Citation Nr: 21040821 Decision Date: 07/07/21 Archive Date: 07/07/21 DOCKET NO. 17-41 993 DATE: July 7, 2021 ORDER Entitlement to an evaluation in excess of 70 percent for adjustment disorder and depressive disorder is denied. Entitlement to an evaluation in excess of 30 percent for migraine headaches is denied. Entitlement to a total rating based on individual unemployability due to service-connected disability (TDIU), from May 22, 2014, is granted. FINDINGS OF FACT 1. The preponderance of the evidence is against a finding that the severity, frequency, and duration of the symptoms of the Veteran's adjustment disorder and depressive disorder more closely approximate total occupational and social impairment. 2. The preponderance of the evidence is against a finding that the Veteran's migraines are of such severity as to result in very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. 3. The Veteran was precluded from securing or following a substantially gainful occupation due to his service-connected disabilities since May 22, 2014. CONCLUSIONS OF LAW 1. The criteria for an evaluation in excess of 70 percent for adjustment disorder and depressive disorder have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9440. 2. The criteria for an evaluation in excess of 30 percent for migraine headaches have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8100. 3. The criteria for a TDIU, from May 22, 2014, have been met. 38 U.S.C. §§ 1155, 5103A, 5107; 38 C.F.R. §§ 3.340, 3.341, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from March 1990 to December 2005. The Board of Veterans Appeals (Board) thanks the Veteran for his service to our country. The Veteran testified before the undersigned Veterans Law Judge during a January 2021 hearing. A transcript of the hearing is in the record before the Board. Following the hearing, the Veteran obtained updated VA treatment records which have been associated with the virtual file. During the pendency of the appeal, a December 2018 rating decision granted TDIU based on the Veteran's migraines and psychiatric disorder, effective July 13, 2018, the date of receipt of a VA Form 21-8940. The Veteran's July 2018 claim for TDIU was based in part on his migraines and psychiatric disorder. The Veteran's appeal thus includes a form of TDIU claim known as a Rice TDIU, because it was raised during the administrative appeal of the Veteran's claim for increased ratings for particular service-connected disabilities and it is, therefore, a component of those claims for benefits related to those disabilities. See Rice v. Shinseki, 22 Vet. App. 447, 454-455 (2009). During the hearing, the Veteran asserted that because the TDIU was based on the combination of his migraine headaches and psychiatric disorder, the effective date of the TDIU grant should be May 22, 2014, the date he filed his claim for an increased evaluation for those disabilities. The US Court of Appeals for Veterans Claims has held that when adjudicating an increased rating claim with a TDIU component, the grant of a TDIU that covers only part of the period on appeal does not end the TDIU analysis. Harper v. Wilkie, 30 Vet. App. 356, 360 (2018). Rather, the award only serves as a partial grant of TDIU, such that the remaining period of time remains in appellate status for the TDIU issue. Id. Therefore, in the present Board decision, the Board must consider whether the Veteran is entitled to a TDIU from the date of the increased rating claim (and considering whether it was factually ascertainable an increase warranting TDIU occurred within the year prior to the claim) to July 13, 2018, as he has also alleged unemployability during this earlier time period as well. Increased Ratings In general, ratings for service-connected disabilities are determined by comparing the Veteran's symptoms with criteria listed in VA's Schedule for Rating Disabilities, which is based, as far as practically can be determined, on average impairment in earning capacity. Separate diagnostic codes identify the various disabilities. 38 C.F.R. Part 4. When rating a service-connected disability, the entire history must be borne in mind. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). When a question arises as to which of two ratings applies under a particular code, the higher rating is assigned if the disability more closely approximates the criteria for the higher rating. 38 C.F.R. § 4.7. An exception to this rule applies when the rating criteria are successive. In such a case, all the requirements of the lower levels must be met before a higher level is awarded, and 38 C.F.R. §§ 4.7 and 4.21 do not apply. Johnson v. Wilkie, 30 Vet. App. 245 (2018). After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3. In a claim for increase in a previously established rating, the present level of disability is the primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, where the evidence contains factual findings that demonstrate distinct time periods when the service connected disability exhibited diverse symptoms meeting the criteria for different ratings during the course of the appeal, staged ratings are to be considered. Hart v. Mansfield, 21 Vet. App. 505 (2007). 