MIGRAINE

Summary

The Veteran, who served from August 1976 to November 1982, appeals the denial of service connection for tension headaches. The Veteran contends that his tension headaches are secondary to his service-connected psychiatric disability. The Board reviewed the procedural history, noting multiple prior remands and the submission of new medical articles by the Veteran's representative. The primary issue was whether the Veteran's current tension headaches were secondary to his service-connected psychiatric condition. The Board considered a November 2021 VA psychological examination which noted the Veteran's psychiatric symptoms included chronic sleep impairment, anxiety, and depressed mood. While a September 2023 VA examiner provided negative opinions, reasoning that tension headaches are often idiopathic and not linked to psychiatric conditions in reviewed literature, the Board found these opinions inadequate as they did not specifically address the impact of the Veteran's known psychiatric symptoms. The Board found the evidence, including medical articles submitted by the Veteran's representative, competently linked tension headaches to anxiety and depression. Finding the evidence in approximate balance, the Board applied the benefit of the doubt doctrine. Service connection for tension headaches as secondary to the service-connected psychiatric disability was granted.

Rationale

Evidence in approximate balance; Benefit of the doubt applied; Secondary to service-connected psychiatric disability

Full Decision Text

Citation Nr: 26004524
Decision Date: 04/14/26	Archive Date: 04/14/26

DOCKET NO. 17-06 186
DATE: April 14, 2026

ORDER

Entitlement to service connection for tension headaches is granted, subject to the laws and regulations governing the award of monetary benefits.

FINDING OF FACT

The evidence is at least in approximate balance that the Veteran's current tension headaches disability is secondary to his service-connected other specified trauma and stressor-related disorder (hereinafter, "psychiatric disability"). 

CONCLUSION OF LAW

The criteria for entitlement to service connection for tension headaches as secondary to the service-connected psychiatric disability are met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

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REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from August 1976 to November 1982.  He also had additional periods of Reserves and National Guard service.

This matter comes to the Board of Veterans' Appeals (Board) on appeal from a December 2014 rating decision of a U.S. Department of Veterans Affairs (VA) Regional Office, which is the Agency of Original Jurisdiction (AOJ). 

This appeal has a long procedural history.  The Board previously remanded this appeal multiple times, most recently in August 2024.  The appeal has returned to the Board for appellate review.  The Board finds that the AOJ substantially complied with the most recent, prior Board remand. See Stegall v. West, 11 Vet. App. 268 (1998).  

In a March 2025 brief, the Veteran's representative included excerpts of a medical article.  This additional evidence was received in the claims file after the AOJ issued the most recent, December 2024 Supplemental Statement of the Case (SSOC).  However, a waiver of the Veteran's right to initial AOJ review of such evidence is not necessary here.  Since the Veteran (through his representative) submitted this evidence, and the VA Form 9 (substantive appeal) was filed in 2017, such waiver is presumed.  (Moreover, as the Board is granting the benefit sought on appeal, proceeding with a favorable decision does not prejudice the Veteran.)

Entitlement to service connection for tension headaches is granted.

The Veteran contends in part that his current tension headaches disability is secondary to his service-connected psychiatric disability. 

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).  

Alternatively service connection may be granted on a secondary basis for a disability that is due to, or aggravated by, a service-connected disability.  See 38 C.F.R. § 3.310.  

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant.  38 U.S.C. § 5107(b).  The benefit-of-the-doubt rule applies if the competing evidence is "nearly equal" or in "approximate balance."  See Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).

Here, a  December 2021 VA examiner competently diagnosed the Veteran with tension headaches.  Moreover, the Veteran is service-connected for multiple disabilities, including a psychiatric disability.  Accordingly, the secondary service connection theory raised in this appeal mainly hinges on whether the Veteran's current headaches disability is secondary to a service-connected disability, to include the psychiatric disability.  

The Veteran's representative provided excerpts of online medical articles from the Cleveland Clinic.  See March 2025 Appellate Brief.  The article excerpt notes that "researchers are still seeking a single cause for tension headaches."  It further states that causes of tension headaches can include sleep disorders (to include changes in sleep or lack of sleep), anxiety, and depression.  

A November 2021 VA psychological examination report competently noted that that Veteran's service-connected psychiatric disability symptoms include chronic sleep impairment, anxiety, and depressed mood.  

The
 a psychiatric disability.  Accordingly, the secondary service connection theory raised in this appeal mainly hinges on whether the Veteran's current headaches disability is secondary to a service-connected disability, to include the psychiatric disability.  

The Veteran's representative provided excerpts of online medical articles from the Cleveland Clinic.  See March 2025 Appellate Brief.  The article excerpt notes that "researchers are still seeking a single cause for tension headaches."  It further states that causes of tension headaches can include sleep disorders (to include changes in sleep or lack of sleep), anxiety, and depression.  

A November 2021 VA psychological examination report competently noted that that Veteran's service-connected psychiatric disability symptoms include chronic sleep impairment, anxiety, and depressed mood.  

The AOJ obtained multiple VA medical opinions addressing the etiology of the Veteran's headaches disability, including whether the Veteran's current headaches condition is secondary to a service-connected disability.  To the extent that prior Board remands found most of the negative VA medical opinions inadequate for adjudication purposes, the Board affords those opinions little probative weight.  

For example, a September 2023 VA examiner provided negative secondary service connection opinions.  The opinions reasoned in part that the cause of tension headaches is idiopathic or unexplained.  The opinions acknowledged multiple factors that may cause tension headaches, including "emotional" causes.  However, the opinions did not specifically address whether the known emotional manifestations of the Veteran's service-connected psychiatric disability caused or aggravated his tension headaches.  (In the August 2024 remand, the Board found the September 2023 VA medical opinions inadequate.)  

On balance, the Board finds that the negative VA medical opinions of record do not persuasively refute the Cleveland Clinic medical article competently, credibly, and persuasively linking the Veteran's tension headaches to his known service-connected psychiatric symptoms.  For example, the September 2023 VA examiner summarily concluded that there "was no evidence to suggest that the headache condition is due to any one particular cause," and that the Veteran's specific service-connected conditions, including his psychiatric disability, were "not recognized as causes of tension headaches in any medical literature reviewed."  However, as discussed above, this negative VA medical opinion did not address the impact of the Veteran's specific, known, service-connected psychiatric symptoms, including those identified among the possible causes of tension headaches.

In summary, the Board finds that the evidence of record is at least in approximate balance that the Veteran's current tension headaches disability is secondary to his service-connected psychiatric disability.  Accordingly, resolving reasonable doubt in his favor, service connection for a tension headache disability is granted, as secondary to the service-connected psychiatric disability.  38 U.S.C. § 5107; 38 C.F.R. §§ 3.102. 3.310.

 

 

R. JANOFSKY

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	C. Hart, 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.