Citation Nr: 21039942 Decision Date: 07/01/21 Archive Date: 07/01/21 DOCKET NO. 15-05 657 DATE: July 1, 2021 ORDER Entitlement to an initial rating higher than 30 percent for major depressive disorder (MDD) is denied. Entitlement to an initial rating of 10 percent, but not higher, for the entire period on appeal, for degenerative arthritis of the left wrist is granted. Entitlement to an initial rating higher than 0 percent prior to July 24, 2018 and a rating higher than of 10 percent thereafter, for degenerative arthritis of the cervical spine is denied. Entitlement to an initial rating of 10 percent rating, but not higher, for the entire period on appeal, for a right knee disability is granted. Entitlement to an initial rating higher than 30 percent for migraines is denied. REMANDED Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. FINDINGS OF FACT 1. The severity, frequency, and duration of the Veteran's MDD symptoms did not more closely approximate occupational and social impairment with reduced reliability and productivity. 2. Throughout the appeal period, the Veteran's degenerative arthritis of the left wrist has manifested with painful motion. 3. Prior to July 24, 2018 the Veteran's degenerative arthritis of the cervical spine has been manifested by forward flexion greater than 40 degrees and a combined range of motion greater than 335 degrees. No muscle spasm or guarding due to the cervical spine disability severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis or incapacitating episodes requiring bed rest prescribed by a physician were shown. 4. From July 24, 2018, the Veteran's degenerative arthritis of the cervical spine has been manifested by cervical spine flexion limited to, at worst, 40 degrees and a combined range of motion of 275 degrees with painful motion; no muscle spasm or guarding due to the cervical spine disability severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis or incapacitating episodes requiring bed rest prescribed by a physician were shown. 5. Throughout the appeal period, the Veteran's right knee disability manifested with painful motion and flexion limited to at worst, 75 degrees. 6. Throughout the appeal period, the Veteran's migraine headaches were manifest by characteristic prostrating attacks occurring on an average of once a month. CONCLUSIONS OF LAW 1. The criteria for entitlement to an initial rating higher than 30 percent for MDD are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code (DC) 9434. 2. Throughout the period of appeal, the criteria for entitlement to an initial 10 percent rating, but not higher, for degenerative arthritis of the left wrist are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.71a, DCs 5003-5215. 3. The criteria for entitlement to an initial compensable rating prior to July 24, 2018 and a rating in excess of 10 percent thereafter for degenerative arthritis of the cervical spine are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, DC 5242. 4. Throughout the period of appeal, the criteria for entitlement to an initial 10 percent rating, but not higher, for a right knee disability are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, DC 5260. 5. The criteria for entitlement to an initial rating higher than 30 percent for migraines are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, DC 8100. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from April 1991 to September 2003 and from October 2008 to July 2011. This case comes before the Board of Veterans' Appeals (Board) on appeal from a February 2012 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). In January 2018, the Veteran testified before a Veterans Law Judge (VLJ) who has since retired from the Board. A transcript of the hearing is associated with the claims file. An April 2021 letter notified the Veteran that the VLJ who conducted his hearing is no longer at the Board, and he was asked to respond within 30 days indicating whether he would like a new hearing. In April 27, 2021 correspondence, the Veteran informed the Board that he did not wish to appear at another Board hearing; the Veteran requested that his case be considered based on the evidence of record. As such, the Board will proceed to adjudicate the appeal at this time. In June 2018, the Board remanded the issues on appeal for further development. There has been substantial compliance with the remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Higher Rating Disability ratings are determined by applying a schedule of reductions in earning capacity from specific injuries or a combination of injuries that is based upon the average impairment of earning capacities. 38 U.S.C. § 1155. Each disability must be viewed in relation to its entire history, with emphasis upon the limitations proportionate to the severity of the disabling condition. 38 C.F.R. § 4.1. Where there is a question as to which of the two disability evaluations is applied, the higher evaluation 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. Where the question for consideration is the propriety of the initial evaluation assigned, evaluation of the medical evidence since the grant of service connection and consideration of the appropriateness of "staged rating" is required. Fenderson v. West, 12 Vet. App. 119, 126 (1999); Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007). Where there is a question as to which of the two disability evaluations is applied, the higher evaluation 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. After careful consideration of the evidence of record, any reasonable doubt remaining will be resolved in favor of the Veteran. 38 C.F.R. § 4.3. When rating the Veteran's service-connected disability, the entire medical history must be reviewed. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). The Board must also fully consider the lay assertions of record. See Layno v. Brown, 6 Vet. App. 465, 470 (1994). When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) ("[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran's disability, after which a rating is determined based on the § 4.71a criteria."). Under 38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis; however, 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. See Burton v. Shinseki, 25 Vet. App. 1 (2011). 1. Entitlement to an initial rating higher than 30 percent for MDD Service connection for major depressive disorder was granted in a February 2012 rating decision. A 10 percent rating was assigned under 38 C.F.R. § 4.130, DC 9434. The effective date of the grant of service connection is February 4, 2011. During the pendency of the appeal, a January 2015 rating decision awarded the Veteran a higher initial rating of 30 percent for his MDD, effective February 4, 2011. As this rating does not reflect the full grant of the benefit sought on appeal, the issue remains in appellate status. See AB v. Brown, 6 Vet. App. 35 (1993). The Veteran asserts in a March 2012 statement that he disagrees with the initial evaluation for his MDD. Under the General Formula for Mental Disorders (General Formula), the Board must conduct a "holistic analysis" that considers all associated symptoms, regardless of whether they are listed as criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017); 38 C.F.R. § 4.130. The Board must determine whether unlisted symptoms are similar in severity, frequency, and duration to the listed symptoms associated with specific disability percentages. Then, the Board must determine whether the associated symptoms, both listed and unlisted, caused the level of impairment required for a higher disability rating. