MIGRAINE

Summary

The veteran, who served from February 1994 to August 1995, appeals the denial of service connection for migraine headaches and hypertension. The Board reviewed new and relevant evidence submitted after the April 2016 rating decision, including a private physician's opinion and updated treatment records, which warranted readjudication of these claims. The Board found that the Veteran's migraine headaches were proximately related to his service-connected tinnitus, based on a private physician's opinion that cited medical literature supporting a nexus between tinnitus and migraines. The Board also found that the Veteran's hypertension was proximately related to his service-connected persistent depressive disorder with alcohol use disorder and insomnia, again relying on a private physician's opinion that cited medical literature linking depression to hypertension. The VA examiner's opinion regarding migraines was deemed not probative for the secondary connection issue. Service connection for both migraine headaches and hypertension was granted on a secondary basis.

Rationale

Current disability documented in treatment records.; Service-connected for tinnitus.; Private physician opinion found migraines at least as likely as not proximately due to service-connected tinnitus, citing medical literature.

Full Decision Text

Citation Nr: A25037550
Decision Date: 04/23/25	Archive Date: 04/23/25

DOCKET NO. 210628-168781
DATE: April 23, 2025

ORDER

New and relevant evidence has been submitted to warrant readjudication of the claim of entitlement to service connection for migraine headaches. 

New and relevant evidence has been submitted to warrant readjudication of the claim of entitlement to service connection for hypertension. 

Entitlement to service connection for migraine headaches is granted.

Entitlement to service connection for hypertension is granted.

FINDINGS OF FACT

1. The Veteran was denied entitlement to service connection for migraine headaches in an April 2016 rating decision. Evidence has been received subsequent to the April 2016 rating decision which tends to prove or disprove the issue of entitlement to service connection for migraine headaches and was neither redundant nor cumulative of evidence previously of record.

2. The Veteran was denied entitlement to service connection for hypertension in an April 2016 rating decision. Evidence has been received subsequent to the April 2016 rating decision which tends to prove or disprove the issue of entitlement to service connection for hypertension and was neither redundant nor cumulative of evidence previously of record.

3. The persuasive weight of the evidence is in support of a finding that the Veteran's migraine headaches were proximately related to his service-connected tinnitus.

4. The persuasive weight of the evidence is in support of a finding that the Veteran's hypertension was proximately related to his service-connected persistent depressive disorder with alcohol use disorder and insomnia.

CONCLUSIONS OF LAW

1. The criteria for readjudicating the claim of entitlement to service connection for migraine headaches have been met. 38 U.S.C. § 5108; 38 C.F.R. §§ 3.156(d), 3.2501, 19.2(a).

2. The criteria for readjudicating the claim of entitlement to service connection for hypertension have been met. 38 U.S.C. § 5108; 38 C.F.R. §§ 3.156(d), 3.2501, 19.2(a).

3. The criteria for entitlement to service connection for migraine headaches have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310.

4. The criteria for entitlement to service connection for hypertension have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had active service from February 1994 to August 1995.

This matter is on appeal from a May 2021 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO) which adjudicated the issues based on the evidence of record at the time of the decision. The Veteran subsequently filed a VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement) (NOD) in June 2021 in which the Veteran elected the Evidence Submission option. Accordingly, this decision has been written consistent with the Appeals Modernization Act (AMA) framework.

In this case, the Board may only consider the evidence of record at the time of the Agency of Original Jurisdiction (AOJ) decision on appeal, which is dated May 25, 2021, as well as any evidence submitted by the Veteran with, or within 90 days from receipt of, the VA Form 10182. See 38 C.F.R. § 20.303.

If evidence was associated with the claims file during a period when additional evidence was not allowed, the Board has not considered it in its decision. Id.

Initially, the Board notes that a claim of service connection encompasses all pertinent symptomatology, regardless of how that symptomatology is diagnosed. See Browkowski v. Shinseki, 23 Vet. App. 79 (2009); see also Grimes v. McDonough, 34 Vet. App. 84 (2021) (holding that "a claim for service connection may encompass a related condition that is initially referenced by the claimant but not diagnosed until later in the appeal stream"). In light of Browkowski, the Board has recharacterized the issue on appeal as reflected above. Id.

1. New and relevant evidence has been submitted to warrant readjudication of the claim of entitlement to service connection for migraine headaches.

2. New and relevant evidence has been submitted to warrant readjudication of the claim of entitlement to service connection for hypertension.

