Citation Nr: 21015925 Decision Date: 03/18/21 Archive Date: 03/18/21 DOCKET NO. 16-46 598 DATE: March 18, 2021 ORDER Prior to December 12, 2019, a 30 percent rating, but no higher, for the service-connected headache disability is granted. Beginning December 12, 2019, a 50 percent rating, but no higher, for the service-connected headache disability is granted. REMANDED Entitlement to a rating higher than 10 percent for the right lateral collateral ligament sprain with subluxation of the peroneal tendon is remanded. Entitlement to a rating higher than 20 percent for the right lower extremity neuropathy is remanded. Prior to August 30, 2020, entitlement to an initial compensable rating for the service-connected traumatic brain injury (TBI) is remanded. Beginning August 30, 2020, entitlement to a rating higher than 10 percent for the service-connected TBI is remanded. Prior to August 30, 2020, entitlement to a compensable rating for the service-connected left eyebrow scar as a residual of the service-connected TBI is remanded. Beginning August 30, 2020, entitlement to a rating higher than 10 percent for the service-connected left eyebrow scar as a residual of the service-connected TBI is remanded. Entitlement to a separate rating for the benign paroxysmal positional vertigo (BPPV) as a separately diagnosed physical manifestation of the service-connected TBI is remanded. FINDINGS OF FACT 1. Prior to December 12, 2019, the headache disability more nearly manifested with characteristic prostrating attacks occurring on average once a month over several months. 2. Beginning December 12, 2019, the headache disability more nearly manifested as very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. 3. The December 12, 2019 hearing was the first date it was factually ascertainable that the headache disability had worsened to a sufficient severity to more nearly manifest as being very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. CONCLUSIONS OF LAW 1. Prior to December 12, 2019, the criteria for a 30 percent rating, but no higher, for the service-connected headache disability have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.21, 4.124a, Diagnostic Code 8100. 2. Beginning December 12, 2019, the criteria for a 50 percent rating, but no higher, for the service-connected headache disability have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.21, 4.124a, Diagnostic Code 8100. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 1983 to October 1984. This matter comes on appeal before the Board of Veterans’ Appeals (Board) from a March 2015 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). By way of procedural background, the RO initially granted a 20 percent rating for residuals for a right leg injury (to include soft tissue wounds, sensory defects, and right ankle impairment). While on remand, the RO granted a separate rating of 20 percent for right lower extremity neuropathy (previously rated as residuals of the right leg injury) effective April 1, 2014 in addition to a 10 percent rating for the right lateral collateral ligament sprain with subluxation of the peroneal tendons effective April 1, 2014. As such, the Board has recharacterized the claims as noted above to reflect these changes in the assigned ratings. This matter was previously before the Board in January 2020. As to the headache disability, the RO has substantially complied with the Board’s remand directives. In December 2019, the Veteran testified before the undersigned Veterans Law Judge via videoconference hearing. A copy of the hearing transcript is of record and has been reviewed. The Veteran testified at the December 2019 Board hearing that he was currently employed full time. There is no evidence that he is employed in a protected environment or that his employment is less than substantially gainful. Thus, the current evidence of record does not indicate that the Veteran is unemployable due to his service-connected disabilities at this time. Further, the Veteran has not raised the issue of entitlement to total disability rating due to individual unemployability. Therefore, the Board will not address whether a TDIU is warranted at this time. See Rice v. Shinseki, 22 Vet. App. 447 (2009).   Preliminary Matters The Board has limited the discussion below to the relevant evidence required to support its finding of fact and conclusion of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016). 1. Prior to December 12, 2019, a 30 percent rating, but no higher, for the service-connected headache disability is granted. 2. Beginning December 12, 2019, a 50 percent rating, but no higher, for the service-connected headache disability is granted. Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule) found in 38 C.F.R. Part 4. 38 U.S.C. § 1155. It is not expected that all cases will show all the findings specified; however, findings sufficiently characteristic to identify the disease and the disability therefrom and coordination of rating with impairment of function will be expected in all instances. 38 C.F.R. § 4.21. Where there is a question as to which of two disability ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. It is the defined and consistently applied policy of VA to administer the law under a broad interpretation, consistent, however, with the facts shown in every case. When after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability such doubt will be resolved in favor of the claimant. 