MIGRAINES

M. C. GRAHAM · 2026 · Case ID: A26015006

MIXED

Summary

The Veteran served from April 1987 to August 1994. The Veteran appealed the denial of an initial compensable rating for migraines and sought increased ratings for patellofemoral pain syndrome of the right and left knees. The Board granted service connection for migraines at the 50% level, finding that the Veteran experienced very frequent, completely prostrating, and prolonged attacks productive of severe economic inadaptability during the relevant appeal period. This decision was based on a review of treatment records from November 2019 and March 2020, which documented weekly headaches causing missed work, frequent migraines, and significant pain, despite the VA examiner's less favorable findings. The Board applied the benefit of the doubt doctrine, resolving reasonable doubt in the Veteran's favor to grant the 50% rating, the maximum schedular rating for migraines. The claims for increased ratings for bilateral knee conditions were remanded due to pre-decisional duty to assist errors. Specifically, the Board identified failures to obtain relevant private treatment records regarding steroid injections, a potentially relevant future VA treatment record for knee pain, and adequate supplemental opinions addressing functional limitations without considering medication's ameliorative effects. The Board noted that the issue of TDIU was not before it as it had been granted by the RO and was no longer on appeal.

Rationale

Evidence of record demonstrates very frequent, completely prostrating, and prolonged attacks.; Attacks were productive of severe economic inadaptability.; Benefit of the doubt resolved in Veteran's favor.

Special Benefit

NO SPECIAL BENEFIT

Diagnostic Code

8100

Docket No.

201223-131474

Full Decision Text

Citation Nr: A26015006
Decision Date: 02/18/26 Archive Date: 02/18/26

DOCKET NO. 201223-131474
DATE: February 18, 2026

ORDER

Entitlement to an initial evaluation of 50 percent for migraines, is granted, subject to the laws and regulations governing the award of monetary benefits.

REMANDED

Entitlement to a rating in excess of 10 percent for patellofemoral pain syndrome of the right knee is remanded.

Entitlement to a rating in excess of 10 percent for patellofemoral pain syndrome of the left knee is remanded.

FINDING OF FACT

1. During the initial appeal period, resolving reasonable doubt in the Veteran's favor, her migraines manifested in very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability.

CONCLUSION OF LAW

1. Throughout the initial appeal period, the criteria for a rating of 50 percent for migraine headaches have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.124a, Diagnostic Code 8100.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from April 1987 to August 1994. The Board of Veterans' Appeals (Board) thanks the Veteran for her service to our country.

As to the claim for an initial compensable rating for migraines, the rating decision on appeal was issued in April 2020 and constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies.

As to the claims for increased ratings for patellofemoral pain syndrome of the right knee and patellofemoral pain syndrome of the left knee, the rating decision on appeal was issued in March 2020 and constitutes an initial decision; therefore, the modernized review system, also known as the AMA, again applies.

In the December 2020 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on August 27, 2024.

Therefore, the Board may only consider the evidence of record at the time of the applicable agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or her representative at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801.

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim of entitlement to an increased initial rating for migraines, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

However, because the Board is remanding the claims of entitlement to a rating in excess of 10 percent for patellofemoral pain syndrome of the right knee, and entitlement to a rating in excess of 10 percent for patellofemoral pain syndrome of the left knee, any evidence the Board could not consider will be considered by the AOJ in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii).

Also, in her December 2020 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran did not express disagreement with the effective date assigned for the award of service connection for her migraines, but rather stated "[e]ntitlement to an increased evaluation for migraine headaches." Thus, this claim is limited to a claim for an initial compensable rating for migraines.

As to the issue of representation, February 20, 2021 VA correspondence notified the Veteran that she had 90 days from the date the Board received her Board Appeal request (VA Form 10182) or until the Board issued a decision (whichever comes first) to change her representative. In April 2022, more than 90 days from the
Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran did not express disagreement with the effective date assigned for the award of service connection for her migraines, but rather stated "[e]ntitlement to an increased evaluation for migraine headaches." Thus, this claim is limited to a claim for an initial compensable rating for migraines.

