Citation Nr: 22015164 Decision Date: 03/16/22 Archive Date: 03/16/22 DOCKET NO. 16-57 583 DATE: March 16, 2022 ORDER Entitlement to a rating in excess of 30 percent for posttraumatic stress disorder (PTSD) and major depressive disorder prior to March 7, 2017, and in excess of 70 percent as of March 7, 2017, is denied. Entitlement to a rating in excess of 30 percent for headaches prior to March 7, 2017, and in excess of 50 percent as of March 7, 2017, is denied. REMANDED Entitlement to a total disability rating based on unemployability due to service-connected disability (TDIU) prior to November 17, 2021, is remanded. FINDINGS OF FACT 1. Prior to March 7, 2017, the severity, frequency, and duration of the Veteran's psychiatric symptoms did not more closely approximate occupational and social impairment with reduced reliability and productivity 2. As of March 7, 2017, the severity, frequency, and duration of the Veteran's psychiatric symptoms did not more closely approximate total occupational and social impairment 3. Prior to March 7, 2017, the Veteran experienced migraines with characteristic prostrating attacks occurring on average once a month over the last several months, and headaches did not manifest in very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. 4. As of March 7, 2017, the Veteran is in receipt of the maximum schedular rating for headaches. CONCLUSIONS OF LAW 1. Prior to March 7, 2017, the criteria for a rating in excess of 30 percent for PTSD with depressive disorder were not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9411. 2. As of March 7, 2017, the criteria for a rating in excess of 70 percent for PTSD with 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 9411. 3. Prior to March 7, 2017, the criteria for a rating in excess of 30 percent for migraines were not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8100. 4. As of March 7, 2017, the criteria for a rating in excess of 50 percent for migraines have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8100 (2021). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 1984 to August 1989. These matters come before the Board of Veterans' Appeals (Board) on appeal from an October 2016 rating decision by the Department of Veterans Affairs (VA). In December 2017, the Agency of Original Jurisdiction (AOJ) issued a rating decision that increased the rating for PTSD to 70 percent and the rating for headaches to 50 percent, effective March 7, 2017. This matter was most recently before the Board in October 2021. Increased Rating Disability rating are determined by the application of VA's Schedule for Rating Disabilities, which is based on average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the veteran. 38 C.F.R. § 4.3. A veteran's entire history is to be considered when assigning disability ratings. 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). In rating a claim for a higher rating, staged ratings are appropriate when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007); Fenderson v. West, 12 Vet. App. 119 (1999). 1. Entitlement to increased ratings for PTSD with major depressive disorder Under the General Formula for Mental Disorders, the Board must conduct a holistic analysis that considers all associated symptoms, regardless of whether they are listed in the rating criteria, and the occupation and social impairment caused by those symptoms. Bankhead v. Shulkin, 29 Vet. App. 10 (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 ratings. Then, the Board must determine whether the associated symptoms, both listed and unlisted, caused the level of impairment required for a higher rating. Vazquez-Claudio v. Shinseki, 713 F.3d 112 (Fed. Cir. 2013). The Board concludes that the Veteran's symptoms did not cause the level of impairment required for a more than 50 percent rating prior to March 7, 2017, or that warranted a 100 percent as of March 7, 2017. The Board finds that 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 prior to March 7, 2017, and more nearly approximated the rating criteria for a70 percent rating as of March 7, 2017. A 0 percent rating is assigned when a mental condition has been formally diagnosed, but symptoms are not severe enough to either require continuous medication, or to interfere with occupational and social functioning. A 10 percent rating is assigned when mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of occasional stress, or symptoms controlled by medication cause occupational and social impairment. A 30 percent rating is assigned for 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 conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, and mild memory loss (such as forgetting names, directions, recent events). A 50 percent rating is assigned for occupational and social impairment with reduced reliability and productivity due to such symptoms 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; and difficulty in establishing and maintaining effective work and social relationships. A 70 percent rating is assigned for occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; 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); and inability to establish and maintain effective relationships. 