MIGRAINE

B. MULLINS · 2025 · Case ID: A25098547

GRANTED

Summary

The veteran, who honorably served in the U.S. Army from January 1988 to September 1992, appeals the denial of service connection for migraines and erectile dysfunction (ED), both claimed as secondary to his service-connected PTSD with alcohol and opioid use disorder in remission. The Board granted both claims. For migraines, the veteran submitted a private medical report concluding it was as likely as not that his PTSD aggravated his migraines, citing studies linking PTSD and substance abuse to migraines. The VA examiner found migraines less likely than not caused by toxic exposures and noted a significant time gap since service, but confirmed the diagnosis. The Board found the private opinion persuasive, noting the lack of contrary medical opinion and applying the benefit of the doubt, granting service connection for migraines. For ED, the veteran claimed it was caused by his service-connected PTSD and its treatment medication. The Board found the evidence in approximate balance, granting the claim by applying the benefit of the doubt. The VA examiners opined it was less likely than not that PTSD or toxic exposures caused ED, with one noting insufficient evidence and another finding no scientific link between toxic exposures and ED, and that medication effects were not considered. However, a private physician concluded it was as likely as not that PTSD and lithium treatment caused the ED, citing the impact of PTSD on the nervous system and literature linking lithium to ED. The Board found the evidence equally balanced, thus granting service connection for ED secondary to PTSD and its treatment.

Rationale

Private medical opinion found as likely as not that PTSD aggravated migraines.; VA examiner found migraines less likely than not caused by toxic exposures.; Board found private opinion persuasive due to lack of contrary medical opinion and applied benefit of doubt.

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

241107-490590

Full Decision Text

Citation Nr: A25098547
Decision Date: 11/13/25 Archive Date: 11/13/25

DOCKET NO. 241107-490590
DATE: November 13, 2025

ORDER

Entitlement to service connection for migraines to include as secondary to post traumatic stress disorder (PTSD) with alcohol and opioid use disorder in remission in controlled environment is granted.

Entitlement to service connection for erectile dysfunction (ED) to include as secondary to PTSD with alcohol and opioid use disorder in remission in controlled environment is granted.

FINDINGS OF FACT

1. The competent evidence of record shows that the Veteran's service-connected PTSD with alcohol and opioid use disorder in remission in controlled environment aggravated the Veteran's migraines.

2. The competent evidence of record shows that the Veteran's service-connected PTSD with alcohol and opioid use disorder in remission in controlled environment, and the medication prescribed to treat that condition, caused the Veteran's ED.

CONCLUSIONS OF LAW

1. The criteria for establishing entitlement to service connection for migraines to include as secondary to PTSD with alcohol and opioid use disorder in remission in controlled environment have been met. 38 U.S.C. §§ 1110, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

2. The criteria for establishing entitlement to service connection for ED to include as secondary to PTSD with alcohol and opioid use disorder in remission in controlled environment have been met. 38 U.S.C. §§ 1110, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served honorably in the United States Army from January 1988 to September 1992. Among his awards the Veteran received the National Defense Service Medal and the Army Achievement Medal with one Oak Leaf Cluster.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from two March 2024 rating decisions issued by a Department of Veterans Affairs (VA) regional office (RO).

In the November 7, 2024, VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Evidence Submission docket.

Therefore, the Board may only consider the evidence of record at the time of the March 2024 decision and the March 2023 agency of original jurisdiction (AOJ) decision which was subsequently subject to higher-level review, as well as any evidence submitted by the Veteran [or representative] with, or within 90 days from receipt of, the VA Form 10182. 38 C.F.R. § 20.303. If evidence was submitted either (1) during the period after the AOJ issued the decision, which was subsequently subject to higher-level review and prior to the date the Board received the VA Form 10182, or (2) more than 90 days following the date the Board received the VA Form 10182, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.303, 20.801.

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

The Board finds that the Veteran, through his representative, amended his November 2024 VA Form 10182 by way of a December 2024 correspondence. In the correspondence, the Veteran's representative indicated that the Veteran requested that his appeal be processed on the Evidence Docket instead of the Direct Docket. The Veteran also specified that he wished to appeal the issues entitlement to service connection for migraines and entitlement to service connection for ED.

Service connection.

Service connection is warranted where the evidence of record establishes that a particular injury or disease resulting in disability was incurred in the line of duty in the active military service or, if pre-existing such service, was aggravated thereby. 38 U.S.C. § 1110, 1131; 38 C.F.R. § 3.303 (a).