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 114-118 (Fed. Cir. 2013). The issue in this appeal is whether the Veteran's associated symptoms caused the level of impairment required for a disability rating of 50 percent or higher. The Board concludes that the Veteran's symptoms did not cause the level of impairment required for a disability rating of 50 percent or higher. The Veteran's symptoms more closely approximated the symptoms associated with a 30 percent rating and resulted in a level of impairment that most closely approximated the level of impairment associated with a 30 percent rating. A 30 percent rating is assigned when symptoms such as depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, or mild memory loss (such as forgetting names, directions, or recent events), cause occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and normal conversation). A 50 percent rating is assigned when symptoms such as flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; or difficulty in establishing and maintaining effective work and social relationships cause occupational and social impairment with reduced reliability and productivity. A 70 percent rating is assigned when symptoms such as suicidal ideation; obsessional rituals which interfere with routine activities; intermittently illogical, obscure, or irrelevant speech; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); or inability to establish and maintain effective relationships cause occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. A 100 percent rating is assigned for total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; or memory loss for names of close relatives, own occupation or own name. VA treatment records and examinations, along with the Veteran's lay statements show that the Veteran's MDD was manifested by symptoms associated with a 30 percent rating (anxiety, depressed mood, chronic sleep impairment), and symptoms associated with a 50 percent rating (disturbances of motivation and mood). He also had symptoms that are not listed with a specific rating, such as irritability, social withdrawal, and fatigability. The Board finds the severity, frequency, and duration of the Veteran's unlisted symptoms more closely approximate the symptoms contemplated by a 30 percent rating, which are less severe, less frequent, and shorter in duration than those contemplated by a 50 percent rating. See 38 C.F.R. § 4.126. It was noted at his December 2010 VA examination that these symptoms were not present daily, but were episodic, fluctuate, or wax and wane. The severity of his symptoms was described as mild, and he indicated that the symptoms affected his total daily functioning, which resulted in some irritability with coworkers and family. The Board notes that irritability, social withdrawal, and fatigability are similar to depressed mood, and sleep impairment, which are contemplated by the assigned 30 percent rating. The Board also finds the level of impairment caused by the Veteran's symptoms more closely approximates the level associated with a 30 percent rating. The Veteran experienced occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, but was generally functioning satisfactorily, with routine behavior, self-care, and normal conversation. Mental status examinations in VA and private treatment records and the October 2012 VA examination indicate that the Veteran had unremarkable thought process and content; no delusions; average intelligence; orientation to person, time, and place; no inappropriate behavior; a partial understanding that he has a problem. His affect was noted as constricted and mood, irritable. The examiner determined that the Veteran's mental disorder symptoms were not severe enough to interfere with occupation and social functioning. VA treatment records such as a September 2016 VA psychiatry initial evaluation note report that the Veteran was last seen in October 2014, before relocating to South Carolina for work. The treatment note suggests that the Veteran was generally performing well at work, though he had reported "no motivation to do anything" and was concerned with that feeling. In fact, the appointment was for the Veteran to restart his antidepressant medication (which he stopped two years ago) prior to relocating to California for a new position. However, by the July 2018 VA examination, the Veteran reported that he had been unemployed due to his migraines since March 2018. The Veteran's symptoms of depressed mood and anxiety remained present. He also reported that he felt depressed every day and experienced panic attacks. To clarify, the Veteran described his panic attacks as "[m]y wife, she always makes sure like I don't sit with my back to the door" and furthered, "I don't know, like in tight spaces things are closing on me." An example being, he Veteran could not walk in between racks in the mall. The examiner indicated that the Veteran had occupational and social impairment with mild or transient symptoms which decreased work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by medication. While the Veteran did occasionally experience a few symptoms contemplated by a 50 percent ratingdisturbances of motivation and moodthe evidence overall does not consistently demonstrate the level of impairment associated with a 50 percent rating. As noted above, the Veteran's other remaining symptoms were either contemplated by or more consistent with a 30 percent rating. Further, During the December 2020 VA examination, the Veteran reported symptoms of depressed mood, chronic sleep impairment, irritability, and social withdrawal. The examiner indicated that the Veteran was gainfully employed as a dental assistant. The Veteran noted no difficulties carrying out his daily work responsibilities. While he noted boredom, he reported good short-term memory, focus, language skills, comprehension, motor skills and cooperative effort. The examiner remarked that the Veteran's depression had lightened from prior summaries or depictions, with a more chronic subtle presence best diagnosed as persistent depressive disorder. The VA examiner described Veteran's occupational and social impairment as mild or transient symptoms which decreased work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by medication. Based on the review of the evidence, the Board finds that a rating in excess of the 30 percent is not and has not been warranted for the Veteran's MDD. The Board acknowledges the Veteran's January 2018 testimony from his Board hearing, where he reported that his MDD symptoms had worsened, noting that he recently saw a psychiatrist and his prescription medication was increased. To that extent, both his July 2018 and December 2020 VA examinations reflect occupational and social impairment with mild or transient symptoms, which is worse than the October 2012 VA examiner's finding of no occupational or social impairment. However, the Veteran's symptoms have not consistently increased