DEPRESSIVE DISORDER

SHAUN S. SPERANZA · 2026 · Case ID: A26035807

MIXED

Summary

The Veteran served from October 1969 to October 1973. This case involves appeals for service connection of acquired psychiatric disorders secondary to a service-connected Traumatic Brain Injury (TBI), an increased rating for right knee disability, and entitlement to a Total Disability based on Individual Unemployability (TDIU). The Board granted service connection for acquired psychiatric disorders (mild neurocognitive disorder, depressive disorder, anxiety disorder, and insomnia disorder) secondary to TBI, finding the evidence in approximate balance and applying the benefit of the doubt. A 20 percent rating was granted for right knee limitation of extension from December 20, 2018, to November 22, 2021, and a temporary 100 percent rating for total right knee replacement was granted from November 23, 2021, to November 23, 2022, followed by a 30 percent rating from November 24, 2022. The claim for migraines was denied, as the evidence persuasively weighed against a compensable rating. The Board remanded claims for residuals of TBI and TDIU due to inadequate VA examinations, noting inconsistencies in the examiner's findings regarding the Veteran's cognitive and neurobehavioral symptoms and the lack of specific nexus opinions for certain TBI residuals. A new VA examination is required to clarify the nature and severity of TBI residuals and their relationship to comorbid conditions.

Rationale

Private examination diagnosed mild neurocognitive disorder, depressive disorder, anxiety disorder, and insomnia disorder.; Examiner opined conditions were as likely as not developed due to service-connected TBI.; No negative nexus opinion in record; Board found private opinion adequate.; Evidence in approximate balance regarding causation by TBI.; Benefit of the doubt applied for grant of secondary service connection.

Special Benefit

TDIU

Docket No.

250922-588207

Full Decision Text

Citation Nr: A26035807
Decision Date: 04/16/26 Archive Date: 04/16/26

DOCKET NO. 250922-588207
DATE: April 16, 2026

ORDER

Entitlement to service connection for an acquired psychiatric disorder, to include mild neurocognitive disorder, depressive disorder, anxiety disorder, and insomnia disorder, as secondary to service-connected traumatic brain injury (TBI) is granted.

Entitlement to a rating of 20 percent for right knee limitation of extension is granted from December 20, 2018 to November 22, 2021.

Entitlement to a temporary rating of 100 percent for total right knee replacement surgery from November 23, 2021 to November 23, 2022 is granted.

Entitlement to a rating of 30 percent for total right knee replacement is granted from November 24, 2022.

Entitlement to a compensable rating for migraines is denied.

REMANDED

Entitlement to a compensable rating prior to August 25, 2022, for residuals of TBI, to include blurred vision, headaches, fatigue, and sleeplessness is remanded.

Entitlement to a rating in excess of 10 percent for residuals of TBI from August 25, 2022 is remanded.

Entitlement to a total disability evaluation based upon individual unemployability (TDIU) is remanded.

FINDINGS OF FACT

1. The Veteran's acquired psychiatric disorder, to include mild neurocognitive disorder, depressive disorder, anxiety disorder, and insomnia disorder, is caused by his service-connected TBI.

2. From December 20, 2018 to November 22, 2021, the Veteran's right knee manifested, at worst, limitation of motion of extension to 15 degrees.

3. On November 23, 2021, the Veteran underwent total right knee replacement surgery.

4. The Veteran does not have chronic or intermediate degrees of residuals from his total right knee replacement.

5. The evidence weighs persuasively against finding the Veteran's migraine symptoms produce or approximate characteristic prostrating attacks.

6. The Veteran's migraines do not produce characteristic prostrating attacks.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for acquired psychiatric disorder, to include mild neurocognitive disorder, depressive disorder, anxiety disorder, and insomnia disorder, as secondary to service-connected TBI have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

2. From December 20, 2018 to November 22, 2021, the criteria for a 20 percent rating for right knee limitation of motion of extension have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.71a, Diagnostic Code (DC) 5261.

3. The criteria are met for a temporary total evaluation for total right knee replacement surgery from November 23, 2021 to November 23, 2022. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.30, 4.71a, DC 5055.

4. The criteria are met for a 30 percent evaluation for total right knee replacement from November 24, 2022. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.30, 4.71a, DC 5055.

5. The criteria for a compensable rating for migraines have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.124a, DC 8100.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from October 1969 to October 1973.

This appeal is being processed under the modernized review system, commonly referred to as the "AMA," as established by the Veterans Appeals Improvement and Modernization Act of 2017. 115 Pub. L. No. 55, 131 Stat. 1105.

