MIGRAINES

Summary

The veteran, who served from August 1983 to September 2003, appeals the denial of an increased disability rating for migraine headaches. The veteran is currently rated at 30 percent for migraines under Diagnostic Code 8100 and seeks a 50 percent rating. The Board reviewed the evidence of record at the time of the January 2025 rating decision. The criteria for a 50 percent rating under Diagnostic Code 8100 require very frequent, completely prostrating, prolonged attacks productive of severe economic inadaptability. The Board found the veteran's lay statements credible and afforded them significant probative value. The evidence, including VA examiner opinions and the veteran's own testimony, indicated daily and weekly attacks causing severe pain, light and sound sensitivity, and requiring rest. The Board also considered the veteran's work history, noting supervisor comments about the veteran needing breaks due to migraines and subsequent sick calls. Applying the benefit of the doubt doctrine, the Board found the evidence in approximate balance and resolved reasonable doubt in the veteran's favor. Service connection for migraines is granted at an initial disability rating of 50 percent.

Rationale

Migraines rated under DC 8100; Criteria for 50% rating met: very frequent, completely prostrating, prolonged attacks productive of severe economic inadaptability; Lay evidence found credible and afforded significant probative value

Full Decision Text

Citation Nr: A26010778
Decision Date: 02/05/26	Archive Date: 02/05/26

DOCKET NO. 250715-565378
DATE: February 5, 2026

ORDER

Entitlement to an initial evaluation of 50 percent for migraine headaches is granted.

FINDING OF FACT

Resolving reasonable doubt in favor of the Veteran, his migraines manifested with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability.  

CONCLUSION OF LAW

The criteria for a 50 percent disability rating for migraines have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8100.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from August 1983 to May 1988, and from May 1988 to September 2003.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2025 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO).

In the July 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 January 2025 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. 

Increased Rating

Disability ratings are determined by the application of the VA's Schedule for Rating Disabilities. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. § Part 4. Ratings for service-connected disabilities are determined by comparing the Veteran's symptoms with criteria listed in VA's Schedule for Rating Disabilities, which is based, as far as practically can be determined, on average impairment in earning capacity. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7.

The Veteran's entire history is to be considered when making disability evaluations. See generally 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). Where entitlement to compensation already has been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Where the question for consideration is the propriety of the initial evaluation assigned, evaluation of the medical evidence since the grant of service connection is required. Fenderson v. West, 12 Vet. App. 119, 126 (1999). The Board will also consider entitlement to staged ratings to compensate for times since filing the claim when the disability may have been more severe than at other times during the course of the claim on appeal. Hart v. Mansfield, 21 Vet. App. 505 (2007).

In making all determinations, the Board must fully consider the lay assertions of record. 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). When considering whether lay evidence is competent the Board must determine, on a case-by-case basis, whether the Veteran's particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007).

After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 
. 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). When considering whether lay evidence is competent the Board must determine, on a case-by-case basis, whether the Veteran's particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007).

After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 C.F.R. § 4.3.

Entitlement to an initial evaluation of 50 percent for migraine headaches.

The Veteran contends he is entitled to a higher rating for his headaches. Specifically, the Veteran contends he is entitled to a 50 percent disability rating. The Veteran is currently assigned a 30 percent disability rating under C.F.R. § 4.124a, Diagnostic Code 8100.

The rating period on appeal is August 18, 2023, the effective date of service connection, through the date of this decision.

Migraine headaches are rated pursuant to 38 C.F.R. § 4.124a, Diagnostic Code 8100, for migraines. Under Diagnostic Code 8100, a 30 percent rating is warranted for migraines with characteristic prostrating attacks occurring on an average once a month over last several months. A 50 percent rating is warranted for migraines with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. See 38 C.F.R. § 4.124a.

The rating criteria of Diagnostic Code 8100 are considered successive, meaning that a claimant cannot fulfill the criteria of the higher rating without fulfilling those of the next lower rating. Johnson v. Wilkie, 30 Vet. App. 245, 252 (2018). This renders 38 C.F.R. §§ 4.7 and 4.21 inapplicable. Johnson, 30 Vet. App. at 252.

The rating criteria do not define "prostrating," nor has the Court. Fenderson v. West, 12 Vet. App. 119, 127 (1999) (quoting Diagnostic Code 8100 verbatim and holding evidence established headaches were "prostrating" but not specifically addressing what constitutes a prostrating attack). A prominent medical dictionary defines "prostration" as "extreme exhaustion or powerlessness." See Dorland's Illustrated Medical Dictionary, 1554 (31st Edition 2007).

