PSEUDOFOLLICULITIS BARBAE

DANETTE MINCEY · 2026 · Case ID: 26004843

DENIED

Summary

The veteran, who served in the United States Army from June 1974 to June 1977, appeals the denial of an increased rating for pseudofolliculitis barbae (PFB) and right index finger fracture residuals, and the dismissal of his claim for service connection for headaches. The Board reviewed the claims following a previous remand for additional development. For PFB, the veteran sought a rating higher than 10 percent. A July 2024 VA examination confirmed the diagnosis but found the condition affected less than 5 percent of exposed areas and the total body, with only mild shaving irritation and no medication use in the past 12 months. The Board found this did not meet the criteria for a higher rating, noting the veteran's credible reports of pain and functional impairment but lack of objective findings or systemic therapy to warrant more than the current 10 percent. For the right index finger fracture residuals, the veteran sought a higher rating than the current 10 percent. A September 2024 VA examination confirmed residuals of a fracture with flexion contracture and strain, noting pain with use and moderate flare-ups. However, range-of-motion testing was largely normal, and the evidence did not demonstrate ankylosis, amputation-like impairment, or involvement of additional digits. The Board found the current 10 percent rating, which accounts for painful motion and functional impairment, was appropriate under the applicable diagnostic code (5229) and that no higher rating or separate evaluation was warranted. The headache claim was dismissed as it had been fully granted by the Agency of Original Jurisdiction during the appeal, rendering the issue moot. Therefore, the Board denied the increased ratings for PFB and finger residuals and dismissed the headache claim.

Rationale

VA examination confirmed diagnosis but found minimal skin involvement.; No systemic therapy used in the past 12 months.; Symptoms did not meet criteria for higher rating or disfigurement.

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

20-15 622

Full Decision Text

Citation Nr: 26004843
Decision Date: 04/22/26 Archive Date: 04/22/26

DOCKET NO. 20-15 622
DATE: April 22, 2026

ORDER

Entitlement to a rating in excess of 10 percent for pseudofolliculitis barbae is denied.

Entitlement to a rating in excess of 10 percent for right index finger fracture residuals is denied.

Entitlement to service connection for a headache disability is dismissed.

FINDINGS OF FACT

1. The Veteran's pseudofolliculitis barbae has not been manifested by involvement of at least 20 percent of the entire body or exposed areas, or by systemic therapy such as corticosteroids or other immunosuppressive drugs for the duration required for a higher rating, at any time during the appeal period.

2. The Veteran's right index finger fracture residuals have not been manifested by a gap of one inch (2.5 cm) or more between the fingertip and the proximal transverse crease of the palm, extension limited by more than 30 degrees, ankylosis, functional impairment approximating amputation, involvement of additional digits, or loss of use of the hand, at any time during the appeal period.

3. The Veteran's claim for service connection for a headache disability was granted in full by the Agency of Original Jurisdiction, leaving no remaining allegation of error of fact or law for appellate consideration.

CONCLUSIONS OF LAW

1. The criteria for a rating in excess of 10 percent for pseudofolliculitis barbae have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.118. Diagnostic Code 7813.

2. The criteria for a rating in excess of 10 percent for right index finger fracture residuals have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5229.

3. The criteria for dismissal of the appeal for entitlement to service connection for a headache disability have been met. 38 U.S.C. § 7105; 38 C.F.R. § 19.55.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Army from June 1974 to June 1977.

These matters come before the Board of Veterans' Appeals (Board) on appeal from rating decisions issued by a Department of Veterans Affairs (VA) Regional Office.

In November 2023, the Board remanded the issues currently on appeal for additional development. Following the Board's remand, the Agency of Original Jurisdiction (AOJ) obtained additional evidence, including a September 2024 VA examination and an April 2025 medical opinion, and readjudicated the claims in a May 2025 supplemental statement of the case.

The Veteran previously testified at a Board hearing before a Veterans Law Judge. That Veterans Law Judge is no longer employed by the Board. The Veteran was offered the opportunity to testify at another Board hearing before a different Veterans Law Judge, and in March 2026, the Veteran responded that he does not wish to appear at another Board hearing. Accordingly, the Board will proceed with adjudication of the appeal.