These matters come before the Board of Veterans' Appeals (Board) on appeal of a March 2025 rating decision (TBI, migraines, and TDIU) and an April 2025 rating decision (right knee disability) issued by a Department of Veterans Affairs (VA) regional office, an agency of original jurisdiction (AOJ).

The Veteran timely initiated an appeal by submitting a September 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice
being processed under the modernized review system, commonly referred to as the "AMA," as established by the Veterans Appeals Improvement and Modernization Act of 2017. 115 Pub. L. No. 55, 131 Stat. 1105.

The Veteran timely initiated an appeal by submitting a September 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement) and elected the Hearing docket. Pursuant to his election a hearing was scheduled for December 10, 2025. In correspondence dated November 12, 2025, the Veteran's representative withdrew the hearing request and requested the record remain open for 90 days for additional evidence.

As the hearing docket was requested and the Veteran later withdrew the request, the Board's decision is based on the evidence at the time of the prior decisions on appeal and evidence submitted by the Veteran or his representative within 90 days following the date of his hearing withdrawal.

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, 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 for residuals of TBI and TDIU, any evidence the Board could not consider will be considered by the AOJ in the adjudication of these claims. 38 C.F.R. § 3.103(c)(2)(ii).

The Board notes that the Veteran's representative included the issue of an increased rating for prostatitis in the December 2025 memo in lieu of the December 2025 Board hearing. This issue was not included in the September 2025 Notice of Disagreement. Thus, this issue is not on appeal under this docket and will not be reviewed.

Service Connection

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a).

Service connection may also be granted on a secondary basis for a disability which is proximately due to, or the result of, a service-connected disability. 38 C.F.R. § 3.310. Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists; and (2) that the current disability was either: (a) proximately caused by; or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc).

A claimant is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence on any issue material to the claim. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. If the positive and negative evidence is in approximate balance-which includes but is not limited to equipoise-the claimant receives the benefit of the doubt. Lynch v. McDonough, 21 F.4th 776, 781 (Fed. Cir. 2021). If the evidence persuasively favors one side or the other, there is not an approximate balance, and therefore the benefit-of-the-doubt-rule does not apply. Id. at 781-82.

Acquired Psychiatric Disorder

The Veteran submitted a private examination completed in October 2024. The examiner diagnosed the Veteran with mild neurocognitive disorder, depressive disorder, anxiety disorder, and insomnia disorder and opined these conditions were as likely as not developed due to his service-connected TBI.

VA has an obligation to develop claims for secondary service connection that are logically related to an increased rating claim on appeal and reasonably raised by the record. See Wilson v. McDonough, 35 Vet. App. 103 (2022); Bailey v. Wilkie, 22 Vet. App. 188, 203 (2021).

Given the above, a claim for secondary service connection for mild neurocognitive disorder, depressive disorder, anxiety disorder, and insomnia disorder is reasonably raised and logically related to the increased rating claim for residuals of TBI on appeal. Furthermore, 38 C.F.R
depressive disorder, anxiety disorder, and insomnia disorder and opined these conditions were as likely as not developed due to his service-connected TBI.

Given the above, a claim for secondary service connection for mild neurocognitive disorder, depressive disorder, anxiety disorder, and insomnia disorder is reasonably raised and logically related to the increased rating claim for residuals of TBI on appeal. Furthermore, 38 C.F.R. § 3.310(d) provides a presumption of service connection for depression that manifests within three years of a moderate or severe TBI or within one year of a mild TBI.

Under 38 C.F.R. § 3.310(d)(3), a TBI is mild in severity if there is normal structural imaging, loss of consciousness for up to 30 minutes, alteration of consciousness or mental statement for a moment to up to 24 hours, post-traumatic amnesia for up to a day, and a Glasgow Coma Scale ranging from 13 to 15. A TBI is moderate in severity if there is normal or abnormal structural imaging, loss of consciousness from 30 minutes to less than 24 hours, alteration of consciousness or mental state for more than 24 hours, post-traumatic amnesia from one to 7 days, or Glasgow Coma Scale from 9-12. A TBI is severe if there is normal or abnormal structural imaging, loss of consciousness for more than 24 hours, alteration of consciousness or mental state for more than 24 hours, post-traumatic amnesia for more than 7 days or a Glasgow Coma Scale of 3-8.

The Veteran's record is silent for a diagnosis of depression within three years of the Veteran's TBI. Therefore, the Board will consider whether secondary service connection is warranted.

VA treatment records from May 2000 note a diagnosis of depression and a prescription of Prozac. VA treatment records from March 2022, March 2007, February 2015, and March 2024, continue to note a history of depression. VA treatment records also note complaints and treatment for insomnia. See November 2001 and May 2025 VA treatment records.