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; and memory loss for names of close relatives, own occupation or own name. A July 2016 VA PTSD examination diagnosed PTSD and major depressive disorder. The psychiatric disability was assessed to be productive of 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 reported being single, having never been married, and having no children. He was last in a romantic relationship approximately 30 years ago. He described experiencing significant trust issues that made it very difficult for him to be in romantic relationships. The Veteran reported being homeless, and residing in transitional housing due to having left his last employment in 2011. He reported having a positive relationship with his mother, and being estranged from his father. He described having no friends and no social supports aside from one brother. He described how he used to enjoy various hobbies and leisure activities including music, art, food, family gatherings, and travel, but that he had not been able to enjoy any of those activities in a very long time. Clinical evaluation found that the Veteran's symptoms were reported as depressed mood; anxiety; panic attacks that occurred weekly or less often; chronic sleep impairment; and impairment of short- and long-term memory, for example, retention of only highly learned material, while forgetting to complete tasks. In terms of behavioral observations, the Veteran was noted to have arrived on time for the examination. He was appropriately groomed and dressed; was pleasant, was polite and cooperative; and rapport was established and maintained throughout the evaluation. He had a dysthymic mood with a consistent affect. His thought process was generally linear and goal-directed. No overt cognitive deficits were noted. There were no abnormalities in speech. There was no apparent or reported active suicidal or homicidal ideation, intent, or plan. There was no evidence of psychosis, paranoia or mania. Insight and judgment were fair. Other symptoms attributable to PTSD were noted to include poor energy and thoughts of worthlessness. A September 2016 VA PTSD examination diagnosed PTSD and major depressive disorder. The psychiatric disability was assessed to be productive of 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 examiner noted that there were no significant changes in the social history since the previous VA examination of July 2016. It was noted the Veteran had a cordial, respectful and civil living arrangement at a Veterans shelter. It was reported the Veteran became tearful when speaking about his lack of friendships, and describing his loneliness. The Veteran confirmed maintaining a positive relationship with one brother. He denied doing any leisure activities. Clinical evaluation found that the Veteran's symptoms were reported as depressed mood; anxiety; suspiciousness; chronic sleep impairment; and impairment of short- and long-term memory, for example, retention of only highly learned material, while forgetting to complete tasks. In terms of behavioral observations, the Veteran was noted to have arrived on time for the examination. He was appropriately groomed and dressed, and was pleasant, polite, and cooperative. Rapport was established and maintained throughout the evaluation. He had a dysthymic mood with a consistent affect. His thought process was generally linear and goal-directed. No overt cognitive deficits were noted. There were no abnormalities in speech. There was no apparent or reported active suicidal or homicidal ideation, intent, or plan. There was no evidence of psychosis, paranoia, or mania. Insight and judgment were fair. Other symptoms attributable to PTSD were noted to include thoughts of worthlessness, hopelessness, and poor energy. A June 2017 VA PTSD examination diagnosed PTSD and major depressive disorder. The Veteran's psychiatric disability was assessed to be productive of 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 reported living in his brother's home and paying rent. He indicated he was living with his brother, his sister-in law, their daughter and grandchild, and his parents. He reported having no relationship with his father and a strained relationship with his mother. He reported having never been married and having no children. He denied having any additional familial or social supports. He reported that he did not find enjoyment in any activities since service, and being independent with activities of daily living. He reported struggling with interactions with other people. Clinical evaluation found that the Veteran's symptoms were reported as depressed mood; anxiety; suspiciousness; chronic sleep impairment; impairment of short- and long-term memory, for example, retention of only highly learned material, while forgetting to complete tasks; flattened affect; difficulty in understanding complex commands; impaired judgment; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships; difficulty in adapting to stressful circumstances, including work or a worklike setting; and neglect of personal appearance and hygiene. In terms of behavioral observations, the Veteran was noted to be disheveled, dressed with clothes with obvious stains and holes, and sub-optimally groomed facial hair. Rapport was established quickly and maintained throughout the evaluation. He was cooperative, alert, and fully oriented. He made limited eye contact. Speech was slow, but responses were logical and goal-oriented. Mood was depressed