MIGRAINE

B.T. KNOPE · 2026 · Case ID: A26026197

MIXED

Summary

The veteran, who served in the Navy from June 2011 to August 2020, appeals the denial of a separate compensable rating for seborrheic dermatitis and seeks an increased rating for his migraines, allergic rhinitis, and pseudofolliculitis barbae (PFB) with seborrheic dermatitis. The Board reviewed evidence from VA examinations in September and November 2020, along with the veteran's testimony from a July 2024 hearing. For migraines, the Board found the veteran's testimony regarding prostrating attacks three times per week, while not directly tied to the appeal period, indicated symptoms warranting a 10 percent rating, though not the higher 30 percent rating due to lack of characteristic prostrating attacks as defined by the rating criteria. For allergic rhinitis, the Board granted a 10 percent rating based on the November 2020 VA examiner's finding of greater than 50 percent obstruction in both nasal passages, but noted the absence of nasal polyps prevented a higher rating. For PFB with seborrheic dermatitis, the Board found the veteran's July 2024 testimony credible regarding the extent of his scalp and beard involvement, warranting a 10 percent rating, but denied a separate rating for seborrheic dermatitis as combining the conditions provided the highest possible rating. Service connection for migraines, allergic rhinitis, and PFB with seborrheic dermatitis were granted at 10 percent each.

Rationale

Benefit of the doubt applied to grant 10% rating; VA examiners opined migraines were not prostrating; Veteran's testimony regarding frequency not tied to appeal period

Service Branch

NAVY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

201127-123953

Full Decision Text

Citation Nr: A26026197
Decision Date: 03/24/26 Archive Date: 03/24/26

DOCKET NO. 201127-123953
DATE: March 24, 2026

ORDER

Entitlement to an initial 10 percent rating for migraines is granted.

Entitlement to an initial 10 percent rating for allergic rhinitis is granted.

Entitlement to an initial 10 percent rating for pseudofolliculitis barbae (PFB) with seborrheic dermatitis is granted.

Entitlement to a separate compensable rating for seborrheic dermatitis is denied.

FINDINGS OF FACT

1. Resolving all reasonable doubt in the Veteran's favor, during the period on appeal his migraine disorder occurred, on average, once every two months; prostrating migraines occurring once a month have not been shown.

2. During the period on appeal, the Veteran's allergic rhinitis has been manifested by an obstruction that was greater than 50 percent of the naval passage on both sides; however, obstruction with polyps is not shown.

3. Affording him the benefit of the doubt, the Veteran's pseudofolliculitis barbae with seborrheic dermatitis affects at least 5 percent, but less than 20 percent, of his exposed areas affected; however, characteristic lesions involving at least 20 percent but less than 40 percent is not shown; nor was intermittent 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 for a total duration of less than 6 weeks over the past 12-month period, at any point during the appeal period.

4. Keeping the Veteran's PFB with seborrheic dermatitis rated together, affords him the highest possible rating under the Diagnostic Criteria.

CONCLUSIONS OF LAW

1. The criteria for an initial 10 percent rating for migraines have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8100.

2. The criteria for entitlement to a 10 percent rating for allergic rhinitis have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.7, 4.15, 4.16, 4.97, DC 6522.

3. The criteria for an initial 10 percent rating for pseudofolliculitis barbae with seborrheic dermatitis (PFB) have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.10, 4.118, DC 7813-7806.

4. The criteria for a separate compensable rating for seborrheic dermatitis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.10, 4.118, DC 7806.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served in the Navy, on active duty from June 2011 to August 2020. His awards include the Global War on Terrorism Expeditionary Medal, among others.

This claim comes before the Board of Veterans' Appeals (Board) on appeal from an October 2020 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). However, the Board notes another rating decision was issued in November 2020 regarding these same issues. The Board finds the rating decision on appeal is the November 2020 rating decision, as it affords him the longest evidentiary window that is most favorable to him. In November 2020, the Veteran submitted a timely VA Form 10182, electing the Hearing lane. In July 2024, he testified before the undersigned Veterans Law Judge. A transcript of that hearing is of record.

