Citation Nr: 18160469
Decision Date: 12/26/18	Archive Date: 12/26/18

DOCKET NO. 15-18 817A
DATE:	December 26, 2018
ORDER
Entitlement to a rating of 50 percent for service-connected migraine headaches associated with post-traumatic stress disorder (PTSD) with major depressive disorder, from March 13, 2013, is granted.
FINDING OF FACT
Since March 13, 2013, the Veteran has experienced very frequent completely prostrating and prolonged attacks of migraine headaches which are productive of severe economic inadaptability.
CONCLUSION OF LAW
The criteria for entitlement to a rating of 50 percent for service-connected migraine headaches associated with PTSD with major depressive disorder, from March 13, 2013, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.124a, Diagnostic Code (DC) 8100.
REASONS AND BASES FOR FINDING AND CONCLUSION
The Veteran served in the Navy from December 1978 to December 1982.
This matter comes before the Board of Veterans Appeals (Board) through an appeal of the August 2014 rating decision. 
1. Entitlement to a rating of 50 percent for service-connected migraine headaches from March 13, 2013
The Veteran contends that a higher rating for her service-connected migraine headaches is warranted. The Veteran asserts that she experiences multiple migraines each week and headaches almost daily. See Correspondence dated November 2014; Notice of Disagreement dated October 2014; VA Examination dated September 2013; Correspondence dated March 2013. She contends that her migraines are often incapacitating, forcing her to call out of work and stay in bed. See VA Examinations dated October 2016, July 2014, and September 2013; VA Treatment Records dated December 2015, September 2015, and June 2015. In reports to treating physicians, the Veteran has described the migraine headache pain as “excruciating.” See VA Treatment Record dated August 2016.
The Veteran’s headaches are rated under 38 C.F.R. § 4.124a, DC 8100. Under DC 8100, migraines are evaluated as follows: a 30 percent rating is assigned with characteristic prostrating attacks occurring on an average once a month over last several months; and a 50 percent rating is assigned with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. 38 C.F.R. § 4.124a, DC 8100.
Neither the rating criteria nor the courts have defined the term “prostrating” as used in the rating criteria. According to Merriam-Webster’s Collegiate Dictionary, 999 (11th ed. 2007), “prostration” is defined as “complete mental or physical exhaustion.” A very similar definition is found in Dorland’s Illustrated Medical Dictionary 1554 (31st ed. 2007), in which “prostration” is defined as “extreme exhaustion or powerlessness.”  
The term “severe economic inadaptability” is also not defined by VA regulations.  The Court, however, has stated that this term is not synonymous with being completely unable to work and that the phrase “productive of” could be read to mean either “producing” or “capable of producing” economic inadaptability. See Pierce v. Principi, 18 Vet. App. 440, 446-47 (2004).
The Veteran underwent VA examinations in October 2016, July 2014, and September 2013. The October 2016 VA examiner found that the Veteran experienced symptoms of constant head pain, pulsating and throbbing head pain, pain on both sides of head, worsening with physical activity; worsening with mental effort, nausea, vomiting, sensitivity to light/sound, and blurred vision. See VA Examination dated October 2016. The examiner found that head pain would last 1-2 days and that it occurred more frequently than once per month. The examiner found that the Veteran experienced prostrating and prolonged attacks of migraine headache pain and that the Veteran was unable to focus, concentrate, and think while experiencing head pain. The pain would lead to her subsequently being unable to work and having to take time off. See VA Examination dated October 2016.
The July 2014 VA examiner found the Veteran experienced similar symptoms to those found by the October 2016 examiner, and found that the Veteran experienced prostrating and prolonged attacks of migraine headache pain. See VA Examination dated July 2014.
The September 2013 VA examiner found that the Veteran experienced incapacitating episodes of migraine headache pain of about 3 times per month. See VA Examination dated September 2013. Furthermore, the VA examiner found that the Veteran would be unable to work on days of incapacitating episodes, even though the Veteran stated that she had not had to miss work due to any incapacitating episodes. The examiner also found that the Veteran experienced prostrating and prolonged attacks of migraine headache pain. See VA Examination dated September 2013. During the September 2013 VA examination, the Veteran stated that she had been experiencing headaches at a rate of about 4-5 times per week and that with medication that rate was still at about 3 times per week.
The Board finds all of the VA examinations to be adequate and finds that all three examinations hold significant probative weight because they provide a full examination of the Veteran as well as consideration of her lay statements and the evidence of record. 
The Veteran’s medical records demonstrate that the Veteran experiences frequent, prolonged, and prostrating attacks of migraine headache pain. Physicians have noted periods of near daily migraines, migraines lasting for days, hospitalization for migraine pain, and increased migraine frequency. See VA Treatment Records dated September 2015, June 2015, September 2014, and February 2013; Non-Governmental Treatment Records dated September 2014. Even with medication, the Veteran reports continued migraines and headaches on a consistent basis to her physicians. See VA Treatment Records dated December 2015 and September 2015; Non-Governmental Treatment Records dated October 2014. These medical records show that while the Veteran is currently employed, she often experiences symptoms while she is at work or ends up using sick leave. See VA Treatment Records dated August 2016, December 2015, and June 2015; VA Examination dated October 2016.
The Veteran also submitted several lay statements addressing how her migraine pain produces severe economic inadaptability. A coworker, N.S., stated that the Veteran has debilitating headaches while at work and that she performs her job with difficulty. See Lay Statement from N.S. dated October 2014. N.S. also stated that the Veteran has made comments that she feels she might be unable to complete her shifts due to the pain. See Lay Statement from N.S. dated October 2014. Another coworker, R.H., noted that the Veteran experiences pain and appears uncomfortable during shifts. See Lay Statement from R.H. dated September 2014. W.W., another coworker, stated that the migraines appear to interfere with the Veteran’s ability to effectively perform her duties as a nurse. See Lay Statement from W.W. dated September 2014. 
In making all determinations, the Board must fully consider the lay assertions of record. A layperson is competent to report on the onset and recurrence of symptoms. See Layno v. Brown, 6 Vet. App. 465, 470 (1994). Lay evidence can also be competent and sufficient evidence of a diagnosis or to establish etiology if (1) the layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007).
The Board finds that the Veteran and her coworkers are competent to report the onset and recurrence of the Veteran’s symptoms that they are able to personally observe. Furthermore, the Board finds that the statements made by the Veteran and her coworkers are supported by the Veteran’s diagnosis made by a medical professional. The Board further finds the statements to be credible and to hold significant probative weight because they are consistent with the medical evidence of record.
In looking at the evidence, the Board finds that a rating of 50 percent most nearly approximates the Veteran’s symptoms. The medical and lay evidence of record show that the Veteran experiences frequent migraine and headache pain which cause completely prostrating and prolonged attacks which affect the Veteran’s ability to work and function. When experiencing an attack, the Veteran has reported “excruciating” pain which last sometimes for days and occurs more than once per month. The September 2013 VA examiner approximated that the Veteran experiences incapacitating episodes three times per month and the subsequent medical reports and VA examinations indicate an even greater frequency. These instances effect the Veteran’s ability to work and often leads to her calling out of work. 
(Continued on the next page)
 
Therefore, the Board finds that a rating of 50 percent is warranted. An effective date of March 13, 2013 is assigned as that is the date of the September 2013 VA examination which gave entitlement to a higher rating.
 
R. FEINBERG
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	S. Bognar, Associate Counsel 

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