MIGRAINE

L. CHU · 2026 · Case ID: 26003288

DENIED

Summary

The veteran, who served from July 1970 to April 1971, appeals the denial of service connection for migraine headaches and peripheral neuropathy of the bilateral lower and upper extremities. The veteran contends these conditions are related to in-service toxic exposure, specifically to jet fuel and fumes, and potentially Agent Orange. The Board found current diagnoses for these conditions, but the service treatment records were negative for any related complaints or findings. The veteran testified that her migraines began decades after service, and her peripheral neuropathy symptoms started about four years prior to a November 2023 VA examination. While the veteran mentioned potential Agent Orange exposure and the Board acknowledged in-service exposure to jet fuel and fumes, the VA examinations in September and November 2025 concluded that the conditions were less likely than not caused by these exposures. The examiner noted that migraines have genetic components and are not typically linked to jet fuel exposure, and that the Veteran's peripheral neuropathy was likely due to her diabetes mellitus type 2, a condition diagnosed decades after service. The Court of Appeals for Veterans Claims had previously remanded the case for inadequate examinations, but the subsequent VA opinions were found to be probative and persuasive, based on accurate medical history and accepted principles. The Board also noted that the Veteran's lay testimony regarding nexus is not competent due to the medical complexity of the issues. The Board concluded that the evidence persuasively weighs against a service connection for these conditions, and therefore the benefit of the doubt doctrine was not applicable. Service connection for all claimed conditions was denied.

Rationale

Service treatment records negative for complaints or findings.; Veteran's reported onset decades after service.; VA examiner opined less likely than not caused by TERA.; Migraine headaches have common triggers unrelated to occupational exposure.; No objective evidence linking migraines to in-service exposure.

Special Benefit

NO SPECIAL BENEFIT

Docket No.

18-38 520A

Full Decision Text

Citation Nr: 26003288
Decision Date: 03/11/26 Archive Date: 03/11/26

DOCKET NO. 18-38 520A
DATE: March 11, 2026

ORDER

Entitlement to service connection for migraine headaches is denied.

Entitlement to service connection for peripheral neuropathy of the right lower extremity is denied.

Entitlement to service connection for peripheral neuropathy of the left lower extremity is denied.

Entitlement to service connection for peripheral neuropathy of the right upper extremity is denied.

Entitlement to service connection for peripheral neuropathy of the left upper extremity is denied.

FINDINGS OF FACT

1. The evidence of record persuasively weighs against finding that the Veteran's migraine headaches are etiologically related to an in-service injury or disease.

2. The evidence of record persuasively weighs against finding that the Veteran's peripheral neuropathy of the right lower extremity manifested in service or within a year of service discharge, or is otherwise etiologically related to an in-service injury or disease.

3. The evidence of record persuasively weighs against finding that the Veteran's peripheral neuropathy of the left lower extremity manifested in service or within a year of service discharge, or is otherwise etiologically related to an in-service injury or disease.

4. The evidence of record persuasively weighs against finding that the Veteran's peripheral neuropathy of the right upper extremity manifested in service or within a year of service discharge, or is otherwise etiologically related to an in-service injury or disease.

5. The evidence of record persuasively weighs against finding that the Veteran's peripheral neuropathy of the left upper extremity manifested in service or within a year of service discharge, or is otherwise etiologically related to an in-service injury or disease.

CONCLUSIONS OF LAW

1. The criteria for service connection for migraine headaches are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

2. The criteria for service connection for peripheral neuropathy of the right lower extremity are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

3. The criteria for service connection for peripheral neuropathy of the left lower extremity are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

4. The criteria for service connection for peripheral neuropathy of the right upper extremity are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

5. The criteria for service connection for peripheral neuropathy of the left upper extremity are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from July 1970 to April 1971.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2016 rating decision.

In November 2021, the Veteran testified at a hearing before a Veterans Law Judge who is no longer employed by the Board. She elected to have another hearing and in July 2022, she presented testimony before the undersigned Veterans Law Judge. Transcripts of both hearings are associated with the claims file.

In February 2024, the Board issued a decision that denied service connection for migraine headaches and peripheral neuropathy of the bilateral lower and upper extremities. The Veteran timely appealed to the Court of Appeals for Veterans Claims (Court). In January 2025, the Court issued a Memorandum Decision vacating the Board's February 2024 decision and remanding the appeal to the Board for further development.