During the pendency of the appeal, the AOJ granted service connection for migraine headaches. As this represents a full grant of the benefit sought, that issue is no longer before the Board.

The remaining issues have now returned to the Board for appellate consideration.

INCREASED RATINGS

Disability ratings are determined by applying the criteria set forth in the 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 evaluations 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.

In determining the severity of a disability, the Board is required to consider the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the Veteran, as well as the entire history of the Veteran's disability. 38 C.F.R. §§ 4.1, 4.2; Schafrath v. Derwinski, 1 Vet. App. 589,595 (1991).

If the disability more closely approximates the criteria for the higher of two ratings, the higher rating will be assigned
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.

If the disability more closely approximates the criteria for the higher of two ratings, the higher rating will be assigned; otherwise, the lower rating is assigned. 38 C.F.R. § 4.7. It is not expected that all cases will show all the findings specified; however, findings sufficiently characteristic to identify the disease and the disability therefrom and coordination of rating with impairment of function will be expected in all

instances. 38 C.F.R. §4.21.

In deciding this appeal, the Board has considered whether separate ratings for different periods of time, based on the facts found, are warranted, a practice of assigning ratings referred to as "staging the ratings." See Fenderson v. West, 12 Vet.

App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2008).

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.

In view of the number of atypical instances it is not expected, especially with the more fully described grades of disabilities, that all cases will show all the findings specified. Findings sufficiently characteristic to identify the disease and the disability therefrom, and above all, coordination of rating with impairment of function will, however, be expected in all instances. 38 C.F.R. § 4.21.

In evaluating a disability, the Board considers the current examination reports in light of the whole recorded history to ensure that the current rating accurately reflects the severity of the condition. The Board has a duty to acknowledge and consider all regulations that are potentially applicable. The medical as well as industrial history is to be considered, and a full description of the effects of the disability upon ordinary activity is also required. 38 C.F.R. §§ 4.1, 4.2, 4.10.

Evidence of pain, weakened movement, excess fatigability, or incoordination must be considered in determining the level of associated functional loss in light of 38 C.F.R. § 4.40, taking into account any part of the musculoskeletal system that becomes painful on use. DeLuca v. Brown, 8 Vet. App. 202, 205-08 (1995). The provisions of 38 C.F.R. § 4.14 (avoidance of pyramiding) do not forbid consideration of a higher rating based on greater limitation of motion due to pain on

use, including flare ups. 38 C.F.R. § 4.14.

The provisions of 38 C.F.R. § 4.40 and 38 C.F.R. § 4.45, however, should only be considered in conjunction with the DCs predicated on limitation of motion. Johnson v. Brown, 9 Vet. App. 7, 11 (1996). Also, functional loss due to pain must be supported by pathology and shown through objective observation. Johnston v. Brown, 10 Vet. App. 80, 84-85 (1997) (citing 38 C.F.R. § 4.40); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011) (relying on DeLuca for proposition that an adequate joint examination report must comply with § 4.40 and include an "opinion on whether pain could significantly limit functional ability during flare-ups or when the [joint] is used repeatedly over a period of time").

The intent of the rating schedule is to recognize painful motion with joint or periarticular pathology as productive of disability. It is the intention to recognize actually painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59. The United States Court of Appeals for Veterans Claims has held that the final sentence of § 4.59 creates a
relying on DeLuca for proposition that an adequate joint examination report must comply with § 4.40 and include an "opinion on whether pain could significantly limit functional ability during flare-ups or when the [joint] is used repeatedly over a period of time").

The intent of the rating schedule is to recognize painful motion with joint or periarticular pathology as productive of disability. It is the intention to recognize actually painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59. The United States Court of Appeals for Veterans Claims has held that the final sentence of § 4.59 creates a requirement that certain range of motion testing be conducted whenever possible in cases of joint disabilities. Correia v. McDonald, 28 Vet. App. 158, 168 (2016).

