MIGRAINE

Summary

The veteran, who served from September 1981 to March 1990, appeals the denial of service connection for migraine headaches and erectile dysfunction. The Board granted service connection for migraine headaches on a presumptive basis, finding that the condition was noted in service with continuity of symptomatology. The veteran reported headaches following two in-service motor vehicle accidents in 1982 and 1985, which persisted and were documented in subsequent VA and private examinations. The Board found the veteran's lay statements credible and consistent with the record, giving them probative weight. For erectile dysfunction, the veteran claimed secondary service connection to his service-connected unspecified depressive disorder with insomnia. The Board found competent and credible evidence of a current diagnosis of erectile dysfunction. While VA examiners provided negative opinions, citing age and concomitant conditions as primary causes, the Board found these opinions deficient for failing to address aggravation by the psychiatric condition and for relying on an incomplete premise. A private physician's opinion, however, found a positive nexus, stating it was at least as likely as not that the erectile dysfunction was related to the psychiatric condition, considering the impact of depression and its treatment on sexual functioning. The Board found this private opinion more probative, leading to the grant of secondary service connection for erectile dysfunction.

Rationale

Migraine headaches noted in service; Continuity of symptomatology since service; Presumptive service connection met

Full Decision Text

Citation Nr: A25101158
Decision Date: 11/20/25	Archive Date: 11/20/25

DOCKET NO. 250129-513423
DATE:       November 20, 2025

ORDER

Service connection for migraine headaches is granted.

Service connection for erectile dysfunction is granted.

FINDINGS OF FACT

1. The Veteran's headaches were noted in service, with continuity of symptomatology since service that is attributable to the chronic disease.

2. The Veteran has erectile dysfunction related to his service-connected unspecified depressive disorder with insomnia. 

CONCLUSIONS OF LAW

1. The criteria for service connection for migraine headaches have been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

2. The criteria for service connection for erectile dysfunction have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from September 1981 to September 1985 and from December 1985 to March 1990.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a May 2024 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO).

In the January 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the direct review docket. Therefore, the Board may only consider the evidence of record at the time of the May 2024 agency of original jurisdiction (AOJ) decision on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 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, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a supplemental claim are included with this decision. 

1. Service connection for migraine headaches is granted.

The Veteran contends that he has migraine headaches related to his active service, or alternatively, related to his service-connected disabilities and the treatment thereof.

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004).

Service connection may also be warranted for a disability that is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Such secondary service connection is warranted for any increase in severity of a nonservice-connected disability that is proximately due to or the result of a service-connected disability. 38 C.F.R. § 3.310(b).

Certain chronic diseases will be presumed related to service if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service, with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013).

The Veteran has a current diagnosis of headaches and migraines as evidenced by March 2021, October 2021, and March 2024 VA examinations. Organic diseases of the nervous system, to include migraine headaches, are an enumerated condition under 38 C.F.R. § 3.309(a); Walker,
 symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013).

The Veteran has a current diagnosis of headaches and migraines as evidenced by March 2021, October 2021, and March 2024 VA examinations. Organic diseases of the nervous system, to include migraine headaches, are an enumerated condition under 38 C.F.R. § 3.309(a); Walker, 708 F.3d 1331; see also M21-1 VA Adjudication Procedures Manual (M21-1), V.iii.12.A.1.d.

The Board finds that the Veteran's migraine headaches were noted in service, with continuity of symptomatology since service. The record shows that the Veteran was in a motor vehicle accident during his active service in 1982. In the October 2021 VA examination, the examiner noted that the Veteran's migraine condition began with severe headaches after the 1982 accident. During a March 2020 private examination, the Veteran reported an onset of headaches following the accident, which headaches have persisted ever since. During VA treatment in November 2020 and in a May 2022 statement, the Veteran reported his headaches began following the car accident.

The Veteran was then in another motor vehicle accident during service in 1985. The police report of the accident indicates that the Veteran complained of head pain immediately following the accident. During VA treatment in November 2020, the Veteran noted having another accident in 1985, in which he sustained a head injury. In a May 2022 statement, the Veteran noted that he had an accident in 1985, in which his head impacted the windshield and caused a bad headache. In a May 2024 VA opinion, the examiner noted that the Veteran was in a motor vehicle accident in 1985, in which he developed posttraumatic headaches. The examiner then stated that it was well-documented in the previous examinations that the Veteran's headaches began after the motor vehicle accident in service in March 1985.