in severity to warrant a 50 percent rating at any point. The July 2018 VA examiner reported that the Veteran does not meet diagnostic criteria for panic attacks. The Veteran's judgment has been fair and thought process, logical. The Board has considered both the January 2020 and August 2020 lay statements from the Veteran's wife who has reported that the Veteran "has been having panic attacks 2 to 3 times per week" and having difficulty with long-term and short-term memory. The Veteran's wife also reported that his mood decreased, "he thinks that life isn't worth living" and is having problems dealing with stress, which is affecting his relationship with his family. In comparing the wife's statements with the Veteran's treatment records and VA examinations, the Board finds a lack of consistency between the two. As discussed earlier, the Veteran described his wife's perception of panic attacks at his July 2018 VA examination, and the examiner found that there was no diagnosis. Treatment records prior to that examination report and since, do not indicate that the Veteran suffered with panic attacks to the degree mentioned by his wife. Notably, the Veteran's December 2020 VA examination is silent on the issue of panic attacks; the Veteran did not report having them. Regarding the Veteran's memory, mental status exams from as early as November 2010 to as recent as his December 2020 VA examination where the examiner noted that the Veteran "reported good short-term memory" have consistently found his memory to be intact. While the examination report did not explicitly mention long-term memory, it is presumed, that if the Veteran's memory was impaired to the degree contemplated by the 50 percent rating, it would be reported by one of his medical providers. To the extent the wife's statement implies suicidal ideation, the Board notes that the Veteran's treatment records have by and large denied suicidal and or homicidal ideation. Lastly, while it appears to be the wife's contention, the Board notes that the record does not demonstrate that a 50 percent rating is warranted due to the Veteran's inability to establish and maintain effective relationships. The record shows that the Veteran has been married to his wife for over 20 years, generally reports having a good relationship with his wife and children and has social friends. While the Veteran did report that he has a relationship with his wife that "has its moments" and had periodic separations to include one in 2018, contemporaneous treatment records also report that the Veteran described having a good relationship with his family, and having a supportive wife. Thus, based on a review of the evidence as a whole, the Board finds that a rating in excess of the 30 percent currently assigned is not warranted for MDD. The preponderance of the evidence weighs against finding that the severity, frequency, and duration of the Veteran's symptoms resulted in the level of impairment required for a 50 percent rating. The criteria for a 50 percent or higher rating are not met and the appeal must be denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 2. Entitlement to a rating higher than 0 percent prior to July 24, 2018, and higher than 10 percent as of July 24, 2018, for degenerative arthritis of the left wrist The February 2012 rating decision on appeal granted service connection for degenerative arthritis of the left wrist. A noncompensable rating was assigned under 38 C.F.R. § 4.71a, DC 5003-5215. The effective date of the grant of service connection is February 4, 2011. The Veteran contends he is entitled to an initial compensable rating for his left wrist arthritis, prior to July 24, 2018. Thus, the Board must determine whether a compensable rating is warranted prior to July 24, 2018 and the Board finds that it is. Arthritis shown by X-ray studies is rated based on limitation of motion of the affected joint. When limitation of motion would be noncompensable under a limitation-of-motion code, but there is at least some limitation of motion, a 10 percent rating may be assigned for each major joint so affected. 38 C.F.R. § 4.71a, DC 5003. DC 5003 states that degenerative arthritis established by X-ray findings will be rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved. The limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. In the absence of limitation of motion, X-ray evidence of arthritis involving two or more major or minor joint groups will warrant a 10 percent rating, and two or more major or minor joint groups with occasional incapacitating exacerbations will warrant a 20 percent rating. The 10 percent and 20 percent ratings based on X-ray findings will not be combined with ratings based on limitation of motion. 38 C.F.R. § 4.71a, DC 5003 Note 1. In this case, the Veteran's left wrist arthritis is rated under DCs 5003-5215. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the assigned rating; the additional code is shown after the hyphen. Here, the hyphenated diagnostic code indicates that arthritis (Diagnostic Code 5003) is rated under the criteria for limitation of motion (Diagnostic Code 5215). For the purpose of rating disability from arthritis, the wrist is considered a major joint. 38 C.F.R. § 4.45(f). During the pendency of the appeal, the rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71a were amended effective February 7, 2021. 85 Fed. Reg. 230 (Nov. 30, 2020). These amendments revised select diagnostic codes "to ensure that this portion of the rating schedule uses current medical terminology and provides detailed and updated criteria for the evaluation of musculoskeletal disabilities." Id. If a law or regulation changes during the course of a claim or an appeal, the version more favorable to the Veteran will apply, to the extent permitted by any stated effective date in the amendment in question. 38 U.S.C. § 5110(g). If the revised version of the regulation is more favorable, the implementation of that regulation under 38 U.S.C. § 5110(g) can be no earlier than the effective date of that change. If the former version is more favorable, VA can apply the earlier version of the regulation for the period prior to, and from, the effective date of the change. 38 U.S.C. § 5110. Therefore, the Board will consider the Veteran's claim under the old criteria prior to February 7, 2021 and both the old and new rating criteria from February 7, 2021. The criteria that is more favorable to the Veteran will be applied. Prior to the regulatory change, DC 5003 applied to degenerative arthritis (hypertrophic or osteoarthritis). As of February 7, 2021, under the amended criteria, with the rating criteria remaining the same, DC 5003 only applies to degenerative arthritis, other than post-traumatic. Prior to July 24, 2018, the Veteran's service-connected left wrist disability, was rated as noncompensable by the RO under the provisions of DC 5215. Under this regulatory provision, a 10 percent rating is warranted when palmar flexion is limited in line with the forearm, or when dorsiflexion is less than 15 degrees. This is the only rating allowable under this diagnostic code. There has been no change to DC 5215. Higher ratings are not available unless there is evidence of ankylosis of the wrist. 