With respect to the joints, the factors of disability reside in reductions of their normal excursion of movements in different planes. Inquiry will be directed to these considerations: (a) less movement than normal (due to ankylosis, limitation or blocking, adhesions, tendon-tie-up, contracted scars, etc.); (b) more movement than normal (from flail joint, resections, nonunion of fracture, relaxation of ligaments, etc.); (c) weakened movement (due to muscle injury, disease or injury of peripheral nerves, divided or lengthened tendons, etc.); (d) excess fatigability; (e) incoordination, impaired ability to execute skilled movements smoothly; and (f) pain on movement, swelling, deformity or atrophy of disuse. Instability of station, disturbance of locomotion, interference with sitting, standing and weight-bearing are

related considerations. 38 C.F.R. § 4.45.

Under 38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis; however, 38 C.F.R. § 4.59 is not limited to disabilities involving

arthritis. See Burton v. Shinseki, 25 Vet. App. 1 (2011).

In Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court held that VA examiners must obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment of flares from the veterans themselves, when a flare-up is not observable at the time of examination.

The evaluation of the same disability under various diagnoses is to be avoided. 38 C.F.R. § 4.14. However, § 4.14 does not preclude the assignment of separate evaluations for separate and distinct symptomatology where none of the symptomatology justifying an evaluation under one diagnostic code is duplicative of or overlapping with the symptomatology justifying an evaluation under another diagnostic code. Esteban v. Brown, 6 Vet. App. 259, 262 (1994).

The Board has reviewed all the evidence in the Virtual folders, which includes: the Veteran's contentions and examination reports. Although there is an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that the evidence submitted by the Veteran or obtained on his behalf be discussed in detail. Rather, the claim and what the evidence in the claims file shows, or fails to show, with respect to the claim. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000); Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000).

It is noted that the Veteran has not raised any challenges with respect to any deficiencies in the examination reports. Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015).

During the pendency of the appeal, the rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71a were amended effective February 7, 2021. See 85 Fed. Reg. 230 (Nov. 30, 2020). These amendments revised select diagnostic codes "to ensure that this portion of the rating schedule uses current medical terminology and provides detailed and updated criteria for the evaluation of musculoskeletal disabilities." Id.

If a law or regulation changes during the course of a claim or an appeal, the version more favorable to the Veteran will apply, to the extent permitted by any stated effective date in the amendment in question. 38 U.S.C. § 5110 (g). If the revised version of the regulation is more favorable, the implementation
38 C.F.R. § 4.71a were amended effective February 7, 2021. See 85 Fed. Reg. 230 (Nov. 30, 2020). These amendments revised select diagnostic codes "to ensure that this portion of the rating schedule uses current medical terminology and provides detailed and updated criteria for the evaluation of musculoskeletal disabilities." Id.

If a law or regulation changes during the course of a claim or an appeal, the version more favorable to the Veteran will apply, to the extent permitted by any stated effective date in the amendment in question. 38 U.S.C. § 5110 (g). If the revised version of the regulation is more favorable, the implementation of that regulation under 38 U.S.C. § 5110 (g) can be no earlier than the effective date of that change. If the former version is more favorable, VA can apply the earlier version of the regulation for the period prior to, and from, the effective date of the change. 38 U.S.C. § 5110. Therefore, the Board will consider the Veteran's claim under both the old and new rating criteria for only the period from February 7, 2021. The criteria that is more favorable to the Veteran will be applied.

1. Entitlement to a rating in excess of 10 percent for pseudofolliculitis barbae

The Veteran seeks a rating in excess of 10 percent for his service-connected pseudofolliculitis barbae (PFB). See May 2022 hearing transcript.

The Veteran's PFB is currently evaluated under 38 C.F.R. § 4.118, Diagnostic Code 7813. Pseudofolliculitis barbae and other infections of the skin not listed elsewhere (including bacterial, fungal, viral, treponemal, and parasitic diseases) are to be evaluated under the General Rating Formula for the Skin.