As noted above, the Veteran was diagnosed with mild neurocognitive disorder, depressive disorder, anxiety disorder, and insomnia disorder in an October 2024 private examination. The examiner noted the diagnoses conform with the DSM-5.

Thus, the first element of service connection is satisfied.

The Veteran's TBI is service-connected. Therefore, the question for the Board to resolve is whether the Veteran's current acquired psychiatric disabilities are caused or aggravated by his service-connected TBI.

A VA mental health examination has not been completed and there is no negative nexus opinion in the Veteran's record for the Veteran's psychiatric disorders. Although the Board could remand for a VA examination and opinion, the Board finds that it would cause undue delay. The October 2024 private examination findings are adequate and constitute highly probative evidence.

The Board finds that the evidence is at least in approximate balance as to whether the Veteran's acquired psychiatric disabilities are caused by his service-connected TBI. Therefore, he receives the benefit of the doubt and service connection for acquired psychiatric disabilities as secondary to service-connected TBI is granted. See 38 U.S.C. § 5107; Lynch, 21 F.4th at 781.

Disability Ratings

Disability evaluations are determined by the application of VA's Schedule for Rating Disabilities (Rating Schedule). 38 C.F.R. § Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during service and their residual conditions in civil occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321(a), 4.1.

In evaluating the severity of a particular disability, it is essential to consider its history. 38 C.F.R. § 4.1; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary importance. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Separate ratings may be assigned for separate periods of time based on the facts found. Hart v. Mansfield, 21 Vet. App. 505 (2007).

Any reasonable doubt regarding the degree of disability should be
321(a), 4.1.

Any reasonable doubt regarding the degree of disability should be resolved in favor of the claimant. 38 C.F.R. § 4.3. Where there is a question as to which of two evaluations shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that evaluation. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7.

Right Knee Disability

December 20, 2018 to November 22, 2021

The Veteran contends that his right knee meniscal tear is worse than contemplated by the currently assigned 10 percent evaluation prior to June 27, 2024 and 20 percent evaluation from June 27, 2024. In a December 2025 memo in lieu of hearing, the Veteran's representative argues that the Veteran's right knee condition has worsened since his last VA examination and that an additional examination is appropriate. His representative also argues that the Veteran's description of limitations walking up hills and climbing stairs shows limited extension within the 20-29 degree goniometer measurement.

To the extent the Veteran asserts that a higher rating is warranted for limited range of motion for his right knee, the Board notes the Veteran is competent to report subjective symptoms such as pain. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). However, the Veteran is not considered competent to assess the relative severity of his knee disability, as doing so involves medical testing and medical knowledge the Veteran has not been shown to possess. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011).

The request for a new VA examination was made after the rating decision on appeal was issued. Furthermore, the AOJ complied with May 2025 Board remand directives and obtained an addendum VA medical opinion and a January 2026 VA knee examination was completed and is within the evidence window for the Board to consider.

The AOJ granted entitlement to service connection for right knee meniscal tear with a 10 percent rating under DC 5261 effective December 20, 2018 in a March 2019 rating decision. The Veteran appealed the assigned rating with a Notice of Disagreement in June 2023. Good cause for an extension for time to submit the Notice of Disagreement was found and the appeal was docketed with the Board. See September 2023 Notification Letter. The Veteran attended a Board hearing in January 2024 and the Board remanded the claim in a May 2024 decision. A rating decision was issued in April 2025 granting a 20 percent rating for right knee meniscal tear effective June 27, 2024.

When evaluating disabilities of the musculoskeletal system, functional loss due to pain and weakness causing additional disability beyond that reflected on range of motion measurements must be considered. See 38 C.F.R. § 4.40; DeLuca v. Brown, 8 Vet. App. 202 (1995). Consideration must also be given to weakened movement, excess fatigability and incoordination. 38 C.F.R. § 4.45.

Under DC 5261, a noncompensable rating is warranted for extension limited to 5 degrees. A 10 percent rating is warranted for extension limited to 10 degrees. A 20 percent rating is warranted for extension limited to 15 degrees. A 30 percent rating is warranted for extension limited to 20 degrees. A 40 percent rating is warranted for extension limited to 30 degrees. A 50 percent rating is warranted for extension limited to 45 degrees. Id. Effective February 7, 2021, VA amended the rating criteria for disabilities of the knee and leg; however, Diagnostic Code 5261 was unchanged.