In August 2025, the Board remanded the claims on appeal for further development.

Service Connection

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 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).

In
Board remanded the claims on appeal for further development.

Service Connection

In addition, certain chronic diseases will be presumed related to service, absent an intercurrent cause, 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 (or within an applicable presumptive period) 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).

In making determinations, VA is responsible for ascertaining whether the evidence supports the claim. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. If the positive and negative evidence is in approximate balance (which includes but is not limited to equipoise), the claimant receives the benefit of the doubt. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc). 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.; Gilbert v. Derwinski, 1 Vet. App. 49, 54 (1990).

1. Entitlement to service connection for migraine headaches is remanded.

2. Entitlement to service connection for peripheral neuropathy of the right lower extremity is remanded.

3. Entitlement to service connection for peripheral neuropathy of the left lower extremity is remanded.

4. Entitlement to service connection for peripheral neuropathy of the right upper extremity is remanded.

5. Entitlement to service connection for peripheral neuropathy of the left upper extremity is remanded.

The Veteran is seeking service connection for migraine headaches and peripheral neuropathy of the bilateral lower and upper extremities, contending these conditions are related to her service, specifically, toxic exposure consistent with the circumstances of her service, including jet fuel and fumes.

VA and private treatment records reflect current diagnoses of migraine headaches, peripheral neuropathy of the bilateral upper extremities, and peripheral neuropathy of the bilateral lower extremities. Thus, current disabilities are shown. See Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(d).

The question remaining for the Board is whether the Veteran's currently diagnosed migraine headaches and peripheral neuropathy of the bilateral upper and lower extremities began during service or are at least as likely as not related to an in-service injury, event, or disease.

The Board concludes that, while the Veteran has current diagnoses, and evidence shows that in-service toxic exposure to jet fuel and fumes occurred, the evidence weighs against finding that the Veteran's diagnoses of migraine headaches and peripheral neuropathy of the bilateral upper and lower extremities began during service or is otherwise related to an in-service injury, event, or disease.

Here, service treatment records are negative for any findings or complaints related to these disabilities. While not entirely dispositive, this weighs against the Veteran's claims.

Treatment records show, and the Veteran confirmed in her testimony, that she was not diagnosed with any of these diseases until decades after her separation from service. During a November 2023 VA examination for migraine headaches, the Veteran reported that the condition began around 2000 and she was diagnosed with migraines in 2021. During a November 2023 VA examination for peripheral neuropathy, the Veteran reported that the condition began about four years prior.

During the November 2021 Board hearing, the Veteran reported that she might have been exposed to Agent Orange when herbicide was sprayed in the Lackland Air Force Base. However, an August 2023 toxic exposure risk activity (TERA) Memorandum indicates that the Veteran does not qualify for a presumption of exposure to herbicide agent but there was evidence of non-deployment related exposure while serving her military occupation specialty (MOS) as an aerospace operations control helper and air traffic control and warning helper, the Veteran was exposed to fuels, fumes, jet fuels, fuel fumes/exhaust, oils, oil fumes, and engine exhaust/fumes.

The November 2023 VA examiner opined that the Veteran's migraine headaches and peripheral neuropathy condition were less likely than not (likelihood is less than approximately balanced or nearly equal) caused by the indicated TERA, after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all toxic exposure risk activities of the Veteran. In support of this opinion, the examiner noted she was unable to verify a TERA, therefore, according to medical literature, the most likely cause of the Veteran's migraine headaches is something other than any in-service toxic exposure risk activity. The examiner noted a diagnosis of diabetic neuropathy of the bilateral upper and lower extremities and explained that the Veteran was diagnosed with diabetes in the 1990s and had gestational diabetes while pregnant in the 1970s and she did not start having upper and lower extremity neuropathy symptoms until four years prior. The examiner explained that researchers think that over time, uncontrolled high blood sugar damages nerves and interferes with their ability to send signals, leading to diabetic neuropathy; high blood sugar also weakens the walls of the small blood vessels (capillaries) that supply the nerves with oxygen and nutrients.

However, in the January 2025 Memorandum Decision, the Court found that the November 2023 VA headache and neuropathy examinations and opinions were inadequate because the examiners did not consider the Veteran's toxic exposure as indicated by the August 2023 TERA memorandum. Additionally, the examiner did not address the Veteran's testimony that she started having headaches when breathing airplane fumes, while still on active duty, which progressed to migraines.