38 C.F.R. § 4.71a, DC 5214. As no such pathology is shown, either actual or practical, that rating criteria is not for consideration in this matter. Turning to the evidence of record, the VA examination report in November 2010 noted the Veteran reported a prior diagnosis of snuff box fracture of the left wrist, a condition that existed for two years. He reported symptoms of weakness, stiffness, swelling, giving way, lack of endurance, fatigability and pain. The Veteran reported flare-ups as often as twice per month lasting two hours with a severity level of 10. On examination, the examiner found no signs of edema, instability, abnormal movement, effusion, weakness, tenderness, redness, heat, deformity, subluxation or guarding of movement, and no ankylosis. Range of motion testing was within normal limits. There was no additional limitation caused by pain, fatigue, weakness, lack of endurance or incoordination after repetitive use. September 2010 x-ray results revealed degenerative arthritic changes in the left wrist but no acute left wrist fracture. The impression was chronic non-united scaphoid fracture with radiocarpal and scapholunate degenerative change. A December 2013 VA primary care note indicates that the Veteran complained of a having a history of left wrist pain and requested a brace. He indicated that the pain increases with wrist flexion and that he used a brace in the past with good result. In July 2014, the Veteran was also seen with a complaint of left wrist pain described as throbbing. During his July 2018 VA examination, the Veteran denied pain and flare-ups; however, he endorsed regular use of his wrist brace. The Board notes that the Veteran has previously been assigned a rating of 0 percent prior to July 24, 2018, and a rating of 10 percent after July 24, 2018, for his left wrist disability. After reviewing the evidence, the Board finds that a 10 percent rating, but not higher, is warranted throughout the entire period of appeal. This grant is made in recognition that the intent of the schedule is to recognize painful joints as entitled to the minimum compensable rating for the joint. 38 C.F.R. § 4.59. In this regard, although not showing limitation of motion to a compensable degree in the left wrist, the 2010 examination did show painful motion in the left wrist, with some limitation. Additionally, the Veteran made similar reports several years later, noting relief with the use of a brace. Indeed, it is painful motion in the July 2018 examination which afforded the Veteran the 10 percent rating assigned from that date forward. As such, the Board will afford the Veteran a similar rating based upon the same logic from the date of service connection through the entire period of appeal, as during that period of time, the evidence of record showed painful motion in the left wrist. Under 38 C.F.R. § 4.71a, Diagnostic Code 5215, this is the maximum schedular rating. The Board finds that a rating higher than 10 percent for the left wrist disability is not warranted at any time throughout the period of appeal. Here, the Board notes that the Veteran's left wrist rating is based upon painful motion, which has not risen to the level of compensable based on loss of range of motion, per the schedule, but it is painful, nonetheless. In order for a higher rating to be granted for the left wrist, the Veteran would need to show evidence of ankylosis, either actual or functional. In this case, there is no evidence that the Veteran's left wrist disability has resulted in fixation of the joint at any point in time. As such, a rating in excess of 10 percent for the Veteran's left wrist disability is denied. A rating in excess of 10 percent is not warranted under DC 5003 as the involvement of the Veteran's left wrist is a single joint, and DC 5003 requires involvement of two or more joints, either major or minor, with occasional incapacitating exacerbations, for a 20 percent evaluation. The assigned 10 percent evaluations for the Veteran's left wrist disability fully contemplate all associated symptomatology and the limitation of motion experienced by the Veteran. In sum, resolving reasonable doubt in the Veteran's favor, the Board finds an initial rating of 10 percent, and no higher, is warranted for the entire period on appeal for the Veteran's left wrist disability. As the preponderance of the evidence is against this claim for a rating in excess of 10 percent, the benefit-of-the-doubt doctrine does not apply, and it must be denied. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7; Gilbert, 1 Vet. App.at 53-56. 3. Entitlement to rating higher than 0 percent prior to July 24, 2018 and a rating higher than 10 percent as of July 24, 2018 for degenerative arthritis of the cervical spine The February 2012 rating decision on appeal granted service connection for degenerative arthritis of the cervical spine. A noncompensable rating was assigned under 38 C.F.R. § 4.71a, DC 5242. The effective date of the grant of service connection is February 4, 2011. The Veteran seeks a compensable rating prior to July 24, 2018. The Board notes that during the pendency of the appeal, the Veteran was awarded a higher rating of 10 percent for his cervical spine disability effective July 24, 2018, the date of his VA examination. As this rating does not reflect the full grant of the benefit sought on appeal, the issue remains in appellate status. See AB v. Brown, 6 Vet. App. 35 (1993). The Veteran seeks a higher initial rating for cervical spine disability and asserts that the condition is worse than the rating assigned. The Veteran's cervical spine disability is currently rated under DC 5242, for degenerative arthritis of the spine. 38 C.F.R. § 4.71a. The Board notes that during the pendency of the appeal, the rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71a were amended effective February 7, 2021. 85 Fed. Reg. 230 (Nov. 30, 2020). While portions of the rating schedule addressing the musculoskeletal system were revised, this diagnostic code was not changed. Under the General Rating Formula for Diseases and Injuries of the Spine, a 10 percent rating is warranted for forward flexion of the cervical spine greater than 30 degrees but not greater than 40 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 cervical spine greater than 15 degrees but not greater than 30 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 to 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. A 100 percent rating is warranted for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine. Any associated objective neurological abnormalities, including, but not limited to, bowel or bladder impairment, are to be evaluated separately under an appropriate diagnostic code. Id. at Note 1. Prior to July 24, 2018 The Board finds that the preponderance of the evidence is against a rating higher than 0 percent for the Veteran's cervical spine disability prior to July 24, 2018. Turning to the relevant evidence, an August 2010 service treatment record (STRs) notes that the Veteran was receiving continued treatment for his neck. The Veteran underwent a VA examination in November 2010 VA. The examiner's report indicated that the range of motion of the cervical spine was within normal limits and had no additional degree of limitation. There was no evidence of radiating pain on movement, muscle