38 C.F.R. § 4.3. In general, all disabilities, including those arising from a single disease entity, are rated separately, and all disability ratings are then combined in accordance with 38 C.F.R. § 4.25. Pyramiding, the rating of the same disability, or the same manifestation of a disability, under different diagnostic codes, is to be avoided when rating a veteran’s service-connected disabilities. 38 C.F.R. § 4.14. It is possible for a veteran to have separate and distinct manifestations from the same injury which would permit rating under several diagnostic codes; however, the critical element in permitting the assignment of several ratings under various diagnostic codes is that none of the symptomatology for any one of the conditions is duplicative or overlapping with the symptomatology of the other condition. Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994). When an unlisted condition is encountered it will be permissible to rate under a closely related disease or injury in which not only the functions affected, but the anatomical localization and symptomatology are closely analogous. Conjectural analogies will be avoided, as will the use of analogous ratings for conditions of doubtful diagnosis, or for those not fully supported by clinical and laboratory findings. Nor will ratings assigned to organic diseases and injuries be assigned by analogy to conditions of functional origin. 38 C.F.R. § 4.20. Where an increase in the level of a service-connected disability is at issue, the primary concern is the present level of disability. See Francisco v. Brown, 7 Vet. App. 55 (1994). Staged ratings are appropriate for any initial rating claim when the factual findings show distinct time periods during the appeal period where the service-connected disability exhibits symptoms that would warrant different ratings. Fenderson v. West, 12 Vet. App. 119, 126 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive and provide the reasons for its rejection of any material favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). A veteran is competent to report symptoms because this requires only personal knowledge, not medical expertise, as it comes to him through his senses. See Layno v. Brown, 6 Vet. App. 465 (1994). Lay testimony is competent to establish the presence of observable symptomatology, where the determination is not medical in nature and is capable of lay observation. Barr v. Nicholson, 21 Vet. App. 303 (2007). When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with a veteran prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. The Veteran contends that he is entitled to a higher rating for the service-connected headache disability. 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 contains 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). In rating headaches or migraines under DC 8100, the Board may not consider the ameliorative effects of medication. See Jones v. Shinseki, 26 Vet. App. 56, 63 (2012). Turning to the evidence of record, the Veteran was afforded a VA examination for the traumatic brain injury (TBI) in October 2014. The examiner, a Board-certified neurologist, diagnosed the Veteran with post-traumatic headaches with onset after a motor vehicle accident in February 1984. Service treatment records show that he was driving a jeep when he lost control of the vehicle on a curve. The Jeep rolled over, and he was ejected from the vehicle, sustaining multiple injuries. He did not remember the events. He woke up one day later, indicating post-traumatic amnesia. The emergency department records reported the Veteran was confused about the time and place. The Veteran had severe headaches during the first year following the accident. The headaches pulsated in the left temporal area, and were associated with photophobia, phonophobia, and dizziness. The Veteran reported he was evaluated with an EEG, but it was negative. His current symptoms included rare headaches a few times a year that lasted one hour to a few hours. He treated the headaches with Tylenol. The examiner concluded that the post-traumatic headaches were a residual of the service-connected TBI. The Veteran was also afforded a VA headache examination with the same Board-certified neurologist in October 2014. The examiner noted the Veteran treated the headaches with Tylenol as needed. The headache pain was pulsating or throbbing pain that was localized to the left side of his head. During his headaches, he also experienced sensitivity to light, sound, and dizziness. The headaches usually lasted less one day. The examiner found that the Veteran did not have characteristic prostrating attacks of headache pain. The headache condition did not impact the Veteran’s ability to work. In July 2015, the Veteran was treated at a private facility. He reported that he had headaches intermittently since the 1980s after the head trauma. Since then, he experienced intermittent left sided headaches. Occasionally, the headaches were severe with throbbing and photophobia. The headaches were as frequent as two times a month to two times a week. He was given over the counter pain medications. The assessment was questionable migraines and a workup was recommended. The Veteran wanted to treat them naturally but was prescribed Imitrex, if he needed it. In an August 2015 e-mail exchange, the Veteran’s private physician reported that, after reviewing the Veteran’s