MIGRAINE

Summary

The Veteran, an Army Veteran who served from July 2018 to February 2022, appeals a denial of service connection for headaches, also claimed as migraines, and a remand for a left shoulder disability. The Veteran initially appealed to the Board of Veterans' Appeals (Board) via VA Form 10182. The Board noted a subsequent Supplemental Claim filing but confirmed its jurisdiction due to the earlier Board appeal. The Veteran claimed headaches were due to toxic exposure risk activities (TERA) and secondary to tinnitus. VA medical opinions found it less likely than not that headaches were service-related or due to TERA. However, the Board found a favorable diagnosis for headaches from the AOJ and existing service connection for tinnitus. A private physician's opinion in November 2024 concluded it was at least as likely as not that the headaches were caused by the service-connected tinnitus, citing increased neural activity and stress as potential precursors. The Board found this private opinion dispositive, granting service connection for headaches based on the approximate balance of evidence and the benefit of the doubt. The claim for a left shoulder disability was remanded due to a pre-decisional duty to assist error, requiring a new medical examination and opinion to determine the etiology, considering the Veteran's assertion of in-service onset related to weightlifting and exercise.

Rationale

Favorable diagnosis for headaches from AOJ; Existing service connection for tinnitus; Private opinion found headaches likely caused by tinnitus

Full Decision Text

Citation Nr: A26001255
Decision Date: 01/07/26	Archive Date: 01/07/26

DOCKET NO. 241021-483658
DATE: January 7, 2026

ORDER

Entitlement to service connection for headaches (also claimed as migraines) is granted.

REMANDED

Entitlement to service connection for a left shoulder disability is remanded.

FINDING OF FACT

The Veteran's headaches (also claimed as migraines) are due to his service-connected tinnitus.

CONCLUSION OF LAW

The criteria for service connection for headaches (also claimed as migraines) as secondary to tinnitus are met.  38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.310.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty in the United States Army from July 2018 through February 2022.

This case is before the Board of Veterans' Appeals (Board) on an appeal from an October 2024 rating decision issued by the Agency of Original Jurisdiction (AOJ). 

In October 2024, the Veteran submitted a VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement). The Veteran selected the evidence submission docket.

Therefore, the Board may only consider the evidence of record at the time of the October 2024 AOJ decision on appeal, as well as any evidence submitted by the Veteran 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 on appeal 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, 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 claim of a left shoulder disability, any evidence the Board could not consider will be considered by the AOJ in the adjudication of that claim. 38 C.F.R. § 3.103(c)(2)(ii).

The Board notes that in November 2024, the Veteran submitted a VA Form 20-0995, Decision Review Request: Supplemental Claim (Supplemental Claim), regarding the same issues of entitlement to service connection for headaches and a left shoulder disability. 

A claimant is only entitled to elect review under one of the possible review methods: A Supplemental Claim via VA Form 20-0995, Higher Level Review via VA Form 20-0996, or appeal to the Board via VA Form 10182.  38 U.S.C. § 5104C; 38 C.F.R. § 3.2500(b). Concurrent elections are prohibited.  See Terry v. McDonough, 37 Vet. App. 1, 14 (2023).  As the subsequent VA Form 20-0995, Decision Review Request, Supplemental Claim, was a concurrent election, the AOJ did not accept or adjudicate the claim.  However, the Board is not precluded from adjudicating the issue, as the VA Form 10182 was filed first and the Board still has proper jurisdiction over the appeal.

Entitlement to service connection for headaches (also claimed as migraines) is granted.

The Veteran contends that he is entitled to service connection for his headaches under several theories. The Veteran has stated that his headaches were the result of toxic exposure risk activities (TERA). Additionally, the Veteran has stated that his headaches are related to his tinnitus.

In July 2024, VA obtained medical opinions regarding whether the Veteran's headaches were directly related to the Veteran's service, and whether the Veteran's headaches were the result of TERA. The examiner opined that it is less likely than not that the Veteran's headaches were incurred in or caused by his military service. The examiner also opined that it is less likely than not that the Veteran's headaches were caused by the Veteran's conceded TERA. 

Service connection on a secondary basis requires
 Veteran contends that he is entitled to service connection for his headaches under several theories. The Veteran has stated that his headaches were the result of toxic exposure risk activities (TERA). Additionally, the Veteran has stated that his headaches are related to his tinnitus.

In July 2024, VA obtained medical opinions regarding whether the Veteran's headaches were directly related to the Veteran's service, and whether the Veteran's headaches were the result of TERA. The examiner opined that it is less likely than not that the Veteran's headaches were incurred in or caused by his military service. The examiner also opined that it is less likely than not that the Veteran's headaches were caused by the Veteran's conceded TERA. 