Establishing service connection generally requires (1) evidence of a current disability; (2) evidence of in-service incurrence or aggravation of a disease or injury; and (3) evidence of a nexus between the claimed
ocket. The Veteran also specified that he wished to appeal the issues entitlement to service connection for migraines and entitlement to service connection for ED.

Service connection.

Establishing service connection generally requires (1) evidence of a current disability; (2) evidence of in-service incurrence or aggravation of a disease or injury; and (3) evidence of a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F. 3d 1163, 1167 (Fed. Cir. 2004); see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd per curiam, 78 F. 3d 604 (Fed. Cir. 1996) (table); 38 C.F.R. § 3.303.

Service connection may also be granted for any disease diagnosed after the military discharge, when all the evidence, including that pertinent to the period of military service, establishes that the disease was incurred during the active military service. 38 U.S.C. § 1113 (b); 38 C.F.R. § 3.303 (d).

Service connection may also be established on a secondary basis for a disability which is proximately due to, or aggravated by, a service-connected disease or injury. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.310. In order to prevail on the theory of secondary service connection, there must be evidence of a current disability; evidence of a service-connected disability; and evidence establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998).

In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether evidence persuasively weighs against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded to the Veteran.

1. Entitlement to service connection for migraines is granted.

The Veteran contends that he is entitled to service connection for migraines as secondary to PTSD with alcohol and opioid use disorder in remission in controlled environment. Specifically, the Veteran contends that his migraine headaches have been aggravated by his service-connected PTSD with alcohol and opioid use disorder in remission in controlled environment. Having carefully reviewed the evidence of record, and considering all pertinent laws and regulations, the Board finds that the Veteran's contention is warranted.

As stated previously, secondary service connection requires a showing of a current disability, evidence of a service-connected disability, and evidence establishing a connection between the service-connected disability and the current disability. The March 2024 rating decision acknowledged a diagnosis of migraine headaches. Further, the Veteran's psychiatric condition was found to be service-connected by way of a September 2021 rating decision. Thus, the remaining issue to be decided is whether there is a causal connection between the Veteran's migraines and his service-connected PTSD with alcohol and opioid use disorder in remission in controlled environment.

The Veteran was afforded a VA examination in March 2024. Addressing the Veteran's in-service toxic exposures, the examiner found that it is less likely than not that the Veteran's migraines were caused by the Veteran's toxic exposures considering the total potential exposure through all military deployments and the synergistic, combined effect of all toxic exposure risk activities of the Veteran. The examiner confirmed the diagnosis of migraine headaches. Further, the examiner cited to the large gap in time between the Veteran's in-service exposures and the development of the Veteran's headaches. The examiner reasoned that headaches which were caused by toxic exposure would be expected to arise at a point in time closer to the time of the exposure.

The Veteran submitted a July 2024 private medical report in support of his claim. The private physician confirmed the diagnosis migraine headaches. The physician cited to several medical studies which discuss the relationship between migraine headaches and PTSD accompanied by substance abuse. Based on a thorough review of the medical evidence of record, the physician concluded that it is as likely as not that the
exposure risk activities of the Veteran. The examiner confirmed the diagnosis of migraine headaches. Further, the examiner cited to the large gap in time between the Veteran's in-service exposures and the development of the Veteran's headaches. The examiner reasoned that headaches which were caused by toxic exposure would be expected to arise at a point in time closer to the time of the exposure.

The Veteran submitted a July 2024 private medical report in support of his claim. The private physician confirmed the diagnosis migraine headaches. The physician cited to several medical studies which discuss the relationship between migraine headaches and PTSD accompanied by substance abuse. Based on a thorough review of the medical evidence of record, the physician concluded that it is as likely as not that the Veteran's service-connected PTSD with alcohol and opioid use disorder in remission in controlled environment worsened the symptomatology and disability arising from the Veteran's migraine headaches.

The Board acknowledges the Veteran's statements and medical literature submitted in support of his claim. The Board finds the Veteran is competent to testify as to his symptomatology, the onset of his symptomatology, and the treatment he sought. A Veteran is competent to report on that of which he has personal knowledge. Layno v. Brown, 6 Vet. App. 465, 470 (1994). However, the Veteran is not competent to opine as to the etiology of his migraine headaches. The issue of causation is a medical determination outside the realm of common knowledge of a lay person. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007).