past private treatment records, he had not been worked up for migraines at this private facility. The examiner also indicated that the Veteran should let him know if he had migraines more than two times per month to discuss whether the Veteran was interested in taking a daily preventative medication. It does not appear that the Veteran responded. An October 2016 private treatment record indicated the Veteran was prescribed Sumatriptan (Imitrex) as needed to take at onset and during a migraine headache. The Veteran testified before the Board in December 2019. The Veteran testified that he had headaches every day. The pain started on one side of his head and then moved to the back of his head. Sometimes he was late for work while he waited for the pain to decrease. Sometimes he had to close his window because of the light it let into his room aggravated his headache pain. In addition to photosensitivity, he also testified that his vision became blurry during a headache. The Veteran indicated that, even before January 2014 when he filed the claim, the headaches forced him to lay down in his bed and rest. He clarified that the headaches were not as frequent in 2014 as they were as of the hearing, and the severity of the headache disability had worsened. He was working currently, but he would sometimes call in sick due to the headache pain. An August 2020 VA treatment record indicated the Veteran experienced chronic headaches for approximately 30 years. The Veteran’s history was consistent with headache syndrome with daily headaches and migraine features. The Veteran reported that his private provider prescribed Tylenol, meloxicam, naproxen, and motrin as needed but he was still experiencing headaches almost daily. He requested a second opinion from his VA primary care physician. In the August 2020 VA TBI examination, it was noted the Veteran had severe headaches for the first year following the head injury in service. The examiner, a physician, reported the Veteran’s current symptoms were daily throbbing headaches that lasted from two to four hours per day. He was treated with Tramadol, Gabapentin, and Mobic. He also had frequent hypersensitivity to sound and light. The headaches prevented him from prolonged concentration or focus. The Veteran was also afforded an August 2020 VA headache examination. The examiner, a physician, indicated the headache disability had progressed or worsened. The Veteran was prescribed Tramadol, Gabapentin, and Mobic. The headache pain pulsated and throbbed on both sides of his head. He also experienced nausea and hypersensitivity to sound and light. The headache lasted less than one day. The examiner determined the Veteran had characteristic prostrating attacks of headache pain with severe economic inadaptability. The Veteran’s headache disability limited his ability to work because he experienced limited prolonged concentration and focus during a headache. The headache disability is currently rated as noncompensable prior to August 3, 2020 and 50 percent thereafter. Considering all relevant evidence of record, the Board finds that, prior to December 12, 2019, the Veteran’s headache disability manifested in characteristic prostrating attacks occurring on average once per month over the previous few months, which warrants a 30 percent rating under DC 8100. The Veteran testified at the December 2019 hearing that the headaches resulted in nausea, visual disturbances, and photosensitivity, and that he had to lay down and rest to alleviate the headache pain prior to filing his January 2014 claim. As early as July 2015, the medical evidence shows the Veteran reported he was experiencing headaches as frequently as twice a month to twice a week, and the October 2014 VA examination report indicated that his headaches lasted anywhere from one hour to a few hours but no longer than one day. The Veteran is competent to report these types of symptoms, and the Board has no reason to doubt his credibility as his reported symptoms are consistent with the medical evidence of record. Thus, the Board finds that, prior to December 19, 2019, the Veteran’s headaches more nearly approximated characteristic prostrating attacks with nausea, photosensitivity, and sensitivity to sound, and a 30 percent rating is warranted. However, for the period prior to December 12, 2019, a 50 percent rating under DC 8100 is not warranted. There is no indication prior to the December 2019 hearing that the headaches lasted longer than a few hours, and at worst, less than one day. As such, they could not be considered “prolonged” under the plain language meaning of the word. Accordingly, the evidence does not support a higher 50 percent rating under DC 8100 for the period prior to December 12, 2019. Beginning December 12, 2019, the Board finds the evidence is at least in equipoise that the Veteran’s headaches had worsened to more nearly manifest as completely prostrating and resulted in prolonged attacks productive of severe economic inadaptability. The December 2019 hearing is the first indication in the record the Veteran’s headaches had become daily occurrences, which required that he lay down and rest, block out light from the windows, and call in sick or be late to work due to the headache pain. The Veteran also testified at the December 2019 hearing that his headaches had worsened in severity and frequency than earlier in the appeal period. The Board acknowledges that the