The Veteran underwent a VA knee examination in January 2019 VA. The examiner noted a diagnosis of right knee meniscal tear. The Veteran reported that he can no longer climb stairs or go uphill and that both ascending and descending stairs bothers him. He reported that he has pain in the entire joint when he is using the knee. The Veteran also reported flare-ups of the knee with prolonged weight bearing and stair climbing. The examiner noted that the examination was not being conducted during a flare-up and that she could not say without mere speculation any additional range of motion (ROM) loss during a flare-up or over a period of time. The examiner noted that there was no reduction in muscle strength, no ankylosis, and no history of recurrent subluxation or lateral instability. The examiner noted that the Veteran had a partial meniscectomy in 1994 with residuals of pain and stiffness. The examiner also noted the Veteran experiences frequent episodes of joint "locking" and joint pain on his right side.

In a May 2024 decision, the Board found the January 2019 VA examination inadequate pursuant to Sharp v. Shulkin, 29 Vet. App. 26 (2017) and remanded the claim for a new VA examination.

A VA medical opinion was offered in March 2025. The examiner noted the Veteran reports flare-ups of his right knee with prolonged weight bearing and stair climbing with effusion and/or locking, stiffness, and joint pain. The examiner noted the Veteran had reported experiencing right knee flare-ups once per week and lasting up to 2 days. The examiner opined that during a flare-up, range of motion is additionally limited to 15 degrees extension due to increased effusion and/or locking and stiffness and joint pain. The examiner also opined that flexion would be limited to 80 degrees after repeated use over time and extension would be limited to 15 degrees.

The Veteran reported flare-ups during the January 2019 VA examination and stated that he can no longer climb stairs or go uphill. Thus, the Board finds the estimated ROM during flare-ups noted during the March 2025 VA medical opinion also adequately reflects the Veteran's ROM as described during the January 2019 VA examination.

The Board finds the March 2025 VA medical opinion to be adequate and highly probative evidence demonstrating the Veteran's right knee extension was limited to 15 degrees at worst. Based on these examination findings, the Board finds that beginning December 20, 2018, a 20 percent rating is warranted under DC 5261.

Separate ratings may be assigned for knee disabilities when none of the symptomatology overlaps, and the separate rating is based on additional disabling symptomatology. The evaluation of the same disability under several Diagnostic Codes, known as pyramiding, must be avoided. However, separate ratings may be assigned for distinct disabilities resulting from the same injury so long as the symptomatology for one disorder is not duplicative of the symptomatology of the other disorder. 38 C.F.R. § 4.14; Esteban v. Brown, 6 Vet. App. 259, 262 (1994).

Under Diagnostic Code 5260, a noncompensable rating will be assigned for limitation of flexion of the knee to 60 degrees, a 10 percent rating will be assigned for limitation of flexion of the knee to 45 degrees, a 20 percent rating will be assigned for limitation of flexion of the knee to 30 degrees, and a 30 percent rating will be assigned for limitation of flexion of the knee to 15 degrees. 38 C.F.R. § 4.71a (2019). The probative evidence shows the Veteran's right knee flexion is 80 degrees as its worst. Thus, a separate compensable rating under DC 5260 is not warranted.

Under DC 5258, a 20 percent rating is warranted for dislocation of semilunar cartilage with frequent episodes of "locking," pain, and effusion into the joint. 38 C.F.R. § 4.71a, DC 5258.

Diagnostic Code 5259 provides for a 10 percent rating for symptomatic residuals of removal of a semilunar cartilage. Ratings under Diagnostic Code 5259 require consideration of 38 C.F.R. §§ 4.40 and 4.45 because removal of a semilunar cartilage may result in complications producing loss of motion.

The assignment of a separate rating under DC
, a separate compensable rating under DC 5260 is not warranted.

Under DC 5258, a 20 percent rating is warranted for dislocation of semilunar cartilage with frequent episodes of "locking," pain, and effusion into the joint. 38 C.F.R. § 4.71a, DC 5258.

The assignment of a separate rating under DC 5258 or 5259 would result in pyramiding when combined with the impairment used to establish entitlement to the 20 percent rating under Diagnostic Code 5261. Although the Veteran had a partial meniscectomy in 1994 with residuals of frequent episodes of joint "locking" and joint pain on his right side, this symptomology overlaps with the limitation of extension symptomology. The Veteran's right knee extension is limited to 15 degrees due to "locking," pain, and effusion, thus, these symptoms are duplicative and a higher rating is not warranted under DC 5258 or 5259.

The probative evidence does not show malunion or nonunion of the tibia and fibula or genu recurvatum, so separate disability ratings under DC 5262 and 5263 are not warranted.