The Board finds that the Veteran continued to experience headaches and migraines during service to the present. The Veteran is competent to report having experienced symptoms of head pain during that period but stated that he did not seek treatment because he was afraid of losing his clearance and other harm to his military career. The Veteran's statements are credible and entitled to probative weight, as they are internally consistent and consistent with other evidence of record, including the police report and VA examination, which shows that these symptoms onset with his motor vehicle accidents and have persisted since.

The record contains multiple VA opinions finding that the Veteran's headaches and migraines were not at least as likely as not related to other service-connected conditions or due to in-service toxic substance exposure. However, none of these opinions addressed whether the Veteran's headaches or migraines were due to his in-service motor vehicle accidents. As such, they do not weigh against a finding that the Veteran's headaches began during service and manifested with continuity of symptomatology ever since. In fact, in opining that the Veteran's headaches were not due to in-service toxic substance exposure, the May 2024 VA examiner instead pointed to the Veteran's in-service motor vehicle accident as the cause of the Veteran's headaches. This weighs in favor of finding that the Veteran has experienced continuity of symptomatology since service that is attributable to his chronic migraines.

The Board finds that the evidence of record weighs persuasively in favor of finding that the Veteran's migraines were noted in service, with continuity of symptomatology since service that is attributable to the chronic disease. As such, the criteria for service connection on a presumptive basis are met, and the Veteran's claim is granted.

2. Service connection for erectile dysfunction is granted.

The Veteran contends that he has erectile dysfunction due to his service-connected unspecified depressive disorder.

Regarding the first element of service connection, the Board finds that the Veteran has a current diagnosis of erectile dysfunction. The Veteran was diagnosed with erectile dysfunction in November 2020, December 2020, October 2021, and March 2024 VA examinations and in a September 2020 private medical evaluation. Further, the Veteran has reported having erectile dysfunction, which he is competent to report. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007) (veterans are competent to report symptoms they experienced firsthand). Therefore, there is competent and credible evidence of a current diagnosis, and the first element of service connection is met.

Regarding the second element of service connection,
 of service connection, the Board finds that the Veteran has a current diagnosis of erectile dysfunction. The Veteran was diagnosed with erectile dysfunction in November 2020, December 2020, October 2021, and March 2024 VA examinations and in a September 2020 private medical evaluation. Further, the Veteran has reported having erectile dysfunction, which he is competent to report. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007) (veterans are competent to report symptoms they experienced firsthand). Therefore, there is competent and credible evidence of a current diagnosis, and the first element of service connection is met.

Regarding the second element of service connection, the Veteran was previously granted service connection for an unspecified depressive disorder with insomnia, effective October 3, 2018. Therefore, the second element of service connection on a secondary basis is met.

Regarding the third element of service connection, there is both positive and negative evidence regarding the causal relationship between the Veteran's erectile dysfunction and his service-connected psychiatric condition. The positive evidence of record includes a September 2020 private opinion, in which the clinician opined that it was at least as likely as not that the Veteran's erectile dysfunction was related to his service-connected psychiatric condition. The clinician noted that depression, anxiety, and erectile dysfunction are strongly associated conditions, regardless of other comorbidities. The clinician's report indicates that she considered the Veteran's lay statements regarding his symptomatology, reviewed his medical and military history, and researched relevant medical literature. As a certified physician's assistant, the clinician is competent to diagnose and provide etiological opinions regarding conditions such as erectile dysfunction. Therefore, the Board finds this opinion to be competent, credible, and of significant probative weight.

The record contains multiple negative VA opinions regarding the relationship between the Veteran's erectile dysfunction and his service-connected psychiatric condition; however, the Board finds these opinions to be of less probative weight than the September 2020 private opinion. 

In a December 2020 VA opinion, the examiner opined that the Veteran's erectile dysfunction was less likely than not proximately due to or the result of the Veteran's service-connected condition. The clinician noted that the Veteran had several concomitant medical conditions, to include obstructive sleep apnea, chronic pain, and mental health issues, and was taking medications. The clinician relied heavily on the Veteran's age, noting that age was the most predictive factor of erectile dysfunction. The examiner also relied on the fact that the Veteran's sexual arousal was a symptom of his depression and not a separate diagnosis. However, as noted above, the Veteran has a distinct diagnosis of erectile dysfunction. Thus, it was inaccurate for the examiner to characterize it as a symptom rather than a separate diagnosis. See Reonal v. Brown, 5 Vet. App. 458, 460-61 (1993) (medical opinions based on incomplete or inaccurate factual premise are not probative). 