spasm, tenderness, guarding, weakness, loss of tone and atrophy of the limbs. The joint function of the cervical spine was not additionally limited by pain, fatigue, weakness, lack of endurance or incoordination after repetitive use. Ankylosis of the cervical spine was not found. There was no sign of cervical intervertebral disc syndrome with chronic and permanent nerve root involvement. X-ray findings revealed degenerative arthritis and mild disc space narrowing. Private physical therapy treatment records between January 2013 and August 2014 and from November 2014 to January 2016 indicate that the Veteran was being treated for a back disability and would report moderate degree of sharp pain with stiffness and soreness in the upper right side of his back and neck. His pain over the years ranged between a 4 and 7. His private physician observed signs of malalignment in the lower left and occasionally, right, cervical region. December 2017 x-ray findings reveal that the cervical spine was straightened, with loss of the usual lordosis. There was no spondylolisthesis. The atlantodens interval was within normal limits and vertebral body heights were maintained. There was multilevel loss of intervertebral disc space, primarily from C4 to C7. This was associated with endplate sclerosis and marginal osteophyte formation. The facet joints were maintained, and the prevertebral soft tissues were not abnormally thickened. The x-ray impression was noted as multilevel cervical spondylosis, worst from C4-C7. Upon review of the evidence, the Board finds that an initial rating higher than 10 percent for the Veteran's cervical spine disability is not warranted. Indeed, prior to his VA examination, a STR reports ongoing treatment for the Veteran's neck; however, the record does not indicate that the Veteran suffered from functional loss due to pain, weakness, excess fatigability or incoordination. Looking at his November 2010 VA examination, there were no complaints of functional loss due to the Veteran's cervical spine disability. Moreover, his ranges of motion, as tested by the VA examiner, were within normal limits. To award a 10 percent rating, the Veteran would either need functional loss as discussed above; or a forward flexion of the cervical spine greater than 30 degrees but not greater than 40 degrees; or a combined range of motion of the cervical spine greater than 170 degrees but not greater than 335; 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. There is no evidence in the file or lay report from the Veteran demonstrating or asserting symptoms of functional loss to the degree which would warrant a 10 percent rating for his cervical spine disability. Thus, the preponderance of the evidence is against an initial compensable rating prior to July 24, 2018. From July 24, 2018 The Board finds that the preponderance of the evidence is against a rating higher than 10 percent for the Veteran's cervical spine disability. The Board acknowledges the Veteran's lay reports of symptoms, to include at his January 2018 Board hearing, that there was functional loss due to stiffness and cramping. However, even considering the Veteran's lay reports of symptoms and noted functional loss, the degree of additional limitation would not result in limitation of motion more nearly approximating forward flexion of 15 degrees but not greater than 30 degrees or the combined range of motion of the cervical spine not greater than 170 degrees. Based on his testimony of worsening symptoms, the Veteran was afforded a VA examination in July 2018. The Veteran reported that he was in pain all the time, and used a transcutaneous electrical nerve stimulation (TENS) unit for his back, which helped with his neck. The Veteran denied flare-ups and radiating pain. On range of motion testing, all results were within normal limits. There was no pain on weight bearing or palpation or additional loss of range of motion on repetitive use. The Veteran did not have muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. Private physical therapy treatment records for the Veteran's back disability in March 2019 report that he was aggravated by a frequent moderate grade of dull pain with stiffness and soreness in the right side of his neck. He was also bothered by a frequent moderate level of dull pain with stiffness in the left side of his neck. He described his overall pain as being a 4 out of 10 with 10 being the worst pain possible. Objectively, the physician reported that there was evidence of malalignment detected with myospasm and pain to palpation localized to the left and right lower cervical region. These findings remained consistent for the remainder of that year. Based on the evidence of record, the Board finds that the 10 percent rating assigned effective July 24, 2018 was proper and a higher rating is not warranted. The Veteran's range of motion testing remains within normal limits. Indeed, the Veteran reports dull pain and stiffness in his neck; however, there is no indication of muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. Both Periods Consideration has also been given to assigning a rating under the Formula for Rating Intervertebral Disc Syndrome (IVDS) Based on Incapacitating Episodes. However, the Veteran does not have IVDS and the evidence of record is against a finding that the Veteran was ever prescribed bed rest by a physician for a duration that meets the criteria for a higher rating. See 38 C.F.R. § 4.71a, Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes. Additionally, regarding neurological impairment, the lay and medical evidence of record is against a finding that the Veteran has any other neurological abnormality associated with his spine disability. Lastly, although the Veteran is diagnosed with degenerative arthritis of the cervical spine, a rating in excess of 10 percent is not warranted under DC 5003 as the involvement of the Veteran's cervical spine is considered a single group of minor joints. Moreover, DC 5003 explicitly notes that the Veteran should be rated under the limitation of motion code for the effected joint in this case, the Veteran's cervical spine unless the limitation of motion of that joint is noncompensable under the applicable code; the Veteran has been evaluated for the appropriate limitation of motion for his cervical spine disability in this case and therefore any further contemplation of that disability under DC 5003 would be impermissible pyramiding. Accordingly, there exists no basis for a cervical spine disability rating in excess of 10 percent. 38 C.F.R. § 4.71, DCs 5003, 5242. The assigned 0 percent rating prior to July 24, 2018, and 10 percent rating for the Veteran's cervical spine disability from July 24, 2018, fully contemplate all associated symptomatology and the limitation of motion experienced by the Veteran. For the foregoing reasons, Board finds that an initial compensable rating prior to July 24, 2018 and a rating in excess of 10 percent, thereafter, for the Veteran's degenerative arthritis of the cervical spine is not warranted because the preponderance of the evidence is against the Veteran's claim. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. Gilbert, 1 Vet. App.at 53-56. 