MIGRAINE

NATHANIEL DOAN · 2026 · Case ID: 26001001

GRANTED

Summary

The Veteran, a Veteran who served from July 1986 to July 1989, appeals the denial of service connection for migraines and obstructive sleep apnea (OSA). The Veteran sought service connection for migraines directly, citing jet fuel exposure during service, or secondarily due to tinnitus and a psychiatric disorder. For OSA, the Veteran claimed it was due to tinnitus and/or a psychiatric disorder. The Board found the evidence in equipoise for both conditions, applying the benefit of the doubt doctrine to grant service connection. For migraines, the Board noted the Veteran's credible, internally consistent lay statements of onset during service, despite no treatment at the time and a negative VA nexus opinion. The Board found the Veteran's reports of headaches during service, coupled with jet fuel exposure and later medical literature linking jet fuel to neurological effects, sufficient to grant service connection. For OSA, the Board relied on the Veteran's credible, internally consistent lay statements of sleep walking, snoring, and breathing cessation during service, despite no in-service treatment and negative VA nexus opinions. The Board found the evidence in equipoise, granting service connection for OSA. The Veteran's service records were not explicitly discussed in terms of their status.

Rationale

Credible lay statements of onset during service; Evidence in equipoise; Benefit of the doubt applied

Special Benefit

NO SPECIAL BENEFIT

Docket No.

16-09 872

Full Decision Text

Citation Nr: 26001001
Decision Date: 01/28/26 Archive Date: 01/28/26

DOCKET NO. 16-09 872
DATE: January 28, 2026

ORDER

Entitlement to service connection for migraine headaches (hereafter migraines) is granted.

Entitlement to service connection for obstructive sleep apnea (OSA) is granted.

FINDINGS OF FACT

1. Affording the Veteran all reasonable doubt, his migraines onset during service.

2. Affording the Veteran all reasonable doubt, his OSA had its onset during service.

CONCLUSIONS OF LAW

1. The criteria for service connection for migraines have been met. 38 U.S.C.

§§ 1131, 5107; 38 C.F.R. §§ 3.303.

2. The criteria for service connection for OSA have been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from July 1986 to July 1989.

The issue of migraines is before the Board of Veterans' Appeals (Board) on appeal from a July 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO).

The issue of OSA is before the Board on appeal from an April 2017 rating decision.

The Veteran appeared for a Board hearing in February 2019 before the undersigned Veterans Law Judge. A copy of the transcript is associated with the record.

These matter were remanded by the Board in June 2019, January 2021, May 2021, August 2022, and August 2023 for additional development. These matters have now returned to the Board for appellate consideration. The Board finds there has been substantial compliance with its remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Further, the Board notes that the Board is granting the benefits sought on appeal, and therefore, any failure in this regard would not be prejudicial.

In the August 2015 appeal for service connection for migraines, the Veteran also appealed the issue of an increased rating for bilateral hearing loss, requesting a 10 percent disability rating. The only issue remaining on that appeal is that of migraines, as the other was granted in full, and the Veteran is now in receipt of a 20 percent disability rating, effective March 17, 2016.

In the June 2017 appeal for service connection for OSA, the Veteran also appealed the issue of service connection for depression with anxiety. The only issue remaining on that appeal is that of OSA, as the other issue was granted and the Veteran is now service connected for an acquired psychiatric disorder to include posttraumatic stress disorder with major depressive disorder, effective February 2, 2017.

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 or nearly equal-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.

1. Entitlement to service connection for migraines.

The Veteran seeks service connection for migraines, either on a direct basis, including due to exposure to jet fuel, or on a secondary basis due to his service-connected tinnitus and/or acquired psychiatric disorder. See November 2015 Statement in Support of Claim. As the Board is granting on a direct basis due to onset of symptoms during service, other theories of entitlements need not be discussed further herein.

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated during service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. In order to establish service connection on a direct basis, the record must contain: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden
2015 Statement in Support of Claim. As the Board is granting on a direct basis due to onset of symptoms during service, other theories of entitlements need not be discussed further herein.

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated during service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. In order to establish service connection on a direct basis, the record must contain: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

A January 2023 Toxic Exposure Risk Activity (TERA) Memorandum confirmed the Veteran was exposed to jet fuel during service.

The Veteran was diagnosed with migraines in 2014. See November 2014 Headaches Disability Benefits Questionnaire (DBQ). Additional VA examiners have also made the same diagnosis. Therefore, the first criteria for direct service connection is met.