As to the issue of representation, February 20, 2021 VA correspondence notified the Veteran that she had 90 days from the date the Board received her Board Appeal request (VA Form 10182) or until the Board issued a decision (whichever comes first) to change her representative. In April 2022, more than 90 days from the date the Board received the December 2020 VA Form 10182 as to this appeal, the Veteran submitted a new power of attorney in favor of Virginia A. Girard-Brady, Attorney. 38 C.F.R. § 20.1304. Also, although the Veteran has not submitted a motion for good cause for the delay in appointing a new representative, as Board previously recognized Virginia A. Girard-Brady, Attorney, as the Veteran's representative, including via a designated representative during the August 2024 Board hearing, the Board will continue to recognize Virginia A. Girard-Brady, Attorney as the Veteran's representative.

Additionally, although Virginia A. Girard-Brady, Attorney, did not receive a copy of the February 20, 2021 VA correspondence, which also notified the Veteran her appeal was placed on the hearing docket, as discussed above, a designated representative represented the Veteran during the August 2024 Board hearing. Thus, Virginia A. Girard-Brady, Attorney had actual notice the appeal was docketed under the hearing docket and the hearing itself provided an opportunity to offer additional argument.

In April 2022, the Veteran's representative requested a copy of the Veteran's claims file, which was provided to her in August 2022. Also, in September 2024, the Veteran and her representative were provided with a copy of the August 2024 Board hearing transcript.

The Board acknowledges that on July 27, 2022 VA received from the Veteran information which contained hyperlinks to content that was not otherwise part of the record on appeal; however, that content was not accessed nor considered as part of the record before the Board. See Bowey v. West, 11 Vet. App. 106, 108-09 (1998) (holding that the mere reference to non-VA documents is insufficient to incorporate them into the record).

As a final preliminary matter, in July 2022, the Veteran submitted a VA Form 21-8940, Veteran's Application for Increased Compensation based on Unemployability, and raised the issue of issue of entitlement to a total disability rating for compensation purposes based on individual unemployability (TDIU), partially based on her right and left knee disabilities. Rice v. Shinseki, 22 Vet. App. 477 (2009). A November 2022 rating decision granted entitlement to a TDIU, and the Veteran did not appeal the effective date assigned. Moreover, regardless, on her July 2022 VA Form 21-8940, the Veteran reported her last day of full-time employment was July 22, 2020, which is after the applicable appeal period for consideration for the claims at issue in this appeal. Further, the issue of a TDIU was not raised during the August 2024 Board hearing. Thus, the issue of a TDIU will not be addressed further in this appeal.

Increased Ratings

Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities. The percentage ratings are based on the average impairment of earning capacity and individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1.

VA must consider whether to "stage" the rating, meaning assign different ratings at different times during the rating period to compensate the Veteran for times when the disability may have been more severe than at others. Consideration of the appropriateness of a staged rating is required for increased rating claims, irrespective of whether it is an initial rating at issue or instead an established rating. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2008).

The Board notes that in every instance where the schedule does not provide a zero percent evaluation for a diagnostic code, a zero percent evaluation shall be assigned when the requirements for a compensable evaluation are not met. See 38 C.F.R. § 4
at different times during the rating period to compensate the Veteran for times when the disability may have been more severe than at others. Consideration of the appropriateness of a staged rating is required for increased rating claims, irrespective of whether it is an initial rating at issue or instead an established rating. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2008).

1. Entitlement to an initial compensable rating for migraines

The Veteran seeks an initial compensable rating for migraines. Specifically, in August 2024 testimony, the Veteran reported from December 2019 until the time that she received the total disability rating in May 2022, she had regular headaches, and also migraines, which she "was getting up to two to three a week, and I was having to be out of work quite a bit" and she had to use FMLA (leave under the Family and Medical Leave Act (FLMA)) "because they kept telling me that if I stayed out of work for the migraines, that I could lose my job". The Veteran testified that if she was at work with a migraine "I would go into wherever I could that was the darkest" and stay there, try not to throw up, and get away from noise. She also testified that it was "also hard to drive home" because she could not "do too well seeing or anything else". She also testified that if her medicine "worked really well, it would be gone in about six hours", and if not, she "could have the migraine for up to 24 hours" and then her head would be tender.