1. Entitlement to an evaluation in excess of 70 percent for adjustment disorder and depressive disorder is denied. The rating period on appeal for this issue begins May 22, 2014, the date of receipt of the claim for an increased evaluation. The Veteran contends that he is entitled to a higher evaluation for his adjustment disorder and depressive disorder. During the hearing, he stated he was trying to get an increased evaluation for this disability because it made him unemployable. He questioned why this disability was not evaluated as 100 percent disabling after July 13, 2018, given that he was found to be entitled to TDIU from that date. The Veteran testified that he did not have too many relationships, except for his wife at the house and his grandkids. A lot of time he just stayed in his room. He isolated a lot. He did not have a problem during the coronavirus because he was not going many places anyway. He did not like being bothered with a lot of other people. If asked to socialize, he would not be able to do so if he did not have to. When asked if he had panic attacks, he replied that he shut down and did not feel like being bothered with anybody or anything. This happened anytime he had to go outside and deal with anybody else. He stated that he did have memory loss. He acted as though it did not bother him, but sometimes it did big time. It had been two years since he had been in counseling. He did take medication every day. Once, he had stopped taking it and became irritable. His doctor told him he could not do that and he had not tried it again. 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 symptoms listed in VA's general rating formula for mental disorders are not intended to constitute an exhaustive list, but rather are to serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating. Mauerhan v. Principi, 16 Vet. App. 436 (2002). However, if the evidence shows that a Veteran has symptoms or effects that cause occupational or social impairment equivalent to what would be caused by the symptoms listed in the diagnostic code, the appropriate equivalent rating will be assigned. Id. at 443. 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. Effective August 4, 2014, VA amended the regulations regarding the evaluation of mental disorders by removing outdated references to DSM-IV. The amendments replace those references with references to the updated "DSM-5." These changes do not apply to claims pending before the Board on August 4, 2014. See 79 Fed. Reg. 45093 (August 4, 2014). As the Veteran's claim was initially certified to the Board after August 4, 2014, the DSM-5 is applicable to this case. The issue in this appeal is whether the signs and symptoms associated with the Veteran's adjustment disorder and depressive disorder cause the level of impairment required for a disability rating of 100 percent. The Board finds that the preponderance of the evidence is against a finding that the signs and symptoms of the Veteran's adjustment disorder and depressive disorder cause the level of impairment required for a 100 percent disability, more closely approximate the symptoms associated with a 100 percent rating, or result in a level of impairment that more closely approximates the level of impairment associated with a 100 percent rating. VA CAPRI records dated during the appeal period reflect complaints of depression. The Veteran had relevant past medical history of adjustment disorder with depressed mood, and depressed mood. The report of an October 2015 VA Mental Disorders examination provides a diagnosis of unspecified depressive disorder with anxious distress. The examiner stated that the Veteran's level of social and occupational impairment with regard to the diagnosis was occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by medication. The Veteran had symptoms of depressed mood; anxiety; chronic sleep impairment; mild memory loss, such as forgetting names, directions or recent events; and disturbances of motivation and mood. He had no other symptoms. Prior to military service the Veteran worked as a hospital orderly, custodian, construction worker and landscaper. Since military discharge, the Veteran had graduated from a 4-year college in 2012, majoring in criminal justice, and had attended regular NA meetings and informally begun to appropriately socialize with others. Since his last C&P examination in 2013, the Veteran revealed only a few minor changes within his life. However, several of his previously noted mental health symptoms had apparently resolved and his former DSM-IV diagnosis [chronic adjustment disorder] was no longer appropriate under a DSM-5 mental health criteria for his diagnosis. The Veteran's symptoms warranted a diagnosis of unspecified depressive disorder with anxious distress. The results