MIGRAINE

A. J. SPECTOR · 2026 · Case ID: A26016963

MIXED

Summary

The Veteran, who served on active duty from June 1968 to July 1972, appeals the denial of service connection for headaches, erectile dysfunction, a respiratory condition with breathing difficulties, and dizziness. The Veteran claims these conditions are secondary to his conceded herbicide exposure and service-connected hypertension and diabetes mellitus. The Board granted service connection for headaches as secondary to hypertension and diabetes mellitus, and for erectile dysfunction as secondary to diabetes mellitus. The Board found that the Veteran's service-connected hypertension and diabetes mellitus could contribute to his headaches, and that his erectile dysfunction was a complication of and at least likely as not due to his diabetes mellitus, resolving reasonable doubt in his favor. The Board assigned high probative weight to the VA opinions supporting these grants. However, the Board remanded the claims for a respiratory condition and dizziness. The VA examiner's opinions for these conditions were found inadequate, failing to provide diagnoses, explain findings, consider all relevant evidence (including private treatment records and imaging), or analyze the potential for secondary service connection. The case was remanded for adequate examinations and opinions addressing the nature and etiology of the respiratory and dizziness conditions, their relationship to service, and their secondary connection to service-connected disabilities.

Rationale

VA examiner considered Veteran's medical history including hypertension care management records.; Hypertension and diabetes mellitus can cause headaches due to blood pressure and blood sugar fluctuations.; Resolving reasonable doubt in Veteran's favor due to relative equipoise.

Special Benefit

NO SPECIAL BENEFIT

Docket No.

251125-620026

Full Decision Text

Citation Nr: A26016963
Decision Date: 02/25/26 Archive Date: 02/25/26

DOCKET NO. 251125-620026
DATE: February 25, 2026

ORDER

Entitlement to service connection for headaches as secondary to service-connected hypertension and diabetes mellitus is granted.

Entitlement to service connection for erectile dysfunction as secondary to service-connected diabetes mellitus is granted.

REMANDED

Entitlement to service connection for a respiratory condition with breathing difficulties, to include as secondary to service-connected disabilities, is remanded.

Entitlement to service connection for dizziness, to include as secondary to service-connected disabilities, is remanded.

FINDINGS OF FACT

1. Resolving reasonable doubt in the Veteran's favor, his headaches disability is proximately due to his service-connected hypertension and diabetes mellitus.

2. Resolving reasonable doubt in the Veteran's favor, his erectile dysfunction disability is proximately due to his service-connected diabetes mellitus.

CONCLUSIONS OF LAW

1. The criteria for service connection for headaches as secondary to hypertension and diabetes mellitus are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.310.

2. The criteria for service connection for erectile dysfunction as secondary to diabetes mellitus are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from June 1968 to July 1972.

This matter comes before the Board of Veterans' Appeals (Board) on appeal of May 2025, July 2025, and September 2025 rating decisions issued by a Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ).

In the November 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket.

Therefore, for the issue of service connection for erectile dysfunction, the Board may only consider the evidence of record at the time of the May 2025 rating decision on appeal. 38 C.F.R. § 20.301. For the issues of service connection for headaches and dizziness, the Board may only consider the evidence of record at the time of the July 2025 rating decision. Id. For the issue of service connection for a respiratory condition with difficulty breathing, the Board may only consider the evidence of record at the time of the September 2025 rating decision on appeal. Id. Any evidence submitted after the respective rating decision for each issue 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 regarding service connection for headaches and erectile dysfunction 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 claims, 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 claims of service connection for a dizziness and a respiratory condition, any evidence the Board could not consider will be considered by the AOJ in the adjudication of those claims. 38 C.F.R. § 3.103.

This appeal has been advanced on the Board's docket pursuant to 38 U.S.C. § 7107; 38 C.F.R. § 20.800.

1. Entitlement to service connection for headaches as secondary to service-connected hypertension and diabetes mellitus is granted.

2. Entitlement to service connection for erectile dysfunction as secondary to service-connected diabetes mellitus is granted.

The Veteran asserts that his headaches and erectile dysfunction are related to his in-service exposure to herbicides. See February 2025 VA Form 21-526EZ.

Generally, 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). However, service connection may also be granted on a secondary basis for a disability that is proximately due to, or aggravated by, a service-connected disease or injury. 38 C.F.R. § 3.310. As the Board is granting service connection for headaches and erectile dysfunction on a secondary basis, direct service connection will not be discussed further in this decision.

As a result of the Veteran's conceded herbicide exposure, a March 2024 rating decision granted him presumptive service connection for diabetes mellitus, and the May 2025 rating decision on appeal granted him service connection for hypertension. A July 2025 VA examiner diagnosed the Veteran with unspecified headaches, and an October 2022 VA examiner diagnosed him with erectile dysfunction. Thus, Board must determine whether his diagnosed headaches and erectile dysfunction are proximately due to or aggravated by his service-connected disabilities, including hypertension and diabetes mellitus. Id.

Regarding his headaches, May 2012 VA treatment records show that the Veteran reported occasional headaches during a hypertension care management appointment. A July 2025 VA examiner noted this May 2012 VA treatment records and diagnosed the Veteran with headaches but opined that his condition is less likely than not due to his herbicide exposure as there is insufficient evidence in the medical literature that such exposure causes chronic headache symptoms. The examiner explained that headaches can be caused by many different things, including blood pressure and blood sugar fluctuations, and determined that the Veteran's hypertension and diabetes disabilities can contribute to his headaches.