with a flat affect. Insight and judgement were moderately impaired. He denied suicidal or homicidal ideations. There were no other symptoms attributable to PTSD and depression. A November 2021 VA PTSD examination diagnosed PTSD and major depressive disorder. The psychiatric disability was assessed to be productive of occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, and/or mood. It was reported that since the most recent examination, he remained single, had never married; had no children; lived with his brother; experienced symptoms of anxiety, avoidance, anhedonia, dysphoria, irritability, poor judgment, emotional numbing, insomnia, hypervigilance, startle, neglect of self-care, and poor concentration and memory, and those symptoms had a negative impact on his relationships and social functioning. He indicated sleeping 2.5 to 3 hours per night, and having nightmares several times per week. He reported having intrusive thoughts of trauma several days per week, and dissociative flashbacks monthly, typically triggered by people being too close to him or touching him unexpectedly. He reported being avoidant of discussing his trauma history. He noted he also avoided crowds, having his back exposed, and being in confined spaces. He stated that he had lost pleasure in previously enjoyable activities such as socializing and dating and was in a chronically anxious and low mood. The Veteran reported that he struggled to feel positive emotions and felt like his future was limited due to his symptoms. He struggled with focus and concentration and was forgetful of recent events and conversations. He became confused in familiar locations. He was emotionally distant and detached from others. He was irritable and too short-fused in response to frustration. He was compulsive in his safety checking behavior, reporting that he had to get out of bed to recheck the security of doors and windows he knew he had already secured. He demonstrated poor judgment in engaging weekly shoplifting. He had indiscriminate sexual behavior that he engaged in on a monthly basis. He struggled with personal hygiene and appearance. He had fleeting thoughts of suicide that occurred a couple of times per month. He denied having a method or intention to act on the thoughts. Clinical evaluation found that the Veteran's symptoms were reported as depressed mood; anxiety; suspiciousness; near-continuous depression affecting the ability to function independently, appropriately, and effectively; chronic sleep impairment; mild memory loss; impairment of short- and long-term memory, for example, retention of only highly learned material, while forgetting to complete tasks; flattened affect; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships; difficulty in adapting to stressful circumstances, including work or a worklike setting; suicidal ideation; obsessional rituals which interfered with routine activities; neglect of personal appearance and hygiene; and intermittent inability to perform activities of daily living. In terms of behavioral observations, the Veteran was noted to be alert and oriented to person, place, and time. His thinking was logical, linear, and goal-oriented. His speech was fluent and normal in terms of rate, rhythm, and volume. Auditory comprehension was within normal limits. He was slightly disheveled in appearance. He was cooperative and engaged. His affect was restricted in range. He denied homicidal ideation. He reported fleeting thoughts of suicide about twice a month. He denied having a method or intention to act on the thoughts. He was deemed to be a low immediate threat of harm to self or others. There were no other symptoms attributable to PTSD and depression. For the period prior to March 7, 2017, VA and private treatment records, the July 2016, September 2016 and June 2017 VA examinations, and the Veteran's lay statements show that the Veteran's PTSD with depressive disorder was manifested by symptoms associated with a 30 percent rating, such as depressed mood; anxiety; panic attacks occurring weekly or less often; and chronic sleep impairment, and symptoms associated with a 50 percent rating such as impairment of short- and long-term memory, for example, retention of only highly learned material, while forgetting to complete tasks. He also had symptoms that are not listed with a specific rating, such as thoughts of worthlessness, hopelessness, and poor energy. 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. 38 C.F.R. § 4.126. The Veteran's symptoms of worthlessness, hopelessness, and poor energy are similar to depressed mood and chronic sleep impairment, which are contemplated by the assigned 30 percent rating For the period prior to March 7, 2017, the Veteran did not report suicidal or homicidal plan or ideation. The Board also finds the level of impairment caused by the Veteran's symptoms prior to March 7, 2017, more closely approximated 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, as assessed by VA examiners in July 2016 and September 2016. Mental status examinations in VA and private treatment records and the July 2016 and September 2016 VA examinations indicate that the Veteran had depressed mood; anxiety; panic attacks occurring weekly or less often; and chronic sleep impairment; and impairment of short- and long-term memory, for example, retention of only highly learned