The probative evidence shows the Veteran does not have ankylosis of his right knee. A rating based on ankylosis may be met by evidence demonstrating the functional equivalent of ankylosis. Chavis v. McDonough, 34 Vet. App. 1, 20 (2021). DC 5256 applies to ankylosis of the knee and provides the definition for knee ankylosis. A 40 percent rating is warranted for a knee in flexion between 10 and 20 degrees, a 50 percent rating for a knee in flexion between 20 and 45 degrees, and a 60 percent rating for a knee fixed in flexion at an angle of 45 degrees or more. DC 5256 does not apply to the Veteran's right knee disability, as the knee has not been shown to be fixed in any degree of extension or flexion as defined in the code.

There is no evidence that the Veteran's right knee disability results in genu recurvatum, so DC 5263 does not apply.

In sum, the probative evidence demonstrates that the Veteran's right knee disability results in extension limited to 15 degrees. A 20 percent rating for right knee limitation of extension is therefore warranted.

From November 23, 2021

During the pendency of the appeal, 38 C.F.R. § 4.71a was amended, effective February 7, 2021, which revised DC 5055. Under the previous version of DC 5055, a temporary 100 percent disability rating was assigned for one year following implantation of a knee prosthesis for a service-connected knee disability, while under the new version the temporary 100 percent rating is assigned for four months only.

Under both the previous and revised versions of DC 5055, after the period of temporary 100 percent rating following the prosthetic replacement of a joint, the condition will be rated based on chronic residuals. A 60 percent disability rating is warranted when there are chronic residuals consisting of severe painful motion or weakness. For intermediate degrees of residual weakness, pain, or limitation of motion, a disability rating is made by analogy to DCs 5256, 5261, and 5262. The minimum disability rating under DC 5055 is 30 percent.

VA's General Counsel has held that where a law or regulation changes during the pendency of a claim for a higher rating, the Board must first determine whether the revised version is more favorable to the Veteran. In so doing, it may be necessary for the Board to apply both the old and new versions of the regulation. VA thus must consider the claim for a higher rating pursuant to the former and revised regulations. See VAOPGCPREC 3?2000, 65 Fed. Reg. 33,422 (2000); DeSousa v. Gober, 10 Vet. App. 461, 467 (1997). Therefore, the Board will consider the Veteran's claim under the old criteria prior to February 7, 2021 and both the old and new rating criteria from February 7, 2021. The criteria that is more favorable to the Veteran will be applied.

VA treatment records from November 22, 2021 show that the Veteran reported he was having right knee replacement
and new versions of the regulation. VA thus must consider the claim for a higher rating pursuant to the former and revised regulations. See VAOPGCPREC 3?2000, 65 Fed. Reg. 33,422 (2000); DeSousa v. Gober, 10 Vet. App. 461, 467 (1997). Therefore, the Board will consider the Veteran's claim under the old criteria prior to February 7, 2021 and both the old and new rating criteria from February 7, 2021. The criteria that is more favorable to the Veteran will be applied.

VA treatment records from November 22, 2021 show that the Veteran reported he was having right knee replacement surgery "tomorrow". On November 30, 2021, VA treatment records note that a phone call was made to the Veteran to follow up on his recovery after his knee surgery. The Veteran reported he was getting around with a cane and felt that he was recovering well. VA treatment records from December 6, 2021 note that the Veteran had right knee replacement 2 weeks ago and his knee was "doing fine" and was progressing with his home physical therapy.

During a January 2024 Board hearing, the Veteran testified he had right knee replacement surgery in November 2021and that his knee had improved a lot after surgery. He stated he is able to walk unassisted. The Veteran is competent to report on that of which he has personal knowledge. Layno v. Brown, 6 Vet. App. 465, 470 (1994). The competent lay statements are credible and constitute highly probative evidence.

The Veteran underwent a VA knee examination in January 2026. The examiner noted the Veteran had total right knee replacement in 2021. The Veteran reported he has been in much less pain after his surgery. He did not report flare-ups of the right knee or functional loss or functional impairment, including after repeated use over time. The examiner noted the Veteran's initial range of motion of his right knee is abnormal or outside of normal range. The ranges of right knee motion were recorded as being flexion to 90 degrees and extension to 0 degrees. The Veteran experienced pain during flexion. There was no objective evidence of crepitus and there was no objective evidence of localized tenderness or pain on palpation. The Veteran was able to perform repetitive-use testing and there was no additional loss of function or range of motion after three repetitions. The examiner also determined the Veteran's range of motion would not change after repeated use over time. The examiner noted the Veteran denies flare ups. The Veteran did not have muscle atrophy. The examiner noted the Veteran did not have ankylosis. The examiner also noted the Veteran does not have recurrent subluxation or persistent instability and there has not been a ligament tear. The examiner noted the Veteran does not use an assistive device.

The January 2026 VA examination findings are adequate and constitute highly probative evidence.