Under the AMA, the Board is bound by favorable findings of the AOJ in the absence of evidence of clear and unmistakable error. 38 C.F.R. § 3.104. The April 2020 rating decision did not provide any favorable findings regarding the initial rating assigned for migraines.

The appeal period for consideration is from December 18, 2019, the date service connection was granted, to April 8, 2020, the date the AOJ on appeal was issued.

Throughout the initial appeal period, the Veteran's migraines have been rated under Diagnostic Code 8100, migraines. See 38 C.F.R. § 4.124a, Diagnostic Code 8100. No other diagnostic codes are relevant to the Veteran's claim for an increased rating claim for migraine headaches. Copeland v McDonald, 27 Vet. App. 333 (2015).

Pursuant to Diagnostic Code 8100, a noncompensable rating is warranted for migraines with less frequent attacks. A 10 percent rating is warranted for migraines with characteristic prostrating attacks averaging one in 2 months over the last several months. A 30 percent rating is warranted for migraines with characteristic prostrating attacks occurring on an average once a month over the last several months. A 50 percent rating is warranted for migraines with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. A 50 percent rating is the highest schedular rating under Diagnostic Code 8100.

The rating criteria of Diagnostic Code 8100 are considered successive, meaning that a claimant cannot fulfill the criteria of the higher rating without fulfilling those of the next lower rating. Johnson v. Wilkie, 30 Vet. App. 245, 252 (2018). This renders 38 C.F.R. §§ 4.7 and 4.21 inapplicable. Johnson, 30 Vet. App. at 252.

The phrase "characteristic prostrating attacks" is used in the criteria corresponding to 10 percent and 30 percent ratings under Diagnostic Code 8100 to describe the nature and severity of migraines, but it is not defined in the regulation. Pursuant to Dorland's Illustrated Medical Dictionary 1531 (32d ed. 2012), prostration is defined as "extreme exhaustion or powerlessness." Thus, the phrase "characteristic prostrating attacks" is understood to describe migraine attacks that typically produce extreme exhaustion or powerlessness.

The rating criteria for a 50 percent rating contain several undefined phrases. The descriptive phrase "very frequent" connotes a frequency at least greater than once a month, as is required by the rating criteria corresponding to a lesser 30 percent rating. Johnson, 30 Vet. App. at 253. The phrase "completely prostrating" generally means that the migraines attack must render the veteran entirely powerless. Id. The completely prostrating attacks must also be "prolonged," which is defined as "to lengthen in time: extend duration: draw out: continue, protract." Id. (internal citation omitted). Lastly, the 50 percent rating criteria requires that the very frequent completely prostrating and prolonged attacks be "productive of severe economic inadaptability." Productive can be read as having either the meaning of "producing" or "capable of producing," and, with regard to severe economic inadaptability, nothing in Diagnostic Code 8100 requires that the claimant be completely unable to work in order to qualify for a 50 percent rating. Pierce v. Principi, 18 Vet. App. 440, 445-46 (2004).

Additionally, Diagnostic Code 8100 contemplates all migraine symptoms, not just headache pain. Holmes v. Wilkie, 33 Vet. App. 67 (2020). Therefore, to evaluate migraines, VA must consider all symptoms experienced due to migraine attacks and then rate the symptoms based on the frequency, duration, and economic impact of those attacks.

In rating headaches or migraines under Diagnostic Code 8100, the Board may not consider the ameliorative effects of medication. See Jones v. Shinseki, 26 Vet. App. 56, 63 (2012).

During the appeal period at issue, the Board finds that a 50 percent rating is warranted for the Veteran's migraines. Specifically, during a January 2020 VA examination, the Veteran reported she had nausea, and sensitivity to light/sound and that she took Sumatriptan for her migraines. The January 2020 VA examiner found the Veteran had headache pain, characterized by pulsating or throbbing head pain, and pain on both sides of the head. The January 2020 VA examiner found the Veteran's duration of typical head pain was less than one day and the location of typical head pain was on both sides of the head. The January 2020 VA examiner found the Veteran experienced non-headache symptoms associated with headaches of nausea, and sensitivity to light and sound. The January 2020 VA examiner found the Veteran did not have characteristic prostrating attacks of migraine/non-migraine headache pain.