As the Veteran chose the Hearing lane, the evidence before the Board includes evidence submitted prior to the November 2020 rating decision, evidence submitted at the July 2024 Board hearing, and evidence submitted within 90 days thereafter. As the Board hearing occurred on July 17, 2024, the period to submit additional evidence closed on October 15, 2024.

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a
November 2020, the Veteran submitted a timely VA Form 10182, electing the Hearing lane. In July 2024, he testified before the undersigned Veterans Law Judge. A transcript of that hearing is of record.

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[s], considering the new evidence in addition to the evidence previously considered. Id.

Increased Ratings

Disability ratings are determined by the application of a schedule of ratings, which is based on the average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The Veteran's entire history is reviewed when making disability evaluations. See generally Schafrath v. Derwinski, 1 Vet. App. 589 (1991); 38 C.F.R. § 4.1. Where the question for consideration is the propriety of the initial evaluation assigned, consideration of the medical evidence since the effective date of the award of service connection is required. See Fenderson v. West, 12 Vet. App. 199, 125-26 (1999). Where entitlement to compensation already has been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Further, "[w]here 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.

The Board notes that this appeal stems from an initial claim of service connection submitted while the Veteran was still on active duty. Thus, the period on appeal begins on August 31, 2020, the date after he separated from service. However, the evidentiary window closed on October 15, 2020, the date of the AMA rating decision on appeal.

While the Board will consider the evidence submitted at the Hearing, as well as any evidence submitted in the 90 days following the Hearing as it relates back to the period on appeal, any evidence submitted that indicates a worsening of symptoms or the current status of the Veteran's disabilities post-decision, even if submitted during an evidentiary period, must refer back to the period on appeal or may be the basis of a supplemental claim.

At the outset, the Board notes the Veteran submitted evidence during the 90 days after his Board hearing. However, if post-decisional evidence is submitted during a proper evidence window, the Board must determine whether it is relevant to the appeal period, i.e., whether it reflects the severity and functional impairments of the service-connected disabilities during that period. Here, the Veteran submitted Migraine Buddy reports from July 2023 to July 2024. Further, he submitted private treatment records regarding his rhinitis from January to July 2024. Therefore, it clearly does not refer back to the period on appeal, specifically from August to November 2020. Again, based on the Veteran's docket choice and the evidentiary rules under the AMA, the Board cannot consider this evidence. 38 C.F.R. § 20.300.

1. Entitlement to an initial compensable rating for migraine headaches.

The Veteran contends that his migraine headache symptoms are worse than presently rated during the period on appeal. After a review of the evidence, the Board agrees, and finds that a 10 percent rating, but no higher, is warranted.

Throughout the period on appeal, the Veteran's migraines have been assigned a noncompensable rating under 38 C.F.R. § 4.124a, DC 8100, effective August 31.

The Board notes that, outside of the scope of this appeal, the Veteran's migraine disorder is rated as 30 percent disabling from May 18, 2021. However, the Board reaffirms that the evidentiary window before it is from August 31 to November 20, 2020. Therefore, any evidence or references to symptoms
rated during the period on appeal. After a review of the evidence, the Board agrees, and finds that a 10 percent rating, but no higher, is warranted.

Throughout the period on appeal, the Veteran's migraines have been assigned a noncompensable rating under 38 C.F.R. § 4.124a, DC 8100, effective August 31.

The Board notes that, outside of the scope of this appeal, the Veteran's migraine disorder is rated as 30 percent disabling from May 18, 2021. However, the Board reaffirms that the evidentiary window before it is from August 31 to November 20, 2020. Therefore, any evidence or references to symptoms outside of that period is not probative in this matter.

In order to warrant a compensable rating evaluation of 10 percent, the Veteran's migraines must be characterized by prostrating attacks averaging one in 2 months over the last several months. For a rating of 30 percent, the Veteran's migraines must be characterized by prostrating attacks occurring on an average of once a month over the last several months. Id. 38 C.F.R. § 4.124a, Diagnostic Code 8100. Migraine headaches with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability are rated 50 percent disabling. Id.