4. Entitlement to a rating higher than 0 percent prior to July 24, 2018, and higher than 10 percent as of July 24, 2018, for a right knee disability 5. A rating in excess of 10 percent for a right knee disability is denied. The February 2012 rating decision on appeal granted service connection for right knee proximal fibular fracture. A noncompensable rating was assigned under 38 C.F.R. § 4.71a, DC 5260. The effective date of the grant of service connection is February 4, 2011. The Board notes that during the pendency of the appeal, the Veteran was awarded a higher rating of 10 percent for his right knee disability effective July 24, 2018, the date of his VA examination. As this rating does not reflect the full grant of the benefit sought on appeal, the issue remains in appellate status. See AB v. Brown, 6 Vet. App. 35 (1993). The Veteran seeks a higher initial rating for right knee disability and asserts that the condition is worse than the rating assigned. The Veteran's right knee disability is rated under 38 C.F.R. § 4.71a, DC 5260, for limitation of flexion of the leg. Under DC 5260, a noncompensable rating is warranted for flexion limited to 60 degrees. A 10 percent rating is warranted for flexion limited to 45 degrees. A 20 percent rating is warranted for flexion limited to 30 degrees. A 30 percent rating is warranted for flexion limited to 15 degrees. 38 C.F.R. § 4.71a, DC 5260. The Board notes that during the pendency of the appeal, the rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71a were amended effective February 7, 2021. 85 Fed. Reg. 230 (Nov. 30, 2020). While portions of the rating schedule addressing the musculoskeletal system were revised, this diagnostic code was not changed. The Board finds that prior to July 24, 2018, the preponderance of the evidence supports an initial compensable rating for a right knee disability. At his November 2010 VA examination, the Veteran complained of having a right fibula fracture since October 2010 and reported that localized, sharp pain in the right fibula occurred three times per month and lasted for two hours each time. The Veteran endorsed functional loss due to pain, weakness, stiffness and swelling. His overall impairment involved no running, climbing stairs or bending the leg with flare-ups. On a scale of 1 to 10 (with 10 being the worst), the Veteran described his right knee pain as a 3. He denied any fever, giving way, debility, locking, abnormal motion, heat, and drainage. The Veteran reported that his right knee disability did not limit his ability to stand; however, he did have limitations in walking due to both the right fibula and knee. On examination, the examiner noted the range of motion of the right knee as within normal limits and that the right knee was not additionally limited by pain, fatigue, weakness, lack of endurance or incoordination after repetitive use. The Veteran's posture and gait were normal. His feet did not reveal any signs of abnormal weight bearing or breakdown, callosities, or any unusual shoe wear pattern. He did not require any assistive device for ambulation. Examination of the tibia and fibula revealed normal findings in both knees. The right knee showed no signs of edema; instability; abnormal movement; effusion; weakness; tenderness; redness; heat; deformity; malalignment, drainage, subluxation or guarding of movement. Testing consisting of an x-ray of the right knee was abnormal, revealing transverse fracture involving the proximal end of the fibula. The diagnosis was status post proximal fibula fracture. A September 2012 VA treatment note contains x-ray findings of minimal osteoarthritis in the right knee. Although private treatment records overwhelmingly refer to the Veteran's service-connected left knee disability, they also contain complaints of general knee pain. During the October 2012 VA general examination, only the left knee was examined; thus, that examination is inadequate and cannot be considered in the evaluation of the Veteran's right knee disability. Additional VA treatment records also contain complaints of bilateral knee pain. In a May 2014 treatment note, the Veteran reported right knee pain that would, at its worst, start off as a 9 in the morning and ease up throughout the day to a constant 5. He reported that his prescribed medications, tramadol and naproxen, did not help. The Veteran was noted to have arthralgia. He was seen in January 2015 after sustaining an injury to his right knee; the Veteran reported that he hurt his knee on the treadmill, but it was an old injury. The Veteran was seen in May 2016 with complaints of knee pain and in June, it was noted that he had a knee brace for both his right and left knee. At his January 2018 Board hearing, the Veteran testified that his right knee disability worsened. He stated that he used a knee brace and cane, walked with a limp, was in pain "all the time now," and had cracking in the right knee. In June 2018 the Board remanded the Veteran's right knee disability for an examination, which was performed the following month. At the July 2018 VA examination for knees, the VA examiner reported the Veteran's knee diagnosis as bilateral knee joint osteoarthritis and proximal fibular fracture residuals of the right knee. The Veteran denied flare-ups and there was no finding of functional loss after repeated use over time. The Veteran's flexion was limited to 125 degrees and extension was normal. No pain was noted on exam or with weight bearing. There was no objective evidence of pain on passive range of motion noted. Passive range of motion was unchanged from active range of motion and there was no evidence of pain with the joint in non-weight bearing. There was also no objective evidence of crepitus, or localized tenderness or pain on palpation. The Veteran reported use of a knee brace for support and increase mobility. After this VA examination, the Veteran contacted the RO in July 2018 and expressed several contentions with examiner's report. Notably, the Veteran asserted that the VA examiner did not report his functional limitations, symptoms such as swelling, flare-ups, or pain on examination. Thus, he was afforded a new VA examination in January 2020. At the January 2020 VA examination, the examiner noted the Veteran's right knee diagnosis of right knee fibular fracture. The Veteran described the onset of his right knee disability and reported that he has residual pain in the knee as a result and the pain was more intermittent. He also reported experiencing swelling and having a brace that he "wears some." The Veteran endorsed flare-ups occurring three times per week. He reported functional loss with climbing stairs, running, prolonged walking/standing and driving. On range of motion testing, flexion was limited to 75 degrees and extension was normal. Pain was noted on examination and it significantly limited the Veteran's functional ability with repeated use over a period of time. Although not tested during an episode of flare-ups, pain significantly limited the Veteran's functional ability. The examiner noted that the Veteran was in constant use of a knee brace and occasionally used a cane. The Board notes that the Veteran has previously been assigned a rating of 0 percent prior to July 24, 2018, and a rating of 10 percent after July 24, 2018, for his right knee disability. After reviewing the evidence, and resolving reasonable doubt in the Veteran's favor, the Board finds that a 10 percent rating, but not higher, is warranted throughout the entire period of appeal. This grant is made in recognition that the intent of the schedule is to recognize painful joints as entitled to the minimum compensable rating for the joint. 