material, while forgetting to complete tasks. While the Veteran experienced symptoms contemplated by a 50 percent rating, such as impairment of short- and long-term memory, for example, retention of only highly learned material, while forgetting to complete tasks, the evidence overall does not demonstrate the level of impairment associated with a 50 percent rating. The Veteran's other remaining symptoms were either contemplated by or more consistent with a 30 percent rating. Neither the Veteran nor any VA examiner identified symptoms including circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; impaired judgment; impaired abstract thinking; or disturbances of motivation and mood. In fact, behavior observations during VA examinations in July 2016 and September 2016 show that the Veteran had no speech abnormalities, fair judgement, no cognitive defects, and linear and goal-oriented thought process. Therefore, the Board finds that the symptoms prior to March 7, 2017, more nearly approximated the criteria for a 30 percent rating. As of March 7, 2017, VA and private treatment records, the June 2017 and November 2021 VA examinations, and the Veteran's lay statements show that PTSD with depressive disorder was manifested by symptoms associated with a 70 percent rating, such as suicidal ideation; obsessional rituals which interfere with routine activities; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; neglect of personal appearance and hygiene; and difficulty in adapting to stressful circumstances (including work or a worklike setting, and symptoms associated with a 100 percent rating, such as intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene). The Board finds the severity, frequency, and duration of the Veteran's unlisted symptoms more closely approximate the symptoms contemplated by a 70 percent rating, which are less severe, less frequent, and shorter in duration than those contemplated by a 100 percent rating. 38 C.F.R. § 4.126. The Board notes that the Veteran expressed suicidal ideation, which could rise to the level of persistent danger of self-harm, which is contemplated by the 100 percent criteria. Bankhead v. Shulkin, 29 Vet. App. 10 (2017). However, the severity, frequency, and duration of the Veteran's suicidal ideation has not risen to the level contemplated by the 100 percent rating criteria. The Veteran regularly denied thoughts, intent, or a plan involving self-harm in existing treatment records, and during the 2017 and 2021 VA examinations. Furthermore, both VA examiners during the appellate period specifically indicated that the Veteran did not present a persistent danger of self-harm. The Board also finds the level of impairment caused by the Veteran's symptoms as of March 7, 2017, more closely approximates the level associated with a 70 percent rating. The Veteran experienced occupational and social impairment with reduced reliability and productivity with deficiencies in most areas. Mental status examinations in VA and private treatment records and the June 2017 and November 2021 VA examinations indicated that the Veteran's PTSD with depressive disorder was assessed as not productive of total occupational and social impairment. Specifically, the Veteran's clinical findings included suicidal ideation; obsessional rituals which interfere with routine activities; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); and intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene). While the Veteran experience symptoms contemplated by a 100 percent rating, such as intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene), the evidence overall does not demonstrate the level of impairment associated with a 100 percent rating. The Veteran's other remaining symptoms were either contemplated by or more consistent with a 70 percent rating. While the Veteran has been assigned a total disability rating based on individual unemployability due to service-connected disability, he was not totally socially impaired. The most recent November 2021 VA examination and associated records contain reports that the Veteran still lives with his brother and family. The June 2017 VA examination specified that the Veteran lived with his brother, where his mother, father, sister-in law, their daughter and grandchild also live. The Veteran also reported engaging in sexual behavior in the 2021 VA examination. Furthermore, at no point during the appellate period from March 7, 2017, was the Veteran assessed to have any other symptoms associated with a 100 percent disability rating, including gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; disorientation to time or place; or memory loss for names of close relatives, own occupation or own name. The Board finds that the VA examinations are the most persuasive evidence of record as they were conducted by trained medical professionals and considered the Veteran's reports of symptoms and history when making findings and conclusions. Accordingly, the Board finds that the evidence of record persuasively weighs against finding that the severity, frequency, and duration of the Veteran's symptoms resulted in the level of impairment required for rating greater than 30 percent prior to March 7, 2017, or a rating greater than percent rating as of March 7, 2017. The Board finds that the evidence is not in relative equipoise and there is no reasonable doubt to resolve in favor of the Veteran. The criteria for increased ratings are not met or more nearly approximated, and the appeal must be denied. 