Under the General Rating Formula for the Skin, a noncompensable rating is assigned for no more than topical therapy required over the past 12-month period and at least one of the following: characteristic lesions involving less than 5 percent of the entire body affected; or characteristic lesions involving less than 5 percent of exposed areas affected. A 10 percent rating is assigned for at least one of the following: characteristic lesions involving at least 5 percent, but less than 20 percent, of the entire body affected; or at least 5 percent, but less than 20 percent, of exposed areas affected; or intermittent systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required for a total duration of less than 6 weeks over the past 12-month period. A 30 percent rating is assigned at least one of the following: characteristic lesions involving more than 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected; or systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required for a total duration of 6 weeks or more, but not constantly, over the past 12-month period. A 60 percent rating is assigned for at least one of the following: characteristic lesions involving more than 40 percent of the entire body or more than 40 percent of exposed areas affected; or constant or near-constant systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, psoralen with long-wave ultraviolet-A light (PUVA), or other immunosuppressive drugs required over the past 12-month period. Or rate as disfigurement of the head, face, or neck (Diagnostic Codes 7800) or scars (Diagnostic Codes 7801, 7802, 7803, 7804, or 7805), depending on the predominant disability. 38 C.F.R. § 4.118, General Rating for the Skin for Diagnostic Codes 7806, 7809, 7813-7816, 7820-7822, and 7824.

Effective August 13, 2018, VA regulations explicitly state that systemic therapy is treatment that is administered through any route other than the skin, and topical therapy is treatment that is administered through the skin. 38 C.F.R. § 4.118(a).

The Board finds that the evidence of record persuasively weighs against the assignment of a compensable evaluation under 38 C.F.R. § 4.118, Diagnostic Code 7806.

The Veteran was afforded a
disability. 38 C.F.R. § 4.118, General Rating for the Skin for Diagnostic Codes 7806, 7809, 7813-7816, 7820-7822, and 7824.

The Board finds that the evidence of record persuasively weighs against the assignment of a compensable evaluation under 38 C.F.R. § 4.118, Diagnostic Code 7806.

The Veteran was afforded a VA examination for skin diseases in July 2024, which confirmed his diagnosis of pseudofolliculitis barbae. The Veteran reported his symptoms as including bumps, bleeding, and scars with shaving that started in 1977. The Veteran reported that his symptoms were improved and that he is using only face cream. The only current symptom reported was mild shaving irritation. The VA examiner noted that the Veteran had not had any medication, treatments, or procedures in the past 12 months for any skin condition. The Veteran's PFB was noted to affect less than 5 percent of exposed area and less than 5 percent of total body area. The examiner described the Veteran's skin condition as scattered follicular prominence with re-entrant hairs on the cheeks and anterior neck. He was also found not to have any neoplasm or metastases related to PFB, and his skin condition was not found to have caused scarring or disfigurement or impacted his ability to work.

In view of the foregoing, the Board finds that the evidence of record persuasively weighs against the assignment of a compensable initial evaluation for the Veteran's pseudofolliculitis barbae because it does not more nearly approximate characteristic lesions involving at least 5 percent, but less than 20 percent, of the entire body affected; or at least 5 percent, but less than 20 percent, of exposed areas affected. Further, the evidence does not show, nor does the Veteran contend, that he used intermittent systemic therapy, including that required for a total duration of less than 6 weeks, over the past 12 months or intermittent systemic therapy required for a total duration of less than 6 weeks over the past 12 months period. The examination report only indicates that the Veteran uses face cream. Consequently, the evidence does not support an initial compensable rating.

The Board acknowledges that the Veteran believes that the disability on appeal has been more severe than the assigned disability rating reflects. Moreover, the Veteran is competent and credible to report observable symptoms. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). However, the Veteran does not specifically assert, and medical treatment records do not show, that the pseudofolliculitis barbae more nearly approximates the criteria in the next higher rating. Specifically, the evidence does not demonstrate characteristics of disfigurement, unstable or painful scars, or other symptomatology warranting a higher evaluation under those criteria.

The Board has considered whether any other Diagnostic Codes related to disabilities of the skin would provide for a higher disability evaluation. However, the evidence does not reflect that the pseudofolliculitis barbae would warrant a higher rating under a different diagnostic code. See 38 C.F.R. § 4.118.

