity, including the elbow, wrist, grip, and pinch. The Veteran did not have muscle atrophy. The sensation testing for light touch to the left inner/outer forearm (C6/T1) and left hand/fingers revealed decreased sensations. The examiner noted that the Veteran’s has mild incomplete paralysis involving ulnar nerve affecting his left side. In light of the above, the Board finds that the evidence of record does not show that the Veteran’s has been having severe incomplete paralysis involving the ulnar nerve due to his left upper extremity cubital tunnel syndrome for the period beginning February 1, 2018. Consequently, the Board finds that the Veteran’s entitlement to an evaluation in excess of 20 percent for left upper extremity cubital tunnel syndrome for the period beginning February 1, 2018 is not warranted. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.124a, Diagnostic Code 8516 (2019). MICHAEL LANE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. E. Kim, 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.