As the previous rating criteria under DC 5055 is more favorable to the Veteran, the Board finds a 100 percent temporary rating for total right knee replacement is warranted one year following implantation of a knee prosthesis. Accordingly, the criteria are met for a temporary total evaluation from November 23, 2021 to November 23, 2022. From November 24, 2022, the probative evidence does not show that the Veteran experiences chronic or intermediate residuals from his total right knee replacement. Thus, the minimum rating of 30 percent under DC 5055, beginning November 24, 2022, is warranted.

Migraines

The Veteran seeks a compensable rating for migraines. DC 8100. 38 C.F.R. § 4.124a.

The Veteran's representative contends that the Veteran has consistently described symptoms that equate to frequent prostrating headaches that continue to cause functional loss associated with pain. See December 2025 memo in lieu of hearing.

Under DC 8100, a 10 percent rating is warranted for characteristic prostrating attacks averaging one in two months over the last several months. A 30 percent rating is warranted for characteristic prostrating attacks occurring on an average once a month over the last several months. A 50 percent rating is warranted for very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability.

"Prostration" is defined as extreme exhaustion or powerlessness. See Dorland's Illustrated Medical dictionary (30th ed. 2003). Whereas the Court has noted that the term "productive of" can either have the meaning of "producing" or "capable of producing." Pierce v. Principi, 18 Vet. App. 440, 445 (2004). Although, headaches need not actually "produce" severe economic inadaptability to warrant a
months. A 30 percent rating is warranted for characteristic prostrating attacks occurring on an average once a month over the last several months. A 50 percent rating is warranted for very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability.

Moreover, "economic inadaptability" does not mean unemployability, as that would undermine the purpose of regulations pertaining to a total disability rating based on individual unemployability. Id. at 446; see 38 C.F.R. § 4.16. Rather, the term "severe economic inadaptability" refers to a great degree of inability in adjusting to the environment of an economic marketplace. See Merriam-Webster definitions of "inadaptability;" "adaptation;" "severe;" and "economic."

VA treatment records from March 2021 show the Veteran reported daily headaches and stated that they do not stop him from doing things but slow him down. VA treatment records from October 2021 note that the Veteran was using a Cefaly device which he reported decreased the severity of his headaches. He reported his headaches are on the top of his head and frontal and parietal part of the head. He reported they began in 1973 and became worse in the 1990's. He reported his pain level as 3/10 and stated that they are accompanied by light and sound sensitivity.

Private treatment records from December 2017 note that the Veteran reported his headaches have remained unchanged over the years and are always present. He reported they are "[a]lways there at a low level and pain." He also reported he began having right-sided headaches after he was hit by a car in 2000. The medical provider recommended he try Effexor at night for his headaches.

During a February 2022 Board hearing, the Veteran testified he had low-grade headaches after his TBI in 1973 and still has low-grade headaches.

The Veteran underwent a February 2025 VA headaches examination. The examiner noted a diagnosis of migraine including migraine variants. The examiner noted the Veteran's treatment plan includes taking Tylenol. The examiner noted that the Veteran experiences sensitivity to light, has head pain on both sides of his head, and that his head pain lasts more than 2 days. The examiner determined that the Veteran's does not have characteristic prostrating attacks of migraine/non-migraine pain and does not have completely prostrating and prolonged attacks. The examiner noted the Veteran's migraines impacts his ability to perform occupational tasks as he feels tired all the time and his headaches cause difficulty concentrating.

The Veteran's migraines are evaluated under DC 8100. In Jones v. Shinseki, the Court held that "the Board may not deny entitlement to a higher rating on the basis of relief provided by medication when those effects are not specifically contemplated by the rating criteria." 26 Vet. App. 56, 63 (2012). More specifically, "if [a diagnostic code (DC)] does not specifically contemplate the effects of medication, the Board is required... to discount the ameliorative effects of medication." McCarroll v. McDonald, 28 Vet. App. 267, 271 (2016) (en banc) (citing Jones, 26 Vet. App. at 63). DC 8100 does not contemplate the effects of medication. Under Jones, the Board is precluded from considering the effects of the Veteran's pain medication when assigning a disability rating under the DC for the Veteran's migraines.

Consequently, the February 2025 VA examination is inadequate for rating purposes as it does not address the impact of the Veteran's medication on his condition. Jones, 26 Vet. App. at 63. The inadequate February 2025 VA examination was before the AOJ at the time it issued the April 2025 rating decision. While the Board could remand for an adequate examination and opinion, the Board finds that it would cause undue delay as a new VA headaches examination was completed in January 2026 and is within the evidence window for the Board to consider in this appeal.