In September 2025, the Veteran underwent new VA examinations. The examiner considered the Veteran's service separation examination noting occasional headaches in April 1971 and her report that she started having headaches when breathing in airplane fumes. Concerning this, the examiner explained that the condition was acute only with no objective evidence of a migraine headache during service. The examiner noted that migraine headache can have several triggers, but a trigger is not the same as the underlying etiology and an association does not equal causation; there are several triggers to migraines including smoke/smells, alcohol/wine, stress and sleep disturbances. The examiner therefore concluded that it is less likely than not that the Veteran's migraine headache was caused by military duties and isolated complaint of occasional headache at separation from service.

In addressing the Veteran's TERA, the examiner opined that the claimed condition was less likely than not (likelihood is less than approximately balanced or nearly equal) caused by the indicated TERA, after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all toxic exposure risk activities of the Veteran.

In a November 2025 addendum opinion, the examiner added that migraines have a genetic component and medical literature shows no causal relationship between migraine headache and exposure to fuels, fuel fumes, jet fuels, fuel fumes/exhausts, oils, oil fumes, engine exhausts/fumes. The examiner explained that migraine is a common disorder that affects the general population and is not specific to occupational exposures.

With regard to peripheral neuropathy, the examiner opined that the claimed condition was less likely than not (likelihood is less than approximately balanced or nearly equal) caused by the indicated TERA, after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all toxic exposure risk activities of the Veteran. The examiner reasoned that medical literature shows no causal relationship between exposure to jet fuels, fumes, exhaust, oil, and engine fumes and upper/lower extremity diabetic peripheral neuropathy. The examiner stated that medical literature shows peripheral neuropathy can happen for many reasons, including diabetes mellitus type 2, vitamin deficiencies, vascular disorder-circulation, alcohol disorder, and metabolic disorders represent the most common clinical category of etiologies, causing extremity pain from underlying peripheral neuropathy conditions. Several causes of peripheral neuropathy exist, but diabetes mellitus is the most common etiology. Other underlying etiologies include alcohol use disorder, nutritional deficiencies (e.g., low b2 Guillain-Barre syndrome Toxins (e.g., chemotherapy), overdose, hereditary or genetic conditions (e.g., Charcot Marie tooth disease, amyloidosis, porphyria), infection/inflammatory conditions (e.g., lupus and rheumatoid arthritis), hypothyroidism, malignancy, and trauma.

In the November 2025 addendum opinion, the examiner clarified that the Veteran's bilateral upper and lower extremity diabetic peripheral neuropathy was due to her diabetes mellitus type 2 and there was no objective evidence linking the Veteran's neuropathy to her lupus; the Veteran had history of diabetes mellitus type 2 and developed diabetes peripheral neuropathy as complication from it.

The September and November 2025 VA negative nexus opinions persuasively weigh against the claims and are probative because they are based on an accurate medical history and provide an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008).

As there is no competent evidence of record establishing that the Veteran's current migraine headaches and bilateral upper and lower extremity peripheral neuropathy conditions had an in-service onset or is otherwise related to service, to include the Veteran's in-service toxic exposure. Accordingly, the competent and probative evidence is against the Veteran's claims.

The Veteran contends that her migraine headaches and peripheral neuropathy are secondary to her lupus, however the medical evidence of record shows that the bilateral upper and lower extremity peripheral neuropathy are due to her diabetes. Because service connection is not in effect for either lupus or diabetes, her claims based on secondary service connection for migraine headaches and bilateral upper and lower extremity peripheral neuropathy must also fail, as the Veteran is not service connected for the claimed primary disability. See 38 C.F.R. § 3.310.

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While the Veteran believes that her disabilities are related to service, she is not competent to provide a nexus opinion regarding these issues. The issues are medically complex. Therefore, they are outside the competence of the Veteran because the record does not show that she has the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the VA examination reports, which were rendered by medical professionals based on review of the records and reliance on accepted medical principles.

In reaching the above conclusions, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the probative evidence is persuasively against the claims, that doctrine is not applicable in this appeal. See 38 U.S.C. § 5107(b); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990).

L. CHU

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board M. J. In

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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