The rating criteria do not define "prostrating," nor has the United States Court of Appeals for Veterans Claims (Court). Cf. Fenderson v. West, 12 Vet. App. 119 (1999) (in which the Court quotes Diagnostic Code 8100 verbatim but does not specifically address the matter of what is a prostrating attack). However, the Board notes that, according to WEBSTER'S NEW COLLEGE DICTIONARY 909 (3d ed. 2008), "prostration" is defined as "complete exhaustion." Similarly, DORLAND'S ILLUSTRATED MEDICAL DICTIONARY 1554 (31st ed. 2007) defines "prostration" as "extreme exhaustion or powerlessness."

Turning to the evidence, the Veteran underwent a VA examination in September 2020. Here, he was diagnosed with a migraine disorder and reported occurrences every two weeks. The VA examiner acknowledged that his treatment plan included taking medication, specifically, Maxalt and naproxen as needed for his migraine pain. Upon examination, the clinician noted pulsating or throbbing head pain on both sides of the head, worsening with physical activity. Additionally, he exhibited sensitivity to light and sounds, dizziness and fatigue. However, the average duration of the pain lasted less than one day. Moreover, his migraines were not characteristic prostrating attacks, nor did they result in pain productive of severe economic inadaptability. Overall, the September 2020 VA examiner opined that his migraines caused no functional impairment.

Next, the Veteran underwent a VA examination in November 2020. Here, he was again diagnosed with migraine headaches. He reported severe symptoms, occasional headaches for which he has to lock himself inside and lie down on the floor. Moreover, he reported going to the Emergency Room in October 2020 for his migraine disorder. Upon examination, he exhibited pain localized to one side of the head, with sensitivity to light and sound. He reported symptoms lasting one to two days, localized to the right side of the head. However, the VA examiner opined that he did not have characteristic prostrating attacks of migraine pain, nor did he have very prostrating and prolonged attacks of migraine pain productive of severe economic inadaptability. Overall, the November 2020 VA examiner opined that his migraine disorder caused no functional impact.

Unfortunately, given the rather short evidentiary window, there are no other contemporaneous medical treatment records. However, the Board has reviewed the Veteran's lay statements, to include Board testimony provided in 2024. In this testimony, he indicated that he suffered from prostrating migraines three times per week. However, as the Board notes above, he did not relate this back to the period on appeal. Indeed, this is more consistent with his current migraine rating of 30 percent, effective May 18, 2021.

Regardless, the Board determines that an initial 10 percent rating is warranted for the Veteran's migraines. Indeed, he reported headaches occurring multiple times per month, and during his November 2020 VA examination, reported having to lie down indoors. Therefore, the Board finds that a 10 percent rating is warranted. However, a higher 30 percent rating is not for application, as multiple VA examiners opined his migraines are not characterized by prostrating attacks that is required for a higher rating.

As such, an initial rating of 10 percent for
relate this back to the period on appeal. Indeed, this is more consistent with his current migraine rating of 30 percent, effective May 18, 2021.

As such, an initial rating of 10 percent for the Veteran's migraines, but no higher, is granted.

2. Entitlement to an initial compensable rating for allergic rhinitis.

The Veteran contends that a compensable rating is warranted for his service-connected allergic rhinitis. After a review of the evidence, the Board finds that an initial 10 percent rating, but no higher, is warranted during the period on appeal.

The Veteran's allergic rhinitis has been assigned a noncompensable rating under 38 C.F.R. § 4.97, DC 6522. In order to warrant an initial compensable rating, the evidence must show rhinitis that is:

" Without polyps, but with greater than 50-percent obstruction of nasal passage on both sides, or complete obstruction on one side (10 percent); or

" With polyps (30 percent).

38 C.F.R. § 4.97, DC 6522.

Turning to the medical evidence of record, the Veteran underwent a VA examination in September 2020. Here, he was diagnosed with allergic rhinitis and reported symptoms of sneezing, watery eyes, nasal drainage, and sore throat. However, upon examination, there was no obstruction greater than 50 percent of the nasal passage on both sides, no complete obstruction on either side, no nasal polyps or granulomatous conditions. However, there is permanent hypertrophy of the nasal turbinates. Overall, the VA examiner opined his allergic rhinitis caused no functional impairment.