Considering the July 2024 private medical opinion and the fact that there is no medical report opining against service connection for migraines as secondary to the Veteran's service-connected PTSD with alcohol and opioid use disorder in remission in controlled environment, the evidence is persuasively in favor of service connection for migraine headaches to include as secondary to PTSD with alcohol and opioid use disorder in remission in controlled environment. Accordingly, resolving all reasonable doubt in favor of the Veteran, service connection for migraines to include as secondary to PTSD with alcohol and opioid use disorder in remission in controlled environment is warranted. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

2. Entitlement to service connection for ED to include as secondary to PTSD with alcohol and opioid use disorder in remission in controlled environment is granted.

The Veteran contends that his PTSD with alcohol and opioid use disorder in remission in controlled environment and the medication prescribed to treat that condition led to the development of ED. Having carefully reviewed the evidence of record, and considering all pertinent laws and regulations, the Board finds that the Veteran's contention is warranted.

As stated previously, secondary service connection requires a showing of a current disability, evidence of a service-connected disability, and evidence establishing a connection between the service-connected disability and the current disability. The March 2024 rating decision acknowledged a diagnosis of ED. Further, the Veteran's psychiatric condition was found to be service-connected by way of a September 2021 rating decision. Thus, the remaining issue to be decided is whether there is a causal connection between the Veteran's ED and his service-connected PTSD with alcohol and opioid use disorder in remission in controlled environment and the medication used to treat that condition.

The VA conducted a review of the claim file in November 2022. The examiner reviewed the evidence of record and concluded that it is less likely than not that the Veteran's service-connected PTSD with alcohol and opioid use disorder in remission in controlled environment caused the Veteran's ED. The examiner indicated that ED can have many causes, including medications and psychiatric conditions. However, in the case at hand, the examiner found that there was insufficient evidence to identify the etiology of the Veteran's ED.

The VA conducted another review of the claim file in March 2023. The examiner reviewed the evidence of record and opined that it is less likely than not that the Veteran's ED was caused by the Veteran's in-service toxic exposure risk activities considering the total potential exposure through all applicable deployments of the Veteran and the synergistic, combined effect of all toxic exposure risk activities of the Veteran. The examiner found that there is no scientific evidence that notes a relationship between the development of ED and participation in toxic exposure risk activities.

The VA conducted a review of the evidence of record in March 2024. The examiner opined that it is less likely than not that the Veteran's PTSD with alcohol and opioid use disorder in remission in controlled environment aggravated the Veteran's ED. The examiner found that the medical records did not show that the Veteran's psychiatric condition caused a worsening of
is less likely than not that the Veteran's ED was caused by the Veteran's in-service toxic exposure risk activities considering the total potential exposure through all applicable deployments of the Veteran and the synergistic, combined effect of all toxic exposure risk activities of the Veteran. The examiner found that there is no scientific evidence that notes a relationship between the development of ED and participation in toxic exposure risk activities.

The Veteran submitted a July 2024 private medical report in support of his claim. The physician found that the Veteran suffers from ED. Further, the physician opined that it is as likely as not that the Veteran's ED was caused, in significant part, by the Veteran's service-connected PTSD with alcohol and opioid use disorder in remission in controlled environment and the medication used to treat that condition, lithium carbonate. In support of his position, the physician reasoned that PTSD stems from dysregulation of the sympathetic and parasympathetic parts of the nervous system, the same parts of the nervous system which play a large role in sexual response. Accordingly, an affliction which affects the sympathetic and parasympathetic parts of the nervous system, such as PTSD, also affects sexual response which could, in turn, result in the development of ED. The physician also found that medical literature confirms a correlation between the use of lithium and the development of ED. Specifically, the physician indicated the use of lithium results in an increased risk for developing ED.

The Board acknowledges the Veteran's statements, arguments, and lay evidence submitted in support of his claim. To the extent that the Veteran's statements describe the Veteran's symptoms and their onset, the Board finds these statements credible. A Veteran is competent to report on that of which he or she has personal knowledge. Layno v. Brown, 6 Vet. App. 465, 470 (1994). However, the Veteran is not competent to opine as to the etiology of his ED. The issue of causation is a medical determination outside the realm of common knowledge of a lay person. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007).

When the VA reports of record are balanced against the July 2024 private medical report, the evidence is, at a minimum, equally balanced on this issue. As such, the Board finds the evidence is at least in approximate balance as to whether the Veteran's service-connected PTSD with alcohol and opioid use disorder in remission in controlled environment and the medication prescribed to treat that condition contributed to the development of the Veteran's ED. Accordingly, resolving all reasonable doubt in favor of the Veteran, service connection for ED as secondary PTSD with alcohol and opioid use disorder in remission in controlled environment is warranted. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

B. MULLINS

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Litts, Norman W. Jr

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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