Citation Nr: 21028623 Decision Date: 05/11/21 Archive Date: 05/11/21 DOCKET NO. 14-26 487 DATE: May 11, 2021 ORDER An initial rating in excess of 10 percent prior to November 14, 2020, and in excess of 20 percent thereafter for residuals of thoracic sprain is denied. An initial rating in excess of 10 percent prior to November 14, 2020, and in excess of 20 percent thereafter for residuals of cervical sprain is denied. An initial rating of 50 percent, but no higher, for migraine headaches is granted, subject to the laws and regulations governing payment of monetary benefits. REMANDED Entitlement to total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is remanded. FINDINGS OF FACT 1. Prior to November 14, 2020, the Veteran's residuals of thoracic sprain is manifested by was manifested by forward flexion greater than 60 degrees and a combined range of motion for the entire thoracolumbar spine greater than 120 degrees, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups, without muscle spasms or guarding severe enough to result in an abnormal gait or abnormal spinal contour, ankylosis, intervertebral disc syndrome (IVDS), or associated objective neurological abnormalities. 2. As of November 14, 2020, the Veteran's residuals of thoracic sprain is manifested by forward flexion greater than 30 degrees, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups, without ankylosis, IVDS, or associated objective neurologic abnormalities. 3. For the appeal period prior to November 14, 2020, the Veteran's residuals of cervical spine strain is manifested by forward flexion of the cervical spine greater than 30 degrees and a combined range of motion greater than 170 degrees, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups, without muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour, ankylosis, IVDS, or associated objective neurologic abnormalities. 4. As of November 14, 2020, the Veteran's residuals of cervical sprain is manifested by forward flexion of the cervical spine greater than 15 degrees, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups, without ankylosis, IVDS, or associated objective neurological abnormalities. 5. Resolving all doubt in the Veteran's favor, for the entire appeal period, his migraine headaches most nearly approximated very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability; however, such disability does not result in symptomatology that is not contemplated by the currently assigned rating. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 10 percent prior to November 14, 2020, and in excess of 20 percent thereafter for residuals of thoracic sprain have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code (DC) 5237. 2. The criteria for a rating in excess of 10 percent prior to November 14, 2020, and in excess of 20 percent thereafter for residuals of cervical sprain have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, DC 5237. 3. The criteria for an initial rating of 50 percent, but no higher, for migraine headaches have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.2, 4.3, 4.7, 4.10, 4.124a, DC 8100. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 1995 to August 1999. This matter comes before the Board of Veterans' Appeals (Board) on appeal from May 2011 and April 2012 rating decisions issued by a Department of Veterans Affairs (VA) Regional Office (RO). In July 2016, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the record. In May 2018, the Board remanded the Veteran's claims for higher initial ratings for residuals of cervical/thoracic sprain and migraine headaches for additional development. In a June 2019 rating decision, the Agency of Original Jurisdiction (AOJ) awarded an initial 30 percent rating for the Veteran's migraine headaches and, in a May 2020 rating decision, the AOJ separated the Veteran's cervical and thoracic disabilities and assigned initial 10 percent ratings for each disability. In July 2020, the Board again remanded the claims for additional development. In a December 2020 rating decision, the AOJ increased the ratings for the Veteran's migraine headaches, cervical spine disability, and thoracic spine disability, to 50, 20, and 20 percent, respectively, effective November 14, 2020. The case now returns for appellate review The Board observes that, in April 2021, the Veteran filed an Application for Increased Compensation Based on Unemployability (VA Form 21-8940) wherein he alleged that migraine headaches rendered him unemployable. Consequently, the Board finds that the issue of entitlement to a TDIU has been raised as part and parcel of such initial rating claim on appeal and, therefore, has assumed jurisdiction over it. Rice v. Shinseki, 22 Vet. App. 447 (2009). Finally, the Board notes that, subsequent to the issuance of the December 2020 supplemental statement of the case, additional VA treatment records have been associated with the record. While the Veteran has not waived AOJ consideration of such evidence, the Board finds that no prejudice results to him in proceeding with the adjudication of his claims at the present time as such are irrelevant to the issues on appeal or contain findings duplicative of those previously considered by the AOJ. 38 C.F.R. § 20.1305(c). Increased Ratings Disability ratings are determined by applying a schedule of ratings that is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R., Part 4. Each disability must be viewed in relation to its history and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of the veteran working or seeking work. 38 C.F.R. § 4.2. All reasonable doubt will be resolved in the claimant's favor. 