Citation Nr: 0000977 Decision Date: 01/12/00 Archive Date: 01/27/00 DOCKET NO. 98-19 779 ) DATE ) ) On appeal from the Department of Veterans Affairs (VA) Regional Office (RO) in Columbia, South Carolina THE ISSUE Entitlement to an increased rating for migraine headaches, currently evaluated as 10 percent disabling. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD M. Miyake, Associate Counsel INTRODUCTION The veteran served on active duty from January 1989 to May 1996. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an October 1998 rating decision by the RO that, among other things, denied a claim of entitlement to an increased rating for migraine headaches. The veteran was notified of the denial by a letter in November 1998. In a written statement of December 1999, the veteran indicated that it was not possible for her to attend a hearing scheduled before a member of the Board in January 2000. FINDING OF FACT Migraine headaches occur approximately four to five times per month and are associated with blurred vision, nausea, and photophobia. CONCLUSION OF LAW A 30 percent rating for service-connected migraine headaches is warranted. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 4.7, 4.124a, Diagnostic Code 8100 (1999). REASONS AND BASES FOR FINDING AND CONCLUSION Disability evaluations are determined by the application of a schedule of ratings, which is in turn based on the average impairment of earning capacity caused by a given disability. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. § 4.1 (1999). Separate diagnostic codes identify the evaluations to be assigned to the various disabilities. 38 C.F.R. § 4.27 (1999). Where there is a question as to which of two evaluations shall be applied, the higher evaluation 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 (1999). Any reasonable doubt regarding the degree of disability will be resolved in favor of the veteran. 38 C.F.R. § 4.3 (1999). When rating the veteran's service-connected disability, the entire medical history must be borne in mind. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). However, it is the more recent evidence that is of primary concern, since this provides the most accurate picture of the current severity of the disability. Francisco v. Brown, 7 Vet. App. 55 (1994). The veteran's migraine headaches are currently evaluated as 10 percent disabling under 38 C.F.R. § 4.124a, Diagnostic Code 8100. When there are very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability, a 50 percent rating is warranted. 38 C.F.R. § 4.124a, Diagnostic Code 8100. With characteristic prostrating attacks occurring on an average of once a month over the last several months, a 30 percent rating is warranted. Id. And, with characteristic prostrating attacks averaging one in 2 months over the last several months, a 10 percent rating is warranted. Id. Based on a review of the evidence of record, the Board finds that the veteran's migraine headache disability warrants a 30 percent rating. The veteran's service medical records show that, in September 1994, a Medical Evaluation Board found that the veteran had vascular headaches which had existed prior to service and was permanently worsened as a result of service. When examined in August and September 1994, the veteran had reported that her headaches were usually preceded by an aura of two hours consisting of nausea, vomiting, blurred vision, and occasional diplopia. "Vascular headaches, existing prior to service, exacerbated by military service" was diagnosed. Thereafter, when examined by VA in October 1996, the veteran reported a history of chronic migraine headaches. At a PTSD examination that same month, she complained of experiencing migraine headaches about 3 times per month. Migraine headaches were diagnosed. She was also considered mildly to moderately disabled due to her depressive disorder. When examined by VA in September 1998, she complained of experiencing severe and long-lasting headaches about 4 to 5 times per month, which lasted 2 to 3 days. She reported receiving treatment for her headaches and taking Imitrex. It was noted that, when asked to described precisely how she took her medication, she became very vague and was unable to say in what fashion she used Imitrex injections and/or tablets. She reported that she probably used 4 or 5 Imitrex injections per month, and used 1 or 2 tablets per headache. It was also noted that she had given the standard response that she had to go into a dark room to lie down for her headaches. Neurologic examination revealed no sign of organic dysfunction or cranial nerve impairment. The impression was that the veteran's story was not plausible as she gave her history, but that she had enough elements to require a diagnosis of migraine without aura, and that with her description, she had 4 or 5 per month. VA outpatient treatment reports show that, in January 1999, the veteran was treated for complaints of increasing migraine headaches. She had required frequent injections of Imitrex with minimal relief. She had described her headaches as a throbbing pain involving the frontal area, and associated with nausea, blurred vision and photophobia. She reported experiencing them 4 to 5 times per month, lasting from 1 to several days. It was noted that Imitrex injection relieved the headache in 20 minutes. She was also taking Verapamil without effect. Migraine with aura was diagnosed. It was recommended that she continue with Imitrex injections. Follow-up treatment was noted in 6 months. Subsequently, when examined in July 1999, she reported having had migraine headaches. The Board finds that, with application of 38 C.F.R. § 4.7, a grant of an increased (30 percent) rating for migraine headaches is warranted. Although it is not clear that the veteran's headaches are characteristically prostrating as contemplated by the rating criteria noted above, what is clear is that she experiences these headaches more frequently than contemplated by the current 10 percent rating. Also, her headaches are accompanied by nausea and photophobia that may be said to have a very nearly prostrating effect, if not entirely characteristic of migraines. Therefore, given the frequency, duration, and severity of the veteran's migraine headaches, the Board finds that the criteria for an increased (30 percent) rating are more nearly approximated. 38 C.F.R. § 4.7. As to whether the veteran's service-connected migraine headaches rise to the level of 50 percent disabling, the Board finds that they do not. As noted above, to receive a 50 percent rating, the migraine headaches must be very frequent, completely prostrating attacks that are prolonged and productive of severe economic inadaptability. Although the veteran's headaches have some prostrating characteristics, such as nausea and photophobia, there is no indication that they result in complete prostration over a prolonged period as contemplated by the 50 percent rating under 38 C.F.R. § 4.124a, Diagnostic Code 8100 (1999). Indeed, certain medications appear to relieve her headaches in about 20 minutes, which strongly suggests that she does not experience prolonged attacks which are completely prostrating. Consequently, the Board finds that no more than a 30 percent rating is warranted. ORDER A 30 percent rating for migraine headaches is granted, subject to the laws and regulations governing the award of monetary benefits. MARK F. HALSEY Member, Board of Veterans' Appeals