Service connection on a secondary basis requires (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) establishing that the service-connected disability either (a) caused, or (b) aggravated, the nonservice-connected disability. 38 C.F.R. § 3.310; Spicer v. McDonough, 61 F.4th 1360 (Fed. Cir. 2023) (invalidating the requirement of "proximate cause" and instead held a "but for" causation for aggravation is enough to show entitlement to secondary service connection).

In the October 2024 rating decision, the AOJ made a favorable finding of a disability diagnosis. The Board is bound by this favorable finding. 38 C.F.R. § 3.104. Further, in February 2023, the Veteran was service connected for tinnitus. Therefore, the only remaining question is whether the Veteran's service-connected tinnitus has caused or aggravated the Veteran's headaches.

In November 2024, the Veteran submitted a private opinion from a certified physician assistant. In November 2024, the certified physician assistant opined that it is at least as likely as not that the Veteran's headaches are caused by his service-connected tinnitus. In reaching this opinion, the certified physician assistant discussed that the Veteran's tinnitus has likely led to increased neural activity and stress, which can contribute to a state of hyperexcitability in the brain, which is a known precursor for migraine development. The certified physician assistant also discussed that the brain's response to the continuous noise of tinnitus can lead to alterations in the central nervous system, affecting pain perception and processing, which can manifest as headaches or migraines. 

The certified physician assistant also discussed that the Veteran's tinnitus may serve as a chronic stressor for migraines. The certified physician assistant continued by discussing that the constant ringing can lead to increased stress and anxiety, both of which are well-documented migraine triggers. 

Here, the November 2024 private nexus opinion was provided by a medical professional who possesses the necessary education, training, and expertise to provide the opinion.  Additionally, the opinion is based on the complete medical history of the Veteran and a review of the Veteran's record. The opinion is also accompanied by a sufficient explanation as to why the Veteran's headaches are caused by his service-connected tinnitus.  Furthermore, there is no competing medical opinion of record regarding secondary causation.  The Board thus finds that the November 2024 private opinion is dispositive of the issue at hand.

Accordingly, the Board finds that the approximate balance of the evidence is for the claim, and entitlement to service connection for headaches is warranted. 38 U.S.C. § 5107 (b); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

REASONS FOR REMAND

Entitlement to service connection for a left shoulder disability is remanded.

The issue of entitlement to service connection for a left shoulder disability is remanded to correct a pre-decisional duty to assist error.

Here, the Veteran contends that his left shoulder disability began in service. Specifically, the Veteran noted on his June 2024 VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits, that he began experiencing shoulder pain in service, which he correlated with lifting weights and exercising while on active duty. 

The Board notes that lifting weights and exercising is entirely consistent with the circumstances of service for an enlisted servicemember on active duty. Further, the Veteran has consistently indicated that his left shoulder disability began in service. 

On remand, a medical examination and opinion should be obtained that includes a complete rationale regarding the etiology of the Veteran's left shoulder disability. The rationale should consider the Veteran's contention that his left shoulder disability began while lifting weights and exercising when he was on active duty.

The matter is REMANDED for the following action:

1. The AOJ should obtain a medical examination and opinion from an appropriate clinician to determine the etiology of the Veteran's left shoulder disability.

The examiner is requested to review all pertinent records associated with the claims file, including
 weights and exercising is entirely consistent with the circumstances of service for an enlisted servicemember on active duty. Further, the Veteran has consistently indicated that his left shoulder disability began in service. 

On remand, a medical examination and opinion should be obtained that includes a complete rationale regarding the etiology of the Veteran's left shoulder disability. The rationale should consider the Veteran's contention that his left shoulder disability began while lifting weights and exercising when he was on active duty.

The matter is REMANDED for the following action:

1. The AOJ should obtain a medical examination and opinion from an appropriate clinician to determine the etiology of the Veteran's left shoulder disability.

The examiner is requested to review all pertinent records associated with the claims file, including the Veteran's service treatment records, post-service medical records, and assertions.

The examiner should note that the Veteran is competent to attest to matters of which he has first-hand knowledge, including observable symptomatology.  If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation.

The examiner should opine as to whether it is at least as likely as not that the Veteran's left shoulder disability is causally or etiologically related to his military service, to include any injury or symptomatology therein.

In rendering this opinion, the examiner must address the Veteran's contention that his left shoulder disability began while lifting weights and exercising when he was on active duty.

A complete rationale for any opinion should be provided. 

 

I. Cannaday

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Schoettmer, Matthew S.

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.