38 C.F.R. § 4.3. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7. Separate ratings can be assigned for separate periods based on the facts found - a practice known as "staged" ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Staged ratings are appropriate whenever the factual findings show distinct periods where the service-connected disability exhibits symptoms that would warrant different ratings. Id. The basis of disability evaluation is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10. 1. Entitlement to an initial rating in excess of 10 percent prior to November 14, 2020, and in excess of 20 percent thereafter for residuals of thoracic sprain. 2. Entitlement to an initial rating in excess of 10 percent prior to November 14, 2020, and in excess of 20 percent thereafter for residuals of cervical sprain. 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. Functional loss may be due to the absence or deformity of structures or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by the visible behavior in undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. § 4.40. In Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011), the United States Court of Appeals for Veterans Claims (Court) held that, although pain may cause a functional loss, "pain itself does not rise to the level of functional loss as contemplated by VA regulations applicable to the musculoskeletal system." Rather, pain may result in functional loss, but only if it limits the ability "to perform the normal working movements of the body with normal excursion, strength, speed, coordination, or endurance." Id., quoting 38 C.F.R. § 4.40. With respect to joints, in particular, the factors of disability reside in reductions of normal excursion of movements in different planes. Inquiry will be directed to more or less than normal movement, weakened movement, excess fatigability, incoordination, pain on movement, swelling, deformity or atrophy of disuse. 38 C.F.R. § 4.45; DeLuca v. Brown, 8 Vet. App. 202 (1995). The intent of the Rating Schedule is to recognize actually painful, unstable or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint, even in the absence of arthritis. 38 C.F.R. § 4.59; Burton v. Shinseki, 25 Vet. App. 1, 5 (2011). In this regard, 38 C.F.R. § 4.59 requires that "[t]he joints involved should be tested for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with the range of the opposite undamaged joint." Correia v. McDonald, 28 Vet. App. 158 (2016). Further, 38 C.F.R. § 4.59 is applicable to the evaluation of musculoskeletal disabilities involving actually painful, unstable or malaligned joints or periarticular regions, regardless of whether the DC under which the disability is evaluated is predicated on range of motion measurements. Southall-Norman v. McDonald, 28 Vet. App. 346 (2016). The Veteran's thoracic and cervical spine disabilities are evaluated as 10 percent disabling as of January 5, 2011, the date of service connection, and 20 percent disabling as of November 14, 2020, pursuant to DC 5237 pertinent to lumbosacral or cervical strain, which, in turn, is evaluated under the General Rating Formula for Diseases and Injuries of the Spine (General Rating Formula) or the Formula for Rating IVDS Based on Incapacitating Episodes (IVDS Rating Formula), whichever method results in the higher evaluation when all disabilities are combined. 38 C.F.R. §§ 4.25, 4.71a. In this regard, ratings under the General Rating Formula are made with or without symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease. Such provides for a 10 percent rating for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, forward flexion of the cervical spine greater than 30 degrees but not greater than 40 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, combined range of motion of the cervical spine greater than 170 degrees but not greater than 335 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height. A 20 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, the combined range of motion of the cervical spine not greater than 170 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 30 percent rating is warranted for forward flexion of the cervical spine 15 degrees or less; or, favorable ankylosis of the entire cervical spine. A 40 percent rating is warranted for unfavorable ankylosis of the entire cervical spine; or, forward flexion of the thoracolumbar spine to 30 degrees or less; or favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine. Finally, a 100 percent rating is warranted for unfavorable ankylosis of the entire spine. The General Rating Formula also includes the following notes: Note (1): Evaluate any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, should be separately evaluated under an appropriate diagnostic code. Note (2): (See also Plate V.) For VA compensation purposes, normal forward flexion of the cervical spine is zero to 45 degrees, extension is zero to 45 degrees, left and right lateral flexion are zero to 45 degrees, and left and right lateral rotation are zero to 80 degrees. Normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the cervical spine is 340 degrees and of the thoracolumbar spine is 240 degrees. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion. Note (3): In exceptional cases, an examiner may state that because of age, body habitus, neurologic disease, or other factors not the result of disease or injury of the spine, the range of motion of the spine in a particular individual should be considered normal for that individual, even though it does not conform to the normal range of motion stated in Note (2). Provided that the examiner supplies an explanation, the examiner's assessment that the range of motion is normal for that individual will be accepted. Note (4): Round each range of motion measurement to the nearest five degrees. Note (5): For VA compensation purposes, unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. Note (6): Separately evaluate disability of the thoracolumbar and cervical spine segments, except when there is unfavorable ankylosis of both segments, which will be rated as a single disability. The IVDS Rating Formula provides that a 10 percent evaluation is warranted when there are incapacitating episodes having a total duration of at least one week but less than 2 weeks during the past 12 months. A 20 percent evaluation is warranted when there are incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months. A 40 percent evaluation is warranted when there are incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months. A 60 percent evaluation is warranted when there are incapacitating episodes having a total duration of at least 6 weeks during the past 12 months. Note (1) provides that an incapacitating episode is a period of acute signs and symptoms due to IVDS that requires bed rest prescribed by a physician and treatment by a physician. As an initial matter, the Board notes that the record does not show, and the Veteran does not contend, that he has IVDS of the thoracic and cervical spine disabilities. In this regard, his treatment records are negative for such a diagnosis, and VA examinations conducted in April 2011, October 2018, and November 2020 are negative for a diagnosis of IVDS related to the Veteran's service-connected spine disabilities. Consequently, the IVDS Rating Formula is inapplicable. The Board further finds that ratings in excess of 10 percent prior to November 14, 2020, and in excess of 20 percent thereafter for the Veteran's cervical and thoracic spine disabilities are not warranted under the General Rating Formula. In this regard, an April 2011 VA examination reflects the Veteran's report that he has lower and upper back pain that remained localized and did not radiate. He further indicated that he had flare-ups of low back pain two to three times a week, which made walking difficult. The examiner noted that the reported associated features of the Veteran's spine disabilities included stiffness, spasms, decreased motion, and urinary incontinence about once a month. He denied fecal incontinence, erectile dysfunction, radiating pain, pins or needles, tingling, or numbness. Upon examination, there were no abnormal spinal curvatures and, while the Veteran had an antalgic gait, such was the result of a right foot disorder as opposed to his cervical or thoracic spine disabilities. Range of motion (ROM) testing revealed full active ROM of the cervical spine without complaint of pain. ROM of the thoracolumbar spine revealed forward flexion to 90 degrees, extension to 30 degrees, and bilateral lateral flexion and rotation to 30 degrees with pain at the end of the range. There was no reduction in ROM following three repetitions. Neurological examination revealed normal sensation, motor, strength, and reflexes. VA treatment records from 2012 through 2014 reflect the Veteran's complaints of back pain with radiation to the bilateral hips, which was aggravated by prolonged walking, sitting, bending, lifting, and cold weather. However, he denied numbness, tingling, or bladder and bowel dysfunction. In March 2012, he had bilateral lateral rotation of the cervical spine to 60 degrees; however, ROM for forward flexion, extension, and lateral flexion were not provided. Additionally in March 2013, the Veteran had no radiation, weakness, or neurological symptoms of the bilateral lower extremities, and denied bladder and bowel dysfunction. At the July 2016 Board hearing, the Veteran described experiencing daily neck and back pain and stiffness, which he stated made it difficult to turn his head. He described using a brace to help with his commute to school, and being unable to sit or stand for long periods of time without changing his position. The Veteran also described radiation of pain into his hip and occasional symptoms of spasms or tensing. At an October 2018 VA examination, the Veteran reported pain and tension in his neck, which was aggravated by carrying heavy objects in a knapsack, and constant pain in his thoracic spine, which was aggravated by climbing stairs, lifting, and prolonged sitting. He denied flare-ups of the cervical and thoracolumbar spines. On examination, the Veteran's ROM of the cervical spine was to 45 degrees of flexion, 35 degrees of extension and bilateral lateral flexion, and 65 degrees of bilateral lateral rotation with pain that caused functional loss. ROM of the thoracolumbar spine was to 70 degrees of flexion, 20 degrees of extension and bilateral lateral flexion, and 30 degrees of bilateral lateral rotation with pain that caused functional loss. There was