Accordingly, the Board finds that the evidence of record persuasively weighs against the claim for a rating in excess of 10 percent for pseudofolliculitis barbae.

As the evidence persuasively weighs against the claim, the benefit-of-the-doubt doctrine is not applicable. See 38 U.S.C. § 5107(b).

2. Entitlement to a rating in excess of 10 percent for right index finger fracture residuals

The Veteran seeks a higher rating for his service-connected right index finger disability. The disability is currently rated as 10 percent disabling under Diagnostic Code 5003-5229.

Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the specific basis for the evaluation assigned. 38 C.F.R. § 4.27.

The rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71a were amended on February 7, 2021. However, only DC 5003 was amended from "arthritis, generative hypertrophic or osteoarthritis" to "degenerative arthritis, other than post-traumatic" and Diagnostic Code 5229 remained unchanged.

Handedness for the purpose of a dominant rating will be determined by the evidence of record,
Diagnostic Code 5003-5229.

Handedness for the purpose of a dominant rating will be determined by the evidence of record, or by testing on VA examination. Only one hand shall be considered dominant. 38 C.F.R. § 4.69. In this case, the evidence shows that the Veteran is left hand dominant. See September 2024 VA Hand and Finger Conditions examination.

Per Diagnostic Code 5003, degenerative arthritis other than post-traumatic, notes that degenerative arthritis established by X-ray findings will be rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved. When however, the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate diagnostic codes, a rating of 10 percent is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under Diagnostic Code 5003. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion, in the absence of limitation of motion the following ratings apply: a ten percent evaluation with X-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups; and a 20 percent evaluation with X-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups with occasional incapacitating exacerbations. Note (1) provides that the 20 percent and 10 percent evaluations based on X-ray findings will not be combined with ratings based on limitation of motion. Note (2) provides that the 20 percent and 10 percent evaluations based on X-ray findings will not be utilized in rating conditions listed under Diagnostic Codes 5013 to 5024 inclusive.

Under Diagnostic Code 5229, index or long finger, limitation of motion: a 10 percent evaluation is warranted where there is a gap of one inch (2.5 cm.) or more between the fingertip and the proximal transverse crease of the palm, with the finger flexed to the extent possible, or; with extension limited by more than 30 degrees. This is the highest evaluation available under Diagnostic Code 5229.

In a September 2024 VA examination, the Veteran's diagnosis was confirmed as residuals of a right index finger fracture with flexion contracture of tip point, as well as right hand strain. The Veteran indicated that his condition has improved with residual pain, and that current symptoms include pain with use of the right hand. Daily flare ups were reported, causative of aching pain precipitated by grabbing, holding and typing activities. The duration was noted to be up to one hour. The examiner described the severity of flare-ups as moderate. The Veteran also reported functional loss, explaining that during acute pain episodes he had difficulty with activities involving frequent grabbing, holding, and typing with the right hand.

On physical examination, range-of-motion testing of the right hand and fingers was largely normal, and the examination did not show a gap of one inch or more between the fingertip and the proximal transverse crease of the palm, nor extension limited by more than 30 degrees. Repetitive-use testing did not produce additional loss of motion. The examination further showed no ankylosis of the right index finger or other digits, no muscle atrophy, no assistive device use, and no functional impairment such that no effective function remained other than that which would be equally well served by amputation with prosthesis. Grip strength was reduced on the right to 4/5, while the left hand was normal, and the examiner did not indicate any loss of effective hand function. The examiner also indicated there were no imaging studies performed in conjunction with the examination and did not document X-ray-confirmed arthritis.

The evidence, including the September 2024 VA examination reflects that the Veteran experiences pain and limitation of motion of the right index finger. However, ankylosis was not shown. The evidence also does not demonstrate functional impairment approximating amputation, nor does it show involvement of additional digits or impairment of overall hand function sufficient to warrant a higher or separate evaluation.

