Citation Nr: 22032011 Decision Date: 06/01/22 Archive Date: 06/01/22 DOCKET NO. 14-00 814 DATE: June 1, 2022 ORDER Prior to May 1, 2018, entitlement to an initial 70 percent rating, but no higher, for posttraumatic stress disorder (PTSD) is granted subject to controlling regulations applicable to the payment of monetary benefits. Effective May 1, 2018, entitlement to a rating in excess of 70 percent disabling for PTSD and traumatic brain injury (TBI) is denied. Prior to June 15, 2018, entitlement to an initial 30 percent rating, but no higher, for headache condition is granted subject to controlling regulations applicable to the payment of monetary benefits. Effective June 15, 2018, entitlement to a rating in excess of 30 percent disabling for headache condition is denied. FINDINGS OF FACT 1. Throughout the period on appeal, the Veteran's PTSD more nearly approximated occupational and social impairment with deficiencies in most areas; however total social and occupational impairment has not been shown. 2. Effective May 1, 2018, the Veteran's TBI more nearly approximated, at worst, level "2" impairment under facets 1 and 7. 3. Throughout the period on appeal, the Veteran's headache condition more nearly approximated characteristic prostrating attacks occurring on an average once a month over last several months. The headache condition has not been manifested by severe economic inadaptability. CONCLUSIONS OF LAW 1. Prior to May 1, 2018, the criteria for an initial 70 percent rating, but no higher, for PTSD have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.7, 4.130, Diagnostic Code (DC) 9411. 2. Effective May 1, 2018, the criteria for a rating higher than 70 percent for PTSD have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.7, 4.124a, DC 8045, 4.130, DC 9411. 3. Prior to June 15, 2018, the criteria for an initial 30 percent rating, but no higher, for a headache condition have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.7, 4.124a, DC 8100. 4. Effective June 15, 2018, the criteria for a rating higher than 30 percent disabling for a headache condition have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.7, 4.124a, DC 8100. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 2007 to February 2011. This matter is before the Board of Veterans' Appeals (Board) on appeal from a May 2011 rating decision by a Department of Veterans Affairs Regional Office (RO). In October 2017, the Veteran testified at a Board hearing before the undersigned. A copy of the transcript of that hearing has been associated with the claims file. The issues on appeal were previously remanded by the Board in a February 2018 Decision for further development. In August 2021, the Board remanded this case and instructed the Agency of Original Jurisdiction (AOJ) to obtain updated VA treatment records. The Board notes that updated VA treatment records have been obtained and associated with the claims file. Accordingly, after reviewing the actions of the AOJ, the Board finds there was substantial compliance with the requested development. Dyment v. West, 13 Vet. App. 141 (1999); Stegall v. West, 11 Vet. App. 268 (1998). As noted in the prior August 2021 Board Decision, there are several claims in appellate status at the Board, including evaluations for bilateral knee, lumbar spine and bilateral lower extremity radiculopathy. The Veteran provided testimony with regard to those claims as a September 2021 Board hearing before a different Veterans Law Judge (VLJ), during which he withdrew his claim for entitlement to a TDIU. Accordingly, these issues will be addressed in later Board decisions. Increased Rating Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The basis of disability ratings is the ability of the body as a whole, or of the psyche, or of a system or organ of the body, to function under the ordinary conditions of daily life, including employment. 38 C.F.R. § 4.10. Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability more nearly approximates the criteria required for that particular rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When a reasonable doubt arises regarding the degree of disability, that reasonable doubt will be resolved in favor of the Veteran. 38 C.F.R. § 4.3. Staged ratings are appropriate for an increase rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). PTSD The Veteran filed a service connection claim for PTSD in November 2010. That claim was granted in a May 2011 rating decision which assigned an initial 30 percent rating effective February 6, 2011; the day following his separation from service. He has appealed his initial rating. During the pendency of the appeal, a November 2018 rating decision granted entitlement to service connection for TBI, with an evaluation to be combined with the service-connected PTSD. Thereafter, another November 2018 rating decision granted an increased 70 percent rating effective May 1, 2018. The evidence of record includes service treatment records (STRs) showing that in March 2010, the Veteran reported having explosive anger that could lead to yelling, breakage and physical altercations. He also stated that he had nearly been charged with assault. He further reported poor sleep with frequent waking. He was referred for counseling. A June 2010 STR shows that he was diagnosed with adjustment disorder with disturbance of emotions and conduct. His appearance was normal, and he did not have any behavioral abnormalities. His mood was dysthymic, frustrated, anxious and irritable. He did not have any suicidal or homicidal ideation. The