pain on passive ROM, weight-bearing, and nonweight-bearing; however, there was no additional loss of ROM following three repetitions. While the examination was not being conducted following repeated use over time, the examiner found that pain, weakness, fatigability, or incoordination significantly limited the Veteran's functional ability as a result of such factor. The Veteran did not have guarding or muscle spasms of the cervical or thoracolumbar spines. Muscle strength, reflex, and sensory examinations were normal, and there was no evidence of radiculopathy or other neurologic abnormalities related to the Veteran's cervical or thoracolumbar spine disabilities, to include bowel or bladder problems. In a November 2018 opinion, the October 2018 VA examiner reviewed the ROM findings from the April 2011 VA examination and opined that the Veteran's ROM of the cervical and thoracolumbar spines were the same on active and passive ROM and on weight-bearing and nonweight-bearing. He further opined that, at such time, there would be no additional limitation of ROM or functional impairment during flare-ups or repeated use. Subsequent VA treatment records, to include those from June 2019, reflect the Veteran's complaints of increased spine pain, and shooting pain and intermittent numbness and tingling in the bilateral lower extremities. Thus, he was afforded another VA examination on November 14, 2020. At such time, the Veteran reported neck pain and stiffness that made it difficult to turn his neck, and middle and lower back pain daily with occasional spasms. He also indicated that he experienced flare-ups of his cervical and thoracolumbar spine disabilities former described as worsening pain in the winter. It was further noted that the Veteran's disabilities made it difficult to turn his neck over his shoulder, increased difficulty with maintaining the neck in a prolonged bent or straight position, difficulty with prolonged standing for more than 45 minutes and sitting for more than one hour, and an inability to run. On examination, the Veteran's ROM of the cervical spine was to 25 degrees of flexion, 30 degrees of extension and bilateral lateral flexion, and 45 degrees of bilateral lateral rotation with pain that caused functional loss. ROM of the thoracolumbar spine was to 45 degrees of flexion, 25 degrees of extension, and 30 degrees of bilateral lateral flexion and bilateral lateral rotation with pain on extension that caused functional loss. There was pain weight-bearing; however, there was no pain on nonweight-bearing. Further, passive ROM testing could not be performed or is not medically appropriate. There was no additional loss of ROM following three repetitions, with repeated use over time, or during flare-ups, with the exception of limitation of thoracolumbar spine flexion and extension to 40 and 20 degrees, respectively. There was no guarding or muscle spasms of the cervical and thoracolumbar spines. Muscle strength, reflex, and sensory examinations were normal, and, while the examiner considered the aforementioned June 2019 reports, there was no evidence of radiculopathy or other neurologic abnormalities related to the Veteran's cervical or thoracolumbar spine disabilities, to include bowel or bladder problems. Based on the foregoing, the Board finds that, prior to November 14, 2020, the Veteran's residuals of cervical and thoracic sprains are manifested by forward flexion greater than 30 and 60 degrees, respectively, and a combined range of motion for the entire cervical and thoracolumbar spines greater than 170 and 120 degrees, respectively, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups. In this regard, in April 2011, he had full ROM of both spines and, in November 2018, he had cervical spine flexion to 45 degrees, with a combined ROM of 280 degrees, and thoracic spine flexion to 70 degrees, with a combined ROM of 190 degrees, without additional loss of ROM on passive ROM, with weight-bearing or nonweight-bearing, on repetitive use, repeated use over time, or during flare-ups. Furthermore, at no time prior to November 14, 2020, did the Veteran's cervical and thoracic spines result in muscle spasms or guarding severe enough to result in abnormal gait or abnormal spine contour. Thus, initial ratings in excess of 10 percent for the Veteran's cervical and thoracic spine disabilities under the General Rating Formula prior to November 14, 2020, are not warranted. The Board further finds the Board finds that, as of November 14, 2020, the Veteran's residuals of cervical and thoracic sprains are manifested by forward flexion greater than 15 and 30 degrees, respectively, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups. Specifically, at the November 2020 VA examination, he had cervical spine flexion to 25 degrees, and thoracic spine flexion to 40 degrees on a flare-up, without additional loss of ROM on passive ROM, with weight-bearing or nonweight-bearing, on repetitive use, repeated use over time, or during flare-ups. Thus, initial ratings in excess of 20 percent for the Veteran's cervical and thoracic spine disabilities under the General Rating Formula as of November 14, 2020, are not warranted. The Board has also considered whether separate ratings are warranted for any objective neurologic abnormalities associated with the Veteran's cervical and thoracic spine disabilities pursuant to Note (1) of the General Rating Formula. In this