The currently assigned 10 percent rating contemplates the Veteran's credible reports of painful motion and functional impairment of the right index finger due to healed
/5, while the left hand was normal, and the examiner did not indicate any loss of effective hand function. The examiner also indicated there were no imaging studies performed in conjunction with the examination and did not document X-ray-confirmed arthritis.

The currently assigned 10 percent rating contemplates the Veteran's credible reports of painful motion and functional impairment of the right index finger due to healed injury. The rating schedule intends to recognize actually painful, unstable, or malaligned joints due to healed injury as entitled to at least the minimum compensable rating for the joint. See 38 C.F.R. § 4.59. However, even with consideration of pain and functional impairment, no rating higher than 10 percent is available under Diagnostic Code 5229.

The Board has also considered whether any other diagnostic code would provide a basis for a higher or separate evaluation.

Diagnostic Code 5225 is not applicable because ankylosis of the index finger is not shown, and irrespective - that code provides no rating higher than 10 percent. Evaluation as amputation under Diagnostic Code 5153 is not warranted because the disability does not approximate amputation, as the Veteran retains motion, strength, and functional use of the finger and hand. The provisions pertaining to multiple digits do not apply because the evidence does not show compensable impairment of additional digits. Diagnostic Code 5003 does not provide a basis for a higher or separate rating because the record does not demonstrate X-ray-confirmed arthritis. Finally, loss of use of the hand is not shown, as effective function remains.

The Board has also considered functional loss due to pain, weakness, fatigability, or incoordination. See 38 C.F.R. §§ 4.40 and 4.45; See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). While the Veteran experiences pain and difficulty with repetitive use, the evidence does not show functional impairment that more nearly approximates ankylosis, amputation, or loss of use of the hand. The VA examination of record is clear that there are no such symptoms. The current 10 percent rating fully contemplates his symptomatology.

The Board has further considered whether referral for extraschedular consideration is warranted. The Veteran's symptoms, including pain and functional limitation with use, are contemplated by the rating schedule, and there is no indication of an exceptional or unusual disability picture with such related factors as marked interference with employment or frequent hospitalization. Referral is therefore not warranted.

Accordingly, the claim for a rating in excess of 10 percent for the right index finger disability is denied.

3. Entitlement to service connection for a headache disability

The Veteran perfected an appeal as to multiple issues following the issuance of a February 2020 Statement of the Case (SOC), including entitlement to service connection for headaches. In a November 2023 decision, the Board of Veterans' Appeals (Board) remanded the issue of entitlement to service connection for headaches for additional development. Following the Board's remand, the AOJ undertook the directed development.

Pertinently, during the pendency of the appeal, the AOJ granted service connection for migraine headaches, associated with traumatic brain injury and traumatic vertigo, and assigned a 50 percent evaluation. See 38 U.S.C. § 7105. Where the benefit sought on appeal has been fully granted, there is no longer a question of law or fact for appellate consideration.

Moreover, the 50 percent evaluation assigned represents the maximum schedular rating available for migraine headaches under the applicable rating criteria. See 38 C.F.R. § 4.124a, Diagnostic Code 8100. The record does not reflect, and the Veteran has not asserted, disagreement with any downstream element of the award, such as the effective date or assigned rating, within the context of the present appeal stream. Accordingly, no downstream issue is presently before the Board.

The November 2025 grant of service connection for migraine headaches is a full grant of the benefit sought on appeal and will not be addressed. Grantham v. Brown, 114 F.3d 1136 (Fed. Cir. 1997) (where an appealed claim for service connection is granted during the pendency of the appeal, a second NOD must thereafter be timely filed to initiate appellate review of "downstream" issues such as the compensation level assigned for the disability or the effective date of service
and the Veteran has not asserted, disagreement with any downstream element of the award, such as the effective date or assigned rating, within the context of the present appeal stream. Accordingly, no downstream issue is presently before the Board.

(Continued on the next page)

Because the benefit sought on appeal has been granted in full, there remains no case or controversy with respect to the claim for service connection for headaches.

Therefore, the appeal as to this issue is dismissed.

Danette Mincey

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.

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