The rating criteria for a 50 percent rating contain several undefined phrases. The descriptive phrase "very frequent" connotes a frequency at least greater than once a month, as is required by the rating criteria corresponding to a lesser 30 percent rating. Johnson, 30 Vet. App. at 253. The phrase "completely prostrating" generally means that the migraines attack must render the veteran entirely powerless. Id. The completely prostrating attacks must also be "prolonged," which is defined as "to lengthen in time: extend duration: draw out: continue, protract." Id. (internal citation omitted). Lastly, the 50 percent rating criteria requires that the very frequent completely prostrating and prolonged attacks be "productive of severe economic inadaptability." Productive can be read as having either the meaning of "producing" or "capable of producing," and, with regard to severe economic inadaptability, nothing in DC 8100 requires that the claimant be completely unable to work in order to qualify for a 50 percent rating. Pierce v. Principi, 18 Vet. App. 440, 445-46 (2004).

VA's Adjudication Procedures Manual (M21-1) defines "prostrating" in DC 8100 to mean "causing extreme exhaustion, powerlessness, debilitation, or incapacitation with substantial inability to engage in ordinary activities." V.iii.12. A.3.b. The M21-1 then defines "completely prostrating" in DC 8100 to mean "extreme exhaustion or powerlessness with essentially total inability to engage in ordinary activities." Id. "Severe economic inadaptability" means "a degree of substantial work impairment" but does not mean that the individual is incapable of substantial gainful employment, and evidence of work impairment includes but is not limited to use of sick leave or unpaid absence. V.iii.12. A.3.e. The M21-1 also defines "very frequent" as attacks that are, on average, less than one month apart over the last
itation with substantial inability to engage in ordinary activities." V.iii.12. A.3.b. The M21-1 then defines "completely prostrating" in DC 8100 to mean "extreme exhaustion or powerlessness with essentially total inability to engage in ordinary activities." Id. "Severe economic inadaptability" means "a degree of substantial work impairment" but does not mean that the individual is incapable of substantial gainful employment, and evidence of work impairment includes but is not limited to use of sick leave or unpaid absence. V.iii.12. A.3.e. The M21-1 also defines "very frequent" as attacks that are, on average, less than one month apart over the last several months. V.iii.12. A.3.f.

Although the Board is not bound by the M21-1, it is "required to discuss any relevant provisions as part of the duty to provide adequate reasons or bases if the Board chooses to rely on an M21-1 provision as a factor to support its decision." Overton v. Wilkie, 30 Vet. App. 257, 264 (2018). In this case, the Board finds the M21-1's guidance helpful insofar as it is consistent with the dictionary definitions and precedent discussed above.

In rating headaches or migraines under DC 8100, the Board may not consider the ameliorative effects of medication. See Jones v. Shinseki, 26 Vet. App. 56, 63 (2012).

Although the Board has an obligation to provide adequate reasons and bases supporting its decision, there is no requirement that the Board discuss every piece of evidence in the record. Hence, the Board will summarize the relevant evidence, as deemed appropriate, and the Board's analysis will focus on what the evidence shows, or fails to show, as to the claim. See Gonzalez v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000).

Resolving reasonable doubts in the Veteran's favor, for the entire period on appeal, the Board finds the Veteran has had migraines with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability, corresponding to the criteria for a 50 percent rating under DC 8100.

The Board finds the medical evidence of record and Veteran's lay statements demonstrate the Veteran experiences prostrating migraine attacks on a daily and weekly basis. The evidence further demonstrates the Veteran's migraine attacks are "completely prostrating" as they result in severe pain, sensitivity to light and sound, changes to vision, and require the Veteran to sit or lay down. The evidence of record supports a finding that the Veteran's migraines are "productive of severe economic inadaptability." The Veteran's VA examiners indicated the Veteran's migraines cause difficulty with concentration. The Veteran's supervisor indicated he has had to tell the Veteran to take a break due to his migraines, and this typically would be followed up on the next day by the Veteran calling off sick. The Veteran also requires the use of medications for the treatment of his migraines.

The Board emphasizes that the Veteran is competent to describe the symptoms associated with his migraine headaches, and there is no evidence of record which suggests he lacks credibility as to this symptomatology. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Thus, the lay evidence regarding the Veteran's migraine headaches symptomatology is afforded significant probative value. 

Accordingly, the Board finds the relevant evidence of record to be at least in approximate balance as to the severity of the Veteran's migraine disability throughout the appeal period on review, and therefore, resolves any reasonable doubt in the Veteran's favor. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 

As such, the instant appeal is granted, and the Veteran assigned an initial disability rating of 50 percent for migraines. The Board notes that 50 percent is the maximum rating for migraine headaches. 38 C.F.R. § 4.124a; DC 8100.

 

 

D. SMART

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	K.A. Murphy

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.