Veteran underwent a VA PTSD examination in December 2010. He reported major problems with nightmares and difficulty sleeping. He also reported symptoms of intrusive thoughts, flashbacks, irritability, having a short temper with periods of violence, restlessness, increased startle response, difficulties handling crowds, low motivation and anhedonia. He denied any suicidal ideation. The examiner noted the Veteran was alert and fully oriented. No thought disorder or memory loss was found present, and he denied any panic attacks, obsessive or ritualistic behavior, hallucinations or delusions. He was found able to maintain minimal personal hygiene and basic activities of daily living. Speech was normal. The examiner noted symptoms of depression, anxiety, sleep disorder, and impulse and temper control problems. He underwent another VA examination in January 2011. The Veteran reported symptoms of suspiciousness, depression, difficulty controlling his temper, irritability, hyperarousal, nightmares, decreased sleep, restlessness, increased startle response, difficulty in crowds, and low motivation. He further reported losing his temper and resorting to violence in social settings. In this regard, he reported assaulting people more than once, including a recent violent outburst caused by jealousness. The examiner found the Veteran fully oriented; his speech was normal, and he maintained minimal personal hygiene. The Veteran denied any panic attacks, delusions or hallucinations, and he was not found to have a thought disorder. He also denied any suicidal ideation. Following his separation from service, he underwent an initial VA mental health assessment in April 2011. The Veteran reported being diagnosed with PTSD, bipolar disorder, adjustment disorder and explosive disorder in 2010. He also reported having been charged with assault by contact in 2010, but that the charges were dropped. The incident involved a physical altercation and he reported firing a pistol close to the head of an assailant. His conduct was determined to be an act of self-defense. The Veteran did state that his ability to get along with others was a strength and asset, and that he had good communication skills. He reported impaired short-term memory, and a history of impulsive behavior. In addition, he reported having a supportive spouse. He was found fully oriented, and his appearance was clean and casually dressed. Speech had normal rate, rhythm and volume. Thought process was logical, coherent and goal directed, and thought content free from delusions or obsessions. He denied any suicidal or homicidal ideation. See VA Medical Records Received November 2013. A January 2013 mental health interview shows the Veteran presented for recurrent nightmares and decreased sleep for the past four to five weeks. He stated that his nightmares occurred three to four times per night, and were about traumatic events that occurred during service. He also reported increased fretfulness and anger, decreased interest in normally enjoyable activities, decreased energy, and an inability to concentrate with memory lapses. He was currently living with his girlfriend, and they had a good relationship. He reported working and taking college classes. Prior alcohol abuse was noted, and the Veteran reported that he used to drink two 750 ml bottles of liquor per night. He currently reported drinking one to two beers in the past month. The Veteran was appropriately dressed and groomed. His speech was within normal limits. His mood was euthymic and affect congruent with his mood. Thought process was appropriate, linear, logical and goal directed, and thought content appropriate. Insight and judgement were good. See VA Medical Records Received September 2021. In January 2014, he reported increased nightmares, feeling depressed, anxious and irritable. He also reported poor sleep, focus and concentration. The psychiatrist noted that he was appropriately groomed and dressed, and he had normal speech. He was fully oriented. His mood was anxious and affect congruent with his mood. Thought process was linear, logical, clear, coherent and goal directed. Insight, judgement and impulse control were good. Attention and concentration were within normal limits. See VA Medical Records Received September 2021. Another VA examination was obtained in April 2015. The examiner noted diagnoses for insomnia disorder, unspecified anxiety disorder and maladaptive personality traits. The psychiatric disorders were found manifested by occupational and social impairment due to mild or transient symptoms. The Veteran reported being capable of getting along with people and maintaining friendships. He did report some problems with his spouse and a friend who lived with them. In addition, he reported that he was attending classes to become an emergency medical technician and hoped to go to medical school. He further reported that he generally got along well with most peers, helped others with complex concepts, and that his teachers loved him because he arrived on time, participated in discussion, and completed his work. His psychiatric disorder was manifested by symptoms of anxiety and chronic sleep impairment. A September 2015 VA medical record shows the Veteran reported doing fairly well and that his mood had been stable. The psychiatrist also noted that his anxiety was at baseline, and he was sleeping and eating well with fewer nightmares. The Veteran reported that his spouse was very supportive. He was fully oriented, and his grooming was average. Speech had normal rate, rhythm and