38 C.F.R. § 4.59. In this regard, although not showing limitation of motion to a compensable degree in the right knee, the November 2010 examination report coupled with the Veteran's credible lay statements of pain and treatment notes show painful motion in the right knee, with some limitation. Additionally, the June 9, 2016 VA examination report demonstrates the Veteran's ongoing knee pain and reports his use of a right knee brace. VA treatment records indicate that the Veteran's knee brace was assigned to him by VA and replaced as needed due to his right knee pain. Thus, resolving reasonable doubt in the Veteran's favor, an initial compensable rating of 10 percent for right knee pain is warranted. Indeed, it is painful motion in the July 2018 examination which afforded the Veteran the 10 percent rating assigned from that date forward. As such, the Board will afford the Veteran a similar rating based upon the same logic from the date of service connection throughout the entire period of appeal for his right knee disability, as the evidence of record shows painful motion in the right knee throughout the period of appeal. Based on the evidence, the Board finds a rating higher than 10 percent is not warranted for the Veteran's right knee disability. Although the Veteran disputes the examination report from July 2018, the Board finds that even without its application, the evidence does not demonstrate that he has flexion limited to 30 degrees. Indeed, the January 2020 examination report shows flexion limited to 75 degrees and both examiners found extension to be normal. Treatment records continue to show the Veteran's use of a right knee brace and complaint of pain however, there are no additional findings or range of motion testing showing a limitation that warrants higher than 10 percent. The Board has also considered the other diagnostic codes pertaining to the knee and leg. Other disability ratings may be assigned only if the symptomatology for a disability is not duplicative or overlapping with the symptomatology of any other disability. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994); Lyles v. Shulkin, 29 Vet. App. 107 (2017) (holding that 38 C.F.R. § 4.14 prohibits paying compensation twice for the same symptoms or functional impairment). Although a September 2012 x-ray reveals minimal osteoarthritis in the right knee joint, a compensable rating is not warranted under DC 5003 because the Veteran's right knee joint does not involve two major or minor joint groups. Additionally, the appropriate rating is based on limitation of motion. Though the Veteran uses a knee brace, it reportedly due to his pain; there is no report of subluxation or lateral instability; extension limited to 10 degrees; and no genu recurvation. Indeed, the Veteran's November 2010 x-ray revealed a transverse fracture involving the proximal end of the fibula; however, there is no indication of a malunion causing a slight, moderate, or marked disability. There is also no report of nonunion with loose motion, requiring brace, as required under the pre-February 7, 2021 diagnostic code 5262 amendment. Moreover, this would result in pyramiding. Id. Additionally, there is no report of subluxation or lateral instability; extension limited to 10 degrees; and no genu recurvation. For the same reasons above, a right knee fibular fracture still does not warrant a separate rating. Accordingly, resolving reasonable doubt in the Veteran's favor, the Board finds an initial rating of 10 percent, and no higher, is warranted for the entire period on appeal for the Veteran's right knee disability. As the preponderance of the evidence is against this claim for a rating in excess of 10 percent, the benefit-of-the-doubt doctrine does not apply, and it must be denied. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7; Gilbert, 1 Vet. App.at 53-56. 6. Entitlement to an initial rating higher than 30 percent for migraines is denied. Service connection for migraines was granted in a February 2012 rating decision. A noncompensable rating was assigned under 38 C.F.R. § 4.124a, DC 8100. The effective date of the grant of service connection is February 4, 2011. During the pendency of the appeal, a January 2015 rating decision awarded the Veteran a higher initial rating of 30 percent for his migraines, effective February 4, 2011. As this rating does not reflect the full grant of the benefit sought on appeal, the issue remains in appellate status. See AB v. Brown, 6 Vet. App. 35 (1993). The Veteran asserts his symptoms of migraine headaches are worse than rated. The issue in this appeal is whether the Veteran's associated symptoms caused the level of impairment required for a disability rating of 50 percent. Migraine headaches are rated pursuant to 38 C.F.R. § 4.124a, DC 8100, for migraine. Under DC 8100, 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). The Board concludes that the Veteran has had migraines with characteristic prostrating attacks occurring on average once a month over the last several months throughout the appeal period, corresponding to the criteria for a 30 percent rating under DC 8100. Turning to the evidence of record, at his November 2010 VA examination, the Veteran reported being diagnosed with migraine headaches, a condition that existed for five years. His headaches were described as intermittent, frontal sharp headache pain causing pain behind the eyes, blurred vision/vomiting, and sensitivities to both light and noise. The Veteran reported that when the headaches occur, he must stay in bed as he is unable to do anything else. He described the pain level as a 10 out of 10. The Veteran reported that he experiences headaches on average, once per month, lasting three minutes. At his October 2012 VA examination, the Veteran reported having headaches about two to three times monthly, lasting one to two days. He reported that most attacks are prostrating. He described the pain as pulsating in the front of the forehead area and indicated that sound and light worsened his headaches. The Veteran also reported that went to the emergency room the month prior for his migraines and was treated with Fioricet with good results. During his VA primary care visit in November 2014 VA, the Veteran reported that he "rarely has a migraine since being discharged from the military." At his Board hearing in January 2018, the Veteran testified that his migraines had worsened. He shared that he had migraines twice a week with pain so severe that he "can't do anything," noting that he has to lie down. In a March 2018 email, the Veteran provided his employer with two-week notice of his intent to resign on April 2, 2018. He did not provide an explanation or reason for resignation. An April 2018 VA treatment note indicates that the Veteran reportedly resigned from his job because he was having three headaches per week causing him to leave work. The Veteran submitted a buddy statement from his former supervisor in July 2018. SFC S reported having first-hand knowledge