of the Assessment of Depression Inventory suggested a moderate depression. The results of the Beck Depression and Anxiety Inventories indicated severe depression and low anxiety. The report of a May 2017 VA Mental Disorders examination provides a diagnosis of adjustment disorder. The examiner stated that the Veteran's level of social and occupational impairment with regard to the diagnosis was occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by medication. The Veteran had symptoms of depressed mood and anxiety. He had no other symptoms. The Veteran's hygiene and grooming were good. He was attentive and cooperative. When approached for the interview, the Veteran's gait and general motor behaviors were without abnormality. During the interview, the Veteran exhibited no signs of psychomotor retardation, agitation or physical distress. His posture was unremarkable and eye contact was normal. The Veteran indicated that the primary mental health symptom he was experiencing was anxiety. He also reported depression. He indicated that his life was affected "a good deal." He reported his current mood as "lack of interest" and described his general mental state as "I think I do okay. I used to have mood swings, but I try not to go with it." His facial expression was responsive to topics of conversation. Affect was euthymic (a normal emotional state, reasonably positive) and generally appropriate to the situation and topics of conversation. He reported experiencing anhedonia (a loss of interest in previously pleasurable activities). He exhibited a generally positive self-image. The Veteran described his sleep as fair, and reported his primary sleep disturbance was waking during the night and not being able to go back to sleep. He reported getting five hours of sleep on average. He indicated that his appetite was more than usual and reported gaining 15 pounds over the past few months. His energy level had decreased. Volume, rate, rhythm and tone of speech were within normal limits. No articulation deficits were observed. Thought processes were organized, logical, coherent and sequential with no evidence of loose associations. Thought content was goal-directed and consistently appropriate to topics of conversation. No perseverative, bizarre or delusional ideation was observed during the course of the examination. He denied current thoughts of harming himself or others. He reported that his grandchildren gave his life meaning. He exhibited no loss of reality contact. There were no obvious preoccupations. He denied experiencing hallucinations in any modality. No perceptual disturbances were noted. He appeared alert and oriented to person, place, time and situation. No significant difficulties with concentration were noted. He did not endorse memory problems. The examiner believed that the Veteran had fair insight into his mental health. The Veteran's capacity to make sound, reasoned and responsible decisions appeared to be intact. The Veteran reported some social isolation. He was currently living with his wife and granddaughter. He reported having family and two close friends whom he could trust and rely upon if needed. He reported involvement with a 12-step program and church. The Veteran's scores on the Assessment of Depression Inventory indicated a moderate level of depression. However, there was some indication of random responding. The examiner started that it was his opinion that the rating increase effective June 7, 2012 [from 30 percent to 70, assigned by a May 2013 rating decision] was in error. It was not clear to him how the rating decision was made, but it was surprising that the Veteran's level of functioning improved, yet the service-connected rating increased from 30 to 70 percent. A large degree of impairment was likely attributed to the Veteran's history of substance abuse. However, the Veteran indicated he had been sober since his residential treatment in 2008. The report of a September 2018 VA Mental Disorders examination provides a diagnosis of adjustment disorder. The examiner stated that the Veteran's level of social and occupational impairment with regard to the diagnosis was occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation. The Veteran had symptoms of depressed mood, anxiety and disturbances of motivation and mood. The Veteran's hygiene and grooming were fair and he was cooperative during the interview. Speech was within normal limits, he maintained normal eye contact, and exhibited no signs of psychomotor retardation, agitation or physical distress. Sufficient impulse control was reported and demonstrated. Affect was euthymic (normal, reasonably positive) and he described his general mental state as "most of the time stable. I have some days worse than others." Thought processes were linear, logical and goal-directed. There were no indications of bizarre behavior. Thought content was goal-directed with no suicidal or homicidal ideations. He denied experiencing hallucinations in any modality and no perceptual