Concerning the second element, the Veteran first sought treatment for his migraines in approximately 2014. Prior to that he self-medicated. The Veteran has consistently reported throughout treatment for migraines that they onset during service or within six months following service. See February 2022 VA examination report, February 2020 VA examination report, November 2014 examination report, February 2019 hearing transcript, November 2015 medical treatment record, and December 2016 neurology clinic note. Post-service medical treatment records show continual treatment for his migraine condition since 2014. The Board affords all of this evidence probative value, including the Veteran's credible lay statements of onset, chronicity and continuity.

The Veteran was afforded several VA examinations for his migraines. While none of them provide a positive nexus to service or find that his migraines were caused by a service-connected condition, the examiners make some noteworthy observations and conclusions. The April 2023 examiner found it "entirely plausible" that the Veteran experienced headaches during service due to extensive exposure to jet fuel, as well as within one year following separation from service, but the examiner concluded they would likely be acute headaches, not migraines. The examiner also noted that the Veteran's May 1989 separation exam did not report headaches.

The Veteran submitted medical literature in February 2019 that he asserts shows a relationship between exposure to jet fuel and migraine headaches. The March 2022 examiner acknowledged that jet fuel has been associated with neurologic effects to include headaches. Further, the examiner stated that symptoms of a headache condition would have begun in service during the time he was exposed to jet fuel. As previously detailed, the Veteran has in fact reported onset in service.

Regarding the third element, the Board notes that there is no positive nexus opinion for direct service connection for the Veteran's diagnosed migraines. However, there is evidence of record in support of this claim, to include the Veteran's lay reports of headaches during service, although he did not seek treatment at that time. Although the Veteran is not able to opine on the etiology of his migraines, he is competent to establish the onset and presence of observable symptomatology. See Barr v. Nicholson, 21 Vet. App. 303, 303 (2007). The Veteran's statements about the onset of his migraines are credible and entitled to probative weight, as they are internally consistent, although not reflected in service treatment records. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); Barr, 21 Vet. App. at 307-08; Washington v. Nicholson, 19 Vet. App. 362, 368 (2005); Layno v. Brown, 6 Vet. App. 465, 470 (1994).

In reaching the above conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. The Board finds the evidence of record is at least in equipoise as to whether the Veteran's migraines had their onset during service. Resolving all doubt in the Veteran's favor, therefore, the Board finds service connection for migraines is warranted on a direct basis. 38?U.S.C. §?5107; 38 C.F.R. §?3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

2. Entitlement to service connection for OSA.

The Veteran and his representative
, 470 (1994).

2. Entitlement to service connection for OSA.

The Veteran and his representative claim he is entitled to service connection for OSA and that his OSA is due to his tinnitus and/or acquired psychological disability. See July 2023 Appellate Brief and February 2019 hearing transcript.

The medical evidence of record shows that the Veteran has a current diagnosis of OSA. Such diagnosis was confirmed by the Veteran's medical treatment records, a sleep study from 2016, and VA clinicians.

The Veteran has consistently asserted that his symptoms of OSA onset in 1987 while he was in the Persian Gulf. He reports sleep walking, snoring, and that he would stop breathing. See January 2020 Sleep Apnea Disability Benefits Questionnaire. See also August 2022 medical treatment record.

The Veteran was afforded VA examinations in March 2017, January 2020, and February 2022, and VA has provided opinions and addendum opinions on direct and secondary opinions, some of which have previously been found to be inadequate by the Board. There is no positive nexus opinion of record. Examiners concluded his OSA is less likely than not incurred in or caused by service, less likely than not proximately due to or the result of the Veteran's service-connected conditions, that there is no evidence of aggravation due to his service-connected disabilities, and that his OSA is less likely than not caused by a toxic exposure risk activity (TERA).

Despite not having a positive medical opinion of record, there is evidence of record in support of this claim, to include the Veteran's lay reports of sleep walking, snoring, and breathing cessation during service, although he did not seek treatment at that time. Although the Veteran is not able to opine on the etiology of his OSA, he is competent to establish the onset and presence of observable symptomatology. See Barr v. Nicholson, 21 Vet. App. 303, 303 (2007). The Veteran's statements about the onset of his sleeping problems are credible and entitled to probative weight, as they are internally consistent, although not reflected in service treatment records. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); Barr, 21 Vet. App. at 307-08; Washington v. Nicholson, 19 Vet. App. 362, 368 (2005); Layno v. Brown, 6 Vet. App. 465, 470 (1994).

In reaching the above conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. The Board finds the evidence of record is at least in equipoise as to whether the Veteran's OSA had its onset during service. Resolving all doubt in the Veteran's favor, therefore, the Board finds service connection for OSA is warranted. 38?U.S.C. §?5107; 38 C.F.R. §?3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

Nathaniel Doan

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Scherba, Heather L.

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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