regard, while the Veteran reported occasional urinary incontinence at the April 2011 VA examination and radiating pain with intermittent numbness and tingling in the bilateral lower extremities in various VA treatment records, all objective examinations reflect that sensation, motor, strength, and reflexes were normal, and there was no evidence of radiculopathy or other neurologic abnormalities related to the Veteran's cervical or thoracolumbar spine disabilities, to include bowel or bladder dysfunction. Moreover, the Veteran's reports of radiating pain is explicitly contemplated in his currently assigned rating under the General Rating Formula. Consequently, the Board finds that separate ratings for objective neurologic abnormalities associated with the Veteran's cervical and thoracic spine disabilities are not warranted. 3. Entitlement to an initial rating in excess of 30 percent prior to November 14, 2020, and in excess of 50 percent thereafter for migraine headaches. The Veteran's migraine headaches are evaluated as 30 percent disabling as of January 5, 2011, the date of service connection, and 50 percent disabling as of November 14, 2020, pursuant to DC 8100 pertinent to migraines. 38 C.F.R. § 4.124a. Such DC provides that migraines with characteristic prostrating attacks occurring on an average once a month over last several months warrant a 30 percent, and migraines with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability warrant a 50 percent rating. The rating criteria do not define "prostrating;" nor has the Court. Cf. Fenderson, supra (in which the Court quotes DC 8100 verbatim but does not specifically address the matter of what is a prostrating attack). By way of reference, the Board notes that, according to Webster's New World Dictionary of American English, Third College Edition (1986), p. 1080, "prostration" is defined as "utter physical exhaustion or helplessness." A very similar definition is found in Dorland's Illustrated Medical Dictionary 1367 (28th Ed. 1994), in which "prostration" is defined as "extreme exhaustion or powerlessness." Additionally, the term "productive of severe economic adaptability" has not been clearly defined by regulations. The Court has, however, explained that "productive of" for purposes of DC 8100 can either mean producing, or capable of producing. See Pierce v. Principi, 18 Vet. App. 440, 445 (2004). Thus, migraine headaches need not actually produce severe economic inadaptability to warrant a 50 percent rating under DC 8100. Id. At 44546. Similarly, "economic inadaptability" does not equate to unemployability, as such would undermine the purpose of regulations pertaining to a TDIU. Id. At 446; see also 38 C.F.R. § 4.16. The Board notes, however, that the migraine headaches must be, at a minimum, capable of producing severe economic inadaptability in order to meet the 50 percent criteria. After a review of the record, the Board finds that the Veteran's migraine headaches more nearly approximate very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability for the entire appeal period, thus warranting an initial 50 percent rating. In this regard, at a May 2011 VA examination, the Veteran reported experiencing headaches off and on, which last for a whole day at times, and indicated that he sometimes had one or two attacks a week. He also noted that such were manifested by throbbing in the back of his head, some black spots in front of his eyes, and occasional nausea, but denied vomiting and light sensitivity. However, in March 2012, the Veteran went to the emergency room with complaints of a migraine headache with blurred vision and nausea. In August, November, and December 2012, headaches were reported, occurring more than once per week, causing blurry vision and intermittent positional vertigo, and were noted to disrupt the Veteran's functioning. In June 2013, he reported daily headaches with possibly associated vertigo, and, in July 2013, he was started on medication as his headaches were interrupting his functioning. Subsequent treatment records continued to note multiple migraines per week, causing vertigo, which were sometimes debilitating. At the July 2016 Board hearing, the Veteran testified to experiencing headaches at least two to three times per week, and up to six times per week when he does not take his migraine medication. He described the duration of such headaches as between an hour and a half to up to three hours and stated that they are accompanied by vertigo. He stated that he sought a quiet, dark room to ameliorate the symptoms of such headaches. In October 2018, the Veteran reported a history of daily headaches with vertigo and blacking out, which interfered with his academics and had been present since his trauma history related to his headaches. At a November 2018 VA examination, the Veteran reported that he had headaches three to four times per week, with varying durations of a few minutes to a few hours. He reported no nausea, vomiting, or visual changes. He did, however, report photophobia and phonophobia in connection to his headaches. The examiner found that the Veteran had characteristic prostrating attacks of headache pain that occurred once every month, but indicated that he did not have very prostrating and prolonged attacks of migraines productive of severe economic inadaptability. She further indicated that there were no other pertinent physical