Citation Nr: 21010579 Decision Date: 02/25/21 Archive Date: 02/25/21 DOCKET NO. 17-62 327A DATE: February 25, 2021 ORDER Entitlement to a 50 percent disability rating for migraine headaches is granted, subject to the criteria applicable to the payment of monetary benefits. FINDING OF FACT Resolving all reasonable doubt in favor of the Veteran, the Board finds that the Veteran experienced migraines with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. CONCLUSION OF LAW Throughout the entire period on appeal the criteria for a disability rating of 50 percent for migraine headaches have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.14, 4.124a, Diagnostic Code 8100. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from April 1985 to December 1986. In February 2021, the Veteran testified at a virtual hearing before the undersigned Veterans Law Judge. The transcript from the hearing has not yet been associated with the file, as the appeal is being granted under the Board’s “One Touch” program. The hearing transcript will be processed and associated with the claims file at a later time. Entitlement to a disability rating in excess of 30 for migraine headaches. The Veteran contends that he is entitled to a higher disability rating for his migraine disorder. Migraine headaches are rated 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 the Veteran has had migraines 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. The Veteran underwent a VA examination in April 2017. The Veteran described worsening headaches that occurred almost daily. For his tolerable headaches, there were no precipitating factors and the headaches were relieved by rest and medication. His severe headaches occurred two to three times per week, with pain starting in the left temporal region behind the left eye and spreading to the right side. The Veteran reported photophobia, phonophobia, and nausea associated with the severe headaches. He stated that he had to lie down in a dark and quiet room during such attacks. He also used rizatriptan to treat his severe attacks. The examiner noted symptoms of pulsating or throbbing head pain, nausea, sensitivity to light, and sensitivity to sound. The examiner found that the Veteran’s characteristic prostrating attacks occurred once a month and that he did not have very prostrating and prolonged attacks of migraine pain productive of severe economic inadaptability. The examiner stated that the Veteran’s migraine disorder impacted his ability to work. It was noted that the Veteran’s headaches slowed him down and made it difficult for him to do household chores or be around others. The Veteran submitted a disability benefits questionnaire completed by A.L., M.D. in August 2017. The Veteran’s diagnosed conditions included migraines and tension headaches. His symptoms were pulsating or throbbing head pain, pain that worsened with physical activity, nausea, vomiting, sensitivity to light, sensitivity to sound, and changes in vision. His headaches lasted one to two days and were located on the left side of the head. Dr. L. found that the Veteran’s characteristic prostrating attacks occurred more frequently than once per month and that his prostrating attacks of non-migraine headache pain occurred once every month. It was also found that the Veteran had very frequent prostrating and prolonged attacks of migraine headache pain. Dr. L. found that the Veteran’s migraine disorder impacted his ability to work. At the February 2021 Board hearing, the Veteran testified that his prostrating attacks occurred two to three times per week and that his doctor recommended that he no longer work. The Veteran is competent to report his readily observable symptoms. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Considering all relevant evidence of record, the Board finds that a 50 percent rating is warranted throughout the entire period on appeal. The Board acknowledges the April 2017 VA examiner’s finding that the Veteran did not experience very prostrating and prolonged attacks of migraine pain productive of severe economic inadaptability. However, the April 2017 VA examiner and Dr. L. agreed that the Veteran’s migraine disorder impacted his ability to work. The evidence of record shows that his migraine disorder slowed him down and made it difficult to complete household chores. Moreover, the Veteran testified that his doctor advised him not to work because of his headache disorder. Additionally, the evidence shows that the Veteran experienced severe headaches that occurred two to three times per week and lasted one to two days. Therefore, the Board finds that the Veteran experienced very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. The Board acknowledges that a 50 percent rating can be assigned where migraine headaches could be productive of severe economic inadaptability, even if they are not actually productive of severe economic inadaptability. Resolving all doubt in the Veteran’s favor, the Board concludes that the Veteran has had migraines with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability throughout the entire period on appeal. B. MULLINS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. McKinley, 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.