2. Entitlement to a rating in excess of 30 percent for headaches prior to March 7, 2017, and in excess of 50 percent as of March 7, 2017 The Veteran contends that he is entitled to ratings in excess of 30 percent for headaches prior to March 7, 2017, and in excess of 50 percent as of March 7, 2017. Migraine headaches are rated pursuant to Diagnostic Code 8100. Under Diagnostic Code 8100, a 0 percent rating is warranted for migraines with less frequent attacks. A 10 percent rating is warranted for migraines with characteristic prostrating attacks averaging one in two months over the last several months. A 30 percent rating is warranted for migraines with characteristic prostrating attacks occurring on an average once a month over the last several months. A 50 percent rating is warranted for migraines with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. A 50 percent rating is the highest schedular rating under Diagnostic Code 8100. 38 C.F.R. § 4.124a, 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. That makes renders 38 C.F.R. §§ 4.7 and 4.21 inapplicable. Johnson v. Wilkie, 30 Vet. App. 245 (2018). The rating criteria for a 50 percent rating contain several undefined phrases. The descriptive phrase very frequent connotes a frequency at least greater than once a month, as is required by the rating criteria corresponding to a lesser 30 percent rating. The phrase completely prostrating generally means that the migraines attack must make the veteran entirely powerless. The completely prostrating attacks must also be prolonged, which is defined as to lengthen in time: extend duration: draw out: continue, protract. Johnson v. Wilkie, 30 Vet. App. 245 (2018). 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 (2004). In rating headaches or migraines under Diagnostic Code 8100, the Board may not consider the ameliorative effects of medication. Jones v. Shinseki, 26 Vet. App. 56, 63 (2012). 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 prior to March 7, 2016, corresponding to the criteria for a 30 percent rating under Diagnostic Code 8100. A July 2016 VA headache examination diagnosed migraines. The treatment plan was noted not to include taking medication. Symptoms were reported to include pulsating or throbbing head pain on both sides of the head, and non-headache symptoms including sensitivity to light and sound lasting less than one day. The Veteran was noted to have characteristic prostrating attacks of migraine and non-migraine headache pain once per month, though none productive of severe economic inadaptability. An MRI found normal findings, and the migraines were assessed to be productive of no functional impact. An April 2017 VA headache examination diagnosed migraines. The Veteran reported suffering form 33 headaches per month. His treatment plan was noted to include taking medication, including Acetaminophen. Symptoms were reported to include pulsating or throbbing head pain on both sides of the head, worsening with physical activity, and non-headache symptoms including sensitivity to light and sound lasting one to two days. The Veteran was noted to have characteristic prostrating attacks of migraine and non-migraine headache pain once per month. He was also noted to have very prostrating and prolonged attacks of migraine and non-migraine pain productive of severe economic inadaptability. An MRI found normal findings, and the migraines were assessed to be productive of difficulty focusing on tasks during a headache. At a November 2021 VA headache examination, the Veteran reported having headaches multiple times per week. The treatment plan was noted to include taking medication. Symptoms were reported to include constant head pain, pulsating or throbbing head pain on both sides of the head, worsening with physical activity, and non-headache symptoms including nausea, sensitivity to light and sound, changes in vision, and sensory changes lasting less than one day. The Veteran was noted to have characteristic prostrating attacks of migraine and non-migraine headache pain once per month. He was also noted to have very prostrating and prolonged attacks of migraine and non-migraine pain productive of severe economic inadaptability. The migraines were assessed to be debilitating, and affected him obtaining employment. At a March 2017 Decision Review Officer hearing, the Veteran reported having a migraine journal, and described the migraines as extremely severe and debilitating, productive of severe pain and sensitivity to light and sound, and requiring spending time alone in a dark place. The frequency was reported as daily, multiple times. The Veteran submitted a migraine journal for the period between November 2016 and March 2017, wherein he described the number and severity of weekly migraine episodes. The Veteran is competent to report readily observable symptoms. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Considering all relevant evidence of record, the Board finds the lay and medical evidence for the period prior to March 7, 2017, to be consistent. Review of the headache journal log indicates that the first notation of migraine pain described as "debilitating" was in the week of January 1, 2017. Prior to that notation, the Veteran described the migraines as mostly severe. The next and only other notation of migraine pain described by the Veteran as debilitating was in the first week of February 2017. The Board acknowledges the findings of the July 2016 VA examiner, which indicate an absence of very prostrating and prolonged attacks of migraine or non-migraine pain productive of severe economic inadaptability. However, the 2016 examiner acknowledged the Veteran's characteristic prostrating attacks, and the noted frequency of once per month is consistent with the Veteran's own journal reports. The Board acknowledges the Veteran's statement of March 2017 indicating he currently had an average of 33 debilitating episodes per month, and was unable to work as a result. However, the Veteran's description of migraines was for current symptoms, and his own journal entries specified the severity of the migraine episodes. Additionally, the Veteran did not submit medical evidence indicative of very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability prior to March 7, 2017. Accordingly, the Board concludes that the Veteran had migraines with characteristic prostrating attacks occurring on average once a month over the last several months prior to March 7, 2017, corresponding to the criteria for a 30 percent rating under Diagnostic Code 8100. A higher 50 percent rating under Diagnostic Code 8100 is not warranted unless there are migraines with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. The attacks for the period prior to March 7, 2017, are not shown to be completely prostrating or prolonged, or productive of severe economic inadaptability at a frequency of more than once per month, according to the Veteran's own journal entries and the 2016 VA examination. The Board finds the headache journal and VA examination to be the most persuasive evidence in this case and that evidence is in agreement. The Board finds no reasonable doubt that could be resolved in favor of the Veteran, and finds that the evidence is not in relative equipoise. AS of March 7, 2017, the Veteran is assigned a 50 percent rating for a headache disability. That 50 percent rating is the maximum schedular rating permitted under Diagnostic Code 8100. Therefore, because the maximum schedular rating has already been assigned under Diagnostic Code 8100, no disability higher than 50 percent may be assigned. Therefore, the claim for entitlement to a schedular rating in excess of 50 percent for service-connected migraines headaches as of March 7, 2017, is without legal merit and must be denied. Sabonis v. Brown, 6 Vet. App. 426 (1994). Because that is the maximum rating, consideration of an extraschedular rating raised by the record. The symptoms associated with the Veteran's headaches which include regular prostrating attacks accompanied by nausea, sensitivity to light and sound, changes in vision, and sensory changes causing severe economic inadaptability are contemplated by the rating criteria. Therefore, the available schedular criteria for the service-connected disability are adequate, and referral for consideration of an extraschedular rating is not warranted. Thun v. Peake, 22 Vet. App. 111 (2008). Accordingly, the claim for a rating in excess of 50 percent for service-connected migraines headaches as of March 7, 2017, must be denied. Thus, the Board concludes that the Veteran did not have migraines with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability for the period prior to March 7, 2017, and is in receipt of the maximum schedular rating thereafter. The Board finds that there is no reasonable doubt to be resolved in favor of the Veteran and the evidence is not in relative equipoise. Therefore, the Board finds that the claim for increased ratings must be denied. REASONS FOR REMAND 1. Entitlement to TDIU prior to November 17, 2021, is remanded. The Veteran contends he has been unable to work due to the service-connected disabilities as of January 1, 2012, as show in a March 2017 VA Form 21-8940. Furthermore, the Veteran met the schedular criteria for consideration of the assignment of TDIU as of at least March 7, 2017. Once the issue of a TDIU has been raised in the context of an appeal, it is not bifurcated by the grant of TDIU for a portion of the applicable period on appeal. Harper v. Wilkie, 30 Vet. App. 356 (2018). Thus, the assignment of TDIU as of November 17, 2021, was only a partial grant of benefits, and the claim for TDIU prior to November 17, 2021, remained as part of the appeal. A December 2021 rating decision incorrectly concluded that the assignment of TDIU as of November 17, 2021, was a full grant of the benefit sought on appeal, and the issue was not addressed in a supplemental statement of the case. Therefore, a supplemental statement of the case must be issued that considers the evidence of record. 38 C.F.R. § 19.31. The matters are REMANDED for the following action: Readjudicate the claim of entitlement to TDIU prior to November 17, 2021, with consideration of all evidence of record. If any decision is adverse to the Veteran, issue a supplemental statement of the case and allow the appropriate time for response. Then, return the case to the Board. Harvey P. Roberts Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Comninos, Georgio 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.