However, other evidence of record demonstrates the Veteran had very frequent, with a frequency at least greater than once a month, characteristic prostrating attacks of migraine/non-migraine headache pain. For example, proximate to the appeal period, a November 2019 VA treatment record documented the Veteran had "[w]eekly headaches causing her to miss work" and that she had been on Amitriptyline daily for prevention and Zomig for acute management. Another November 2019 VA treatment record of the same date also documented the Veteran continued to report multiple migraine episode and minor headaches, that she had kept of diary, and this month she already had five episodes of migraines and four episodes of minor headaches, that she had to leave work most of the time when she has migraines, and that she needed FMLA paperwork. The November 2019 VA treatment record also documented the Veteran was taking Amitriptyline and still had a lot of headaches, as well as taking Zomig, and a muscle relaxer. The November 2019 VA treatment record also documented the Veteran's migraine episodes were like somebody took a chisel and struck the right side of her head, with 10 out of 10 pain and pounding, lasting up to four until medication kicked in, that she was bothered by noise and light, had to squint her eyes because of light sensitivity, that cried due to pain as well experienced as nausea and vomiting.

The Board finds that the evidence is at least in relative equipoise that the Veteran had migraines with characteristic prostrating attacks occurring on an average once a month over the last several months.

The January 2020
had a lot of headaches, as well as taking Zomig, and a muscle relaxer. The November 2019 VA treatment record also documented the Veteran's migraine episodes were like somebody took a chisel and struck the right side of her head, with 10 out of 10 pain and pounding, lasting up to four until medication kicked in, that she was bothered by noise and light, had to squint her eyes because of light sensitivity, that cried due to pain as well experienced as nausea and vomiting.

The January 2020 VA examiner also found the Veteran did not have very prostrating and prolonged attacks of migraines/non-migraine pain productive of severe economic inadaptability. However, other evidence of record reflects the Veteran had very prostrating and prolonged attacks of migraines/non-migraine pain productive of severe economic inadaptability. For example, as discussed above, proximate to the appeal period, a November 2019 VA treatment record documented the Veteran had "[w]eekly headaches causing her to miss work." Also, a March 2020 VA treatment record documented the Veteran "continues to have severe headaches." Also, as discussed above, in August 2020 the Veteran testified that if she was at work with a migraine "I would go into wherever I could that was the darkest" and stay there, try not to throw up, and get away from noise. She also testified that it was "also hard to drive home" because she could not "do too well seeing or anything else".

Thus, considering all relevant lay and medical evidence of record, and after resolving reasonable doubt in the Veteran's favor, the Board finds that the Veteran's migraines more nearly approximate the criteria for a 50 percent disability rating during the initial appeal period at issue. As noted above, a 50 percent rating is the maximum schedular rating assignable under Diagnostic Code 8100.

Also, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board's consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record).

Accordingly, for the reasons and bases discussed, after resolving reasonable doubt in the Veteran's favor, her service-connected migraines warrant a maximum schedular rating of 50 percent throughout the initial appeal period at issue here. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021). Accordingly, entitlement to an initial rating of 50 percent for migraines is granted, subject to the laws and regulations governing the award of monetary benefits.

REASONS FOR REMAND

1. Entitlement to a rating in excess of 10 percent for patellofemoral pain syndrome of the right knee is remanded.

2. Entitlement to a rating in excess of 10 percent for patellofemoral pain syndrome of the left knee is remanded.

Under the AMA, the Board is bound by favorable findings of the AOJ in the absence of evidence of clear and unmistakable error. 38 C.F.R. § 3.104. The March 2020 rating decision did not provide any favorable findings as to these claims.

These claims stem from December 18, 2019, the date VA received an intent to file claim, with an application for benefits received within a year thereafter in January 2020, with claims for increased ratings for patellofemoral pain syndrome of the right knee and patellofemoral pain syndrome of the left knee. For an increased rating claim, the regulations allow for an effective date up to one year prior to the date of claim or intent to file claim ("look back period") when it is factually ascertainable, based on all evidence of record, that an increase in disability had occurred. 38 C.F.R. § 3.400(o)(2). For increased rating claims, an effective date should not be assigned mechanically, but all of the facts should be examined to determine when an increase in the disability can be ascertained. Swain v. McDonald, 27 Vet. App. 219, 224 (2015); DeLisio v. Shinseki, 25 Vet. App. 45 (2011).