The January 2026 VA headaches examiner noted a diagnosis of migraine including migraine variants. The examiner noted the Veteran's treatment does not include taking daily prescribed medication. The examiner noted that the Veteran experiences constant head pain on both sides of the head
does not address the impact of the Veteran's medication on his condition. Jones, 26 Vet. App. at 63. The inadequate February 2025 VA examination was before the AOJ at the time it issued the April 2025 rating decision. While the Board could remand for an adequate examination and opinion, the Board finds that it would cause undue delay as a new VA headaches examination was completed in January 2026 and is within the evidence window for the Board to consider in this appeal.

The January 2026 VA headaches examiner noted a diagnosis of migraine including migraine variants. The examiner noted the Veteran's treatment does not include taking daily prescribed medication. The examiner noted that the Veteran experiences constant head pain on both sides of the head that are continuous. The examiner determined that the Veteran does not have characteristic prostrating attacks of migraine/non-migraine pain and does not have completely prostrating and prolonged attacks. The examiner noted the Veteran's migraines do not impact his ability to perform occupational tasks.

The January 2026 VA examination findings are adequate and constitute highly probative evidence.

Based on the foregoing, a compensable rating is not warranted. Under Diagnostic Code 8100, a noncompensable (0 percent) disability rating is warranted for characteristic prostrating attacks occurring on average less frequently than one in two months over the last several months. The January 2026 VA examiner determined the Veteran does not experience characteristic prostrating headaches. Furthermore, the Veteran has consistently described his headaches as low-grade headaches with constant low-level pain. He has also stated his headaches do not prevent him from doing things but may slow him down.

Here, the evidence for and against a compensable rating is neither evenly balanced nor approximately so. Rather the probative evidence weighs persuasively against a compensable rating. The benefit of the doubt doctrine is therefore not for application and the claim is denied. See 38 U.S.C. § 5107(b), Lynch, 21 F.4th 776 (en banc) (only when the evidence persuasively favors one side or another is the benefit of the doubt doctrine not for application).

REASONS FOR REMAND

Under the AMA, the Board shall remand to the AOJ to correct pre-decisional duty to assist errors. 38 C.F.R. § 20.802(a).

Traumatic Brain Injury

A noncompensable rating is in effect for the Veteran's TBI prior to August 25, 2022 and a 10 percent rating is currently in effect after August 25, 2022. The Veteran's TBI is rated under 38 C.F.R. § 4.124a, DC 8045. While DC 8045 provides for code-specific rating of TBI residuals under three main areas of dysfunction (cognitive, emotional/behavioral, and physical), the rater is directed to first separately evaluate any residual with a distinct diagnosis that may be evaluated under another diagnostic code. 38 C.F.R. § 4.124a. Further, the evaluation of the same disability under various diagnoses is to be avoided. 38 C.F.R. § 4.14. Thus, the same symptoms may not serve as the foundation for multiple separate ratings.

As to the Veteran's claim, the Board finds the AOJ committed a pre-decisional duty to assist error and a remand is required to correct this error prior to adjudication of the Veteran's claim.

The Board finds the February 2025 VA examination evaluating the residuals of the Veteran's TBI to be inadequate. Specifically, the VA examiner determined there were no complaints of impairment of memory, attention, concentration, or executive functions. However, the Veteran has consistently complained of concentration issues. See VA treatment records from March 2022, March 2007, January 2024, and private examinations from August 2023 and October 2024. Despite the above evidence, the February 2025 VA examiner did not explain or rationalize how such complaints could be noted in the Veteran's medical records and yet not be noted on the examination. The VA examiner also determined the Veteran had no neurobehavioral effects. However, the Veteran has consistently reported a lack of motivation. See VA treatment records from January 2002 and March 2023, February 2022 Board hearing transcript, and private examinations from August 2023 and October 2024. Moreover, the examiner did not address the Veteran's medical history showing tinnitus, visual impairment, dizziness, or depression in Section III of the examination. Considering the above evidence and lack of explanation in the VA examination, the Board finds the 2020 VA examination to be inadequate. Consequently, the Board finds the AOJ committed a pre-decisional duty to assist error when it relied on an inadequate VA examination. Accordingly, the Board finds that a remand for a new VA
behavioral effects. However, the Veteran has consistently reported a lack of motivation. See VA treatment records from January 2002 and March 2023, February 2022 Board hearing transcript, and private examinations from August 2023 and October 2024. Moreover, the examiner did not address the Veteran's medical history showing tinnitus, visual impairment, dizziness, or depression in Section III of the examination. Considering the above evidence and lack of explanation in the VA examination, the Board finds the 2020 VA examination to be inadequate. Consequently, the Board finds the AOJ committed a pre-decisional duty to assist error when it relied on an inadequate VA examination. Accordingly, the Board finds that a remand for a new VA examination that considers the entirety of the evidence of record is required prior to adjudication of the claim.