tone. No mania or hypomania were noted. Thought process was linear, logical and goal directed, and free of paranoia, delusions, bizarre thoughts or looseness of association. There was no suicidal, homicidal or violent ideation. Insight and judgement were good, and memory was grossly intact. See VA Medical Records Received September 2021. At an October 2017 Board hearing, the Veteran testified that he experienced anxiety and panic attacks that caused symptoms of sweating, an inability to stay focused, and an inability to sleep. He also reported symptoms of irritability causing him to become aggressive and defensive. He further testified that his symptoms resulted in an inability to calm down which led him to seek emergency room treatment approximately five to six times since 2010. In addition, he reported panic attacks eight to nine times per week. He further reported having difficulty or little energy to do things inside or outside his home once or twice per week. The Veteran reported having one friend outside his family, and that he could only tolerate being around family and friends unless they became overly aggressive. He rarely went out in public, and his spouse did most of the shopping. He reported having difficulty staying focused on things such as reading books or watching shows. With regard to effects on his employment, he reported that he occasionally had to leave a room to get away from people, and that he was unable to function during those times. He also reported having been fired due to his symptoms. In March 2018, he reported having nightmares and that he was not sleeping well. He also reported panic attacks every day when around people. In addition, he reported financial and relationship stressors, and that he might overthink things. Irritability reportedly played a role in difficult relationships. He denied any suicidal or homicidal ideation, or audio or visual hallucinations. The Veteran was appropriately dressed, and his hygiene and grooming were fair. His speech was fluent with normal rate, rhythm and tone. He was fully oriented. His mood was depressed and affect euthymic and stable. Thought process was organized, linear, logical and goal directed. Attention and concentration were adequate, and insight and judgement limited. Cognition and memory were grossly normal. See VA Medical Records Received March 2022. He underwent a VA TBI examination in May 2018. An assessment of facets of TBI-related cognitive impairment and subjective symptoms of TBI revealed a complaint of mild memory loss, attention, concentration or executive functions, but without objective evidence on testing (Facet 1). In this regard, the Veteran reported having mild memory difficulties involving recent conversations, objects, chores and names. Subjective symptoms (Facet 7) did not interfere with work, instrumental activities of daily living, or work, family or close relationships. In this regard, the Veteran reported subjective symptoms of headaches, tinnitus and short-term memory loss. The remainder of the Facets were normal, or free of associated symptoms. Residuals consisted of hearing loss and/or tinnitus, and headaches. Thereafter, a June 2018 VA hearing loss and tinnitus examination revealed normal hearing for VA purposes, and a diagnosis for tinnitus. The Veteran last underwent a VA PTSD examination in August 2018. The examiner noted a diagnosis for PTSD manifested by occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. A diagnosis for TBI was also provided and the examiner noted that it was not possible to differentiate what symptoms were attributable to each diagnosis. The Veteran reported that he had eliminated his parents from his life and that he had received full legal custody of his son. The examiner noted the following symptoms: depressed mood; anxiety; suspiciousness; chronic sleep impairment; flattened affect; irritable behavior and angry outbursts; hypervigilance; exaggerated startle response; problems with concentration; 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, inability to establish and maintain effective relationships. The Veteran reported that he was not making a lot of good decisions in August 2019, and that he had a high amount of energy which made him want to move, spend money all the time, and start his life over somewhere with no reason. He slept eight to nine hours per night. He was well groomed with normal speech. His thought process was circumstantial with some looseness of association, and his thought content was free of delusions. He denied any suicidal or homicidal ideation. Insight and judgement were good, and he was found fully oriented. In June 2020, he reported that he started a firearms company which was keeping him busy. He also reported a lot of associated stress with his new company, but that he had been tolerating it. Sleeping was reported as being hit or miss. He also reported being connected to his family with a good future orientation. Speech had normal rate, rhythm and volume. Thought process was logical and goal directed, and he denied any suicidal or homicidal ideation, or delusions. Insight and judgement were good. See VA Medical Records Received March 2022. Lastly, in April 2021, the Veteran reported owning three gun shops and that he worked six days per week. He reported nightmares and sleeping approximately four hours per night. He reported intrusive thoughts that lasted 10 to 20 minutes, and that he could self-redirect his thoughts and get back to work. His mood was up and down, and he reported irritability. He denied any suicidal or homicidal ideation. His speech had normal rate with blunted tone and volume. Thought process was logical and goal directed, and he denied any delusions. Insight and judgement were good. See VA Medical Records Received March 2022. The Veteran's service-connected PTSD has been rated pursuant to 38 C.F.R. § 4.130, DC 9411. Under DC 9411, a 30 percent rating is assigned for a psychiatric disorder manifested by occupational and social impairment with an occasional decrease in work efficiency and intermittent periods of an 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). 