These
claim, the regulations allow for an effective date up to one year prior to the date of claim or intent to file claim ("look back period") when it is factually ascertainable, based on all evidence of record, that an increase in disability had occurred. 38 C.F.R. § 3.400(o)(2). For increased rating claims, an effective date should not be assigned mechanically, but all of the facts should be examined to determine when an increase in the disability can be ascertained. Swain v. McDonald, 27 Vet. App. 219, 224 (2015); DeLisio v. Shinseki, 25 Vet. App. 45 (2011).

These issues are remanded to correct three pre-decisional duty to assist errors prior to the March 2020 AOJ decision on appeal.

First, these issues are remanded to correct a pre-decisional duty to assist error with respect to the failure to attempt to obtain potentially relevant private treatment records identified in the record prior to the March 2020 AOJ decision on appeal. In this regard, proximate to the look back period, a June 2018 VA treatment record documented the Veteran had knee pain bilateral and that "[s]he was seen by her private provider that did steroid injections in her knees and she was told that if the steroids injections are not helping viscous supplementation can be tried." However, no private treatment records regarding steroid injections in the Veteran's knees in 2018 have been obtained or attempted to be obtained. Thus, failure of the AOJ to request these potentially relevant private treatment records, as identified by the record, is a pre-decisional duty to assist error and a remand is required to allow VA to obtain authorization and request these records. The Veteran is also advised she may provide this evidence (i.e. via mail or direct upload) directly to VA herself.

Second, these issues are remanded to correct a pre-decisional duty to assist error with respect to the failure to attempt to obtain a potentially relevant future VA treatment record identified in the record prior to the March 2020 AOJ decision on appeal. Specifically, a March 11, 2020 VA treatment record documented the Veteran "was seen by orthopedics and physical therapy for her knees" and that "[s]he has another appointment coming up next week" and as to an assessment/plan, as to her bilateral knee pain, she was to follow-up with orthopedics. Therefore, due to a duty to assist error, as the record of the referenced VA orthopedics appointment for bilateral knee pain is not associated with the record but may be relevant to these claims, such VA treatment record should be obtained and associated with the record.

Third, the Board finds a pre-decisional duty to assist error also exists as to these claims as the AOJ erred insofar as it did not obtain supplemental opinions which addressed all functional limitations of the Veteran's right knee and left disabilities, including during exacerbations, while discounting the ameliorative effects of medications. In this regard, the Veteran's impairment of motion affecting her right knee and her left knee may have been ameliorated by medications at the time of the January 29, 2020 VA examination which addressed these disabilities. Specifically, an October 30, 2019 VA treatment record documented the Veteran reported she received bilateral knee steroid injections and "that her knees were 90% better following the injection." A December 18, 2019 VA treatment record documented the Veteran reported she only got about three weeks of very solid improvement with steroid injections last time as to her knees and would like to repeat some kind of injection today. Another December 18, 2019 VA treatment record documented the Veteran underwent a bilateral knee steroid injection. A January 2, 2020 VA treatment record documented the Veteran reported bilateral knee complaints and that "[s]he has gotten some relief from steroid injections, and actually had a repeat steroid injection just a couple of weeks ago" and "[a]t this time, it has not yet worn off" and her physician also "suggested a trial of viscosupplementation, which has been ordered." Thereafter, a January 15, 2020 VA treatment record documented the Veteran requested to be seen for her knee after falling last night at work and that she took Ibuprofen last night and was encouraged to continue taking Ibuprofen with food. Then, at the January 29, 2020 VA examination, the Veteran reported use of nonsteroidal anti-inflammatory drugs (NSAIDs).

However, the ameliorating effects of medication must not be considered when evaluating a disability unless the diagnostic code specifically contemplates medication. See Jones v. Shinseki, 26 Vet. App.
yet worn off" and her physician also "suggested a trial of viscosupplementation, which has been ordered." Thereafter, a January 15, 2020 VA treatment record documented the Veteran requested to be seen for her knee after falling last night at work and that she took Ibuprofen last night and was encouraged to continue taking Ibuprofen with food. Then, at the January 29, 2020 VA examination, the Veteran reported use of nonsteroidal anti-inflammatory drugs (NSAIDs).