Next, the Veteran underwent another VA examination in November 2020. Here, he was against diagnosed with allergic rhinitis, and reported itchy eyes, sneezing, and a runny nose. He described these symptoms as interfering with his work, as he cannot concentrate because it looks messy. Upon examination, the November 2020 VA examiner noted that his rhinitis caused obstruction greater than 50 percent of the nasal passage on both sides, however, there were no nasal polyps. Overall, the Veteran's rhinitis caused no functional impairment.

Unfortunately, there is no other medical treatment records during the period on appeal. While the Veteran provided testimony to the Board in July 2024, this testimony appeared focused on his then-current symptoms. Indeed, he referenced treatment from his private clinician. However, his private treatment records submitted all reference time periods in 2024, post-rating decision.

Affording the Veteran the benefit of the doubt, the Board finds that he had obstruction of both nasal passages at greater than 50 percent during the period on appeal. Indeed, the November 2020 VA examiner opined that this is the case. However, neither the September nor November 2020 VA examiner opined that his rhinitis presented with nasal polyps. Therefore, a rating in excess of 10 percent is not for application.

By virtue of the foregoing, the Board finds that a 10 percent rating, but no higher, for the Veteran's allergic rhinitis is warranted for the period on appeal.

3. Entitlement to a separate compensable rating for seborrheic dermatitis.

4. Entitlement to a compensable rating for pseudofolliculitis barbae (PFB) with seborrheic dermatitis.

The Veteran contends that his skin disorder symptoms are worse than presently rated. Additionally, he seeks a separate compensable rating for his seborrheic dermatitis. After a review of the evidence, the Board finds that an initial rating of 10 percent for PFB with seborrheic dermatitis is warranted. However, a separate compensable rating for seborrheic is not for application.

The Veteran's skin disorder is currently rated as noncompensable under DC 7813-7806 for diseases of dermatophytosis. Hyphenated Diagnostic Codes are used when a rating under one diagnostic code requires use of an additional Diagnostic Code to identify the basis for the evaluation assigned. 38 C.F.R. §§ 4.20, 4.27.

Under DC 7813, a rating is determined
compensable rating for his seborrheic dermatitis. After a review of the evidence, the Board finds that an initial rating of 10 percent for PFB with seborrheic dermatitis is warranted. However, a separate compensable rating for seborrheic is not for application.

Under DC 7813, a rating is determined using the General Rating Formula for Skin. Under the General Rating Formula for Skin, a 10 percent rating is warranted if the disability is manifested by 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 warranted if the disability is manifested by at least one of the following: characteristic lesions involving 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.

DC 7806, dermatitis or eczema, directs to evaluate under the General Rating Formula for the Skin.

The General Rating Formula also provides that the skin condition can be rated as disfigurement of the head, face, or neck (DC 7800) or scars (DCs 7801, 7802, 7804, or 7805), depending on the predominant disability.

In addition, a note preceding 38 C.F.R. § 4.118 provides that, for the purposes of this section, "systemic therapy is treatment that is administered through any route (orally, injection, suppository, intranasally) other than the skin, and topical therapy is treatment that is administered through the skin."

Because "systemic therapy," is connected to the phrase "corticosteroids or other immuno-suppressive drugs" by "such as," those drug types do not constitute an exhaustive list of all compensable systemic therapies but rather serve as examples of the kind and degrees of treatments used to justify a particular disability rating. Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). Consequently, the types of systemic treatment that are compensable are not limited to "corticosteroids or other immunosuppressive drugs." Compensation is available for all systemic therapies that are like or similar to corticosteroids or other immunosuppressive drugs. Warren v. McDonald, 28 Vet. App. 194 (2016).

In Johnson v. Shulkin, 862 F.3d 1351, 1354-56 (Fed. Cir. 2017), the Federal Circuit found that "systemic" is defined as "pertaining to or affecting the body as a whole" and "therapy" is defined as "treatment of diseases." In Burton v. Wilkie, 30 Vet. App. 286, 291 (2018), the Court discussed two ways that a treatment could be shown to be systemic: (1) the method by which the treatment works to treat the medical condition, and (2) the side effects that are possible or actually experienced as a result of the treatment.