38 C.F.R. § 4.130, DC 9411. A 50 percent rating is assigned for a psychiatric disorder manifested by 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. Id. A 70 percent rating is assigned for a psychiatric disorder manifested by 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 work-like setting), or an inability to establish and maintain effective relationships. Id. A maximum 100 percent rating is assigned for a psychiatric disorder manifested by total occupational and social impairment due to such symptoms as gross impairment in thought process 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. Id. The list of symptoms under the rating criteria are meant to be examples of symptoms that would warrant the rating, but are not meant to be exhaustive, and the Board need not find all or even some of the symptoms to award a specific rating. If the evidence shows that the veteran suffers 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. Mauerhan v. Principi, 16 Vet. App. 436 (2002); Sellers v. Principi, 372 F.3d 1318 (Fed. Cir. 2004). After a review of the evidence of record, the Board finds that, prior to May 1, 2018, an increased initial 70 percent disability rating is warranted. The Board further finds that during both periods on appeal, a rating in excess of 70 percent is not warranted. In this regard, prior to May 1, 2018, symptoms included impaired impulse control such as explosive anger with periods of violence, and difficulty in adapting to stressful circumstances such as difficulty handling crowds and increased startle response; symptoms specifically contemplated by a higher 70 percent rating. The Veteran has also exhibited anxiety and panic attacks during the period on appeal. Specifically, a March 2018 VA medical record shows he reported having daily panic attacks when people were in close proximity to him. Accordingly, the Board finds that with regard to the Veteran's panic attacks, during the period on appeal they have been shown, at times, to more nearly approximate near-continuous panic attacks. In fact, most of the same symptoms noted during the August 2018 VA examination, for which the assigned 70 percent rating is based, are shown to have been exhibited at the time the Veteran filed his service connection claim. This includes symptoms of depressed mood, anxiety, suspiciousness, nightmares, chronic sleep impairment, irritable behavior and angry outbursts, hypervigilance, problems with concentration, disturbances of motivation and mood, impaired short-term memory, and restlessness. Taken as a whole, the Board finds that, prior to May 1, 2018, the Veteran's PTSD symptoms more nearly approximate the criteria for a 70 percent rating. The Board has also considered a higher total 100 percent disability rating during both periods on appeal. However, the Veteran's PTSD has not been shown to have been manifested by symptoms such as gross impairment in thought processes or communication, grossly inappropriate behavior, persistent delusion or hallucinations, persistent danger of hurting self or others, intermittent inability to perform activities of daily living (such as maintenance of minimal personal hygiene), disorientation to time or place, or memory loss for names of close relatives, own occupation or own name. Instead, at the time the May 2018 VA examination, the Veteran reported that he started a new business. Since that time, his business has reportedly grown, and he works 6 days per week. Therefore, total occupational impairment has not been shown. As noted above, a November 2018 rating decision granted service connection for TBI, which was combined with the evaluation for the service-connected PTSD. Accordingly, effective May 1, 2018, the Board has further considered a higher rating based on the criteria for rating TBIs. Initially, the Board notes that the Veteran' s TBI residuals consist of mild memory loss, headaches and tinnitus. He is already service connected for a headache condition (addressed in the section below) and tinnitus. Tinnitus has been rated at 10 percent which is the highest rating available for that condition. With regard to mild memory loss, as noted above, his service-connected PTSD is also rated based, in part, on that symptom, and the May 2018 VA PTSD examiner found that his TBI and PTSD symptoms could not be separated. Therefore, symptoms related to his TBI and psychiatric disorder are not able to be differentiated and rated separately as such would constitute prohibited pyramiding. Esteban, 6 Vet. App. at 261-62; 38 C.F.R. § 4.14. Turning to the criteria related to rating TBIs, cognitive impairment is defined as decreased memory, concentration, attention, and executive functions of the brain. Executive functions are goal setting, speed of information processing, planning, organizing, prioritizing, self-monitoring, problem solving, judgment, decision making, spontaneity, and flexibility in changing actions when they are not productive. Not all of these brain functions may be