However, the ameliorating effects of medication must not be considered when evaluating a disability unless the diagnostic code specifically contemplates medication. See Jones v. Shinseki, 26 Vet. App. 56, 61-63 (2012). The criteria for rating for the knee do not contemplate the ameliorative effect of medication, and thus, entitlement to a higher rating may not be denied because of improvement due to the use of medication. The Board finds no adequate basis in the evidence currently of record for making an informed determination as to the level of severity of the Veteran's right knee and left knee disabilities, at the time of the January 2020 VA examination, underlying the ameliorating effects of her medications, specifically the use of steroid injections and NSAIDs, including Ibuprofen. The AOJ's failure to obtain adequate VA opinions addressing the claims on this basis is a pre-decisional error. Barr v. Nicholson, 21 Vet. App. 303, 309 (2011). Accordingly, remand is necessary to obtain supplemental opinions which address all functional limitations of the Veteran's right knee and left knee disabilities at the time of the January 2020 VA examination, including during exacerbations, while discounting the ameliorative effects of steroid injections and/or NSAIDs, including Ibuprofen.

The Board also advises that, at this time, it intimates no opinion as to the credibility or probative value of any lay statements in relation to the Veteran's claims for increased ratings for patellofemoral pain syndrome of the right knee and patellofemoral pain syndrome of the left knee and defers any credibility determinations until final adjudication of these claims.

The matters are REMANDED for the following actions:

1. Ask the Veteran to complete a VA Form 21-4142 for outstanding private treatment records related to steroid injections in the Veteran's knees in 2018, as documented in a June 2018 VA treatment record. Make two requests for these authorized records, unless it is clear after the first request that a second request would be futile. The Veteran is also advised she may provide this evidence (i.e. via mail or direct upload) directly to VA herself.

2. Obtain and upload into VBMS (so as to enable Board review and to include it in the benefits file/VBMS), a March 2020 VA orthopedics record for bilateral knee pain after March 11, 2020. [A March 11, 2020 VA treatment record documented the Veteran "was seen by orthopedics and physical therapy for her knees" and that "[s]he has another appointment coming up next week" and as to an assessment/plan, as to her bilateral knee pain, she was to follow-up with orthopedics.]

3. Please obtain supplemental medical opinions to determine the severity of the Veteran's service-connected patellofemoral pain syndrome of the right knee and her patellofemoral pain syndrome of the left knee without considering the ameliorating effects of medication at the time of the January 2020 VA examination. The clinician should address the following:

(a.) To the extent possible, estimate the Veteran's functional limitations as to her right knee, at the time of the January 2020 VA examination, due to pain, weakness, fatigability, or incoordination in terms of range of motion without consideration of the ameliorating effects of steroid injections and/or NSAIDs, including Ibuprofen.

(b.) To the extent possible, estimate the Veteran's functional limitations as to her right knee, at the time of the January 2020 VA examination, in terms of range of motion during exacerbations (following repeated use) without consideration of the ameliorating effects of steroid injections and/or NSAIDs, including Ibuprofen.

(c.) To the extent possible, estimate the Veteran's functional limitations as to her left knee, at the time of the January 2020 VA examination, due to pain, weakness, fatigability, or incoordination in terms of range of motion without consideration of the ameliorating effects of steroid injections and/or NSAIDs, including Ibuprofen.

(d.) To the extent possible, estimate the Veteran's functional limitations as to her left knee, at the time of the January
right knee, at the time of the January 2020 VA examination, in terms of range of motion during exacerbations (following repeated use) without consideration of the ameliorating effects of steroid injections and/or NSAIDs, including Ibuprofen.

(d.) To the extent possible, estimate the Veteran's functional limitations as to her left knee, at the time of the January 2020 VA examination, in terms of range of motion during exacerbations (following repeated use) without consideration of the ameliorating effects of steroid injections and/or NSAIDs, including Ibuprofen.

M. C. GRAHAM

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board M. Espinoza, 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.

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