findings, complications, conditions, signs, or symptoms related to the Veteran's migraines, and such did not impact his ability to work. Subsequent VA treatment records reflect that, in March 2019, the Veteran reported that his migraines such caused "black out" episodes, which made it difficult to keep up with his coursework at school, and his headaches resulted in loss of concentration, fatigue, and generalized weakness. In October 2019, he indicated that he had headaches many times per week, often with throbbing, light/noise sensitivity, blackout episodes, vertigo, and/or memory loss, and the clinician noted that such were sometimes severe and debilitating. At a November 2020 VA examination, the Veteran reported more frequent and severe headaches, occurring three to four times per week and causing photophobia and phonophobia. He stated, if a severe headache attacks, he was unable to concentrate to study or finish a job as he had to go to a quiet and dark room to sleep. It was noted that the Veteran experienced nausea, sensitivity to light and sound, and changes in vision associated with his headaches. On examination, it was noted that the duration of his typical head pain was less than a day. The examiner found that the Veteran had characteristic prostrating attacks of headache pain that occurred more frequently more than once a month with very prostrating and prolonged attacks productive of severe economic inadaptability. She further indicated that there were no other pertinent physical findings, complications, conditions, signs, or symptoms related to the Veteran's migraines, and such impacted his ability to work in that he was unable to concentrate to study or do his job when he has a migraine attack. Based on the foregoing, the Board resolves all doubt in favor of the Veteran and finds that his migraine headaches more nearly approximate very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability throughout the appeal period. In this regard, while the November 2018 VA examiner found that the Veteran had characteristic prostrating attacks of headache pain that occurred only once every month, the Board finds that the totality of the evidence, to include the VA treatment records reflecting debilitating headaches that occurred multiple times a week, which were accompanied by blurred vision, nausea, vertigo, photophobia, phonophobia, and blacking out, and resulted in a disruption in his functioning, reflects that the Veteran's migraine headaches have been as severe as noted at the November 2020 VA examination since service connection was awarded. In this regard, such VA examiner found that his migraine headaches are manifested by characteristic prostrating attacks of headache pain that occurred more frequently more than once a month with very prostrating and prolonged attacks productive of severe economic inadaptability. Consequently, an initial 50 percent for the Veteran's migraine headaches is warranted. However, as 50 percent is the maximum schedular rating for migraine headaches under the rating schedule, the only avenue for the Veteran to obtain a higher rating for such disability is on an extra-schedular basis. In this regard, an extra-schedular rating is warranted if the case presents such an exceptional or unusual disability picture with such related factors as marked interference with employment or frequent periods of hospitalization that application of the regular schedular standards would be impracticable. 38 C.F.R. § 3.321(b)(1). In Thun v. Peake, 22 Vet. App. 111, 115-16 (2008), the Court stated that the determination of whether a claimant is entitled to an extra-schedular rating under 38 C.F.R. § 3.321 is a three-step inquiry. First, it must be determined whether the evidence presents such an exceptional disability picture that the available schedular evaluations for that service-connected disability are inadequate. In this regard, the Court indicated that there must be a comparison between the level of severity and symptomatology of the claimant's service-connected disability with the established criteria found in the rating schedule for that disability. Under the approach prescribed by VA, if the criteria reasonably describe the claimant's disability level and symptomatology, then the claimant's disability picture is contemplated by the rating schedule, the assigned schedular evaluation is, therefore, adequate, and no referral is required. Second, if the schedular evaluation does not contemplate the claimant's level of disability and symptomatology and is found inadequate, the RO or Board must determine whether the claimant's exceptional disability picture exhibits other related factors such as "marked interference with employment" and "frequent periods of hospitalization." Third, when an analysis of the first two steps reveals that the rating schedule is inadequate to evaluate a claimant's disability picture and that picture has attendant thereto related factors such as marked interference with employment or frequent periods of hospitalization, then the case must be referred to the Under Secretary for Benefits or the Director of the Compensation and Pension Service to determine whether, to accord justice, the Veteran's disability picture requires the assignment of an extra-schedular rating. Id. In the instant case, the Veteran has reported experiencing a variety of symptoms associated with his migraine headaches, to include blurred