disturbances were noted. Insight and judgment were adequate. He was alert and fully oriented. He did not endorse any memory problems. The Veteran reported some social isolation. He was currently living with his wife and two grandchildren (ages 8 and 1). He reported having his family members and three or four close friends whom he could trust and rely upon if needed. In his free time, he took care of his grandchildren. He denied involvement in social clubs or organizations. Regarding employability, the Veteran had received Social Security Disability Insurance benefits since 2006 for depressive disability and migraines. He last worked in the military. When asked to describe his occupational problems, he stated My depression didn't really escalate until I got out of the military. I don't have any job opportunities. I have a problem with taking orders. When I went down this road before, I was confused then. I'm still confused how Social Security can say I'm unemployable and how the military can say I'm still employable. Sometimes when I even think about going to get a job, I just get frustrated. For a while I tried helping my wife out with a barbecue business, but I was just frustrated all the time. I don't like to be bothered by a whole lot of people and don't like to answer a whole lot of questions. The Board finds that the foregoing evidence weighs against the Veteran's claim. The VA medical opinions that the Veteran's adjustment and depressive disorders did not result in total occupational and social impairment are probative evidence against his claim. These medical opinions are based on current examination findings and reviews of the Veteran's relevant medical history and thus are entitled to substantial probative weight. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Moreover, the foregoing evidence does not show that the signs and symptoms of the Veteran's adjustment disorder and depressive disorder include 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. See the General Formula. The foregoing evidence shows that the Veteran had some signs and symptoms that are not listed with a specific rating, such as chronic sleep impairment, increased appetite and weight gain, mood swings, anhedonia, frustration, decreased energy level and being bothered by other people. However, these signs and symptoms are not of similar severity to those required for a 100 percent evaluation. Id. Similarly, the mild memory loss found by the October 2015 VA examination is not of similar severity to the memory loss for names of close relatives, own occupation or own name required for a 100 percent evaluation, and the Veteran does not so contend. Id. Further, the Veteran did not endorse memory problems during the May 2017 or September 2018 VA examinations. In deciding the claim, the Board has considered the Veteran's hearing testimony as to the severity of his adjustment and depressive disorders. The Veteran is competent to report his readily observable symptoms. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). However, while he has asserted that his adjustment and depressive disorders render him unemployable, he has not asserted that they result in total social impairment. See the General Formula; Johnson, 30 Vet. App. at 253. In fact, he consistently reported living with his wife and two grandchildren (ages 8 and 1) and having his family members and three or four close friends whom he could trust and rely upon if needed. Moreover, the Veteran is not competent to identify a specific level of disability according to the General Formula. Competent evidence concerning the nature and extent of his adjustment and depressive disorders has been provided by the medical personnel who have examined him during the current appeal and who have rendered pertinent opinions in conjunction with the evaluations. The medical findings (as provided in the examination reports and the VA clinical records) directly address the criteria under which his adjustment and depressive disorders are evaluated. As such, the Board finds the examination reports and clinical records to be more probative than the Veteran's subjective complaints of increased symptomatology. Further, while the Veteran has been granted TDIU from July 13, 2018, the foregoing evidence does not show that his adjustment and depressive disorders result in total social impairment, as required by a 100 percent evaluation under the General Formula. In fact, he has not argued that they do. The Veteran's grant of a TDIU, from July 13, 2018, is not based solely on his adjustment and depressive disorders alone but on his migraine headaches as well. Thus, the award of the Veteran's TDIU does not show that his adjustment and depressive disorders result in total occupational and social impairment from July 13, 2018. In light of the above, the Board finds that an evaluation in excess of 70 percent for adjustment disorder and depressive disorder is not warranted and must be denied. In reaching this decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, the preponderance of the evidence is against the claim. 