Veteran’s headache disability unlikely became worse on the exact day of the December 12, 2019 hearing; nevertheless, the Board finds that this is the earliest date it was first factually ascertainable that the Veteran’s headaches had worsened in severity sufficient to satisfy the 50 percent rating criteria. Therefore, a 50 percent rating is warranted beginning December 12, 2019. A 50 percent rating is the maximum schedular rating allowed under DC 8100; thus, beginning December 12, 2019, a higher schedular rating for the service-connected headache disability under DC 8100 is not available. See Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). Finally, the Board notes that neither the Veteran nor his representative have raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 69-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). REASONS FOR REMAND 1. Entitlement to a rating higher than 10 percent for the right lateral collateral ligament sprain with subluxation of the peroneal tendon is remanded. The Board notes that new evidence, specifically VA treatment records, were associated with the claims file after the most recent September 2020 Supplemental Statement of the Case (SSOC). Therefore, this VA-generated evidence was not reviewed by the RO. The Board sent the Veteran a letter requesting that the Veteran waive initial review by the AOJ of this additional evidence; however, the Veteran did not respond. 38 C.F.R. §§ 19.37(b). 20.1305(c). Thus, a remand is warranted for the AOJ to consider the additional VA generated evidence and issue an SSOC. 2. Entitlement to a rating higher than 20 percent for the right lower extremity neuropathy is remanded. The Board notes that new evidence, specifically VA treatment records, were associated with the claims file after the most recent September 2020 Supplemental Statement of the Case (SSOC). Therefore, this VA-generated evidence was not reviewed by the RO. 38 C.F.R. §§ 19.37(b). 20.1305(c). The Board sent the Veteran a letter requesting that the Veteran waive initial review of this additional evidence by the AOJ; however, the Veteran did not respond. Thus, a remand is warranted for the AOJ to consider the additional VA treatment records and issue an SSOC. 3. Prior to August 30, 2020, entitlement to an initial compensable rating for the service-connected traumatic brain injury (TBI) is remanded; 4. Beginning August 30, 2020, entitlement to a rating higher than 10 percent for the service-connected traumatic brain injury (TBI) is remanded. The Veteran was afforded an additional VA TBI examination in August 2020 as directed by the Board’s January 2020 remand instructions. Unfortunately, another remand is necessary as the August 2020 TBI examination is inadequate in its current form because it is internally inconsistent and inconsistent with other VA examinations of record. The examiner, a physician, found that the Veteran had symptoms of mild memory loss, attention, concentration, or executive functions but without objective evidence on testing. While this finding does describe the Veteran’s subjective symptoms, it does not appear that the Veteran was afforded neuropsychological testing and the record is unclear if any other testing was conducted to determine whether there were objective signs of these symptoms. Additionally, no explanation was provided as to how the examiner determined there was no objective evidence of the Veteran’s symptoms on testing, if no testing was conducted. The examiner also found that the Veteran was occasionally disoriented to one of the four aspects of orientation, to include person, time, place or situation. Nevertheless, in the comment box, the examiner wrote that the Veteran was occasionally disoriented to time and place – which are two of the four aspects of orientation. No explanation was provided as to this discrepancy. In addition, the August 2020 VA examiner found the Veteran had three or more subjective symptoms that mildly interfered with the Veteran’s work, to include intermittent dizziness, daily mild to moderate headaches, frequent insomnia, and hypersensitivity to sound and light. Despite this characterization of the daily headaches as mild, the same examiner, in the August 2020 headache disability benefit questionnaire, indicated that the headaches were severe and manifested as very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. The August 2020 VA TBI examination is inconsistent with the VA headache examination. Thus, a remand is warranted to afford the Veteran a new VA TBI examination to determine the current nature and severity of the TBI. 4. Prior to August 30, 2020, entitlement to a compensable rating for the service-connected left eyebrow scar (as a TBI residual) is remanded; 5. Beginning August 30, 2020, entitlement to a rating higher than 10 percent for the service-connected left eyebrow scar (as a TBI residual) is remanded In part, this appeal stems from the Veteran’s disagreement with the assigned initial ratings of the TBI and its residuals. One of the residuals of the TBI is a left eyebrow scar; nevertheless, the RO has not made an initial adjudication as to whether the Veteran is entitled to a compensable rating prior to August 30, 2020 or entitled to a rating higher than 10 percent thereafter. The January 2020 Board remand directed that Veteran was to be afforded a VA examination to determine the current nature and severity of the TBI residuals, to include headaches and any other associated manifestations, which would include the left eyebrow scar. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Additionally, after the September 2020 SSOC, the Veteran was afforded additional scar examinations. The Board requested a waiver of AOJ initial consideration of this additional VA generated evidence, but the Veteran did not respond. 38 C.F.R. §§ 19.37(b). 20.1305(c). Therefore, on remand, the RO should issue an SSOC to consider the Veteran’s claim. 5. Entitlement to a separate rating for the benign paroxysmal positional vertigo (BPPV) as a separately diagnosed physical manifestation of the service-connected TBI is remanded. The Veteran was afforded an August 2020 VA examination for the ear, including vestibular and infectious conditions. The examiner, a physician, diagnosed the Veteran with BPPV. The examiner recited the Veteran’s history that led to the service-connected TBI and noted the Veteran has had intermittent vertigo since 1984. The condition had stayed the same since onset. The Veteran’s current symptoms were intermittent vertigo with lightheadedness and spinning sensation several times per week on average. Each episode lasted for a few seconds to a few minutes. It usually occurred when the Veteran stood up from a sitting position or turned his head. The physical examination of the ear was normal, to include the Dix Hallpike test (Nylen-Barany test) for vertigo. The examiner remarked, although the BPPV was asymptomatic on examination, the diagnosis was maintained as the Veteran continued to experience symptoms. The examiner explained that the nature of BPPV is that it is intermittent, so it was not unexpected that it was not seen on physical examination. Nevertheless, BPPV was consistent with the Veteran’s records and his subjective symptoms. Under 38 C.F.R. § 4.124a, DC 8045, applicable to rating a TBI and its residuals, physical residuals, to include neurological dysfunction, should be evaluated under the appropriate diagnostic code. Examples of physical residuals are provided, but the regulations also note that the “…preceding list of types of physical dysfunction does not encompass all possible residuals of TBI. For residuals not listed here that are reported on an examination, evaluate under the most appropriate diagnostic code. Evaluate each condition separately, as long as the same signs and symptoms are not used to support more than one evaluation, and combine under §4.25 the evaluations for each separately rated condition…” The evaluation of the same disability under various diagnoses, known as pyramiding, is generally to be avoided. 38 C.F.R. § 4.14. The critical element in permitting the assignment of several ratings under various DCs is that none of the symptomatology for any one of the disabilities is duplicative or overlapping with the symptomatology of the other disability. See Esteban, 6 Vet. App. at 261-62. Dorland’s Illustrated Medical Dictionary 2051 (32d ed. 2012) defines vertigo generally as “an illusory sense that either the environment or one’s own body is revolving… The term is sometimes erroneously used to mean any form of dizziness.” The record is unclear whether the dizziness associated with the service-connected headache disability is the same symptom as the BPPV diagnosis, which was described as “lightheadedness and spinning sensation” with certain positional changes. Since the same symptoms should not be used as the basis for two ratings, an addendum opinion should be obtained to determine whether a separate rating can be assigned for the BPPV as a TBI residual. The matters are REMANDED for the following action: 1. Obtain any outstanding pertinent VA treatment records and associate them with the claims file. 2. Schedule the Veteran for an additional VA examination with an appropriate clinician to determine the nature and severity of the TBI and all other associated manifestations (except the headache disability, which has already been adjudicated herein). *A copy of this remand must be reviewed by the examiner. All testing, studies, and evaluations must be conducted, to include neuropsychological testing if warranted, and all findings reported in detail and correlated to a specific diagnosis. If neuropsychological testing is not necessary, the examiner should provide an explanation to support this conclusion. *All pertinent symptoms and findings should be reported in detail utilizing the Compensation and Pension Examination TBI Examination Guidelines. a) Identify all manifestations of the service-connected TBI, to include the left eyebrow scar and BPPV. b) Evaluate the nature and severity of the TBI, left eyebrow scar, BPPV, and any other manifestation of the TBI found on examination or on review of the record. *The headache disability has already been adjudicated herein and should not be evaluated. c) Obtain an addendum medical opinion as to whether the symptoms of the BPPV are different symptoms than the dizziness associated with the service-connected headache disability to warrant a separate rating from the TBI. 3. Readjudicate the claims on appeal, to include the right lateral collateral ligament sprain with subluxation of the peroneal tendon, right lower extremity neuropathy, and the TBI and any associated residuals (except the headache disability). S. B. MAYS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Harper, 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.