affected in a given individual with cognitive impairment and some functions may be affected more severely than others. In a given individual, symptoms may fluctuate in severity from day to day. Cognitive impairment is evaluated under the table titled "Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified." Id. Subjective symptoms may be the only residual of TBI or may be associated with cognitive impairment or other areas of dysfunction. Subjective symptoms are evaluated as residuals of TBI, whether or not they are part of cognitive impairment, under the subjective symptoms facet in the table titled "Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified." Id. However, any residual with a distinct diagnosis that may be evaluated under another diagnostic code, such as migraine headache or Meniere's disease, are separately evaluated even if that diagnosis is based on subjective symptoms, rather than under the "Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified" table. The table titled "Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified" contains 10 important facets of TBI related to cognitive impairment and subjective symptoms. It provides criteria for levels of impairment for each facet, as appropriate, ranging from 0 to 3, and a 5th level, the highest level of impairment, labeled "total." The rater is to assign a 100 percent evaluation if "total" is the level of evaluation for one or more facets. If no facet is evaluated as "total," the rater shall assign the overall percentage evaluation based on the level of the highest facet as follows: 0 = 0 percent; 1 = 10 percent; 2 = 40 percent; and 3 = 70 percent. For example, the rater shall assign a 70 percent rating if 3 is the highest level of evaluation for any facet. 38 C.F.R. § 4.124a, DC 8045. The May 2018 VA TBI examination does not demonstrate that any facet of cognitive impairment had a level of impairment higher than "2." Pursuant to the diagnostic criteria, if the highest facet level is "2" then a 40 percent disability rating is provided. As such, assigning a rating pursuant to DC 8045 does not provide the Veteran with a more beneficial outcome, and that diagnostic code will not be considered. In conclusion, the Board finds that, prior to May 1, 2018, an increased initial 70 percent rating, but no higher, is warranted. Effective May 1, 2018, the evidence of record is persuasively against a rating in excess of 70 percent. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.7, 4.130; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Headache Condition The Veteran filed a service connection claim for headache condition in November 2010. That claim was granted in a May 2011 rating decision which assigned an initial noncompensable rating effective February 6, 2011, the day following his separation from service. He has appealed his initial rating. During the pendency of the appeal, a November 2018 rating decision granted an increased 30 percent rating effective June 15, 2018. The evidence of record includes an April 2010 STR showing the Veteran reported daily headaches with sensitivity to light. In June 2010, he reported 7 headaches in the past week, with the severity rated an 8 on a scale to 10. He reported having 2 to 3 headaches per week in September 2010, causing him to become sick and vomit. He underwent a VA general examination in December 2010. He reported developing migraine headaches in 2008, with symptoms of light and noise sensitivity, seeing spots in front of his eyes, nausea and vomiting. Headaches reportedly occurred 2 to 3 times per week with episodes lasting one day. He was diagnosed with migraine headaches. Various VA medical records dating between September 2012 and November 2014 show the Veteran did not currently manifest headache symptoms. He did report a headache in October 2013 in addition to nausea, vomiting, nasal drainage and sinus pressure above his eyes. See VA Medical Records Received September 2021. At an October 2017 Board hearing, the Veteran testified that his migraine headaches would build up over time and cause him to become nauseated. He also testified that during such episodes, he could not be in daylight or around sounds louder than a fan, and that he had to stay in a cold, dark room. Since 2009, he reported increased frequency and intensity of his headaches, and that, on average, he experienced headaches once per week with episodes lasting from hours to 3 to 4 days during which he became completely incapacitated. He also reported having sought hospital treatment during such episodes. A December 2017 VA medical record shows the Veteran reported a history of migraines approximately 2 to 3 times per week. In February 2018, he reported migraines with auras, phonophobia, photophobia and some nausea. Another February 2018 record noted that his headaches did not have any alarming symptoms that might warrant a radiological study. VA medical records also show that in March 2018, the Veteran reported that his headaches had been stable, but that he now had more frequent episodes. His physician noted an imaging study might be obtained if he did not respond well to medication or other long term treatment. See VA Medical Records Received March 2022. He underwent a VA examination in June 2018. The examiner noted a diagnosis for migraine headaches. Symptoms included experiencing pulsating or throbbing head pain, pain localized to one side of the head, nausea, vomiting and sensitivity to light and sound. Characteristic headaches were noted once every month and were not manifested by very prostrating