38 U.S.C. § 5107. The Board has also considered whether a TDIU is warranted based on the Veteran's psychiatric disability alone and finds that the preponderance of the evidence is against a finding that the Veteran's adjustment disorder and depressive disorder alone result in an inability to secure or follow a substantially gainful occupation. The Board has considered the Veteran's reports of difficulty taking orders and with frustrations helping with his wife's business and difficulty being around people and answering questions. However, over the course of the appeal, VA examiners have repeatedly assessed his occupational and social impairment as manifested by mild or transient symptoms or with only occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation. 2. Entitlement to an evaluation in excess of 30 percent for migraine headaches is denied. The rating period on appeal for this issue begins May 22, 2014, the date of receipt of the claim for an increased evaluation. The Veteran contends that he is entitled to a higher rating for migraine headaches because now gets them two to three times a week. The migraines are also more persistent now. He recently had to get a shot to treat a migraine that would not go away. The shot worked for about two to three weeks. Then, in September or November of 2020, he had to get a second shot. These problems existed before the Veteran had his most recent VA examination in October 2018. See January 2021 hearing transcript. Migraine headaches are rated pursuant to 38 C.F.R. § 4.124a, Diagnostic Code 8100, for migraine. Under Diagnostic Code 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 Diagnostic Code 8100. The rating criteria of Diagnostic Code 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, 30 Vet. App. at 252. This renders 38 C.F.R. §§ 4.7 and 4.21 inapplicable. Id. VA regulations, including the rating criteria, do not define the word "prostrating" as used in Diagnostic Code 8100. 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 similar definition is found in DORLAND'S ILLUSTRATED MEDICAL DICTIONARY 1367 (28th ed. 1994) in which prostration is defined as extreme exhaustion or powerlessness. In Johnson, the Court of Appeals for Veterans Claims found that the phrase "characteristic prostrating attacks" means "attacks that typically produce powerlessness or a lack of vitality." Johnson, 30 Vet. App. at 245. In other words, the term prostrating takes on its plain meaning of "lacking in vitality or will: powerless to rise: laid low." Id. 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. 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 Diagnostic Code 8100 requires that the claimant be completely unable to work in order to qualify for a 50 percent rating. Pierce v. Principi, 18 Vet. App. 440, 445-46 (2004). In rating headaches or migraines under Diagnostic Code 8100, the Board may not consider the ameliorative effects of medication. See Jones v. Shinseki, 26 Vet. App. 56, 63 (2012). In this case, although the record reveals one or two isolated incidents of medication injections for headache following attempts to relieve a headache with prescription medication for acute headaches (used only on an as needed basis), the treatment records indicate generally that the Veteran primarily only takes over the counter headache medication on an as needed basis. See August 30, 2018 VA treatment record; October 2018 VA examination report. Therefore, as medication is not regularly required for the Veteran's headache disability, it's ameliorative effects do not support a higher rating in this case. The issue in this appeal is whether the Veteran's migraine headaches cause the level of impairment required for a 50 percent disability rating. The Board finds that the preponderance of the evidence is against a finding that the Veteran has had migraine headaches with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability, as required for a 50 percent rating. Diagnostic Code 8100. VA CAPRI records reflect treatment for migraines during the appeal period. In July 2019 he reported taking Tylenol as needed for mild to moderate headache and sumatriptan for acute attacks VA treatment records submitted by the Veteran after his hearing reflect that in December 2020 he reported a two week history of very severe headaches occurring more frequently, twice a week and sometimes twice a day along with increased tingling in his feet and constant urination. The Veteran was also requesting a covid test. He also reported that he ran out of migraine medication; however, in another record he reported taking more Sumatriptan. He denied mental status change, lethargy or confusion. He received a Toradol injection and topiramate was added to his medications for headaches. At the time of his hearing, the Veteran reported he was "doing good" with respect to his headaches "without none." He indicated that his current