The Veteran asserts that he has submitted new and relevant evidence that warrants readjudication of
. 79 (2009); see also Grimes v. McDonough, 34 Vet. App. 84 (2021) (holding that "a claim for service connection may encompass a related condition that is initially referenced by the claimant but not diagnosed until later in the appeal stream"). In light of Browkowski, the Board has recharacterized the issue on appeal as reflected above. Id.

1. New and relevant evidence has been submitted to warrant readjudication of the claim of entitlement to service connection for migraine headaches.

2. New and relevant evidence has been submitted to warrant readjudication of the claim of entitlement to service connection for hypertension.

The Veteran asserts that he has submitted new and relevant evidence that warrants readjudication of the claims of entitlement to service connection for migraine headaches and hypertension. The Board has carefully reviewed the evidence of record and finds that the Veteran submitted new and relevant evidence to warrant readjudication of these claims. The reasons follow.

At any time after the claim has been adjudicated, the Veteran may request a readjudication of the same claim. See 38 C.F.R. § 3.156(d). A readjudication will be granted and the claim will be readjudicated, so long as the Veteran's request is supported by new and relevant evidence. Id.

Pursuant to the AMA, the provision pertaining to readjudicating previously denied claims through supplemental claims based on the new and material standard was amended and replaced. See 38 U.S.C. § 5108. Accordingly, under the AMA, "[i]f new and relevant evidence is presented or secured with respect to a supplemental claim, the Secretary shall readjudicate the claim taking into consideration all of the evidence of record." 38 U.S.C. § 5108(a).

"New evidence" means evidence not previously part of the actual record before agency adjudicators. 38 C.F.R. § 3.2501(a). "Relevant evidence" refers to any evidence that tends to prove or disprove a matter at issue, to include a theory of entitlement not previously addressed. Id.

The claims of entitlement to service connection for migraine headaches and hypertension were denied in an April 2016 rating decision. See April 2016 Rating Decision - Narrative. 

Since that time, the evidence of record contains medical opinions from a private physician assessing the nature and likely etiology of the Veteran's migraine headaches and hypertension. See June 2021 VA Form 10182 Notice of Disagreement. Moreover, treatment records were associated with the Veteran's claims file which contain additional and continued diagnoses of hypertension and migraine headaches. See March 2021 CAPRI. These treatment records and medical opinions were not part of the record when the April 2016 rating decision was issued and relate directly to establishing the existence of a current disability; a necessary element required to prove entitlement to service connection.

Given the above, the Board finds that new and relevant evidence has been received to readjudicate the claims of entitlement to service connection for migraine headaches and hypertension, and the application to have the claims readjudicated are therefore granted. Accordingly, the Board will proceed to a review of these issues on the merits.

Service Connection

In general, under the relevant laws and regulations, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. See 38 U.S.C. §§ 1110, 1131. Generally, the evidence must show: (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, also known as the "nexus" requirement. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010).

Service connection may also be granted for a disability which is proximately due to or the result of a service-connected disease or injury. See 38 C.F.R. § 3.310(a). A claim for secondary service connection generally requires competent evidence of a causal relationship between the service-connected disability and the nonservice-connected disease or injury. See Jones v. Brown, 7 Vet. App. 134 (1994). There must be (1) competent evidence of a current disability; (2) evidence of a service-connected disability; and (3) competent evidence of a nexus between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). 

In regard to aggravation, the United States Court of Appeals for the Federal Circuit has held that under the causation standard of 38 U.S.C. § 1110, secondary service connection is warranted where a non-service-connected disability would have been less severe but
 between the service-connected disability and the nonservice-connected disease or injury. See Jones v. Brown, 7 Vet. App. 134 (1994). There must be (1) competent evidence of a current disability; (2) evidence of a service-connected disability; and (3) competent evidence of a nexus between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). 

In regard to aggravation, the United States Court of Appeals for the Federal Circuit has held that under the causation standard of 38 U.S.C. § 1110, secondary service connection is warranted where a non-service-connected disability would have been less severe but-for a service-connected disability, either because there is an etiological link (to include worsening of functionality) between the two, or because the service-connected disability resulted in the inability to treat the non-service-connected disability. See Spicer v. McDonough, 61 F.4th 1360 (Fed. Cir. 2023).

As will be addressed below, the Board finds that entitlement to service connection for the Veteran's migraine headaches and hypertension is warranted on a secondary basis so the Board will not address direct service connection further herein.