vision, nausea, vertigo, photophobia, phonophobia, and blacking out with resulting memory loss, loss of concentration, fatigue, and generalized weakness; however, such type of symptoms are consistent with characteristic prostrating attacks of headache pain with very prostrating and prolonged attacks productive of severe economic inadaptability, which is fully contemplated in the currently assigned 50 percent rating under DC 8100. Moreover, the November 2018 and November 2020 VA examiners found that there were no other pertinent physical findings, complications, conditions, signs, or symptoms related to the Veteran's migraine headaches. Therefore, as the totality of his disability level and symptomatology referable to such disability are fully contemplated by the currently assigned 50 percent rating under the rating schedule, referral for extra-schedular consideration is not warranted. Consequently, an initial rating in excess of 50 percent is not warranted for the Veteran's migraine headaches. Other Considerations In making its determination in the instant case, the Board acknowledges the Veteran's belief that his thoracic spine, cervical spine, and migraine headache disabilities are more severe than as reflected by the currently assigned ratings. In this regard, the Board must consider the entire evidence of record when analyzing the criteria laid out in the rating schedule. While the Board recognizes that he is competent to provide statements regarding his observable symptomatology, he is not competent to provide an opinion regarding the severity of his symptomatology in accordance with the rating criteria. Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). Rather, the Board finds the medical evidence in which professionals with medical expertise examined the Veteran, acknowledged his reported symptoms, and described the manifestations of such disabilities in light of the rating criteria to be more persuasive than his own reports regarding the severity of such conditions. The Board has also considered whether additional staged ratings under Fenderson, supra, are appropriate for the Veteran's service-connected disabilities; however, the Board finds that his symptomatology has been stable throughout the periods on appeal. Therefore, assigning additional staged ratings for such disabilities is not warranted. Further, neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record, with regard to the claims adjudicated herein. Doucette v. Shulkin, 28 Vet. App. 366 (2017). In reaching the foregoing determinations, the Board has applied the benefit of the doubt doctrine and resolved all doubt in the Veteran's favor, which has resulted in a partial award of an increased rating for his migraine headaches. However, insofar as the Board has denied higher or separate ratings for his thoracic spine, cervical spine, and migraine headache disabilities, the preponderance of the evidence is against such aspects of the Veteran's claims. Therefore, the benefit of the doubt doctrine is inapplicable in such regard and the Veteran's initial rating claims must otherwise be denied. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. REASONS FOR REMAND 4. Entitlement to a TDIU. As noted in the Introduction, in April 2021, the Veteran filed an Application for Increased Compensation Based on Unemployability (VA Form 21-8940) wherein he alleged that migraine headaches rendered him unemployable. However, such form is incomplete or illegible as it does not include any report of employment even though he reported holding a street vendor license for one year in 2015. Thus, a remand is necessary in order to request that the Veteran complete in full an Application for Increased Compensation Based on Unemployability (VA Form 21-8940) that includes his complete employment history, to include any part-time employment with hours worked and income received, since January 2011. Thereafter, if a response is received, the AOJ should contact employers identified by the Veteran and ask them to complete a Request for Employment Information in Connection with Claim for Disability Benefits (VA Form 21-4192), detailing the dates of his employment, income, and the reasons that he stopped working, if applicable. Furthermore, after the receipt of the Veteran's TDIU application, the AOJ began undertaking development of such claim. Consequently, such should be completed prior to the adjudication of such claim. The matter is REMANDED for the following action: 1. Request that the Veteran complete and return an Application for Increased Compensation Based on Unemployability (VA Form 21-8940) with his complete employment history, to include any part-time employment with hours worked and income received, since January 2011. 2. After receiving a response from the Veteran in connection with the directive in the first paragraph, the AOJ should contact his employers and request that they complete and return a Request for Employment Information in Connection with Claim for Disability Benefits (VA Form 21-4192) detailing the dates of his employment, income, and the reasons that he stopped working, if applicable. 3. Thereafter, the AOJ should complete any pending development in connection with the Veteran's TDIU claim and adjudicate it on the entirety of the evidence of record. A. JAEGER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Breckenridge, 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.