migraine problems existed prior to the time he had his VA headaches examination in 2018. Accordingly, the Board does not find that further development in the form of another VA examination is warranted because the Veteran essentially has testified that his headache disability has overall remained the same during the appeal period. Therefore, the December 2020 treatment for headaches and/or any other such treatment (the Veteran testified he had perhaps had two such shots for headaches) appear to have been isolated events. The report of an August 2014 VA Headaches examination provides a diagnosis of migraine including migraine variants. The report specifies that the Veteran did not have characteristic prostrating attacks of migraine headache pain. His headaches did not impact his ability to work. The report of an October 2018 VA headaches examination also specifies that the Veteran did not have characteristic prostrating attacks of migraine headache pain. His headaches did impact his ability to work. The Board finds that the foregoing medical evidence weighs against a finding that the Veteran's migraine headaches result in completely prostrating attacks that render him entirely powerless. Diagnostic Code 8100; Johnson, 30 Vet. App. at 253. While the Veteran had at least one persistent headache that was improved with an injection of medication in December 2020, before and after that period, his migraine headaches did not result in disability at the 50 percent level. Further, the Board does not find that one or two incidents of medication injection over a period of many years do not equate to "very frequent" events. The medical evidence over the appeal period indicated that the Veteran generally took only Tylenol on an as needed basis for headaches. Although he was prescribed another medication for acute attacks, the only time the evidence reflects he took that medication was prior to his injection(s) in 2020. The Board finds it significant that the August 2014 and October 2018 VA examiners concluded that the Veteran did not have characteristic prostrating attacks of migraine headache pain. The Board also finds it significant that the Veteran's VA treatment records do not show that he had very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. In deciding the claim, the Board has considered the Veteran's hearing testimony as to the severity of his migraines. The Veteran is competent to report his readily observable symptoms. Jandreau, supra. However, he is not competent to identify a specific level of disability of his migraine headaches according to Diagnostic Code 8100. Competent evidence concerning the nature and extent of his migraines has also been provided by the medical personnel who have examined him during the current appeal and who have rendered pertinent opinions in conjunction with the evaluations. The medical findings (as provided in the examination reports and the VA clinical records) directly address the criteria under which his migraine headaches are evaluated. As such, the Board finds the examination reports and clinical records to be more probative than the Veteran's subjective complaints of increased symptomatology. In light of the above, the Board finds that an evaluation in excess of 30 percent for migraine headaches is not warranted and must be denied. In reaching this decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, the preponderance of the evidence is against the claim. 38 U.S.C. § 5107. 3. Entitlement to TDIU, from May 22, 2014, is granted. As noted above, the rating period on appeal for the TDIU issue spans from May 22, 2014, to July 13, 2018. The December 2018 rating decision that granted TDIU, effective July 13, 2018, explained that an October 2018 VA examiner stated that the Veteran's headache disorder would impact his ability to work. A September 2018 VA psychiatric examination showed that the Veteran had a depressed mood, anxiety and disturbance of motivation and mood. The Veteran contends that his service-connected disabilities rendered him unemployable prior to July 13, 2018, and thus he is entitled to a TDIU prior to that date. The Board agrees. On a July 2018 VA Form 21-8940, Veteran's Application for Increased Compensation Based on Unemployability, the Veteran stated that his low back disability, adjustment disorder, right ankle disability, left wrist disability, bilateral knee disabilities and migraine headaches rendered him unemployable. He reported that he last worked full-time, and became too disabled to work, in December 2005. He had completed four years of college and had not had any other education and training before or since becoming too disabled to work. He stated that the last job he had was when he was in the Army. He had not been able to work since. That was in 2005 when he got out. Because of his disabilities that he sustained while serving this country he was not able to gain employment. Total disability will be considered to exist when there is present any impairment of mind or body which is sufficient to render it impossible for the average person to follow a substantially gainful occupation. 