3. Entitlement to service connection for migraine headaches.

The Veteran contends that he is entitled to service connection for his migraine headaches. Specifically, the Veteran asserts that his migraines were caused or aggravated by his service-connected tinnitus. The Board has carefully reviewed the record and finds the persuasive weight of the evidence supports a finding that the Veteran's migraine headaches were at least as likely as not associated with his service-connected tinnitus. The reasons follow.

As to a current disability, the Veteran's treatment records contain multiple notations indicating complaints and diagnoses of, as well as treatments for, migraine headaches. See March 2021 CAPRI. Moreover, VA has conceded the Veteran has been diagnosed with headaches. See September 2014 Rating Decision - Narrative. The Board may not disturb this favorable finding. See 38 C.F.R. §§ 3.104(c), 20.801(a). These diagnoses were made and continued during the pendency of this appeal and therefore the current disability element of secondary service connection has been met. See Wallin, 11 Vet. App. at 512.

In addition, relevant to this claim, the Veteran is service connected for tinnitus. See February 2021 Rating Decision - Narrative. Thus, the second element of secondary service connection, evidence of a service-connected disability, has been met. See Wallin, 11 Vet. App. at 512.

Therefore, the remaining question is whether there is a medical nexus demonstrating that the Veteran's migraine headaches were either caused or aggravated by his service-connected disabilities. As to this matter, the persuasive weight of the evidence supports such a nexus.

In January 2014 the Veteran was afforded a VA examination to assess the nature and etiology of his headaches. See January 2014 C&P Exam. At that time, the Veteran was diagnosed with migraine, including migraine variants. In the accompanying medical opinion, the VA examiner opined that it was "likely than not ... that the veteran's headaches have been caused by or accelerated beyond natural progression due to service." Id. The VA examiner initially noted that the Veteran had "a current normal exam and [treatment records] showing conservative treatment for headaches." Id. The VA examiner then opined that "[n]othing in the [Veteran's] file suggests a military origin to the headaches" and explained that this was "congruent with the medical literature." Id.

Notably, the January 2014 VA examiner provided an opinion only as to whether the Veteran's migraine headaches were directly related to his active service. The VA examiner did not otherwise provide an opinion, nor reasoning or rationale, as to whether the Veteran's service-connected tinnitus caused or aggravated his migraine headaches. The January 2014 opinion of the VA examiner is therefore of no probative value as to that issue.

In June 2021 the Veteran submitted a report from a private physician detailing the nature and likely etiology of the Veteran's migraine headaches. See June 2021 VA Form 10182 Notice of Disagreement. At that time, the private physician reported that the "Veteran is currently being treated for migraine headaches and has a long history of migraine." Id. In the accompanying medical opinion, the private physician initially explained that "[t]innitus can be associated with multiple types of headache disorders." Id. The private physician then cited to multiple studies which purported to demonstrate an association between tinnitus and headache conditions, including migraines. Finally, the private physician noted that the Veteran's headaches "started during a time when he had loud noise exposure and subsequently developing tinnitus symptoms." Id.; see also March 2021 Buddy/Lay Statement. The private physician
 the Veteran's migraine headaches. See June 2021 VA Form 10182 Notice of Disagreement. At that time, the private physician reported that the "Veteran is currently being treated for migraine headaches and has a long history of migraine." Id. In the accompanying medical opinion, the private physician initially explained that "[t]innitus can be associated with multiple types of headache disorders." Id. The private physician then cited to multiple studies which purported to demonstrate an association between tinnitus and headache conditions, including migraines. Finally, the private physician noted that the Veteran's headaches "started during a time when he had loud noise exposure and subsequently developing tinnitus symptoms." Id.; see also March 2021 Buddy/Lay Statement. The private physician therefore concluded that the Veteran's "migraine headache ... is at least as likely than not ... proximately due to or the result of the Veteran's service-connected conditions" as the "medical literature supports such a nexus." Id.

The Board finds the June 2021 opinion by the private physician adequate and probative because the physician reviewed the Veteran's medical file and discussed the relevant evidence, considered the contentions of the Veteran, and provided a supporting rationale for the conclusions reached, including citations to relevant medical literature. See Barr v. Nicholson, 21 Vet. App. 303 (2007); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007); Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). 