or prolonged attacks productive of severe economic inadaptability. A July 2018 VA medical record shows the Veteran reported that he still had some headaches, but that they were not as bad as before. He further reported that his headaches had been better controlled since the start of his medication. An August 2018 medical record shows he reported migraines 2 to 3 times per week, and that his medication was helping. In January 2019, he reported controlled headaches that only occurred once in a while, and which were maintained with medication. See VA Medical Records Received March 2022. The Veteran's headache condition has been rated noncompensable prior to June 15, 2018, and 30 percent disabling thereafter, pursuant to 38 C.F.R. § 4.124a, DC 8100. Pursuant to DC 8100, headaches are assigned a non-compensable rating with less frequent attacks. A 10 percent rating is warranted for characteristic prostrating attacks averaging one in two months over the last several months. A 30 percent rating is warranted for characteristic prostrating attacks occurring on an average once a month over the last several months. A 50 percent rating is warranted for very frequent, completely prostrating and prolonged attacks, productive of severe economic inadaptability. 38 C.F.R. § 4.124a, DC 8100. The rating criteria do not define "prostrating," nor has the Court. By way of reference, the Board notes that, according to Dorland's Illustrated Medical Dictionary 1523 (32nd ed. 2012), "prostration" is defined as "extreme exhaustion or powerlessness." The rating criteria also do not define "severe economic inadaptability;" however, nothing in DC 8100 requires the claimant to be completely unable to work in order to qualify for a 50 percent rating. See Pierce v. Principi, 18 Vet. App. 440 (2004). After a review of the evidence of record, the Board finds that, prior to June 15, 2018, an initial 30 percent rating is warranted. In this regard, the Board notes that prior to, and following, June 15, 2018, the Veteran has consistently reported 2 to 3 headaches per week, including STRs dated shortly prior to his service connection claim, and during his December 2010 VA examination. During that examination, he further reported that his headaches lasted all day. While the Board recognizes that VA medical records note the absence of headaches, it is unclear whether those dates of treatment occurred during periods that the Veteran was asymptomatic, or whether his symptoms were sufficiently treated with medication. In this regard, a March 2018 VA medical record shows the Veteran reported that his headaches had been stable, but that they had started to become more frequent. The physician questioned whether an imaging study should be obtained if he continued to not respond well to medication or other long term treatment. Accordingly, based on symptoms recorded at the time he filed his service connection claim, symptoms noted during his initial VA examination, as well as symptoms noted in March 2018 that are similar to symptoms noted during his June 2018 VA examination, the Board finds that an initial 30 percent rating, is warranted. However, during both periods on appeal, the Board finds that a rating in excess of 30 percent disabling is not warranted. Specifically, the evidence of record does not show that his symptoms were manifested by severe economic inadaptability. In making this determination, the Board recognizes testimony provided during the October 2017 Board hearing, during which the Veteran stated that since 2009, he experienced headaches once per week, with each episode lasting 3 to 4 days. However, the Board notes that his testimony is also contradicted by prior statements. In this regard, in December 2010, he reported headaches 2 to 3 times per week, with episodes lasting up to 1 day. As noted above, VA medical records dating from September 2012 to November 2014 consistently noted the absence of headaches. Additionally, a February 2018 VA medical record noted migraine headaches, but without any alarming symptoms, and a March 2018 VA medical record shows the Veteran reported that his headaches had been stable. Therefore, the Board finds that testimony provided by the Veteran during his Board hearing is not supported by prior or subsequent lay statements, or the medical evidence of record. As such, the Board provides his testimony little probative value. Instead, the Board finds the June 2018 VA examiner's conclusion that the Veteran's headache condition was not productive of severe economic inadaptability the most probative evidence of record. This finding is further supported by a more recent January 2019 VA medical record evidencing marked improvement in the Veteran's headache condition. In this regard, he reported that his headaches were controlled and only occurred "once in a while." In addition, this finding is supported by the fact that during this period on appeal, the Veteran has reported starting a business which has grown, and that he works 6 days per week. Therefore, the evidence of records does not show a headache condition manifested by severe economic inadaptability. In sum, prior to June 15, 2018, an increased 30 percent rating, but no higher, is warranted. Effective June 15, 2018, the evidence of record is persuasively against a rating in excess of 30 percent. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.7, 4.124a, DC 8045; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). S. HENEKS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Lamb, 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.