Turning to the evidence of record, the Veteran underwent a VA examination in September 2020. Here, he was diagnosed with pseudofolliculitis barbae (PFB). He reported improved symptoms since he left service. Upon examination, the clinician noted he has not been treated with medication in the last 12 months for a skin disorder. Moreover, he exhibited PFB on less than 5 percent of total and exposed total area on the face and neck.

Next, the Veteran underwent a VA examination in November 2020. Here, he was diagnosed with PFB and seborrheic dermatitis. He reported itchiness in his scalp, with no current treatment. As for occupational functioning, he indicated that it is embarrassing, as it makes it
the Veteran underwent a VA examination in September 2020. Here, he was diagnosed with pseudofolliculitis barbae (PFB). He reported improved symptoms since he left service. Upon examination, the clinician noted he has not been treated with medication in the last 12 months for a skin disorder. Moreover, he exhibited PFB on less than 5 percent of total and exposed total area on the face and neck.

Next, the Veteran underwent a VA examination in November 2020. Here, he was diagnosed with PFB and seborrheic dermatitis. He reported itchiness in his scalp, with no current treatment. As for occupational functioning, he indicated that it is embarrassing, as it makes it look like he has dandruff. The examiner noted he used topical ketoconazole cream for 6 weeks or more but not constant. Upon examination, his dermatitis covered less than 5 percent of the exposed area. Overall, the VA examiner opined that his skin disorder did not cause functional impairment.

While the VA examinations of record support a noncompensable rating, the Board finds the Veteran's July 2024 testimony to be probative. Specifically, the Veteran testified that his seborrheic dermatitis affected his entire scalp, while his PFB affected his beard area. Moreover, he testified that these symptoms onset during service and continued since. Therefore, the Board finds this testimony relates back to the period on appeal, specifically August to November 2020. The Board finds the Veteran's testimony regarding the affected skin areas to be credible. Given he described his entire scalp and beard areas to be affected, the Board determines that his skin disorder encompasses at least 5 percent, but less than 20 percent, of the exposed areas affected. Therefore, an initial 10 percent rating is warranted.

However, a 30 percent rating is not for application. Specifically, the evidence of record during this period does not show the Veteran suffered from characteristic lesions involving 20 to 40 percent of the entire body and/or the exposed areas. Additionally, the VA examinations indicate he used topical cream for treatment, thus, a 30 percent rating is not warranted for use of systemic therapy or other immunosuppressive drugs required for a total duration of 6 weeks or more over the past 12-month period.

Additional ratings for scars are not considered because there is no evidence of scarring.

The Board has also considered whether to grant separate awards of PFB and seborrheic dermatitis. However, the Board notes that rating these two disorders together provides the highest rating possible for the Veteran. Indeed, should they be separated and each independently rated under the General Rating Formula for the Skin, each would be rated noncompensable as they would cover less than 5 percent of the total exposed area. Thus, as keeping both skin disorders affords the Veteran the highest possible rating, the Board finds that a separate compensable rating for seborrheic dermatitis is not warranted in this case.

In addition to the evidence of record, the Board has considered the Veteran's statements in determining the appropriate disability ratings for his migraines, allergic rhinitis, and skin disorders. Although the Veteran is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses, he is not competent to identify a specific level of disability of his disabilities according to the appropriate DCs. Rucker v. Brown, 10 Vet. App. at 74; Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also Cartwright v. Derwinski, 2 Vet. App. 24, 25 (1991).

On the other hand, such competent evidence concerning the nature and extent of the Veteran's disabilities have been provided by the medical personnel who have examined him during the current appeal and who have rendered pertinent opinions in conjunction with their evaluations. The medical findings of the physicians who performed the VA examinations directly address the criteria under which this disability is evaluated. Because the examiners were able to review the medical file and examine the Veteran, the Board finds the examiners' assessments of greater probative weight.

As such, the Board finds that initial 10 percent ratings, but no higher, are warranted for the Veteran's migraine, rhinitis and combined skin disorders.

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.

B.T. KNOPE

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board McDonald, Thomas K.

' assessments of greater probative weight.

As such, the Board finds that initial 10 percent ratings, but no higher, are warranted for the Veteran's migraine, rhinitis and combined skin disorders.

B.T. KNOPE

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board McDonald, Thomas K.

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