After careful consideration, the Board therefore finds that the persuasive weight of the evidence is in support of a finding that the Veteran's migraine headaches were related to his service-connected disabilities. The June 2021 opinion of the private physician contained rationale which indicated that the Veteran's migraine headaches were at least as likely as not caused or aggravated by his service-connected tinnitus. Notably, there is no probative evidence to the contrary. Accordingly, the Board finds that the persuasive weight of the evidence supports a finding that the Veteran's migraine headaches were related to his service-connected tinnitus and therefore the third element of service connection is established. See Wallin, 11 Vet. App. at 512. Thus, service connection is warranted.

4. Entitlement to service connection for hypertension.

The Veteran contends that he is entitled to service connection for his hypertension. Specifically, the Veteran asserts that his hypertension was caused or aggravated by his service-connected persistent depressive disorder with alcohol use disorder and insomnia. The Board has carefully reviewed the record and finds the persuasive weight of the evidence supports a finding that the Veteran's hypertension was at least as likely as not associated with the Veteran's service-connected disabilities. The reasons follow.

As to a current disability, the Veteran's treatment records contain multiple notations indicating complaints and diagnoses of, as well as treatments for, hypertension. See March 2021 CAPRI. Moreover, VA has conceded the Veteran has hypertension. See April 2016 Rating Decision - Narrative. The Board may not disturb this favorable finding. See 38 C.F.R. §§ 3.104(c), 20.801(a). These diagnoses were made and continued during the pendency of this appeal and therefore the current disability element of secondary service connection has been met. See Wallin, 11 Vet. App. at 512.

In addition, relevant to this claim, the Veteran is service connected for persistent depressive disorder with alcohol use disorder and insomnia. See March 2014 Rating Decision - Narrative. Thus, the second element of secondary service connection, evidence of a service-connected disability, has been met. See Wallin, 11 Vet. App. at 512.

Therefore, the remaining question is whether there is a medical nexus demonstrating that the Veteran's hypertension was either caused or aggravated by his service-connected disabilities. As to this matter, the persuasive weight of the evidence supports such a nexus.

In June 2021 the Veteran submitted a report from a private physician detailing the nature and likely etiology of the Veteran's hypertension. See June 2021 VA Form 10182 Notice of Disagreement. At that time, the private physician reported that the Veteran "suffers from high blood pressure." Id. In the accompanying medical opinion, the private physician initially noted that "individuals experiencing depression area at high risk for developing hypertension." Id. The private physician then cited to medical literature which found that "[d]epression increases the risk for uncontrolled hypertension." Id. The private physician therefore concluded that the Veteran's "high blood pressure is at least as likely than not ... proximately due to or the result of the Veteran's service-connected conditions" as the "medical literature supports such a nexus." Id.

The Board finds the June 2021 opinion by the private physician adequate and probative because the physician reviewed the Veteran's medical file and discussed the relevant evidence, considered the content
 reported that the Veteran "suffers from high blood pressure." Id. In the accompanying medical opinion, the private physician initially noted that "individuals experiencing depression area at high risk for developing hypertension." Id. The private physician then cited to medical literature which found that "[d]epression increases the risk for uncontrolled hypertension." Id. The private physician therefore concluded that the Veteran's "high blood pressure is at least as likely than not ... proximately due to or the result of the Veteran's service-connected conditions" as the "medical literature supports such a nexus." Id.

The Board finds the June 2021 opinion by the private physician adequate and probative because the physician reviewed the Veteran's medical file and discussed the relevant evidence, considered the contentions of the Veteran, and provided a supporting rationale for the conclusions reached, including citations to relevant medical literature. See Barr, 21 Vet. App. at 303; Stefl, 21 Vet. App. at 124; Nieves-Rodriguez, 22 Vet. App. at 301. 

After careful consideration, the Board therefore finds that the persuasive weight of the evidence is in support of a finding that the Veteran's hypertension was related to his service-connected disabilities. The June 2021 opinion of the private physician contained rationale which indicated that the Veteran's hypertension was at least as likely as not caused or aggravated by his service-connected persistent depressive disorder with alcohol use disorder and insomnia. Notably, there is no probative medical evidence to the contrary. Accordingly, the Board finds that the persuasive weight of the evidence supports a finding that the Veteran's hypertension was related to his service-connected persistent depressive disorder and therefore the third element of service connection is established. See Wallin, 11 Vet. App. at 512. Thus, service connection is warranted.

 

 

A. S. CARACCIOLO

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Doyle, Stephan C.

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.