The Board notes that the Veteran was provided an additional VA examination for residuals of TBI in January 2026 in connection with a separate claim. However, the Board finds that this examination is inadequate as well. Again, the VA examiner determined there were no complaints of impairment of memory, attention, concentration, or executive functions. However, the examiner did not address the Veteran's complaints of concentration issues in his medical records nor did the examiner and this finding contradicts the Veteran's report during the examination that his ability to organize his thoughts and activities is greatly impaired and he has difficulties completing tasks and staying on target. Furthermore, the examiner did not address the Veteran's medical history showing tinnitus, visual impairment, dizziness, or depression in Section III of the examination. The examiner noted the Veteran does not have an additional mental health disorder, which is inconsistent with his diagnosis of depression.

The Veteran submitted a private examination completed in October 2024. However, this examination does not provide medical findings or an opinion related to the Veteran's TBI outside of his psychological disabilities, which are comorbid conditions and are now service-connected. The examiner notes that the Veteran reported additional symptoms including loss of consciousness, attention issues, changes in vision, dizziness, word-finding difficulties, confusion, difficulty focusing, double or blurred vision, difficulty reading, sensitivity to light, loss of visual field, difficulty with written and verbal communication, difficulty concentrating, and nervousness. However, the examiner did not reach a medical determination as to whether these symptoms are residuals of the Veteran's TBI, and if so, whether they are separable from the Veteran's headache disability and acquired psychiatric disorders.

The Veteran also underwent a private examination in August 2023. The examiner determined the Veteran had a score of 2 under Subjective symptoms and a score of 2 under Neurobehavioral effects that frequently interfere with workplace interaction, social interaction, or both. The examiner noted the evidence to support this finding includes the Veteran's work history and his frequent moves, including to Main and Alaska, "which are known to be favored by 'end of roaders.'" The examiner also noted that the record documents a nearly constant presence of headaches. The August 2023 opinion is inadequate as the examiner's rationale is not supported by medical evidence and is conclusory. The examiner did not address comorbid disabilities and whether the Veteran's symptoms are separable nor did the examiner address the symptomology that contributes specifically to the Veteran's interference with workplace and/or social interactions.

Where it is unclear if the symptoms are separable, a medical opinion is necessary to determine if the overlapping symptom(s) can be clearly attributable to either the overlapping conditions or as a residual of a TBI.

Accordingly, a new VA examination is warranted for clarification of the nature and severity of the residuals associated with the Veteran's TBI and whether any of the Veteran's symptoms are overlapping with his brain injury residuals is warranted.

TDIU

The Board has granted service connection for the Veteran's acquired psychiatric disorders and has remanded the claim for an increased rating for residuals of TBI.

The Veteran's TDIU claim is inextricably intertwined with the remanded matters. See Harris v. Derwinski, 1 Vet. App. 181 (1991) (two or more issues are inextricably intertwined if one claim could have significant impact on the other). Therefore, this matter must also be remanded.

The matters are REMANDED for the following action:

1. Schedule the Veteran for examination(s) by appropriate clinician(s) to determine the current severity of his service-connected residuals of TBI. The AOJ shall specifically consider whether any manifestations can be separately evaluated under another Diagnostic Code, to include whether any manifestations of TBI overlap with manifestations of a comorbid mental, neurologic, or physical disorder. All examinations necessary to accurately determine the Veteran's full disability picture should be obtained.

(a.) If necessary, conduct separate mental disorder and headaches examinations. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating
could have significant impact on the other). Therefore, this matter must also be remanded.

The matters are REMANDED for the following action:

(b.) If necessary, perform complete and thorough neuropsychological testing.

(c.) The examiner should specifically discuss whether the Veteran has any TBI manifestations that are clearly separate from his symptoms of acquired psychiatric disorder (including mild neurocognitive disorder, depressive disorder, anxiety disorder, and insomnia disorder) and migraines/headaches. He/she should specifically discuss the Veteran's cognitive impairment, and whether he has neurological symptoms which are due to the TBI and are not part of the acquired psychiatric disorders.

(d.) The examiner(s) should provide full descriptions of the residuals of TBI and report all signs and symptoms necessary for evaluating the residuals of TBI under the rating criteria.

(e.) If an opinion cannot be rendered without resorting to speculation, the examiner must fully explain why.?

2. Upon completion of the above development, adjudicate the claim for entitlement to a TDIU.

SHAUN S. SPERANZA

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Magiros, Kristen N.

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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