of the Veteran's headaches and that the Veteran missed significant time from work due to his headaches. SFC S indicated that the Veteran resigned prior to fulfilling his two-year probationary period because of the missed time from work. The Board remanded this issue for a new examination in June 2018 and the Veteran underwent a VA examination in July 2018. There he reported that he received all his medications from VA, was never hospitalized for headaches and had no ER visits for his headaches. The Veteran described his headache pain as pulsating or throbbing head pain, localized to one side of the head, worsened with physical activity. He endorsed symptoms such as nausea, and sensitivity to light and sound. He indicated that his medication worked, stating that after taking them he goes to sleep and "when I wake up the throbbing is gone." The report indicated that the Veteran did not have characteristic prostrating attacks of migraine. The examiner's diagnosis was migraine without aura. After the examination, the Veteran contacted the RO contesting the examiner's report because the examiner informed him that there were employees at the hospital who suffered from migraines and only took limited time off, and never a full day. The Veteran was afforded a new VA examination in January 2020. There, he reported that he had to resign from a job because of the headaches; noting that he missed so many days as a result. He reported that he currently had headaches about three to four times a month and that they started on the left side of his head. He endorsed sensitivity to light and sound, nausea, and sometimes vomiting. The examiner noted that the Veteran had characteristic prostrating attacks of migraine but not very prostrating and prolonged attacks of migraine pain productive of severe economic inadaptability. The Veteran reported that his migraines impacted his ability to work and noted that he "even had his boss write a letter stating such." In a January 2021 notice of disagreement, the Veteran disagreed with the examiner's report. The Veteran asserted that his migraines are "very prostrating and prolong attacks that cause economic inadaptability." That month, the Veteran also submitted an employment form titled Request for Personnel Action, which demonstrates that he resigned from his job effective April 2018. The Veteran then contacted his VA primary care physician in January 2020 for an appointment inquiry. The Veteran indicated that he wanted to discuss his migraines because they affect his work as he had to take days off from work without pay. He explained this was because he had very prostrating and prolonged attacks of migraine pain, productive of severe economic inadaptability. The Veteran is competent to report his readily observable symptoms. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). However, the Veteran has provided conflicting evidence regarding the nature of his headaches. Indeed, the Veteran has headaches that result in migraines if not treated at onset. However, it is notable that the Veteran reported to his primary care physician that he rarely had headaches in November 2014, yet, at his VA examinations, he described a more intense struggle with headaches, which is generally not contained in contemporaneous treatment records. Although the Veteran reports unemployment due to his migraines and submits evidence in support of such, it is noteworthy that he did not indicate that his migraines were the cause for resignation. An April 2018 VA treatment note also indicates that the Veteran worked as a dental tech at VA and "had to stop secondary to back pain." Furthermore, the Veteran's resignation as reported by him remains questionable because during his July 2018 VA examination for headaches, the Veteran shared his employment history which included work at the Department of the Army until March 2018, for which he states, "I voluntarily resigned." It is reasonable to think that three months after the Veteran quit his job ostensibly because of his migraines, he would clearly report that to the examiner evaluating his disability, but he did not. The Board finds it significant that prior to his January 2021 VA treatment note, the Veteran did not report frequent completely prostrating and prolonged migraine attacks to any other VA physician, despite receiving treatment for multiple service-connected disabilities. Based on the entirety of the record, when comparing the Veteran's lay statements from examination and VA treatment, the preponderance of the evidence is against a claim for a 50 percent rating. Accordingly, the Board concludes that the Veteran has had migraines with characteristic prostrating attacks occurring on average once a month over the last several months throughout the appeal period, corresponding to the criteria for a 30 percent rating under DC 8100. A higher 50 percent rating under DC 8100 is not warranted unless there are migraines with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. As discussed above, the Veteran's statements over the course of the appeal have not credibly demonstrated the severity of symptoms he reports. Thus, the Board concludes that the Veteran did not have migraines with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability at any time during the appeal period. A higher 50 percent rating is thus not warranted under DC 8100. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. REASON FOR REMAND 1. Entitlement to a TDIU is remanded. The issue of entitlement to a TDIU was raised by the Veteran at his July 2018 VA examination for MDD. Rice v. Shinseki, 22 Vet. App. 447 (2009). There, the Veteran reported that he resigned from his job in March 2018 due to his service-connected migraines. While the evidence of record generally reports the Veteran as employed, it appears he may have had another period of unemployment as noted in an October 2012 VA examination report. There, the Veteran reported unemployment for one to two years due to his left knee disability and headaches. Given the ambiguity regarding the Veteran's employment status during the appeal period, further development is needed prior to adjudication of this claim. The matter is REMANDED for the following action: 1. Ask the Veteran to complete a VA Form 21-8940 Application for Increased Compensation Based on Unemployability and provide a detailed educational, vocational, and employment history from March 2011 to the present. 2. Forward a VA Form 21-4192, Request for Employment Information in Connection with Claim for Benefits, to all employers identified by the Veteran. 3. Obtain a retrospective addendum opinion from an appropriate clinician regarding the severity of the Veteran's migraines and left knee disability. The examiner should consider the Veteran's complete educational, vocational, and employment history and should note his complaints regarding the impact of his migraines and left knee disability on employment. The examiner should identify all limitations or functional impairment caused solely by these service-connected disabilities. (Continued on the next page) 4. Upon completing any and all development, adjudicate the Veteran's TDIU claim. SPENCER L. LAYTON Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Telamour, 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.