38 C.F.R. § 3.340. If the total rating is based on a disability or combination of disabilities for which the Schedule for Rating Disabilities provides an evaluation of less than 100 percent, it must be determined that the service-connected disabilities are sufficient to produce unemployability without regard to advancing age. 38 C.F.R. § 3.341. In evaluating total disability, full consideration must be given to unusual physical or mental effects in individual cases, to peculiar effects of occupational activities, to defects in physical or mental endowment preventing the usual amount of success in overcoming the handicap of disability and to the effects of combinations of disability. 38 C.F.R. § 4.15. If the schedular rating is less than total, a total disability evaluation can be assigned based on individual unemployability if the Veteran is unable to secure or follow a substantially gainful occupation as a result of service-connected disability, provided that he has one service-connected disability rated at 60 percent or higher; or two or more service-connected disabilities, with one disability rated at 40 percent or higher and the combined rating is 70 percent or higher. 38 C.F.R. § 4.16 (a). For the purpose of one 60 percent disability, or one 40 percent disability in combination, disabilities resulting from common etiology or a single accident will be considered as one disability. Id. Veterans unable to secure and follow a substantially gainful occupation by reason of service-connected disability shall be rated totally disabled. 38 C.F.R. § 4.16 (b). Consideration may be given to a Veteran's level of education, special training, and previous work experience in arriving at a conclusion, but not to his or her age or the impairment caused by any non-service-connected disabilities. See 38 C.F.R. §§ 3.341, 4.16, 4.19. The Veteran is service-connected for adjustment disorder and depressive disorder; migraine headaches; tinea versicolor; gastroesophageal reflux disorder; right knee retropatellar pain syndrome; low back strain; degenerative joint disease, left knee; residuals, right ankle strain; residuals, fracture, left wrist; residuals, fracture, right index (2nd) finger, postoperative, with degenerative changes; residuals, fracture, left small (5th) finger, postoperative, with degenerative changes; hypertension; hemorrhoids; scar, residual to laceration, superior to right eyebrow; and scar, residual to laceration, posterior occipital scalp. His combined evaluation has been 90 percent, with one disability rated at least 40 percent disabling, for the entire appeal period and thus he meets the schedular criteria for TDIU. 38 C.F.R. § 4.16 (a). A September 2008 Social Security Administration (SSA) Disability Determination and Transmittal found that the Veteran was disabled from June 2006. The primary diagnosis was affective or mood disorders. The secondary diagnosis was migraine. VA examination reports dated in June 2018 reflect that the Veteran's right knee disability, low back disability, left knee disability, right ankle disability, left wrist disability, right index (2nd) finger disability, left small (5th) finger disability, hypertension and hemorrhoids did not impact his ability to work. The report of the August 2014 VA Headaches examination provides that the Veteran's headaches did not impact his ability to work. The report of the October 2015 VA Mental Disorders examination and the report of the May 2017 VA Mental Disorders examination provide that the Veteran's unspecified depressive disorder with anxious distress only resulted in occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress. The report of the September 2018 VA Mental Disorders examination provides that the Veteran's adjustment disorder only resulted in occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily. The Board finds it notable that the examiner was aware that SSA had found the Veteran disabled, as he quoted the Veteran's confusion over the fact that SSA had found him unemployable but the military [that is, VA] said he was employable. The Board finds that the Veteran's headache and psychiatric disabilities were essentially unchanged throughout the course of the appeal which began with the Veteran's claim filed on May 22, 2014. The Board does not find that it was factually ascertainable that the Veteran's disabilities worsened such that a TDIU was warranted in the year prior to the May 22, 2014 claim. In other words, the severity of the Veteran's service-connected headaches and psychiatric disability were essentially the same on May 22, 2014 as they were on July 13, 2018, the date the Veteran filed his TDIU claim during the current appeal for increased ratings. Accordingly, TDIU is warranted from May 22, 2014. M. C. GRAHAM Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Davitian, 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.