190103-2079

CourtBoard of Veterans' Appeals
DecidedAugust 22, 2019
Docket190103-2079
StatusUnpublished

This text of 190103-2079 (190103-2079) is published on Counsel Stack Legal Research, covering Board of Veterans' Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
190103-2079, (bva 2019).

Opinion

Citation Nr: AXXXXXXXX Decision Date: 08/22/19 Archive Date: 08/22/19

DOCKET NO. 190103-2079 DATE: August 22, 2019

ORDER

Entitlement to an initial rating in excess of 50 percent for migraine headaches, to include on an extraschedular basis, is denied.

Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU), from September 7, 2018, is granted.

REMANDED

Entitlement to a TDIU, prior to September 7, 2018, is remanded.

FINDINGS OF FACT

1. The Veteran’s service-connected migraine headaches are assigned the maximum schedular rating authorized under Diagnostic Code 8100 and the Veteran’s headache symptoms are contemplated by the schedular criteria.

2. From September 7, 2018, the Veteran’s service-connected disabilities prevent her from obtaining and maintaining substantially gainful employment.

CONCLUSIONS OF LAW

1. There is no legal basis for a schedular rating in excess of 50 percent for the Veteran’s headaches, and an extraschedular rating is not warranted. 38 U.S.C. § 1155 (2012); 38 C.F.R. § § 3.321, 4.124a, Diagnostic Code 8100 (2018).

2. The criteria for entitlement to a TDIU from September 7, 2018, are met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.16 (2018).

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Board notes that the rating decisions on appeal were issued in April 2013 and December 2015. In April 2018, the Veteran elected the modernized review system. 84 Fed. Reg. 138, 177 (Jan. 18, 2019) (to be codified at 38 C.F.R. § 19.2(d)).

The Veteran served on active duty from February 1980 to April 1985. The Veteran selected the Higher-Level Review lane when she opted in to the Appeals Modernization Act (AMA) review system by submitting a Rapid Appeals Modernization Program (RAMP) election form. Accordingly, the November 2018 AMA rating decision considered the evidence of record as of the date VA received the RAMP election form. The Veteran timely appealed this rating decision to the Board and requested direct review of the evidence considered by the Agency of Original Jurisdiction (AOJ).

In the April 2013 rating decision, the AOJ awarded service connection for migraine headaches, assigning a noncompensable initial rating effective April 11, 2012. In June 2013, the Veteran filed a timely notice of disagreement as to the initial rating assigned. Subsequently, in a December 2014 rating decision, the initial rating for migraine headaches was increased from noncompensable to 50 percent effective April 11, 2012. In the December 2015 rating decision, the AOJ denied a TDIU. The Veteran appealed the denial in December 2015.

1. Entitlement to an initial rating in excess of 50 percent for migraine headaches, to include on an extraschedular basis.

Disability ratings are determined by the application of the VA’s Schedule for Rating Disabilities (Rating Schedule), which is based on the average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4 (2018). Pertinent regulations do not require that all cases show all findings specified by the Rating Schedule, but that findings sufficient to identify the disease and the resulting disability and above all, coordination of the rating with impairment of function will be expected in all cases. 38 C.F.R. § 4.21 (2018).

Evaluation of a service-connected disability requires a review of a veteran’s medical history with regard to that disorder. However, the primary concern in a claim for an increased evaluation for service-connected disability is the present level of disability. While the entire recorded history of a disability is important for more accurate evaluations, the regulations do not give past medical reports precedence over current findings. Francisco v. Brown, 7 Vet. App. 55, 58 (1994).

Where a veteran appeals the initial rating assigned for a disability, evidence contemporaneous with the claim and the initial rating decision granting service connection would be most probative of the degree of disability existing at the time that the initial rating was assigned and should be the evidence “used to decide whether an original rating on appeal was erroneous.” See Fenderson v. West, 12 Vet. App. 119, 126 (1999). If later evidence indicates that the degree of disability increased or decreased following the assignment of the initial rating, “staged” ratings may be assigned for separate periods of time. Id.

Diagnostic Code 8100 provides that a 50 percent rating is warranted for headaches with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. A 30 percent rating is warranted for headaches with characteristic prostrating attacks occurring on average once a month over the last several months. A 10 percent rating is warranted for headaches with characteristic prostrating attacks averaging one in two months over the last several months. A noncompensable rating is warranted for headaches with less frequent attacks. 38 C.F.R. § 4.124a.

As to consideration of referral for an extraschedular rating, such consideration requires a three-step inquiry. See Thun v. Peake, 22 Vet. App. 111 (2008), aff’d sub nom. Thun v. Shinseki, 572 F.3d 1366 (Fed. Cir. 2009). The first question is whether the schedular rating criteria adequately contemplate the Veteran’s disability picture. Thun, 22 Vet. App. at 115. If the criteria reasonably describe the Veteran’s disability level and symptomatology, then the Veteran’s disability picture is contemplated by the rating schedule, the assigned schedular evaluation is, therefore, adequate, and no referral is required. If the schedular evaluation does not contemplate the Veteran’s level of disability and symptomatology, and is found inadequate, then the second inquiry is whether the Veteran’s exceptional disability picture exhibits other related factors such as those provided by the regulation as governing norms. If the Veteran’s disability picture meets the second inquiry, then the third step is to refer the case to the Under Secretary for Benefits or the Director of Compensation Service to determine whether an extraschedular rating is warranted.

The Veteran’s headaches have been assigned a 50 percent initial rating. This is the maximum schedular rating assignable for that condition, and she contends that he is entitled to an extra-schedular rating.

An October 2012 VA examination report reflects that the Veteran’s headaches are limiting her activity and associated with nausea malaise and require pain medications at least every other day. She lost work capability 3 to 4 days a month as she has to leave work because of headaches. She described pulsating or throbbing head pain on both sides of the head, with nausea and sensitivity to light and sound. Typical head pain lasts 1 to 2 days.

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Related

Thun v. Shinseki
572 F.3d 1366 (Federal Circuit, 2009)
Dennis M. Thun v. James B. Peake
22 Vet. App. 111 (Veterans Claims, 2008)
Geib v. Shinseki
733 F.3d 1350 (Federal Circuit, 2013)
Johnson v. McDonald
762 F.3d 1362 (Federal Circuit, 2014)
Moore v. Derwinski
1 Vet. App. 356 (Veterans Claims, 1991)
Van Hoose v. Brown
4 Vet. App. 361 (Veterans Claims, 1993)
Hodges v. Brown
5 Vet. App. 375 (Veterans Claims, 1993)
Hatlestad v. Brown
5 Vet. App. 524 (Veterans Claims, 1993)
Sabonis v. Brown
6 Vet. App. 426 (Veterans Claims, 1994)
Francisco v. Brown
7 Vet. App. 55 (Veterans Claims, 1994)
Fenderson v. West
12 Vet. App. 119 (Veterans Claims, 1999)
Bowling v. Principi
15 Vet. App. 1 (Veterans Claims, 2001)

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190103-2079, Counsel Stack Legal Research, https://law.counselstack.com/opinion/190103-2079-bva-2019.