Further, the examiner stated that age was the most predictive factor of erectile dysfunction, without considering the Veteran's specific circumstances and risk factors. The examiner noted the Veteran's concomitant medical conditions, many of which are service connected, but did not explain why his age was still a more accurate etiological cause than these conditions. When it is not possible to separate the effects of a service-connected condition and a non-service-connected condition, the benefit of the doubt requires that such symptoms be attributed to the service-connected condition. See Mittleider v. West, 11 Vet. App. 181, 182. However, the examiner concluded, without explanation, that age was the most likely cause of the condition.

Moreover, the examiner did not seem to consider whether the Veteran's erectile dysfunction was aggravated by his psychiatric condition, including whether the claimed disability would be less severe or result in less functional impairment but for the service-connected disability because the service-connected disability results in the inability to treat the claimed disability. See El Amin v. Shinseki, 26 Vet. App. 136, 140 (2013) (a medical opinion addressing secondary service connection must address both causation and aggravation). As the examiner did not consider the Veteran's specific circumstances and did not consider aggravation, to include due to treatment of the service-connected disability, the opinion does not contain sufficient detail. See D'Aries v. Peake, 22 Vet. App. 97, 104 (2008) (an opinion is inadequate where it does not describe the disability in sufficient detail so that the Board's evaluation will be a fully informed one). Therefore, this opinion is of little probative value to the Board.

In an October 2021 VA opinion, the examiner opined that the Veteran's erectile dysfunction was less likely than not proximately due to or the result of the Veteran's service-connected psychiatric condition
 address both causation and aggravation). As the examiner did not consider the Veteran's specific circumstances and did not consider aggravation, to include due to treatment of the service-connected disability, the opinion does not contain sufficient detail. See D'Aries v. Peake, 22 Vet. App. 97, 104 (2008) (an opinion is inadequate where it does not describe the disability in sufficient detail so that the Board's evaluation will be a fully informed one). Therefore, this opinion is of little probative value to the Board.

In an October 2021 VA opinion, the examiner opined that the Veteran's erectile dysfunction was less likely than not proximately due to or the result of the Veteran's service-connected psychiatric condition or tinnitus. The examiner stated that there was no medical pathophysiologic relationship between tinnitus and/or unspecified depressive disorder with insomnia causing or leading to erectile dysfunction since they are both anatomically different physiological systems. In a March 2024 VA opinion, the examiner opined that the Veteran's erectile dysfunction was less likely than not proximately due to or the result of the Veteran's service-connected psychiatric condition. The examiner noted that the Veteran reported that his erectile dysfunction began in his twenties and thirties and had been progressive. The examiner then stated that, although there is an association between depressive disorders and erectile dysfunction, studies have not shown depressive disorders to be a cause of erectile dysfunction.

These opinions do not consider whether the Veteran's erectile dysfunction was aggravated by his service-connected condition, including the treatment thereof. See El Amin, 26 Vet. App. at 140. Further, the October 2021 VA opinion relies on the premise that erectile dysfunction and depression are anatomically different physiological systems. However, in an article submitted with the September 2020 private opinion, the doctor noted that sexual desire is cultivated in the brain, and sex organs rely on chemicals in the brain to promote libido as well as the changes in blood flow needed for the sexual act. Thus, when depression disrupts these brain chemicals, it can make sexual activity more difficult. The article also noted that antidepressants often also have side effects on sexual functioning. The October 2021 VA examiner did not address how psychiatric conditions and the treatment thereof can impact brain chemicals and signals, which impact sexual functioning. 

The March 2024 VA examiner stated that studies have shown that there was an association, not a cause, between depressive disorders and erectile dysfunction. However, the examiner did not explain why the association shown in studies was not sufficient for a positive nexus opinion.

Based on the above deficiencies, the Board finds that the October 2021 and March 2024 VA opinions contain insufficient detail for the Board to make a fully informed decision. See D'Aries, 22 Vet. App. at 104. Therefore, the opinions are of little probative weight.

After considering the significant probative value of the September 2020 positive private opinion and the minimal probative value of the VA opinions of record, the Board finds that the evidence weighs persuasively in favor of finding the Veteran's erectile dysfunction is causally related to his service-connected psychiatric condition. As such, the third element of service connection is met.

As the elements of service connection have been met, the Veteran's claim for service connection for erectile dysfunction as secondary to his service-connected psychiatric condition is granted. 

 

M. Donohue

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	N. Keddington, Associate Counsel

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.