With respect to the Veteran's erectile dysfunction, treatment records are silent for complaints of this condition prior to his February 2025 VA Form 21-526EZ. However, at an October 2022 VA examination for his diabetes mellitus, he reported erectile dysfunction and the October 2022 VA examiner indicated that his condition is a complication of and at least likely as not due to his diabetes mellitus. In a separate examination for male reproductive organ conditions, the same examiner diagnosed the Veteran with erectile dysfunction and noted his report of worsening symptoms over a 15-year period. The examiner also noted that the Veteran's erectile dysfunction had a known etiology, which is diabetes mellitus type 2.

After review, the Board finds that service connection for headaches and erectile dysfunction as secondary to service-connected disabilities is warranted.

While the July 2025 VA examiner did not provide an opinion on secondary service connection for headaches, the examiner considered the Veteran's entire medical history, including his May 2012 VA treatment records for headaches related to hypertension, and fully explained how his hypertension and diabetes mellitus can both cause headaches due to blood pressure and blood sugar fluctuations. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Similarly, the October 2022 VA examiner noted the Veteran's complaints of ongoing symptoms of erectile dysfunction and indicated that this condition is a complication of and therefore at least as likely as not due to diabetes mellitus type 2. Id. As the July 2025 and October 2022 VA examiners reviewed the facts of the case and provided fully articulated, sound reasoning for the conclusions drawn, the Board assigns these opinions high probative weight. Id.

The Board acknowledges that the January 2024 VA examiner concluded that the Veteran did not have a diagnosis of erectile dysfunction. However, while the Board cannot ignore or disregard the VA examiner's medical conclusions, it is free to assess medical evidence and not compelled to accept a medical opinion. Willis v. Derwinski, 1 Vet. App. 66 (1991); Wilson v. Derwinski, 2 Vet. App. 614 (1992).

Although the January 2024 VA examiner noted the October 2022 VA examination for diabetes mellitus, the examiner did not explain the disagreement with the previous examiner's diagnosis. Stefl v. Nicholson, 21 Vet. App. 120, 124-25 (2007). Furthermore, this examiner did not discuss significant facts of the case, to include the findings in the October 2022 VA examination for male reproductive organ conditions. Nieves-Rodriguez, 22 Vet. App. at 304. As this
Willis v. Derwinski, 1 Vet. App. 66 (1991); Wilson v. Derwinski, 2 Vet. App. 614 (1992).

Although the January 2024 VA examiner noted the October 2022 VA examination for diabetes mellitus, the examiner did not explain the disagreement with the previous examiner's diagnosis. Stefl v. Nicholson, 21 Vet. App. 120, 124-25 (2007). Furthermore, this examiner did not discuss significant facts of the case, to include the findings in the October 2022 VA examination for male reproductive organ conditions. Nieves-Rodriguez, 22 Vet. App. at 304. As this examiner did not consider the Veteran's entire medical history, including the October 2022 VA examination or provide fully articulated, sound reasoning for the conclusions drawn, the Board assigns the examination little probative weight. Id. at 301, 304.

In sum, the Board finds that the evidence is at least in relative equipoise as to whether the Veteran's headaches and erectile dysfunction are due to his service-connected hypertension and/or diabetes mellitus, and as such, resolves reasonable doubt in favor of the Veteran. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 3.310; Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021). The appeal is granted.

REASONS FOR REMAND

1. Entitlement to service connection for a respiratory condition with breathing difficulties, to include as secondary to service-connected disabilities, is remanded.

2. Entitlement to service connection for dizziness, to include as secondary to service-connected disabilities, is remanded.

The Veteran asserts that his breathing difficulties and dizziness are due to his conceded herbicide exposure. See February 2025 VA Form 21-526EZ.

When VA undertakes to provide a VA examination or obtain a VA medical opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Unfortunately, the Board finds remand is necessary as the VA opinions of record are inadequate.

The same July 2025 VA examiner provided opinions for the Veteran's respiratory and dizziness conditions. The examiner noted the Veteran's current symptoms of shortness of breath with exertion, as well as dizziness, loss of balance and lightheadedness, but concluded that there was "no pathology to render" any diagnoses without providing a medical analysis as to why this is so. Stefl, 21 Vet. App. at 124-25. Additionally, the examiner failed to explain why they concluded that the Veteran does not have an ear condition without performing an ear examination or why they indicated that the Veteran's has no symptoms of any other diagnosed condition while at the same time indicating he has symptoms of vertigo and staggering. Id.

Further, the July 2025 examiner did not consider or analyze significant facts of the Veteran's case, to include an x-ray revealing a mildly elevated central right diaphragm and private treatment records showing non-cardiac shortness of breath and ongoing dizziness and lightheadedness. Nieves-Rodriguez, 22 Vet. App. at 304. Finally, the examiner did not consider whether secondary service connection is warranted for the Veteran's conditions, which theory of entitlement is reasonably raised by the record. Szemraj v. Principi, 357 F.3d 1370, 1373 (Fed. Cir. 2004). Remand is necessary to obtain adequate examinations and opinions on the Veteran's conditions. Barr, 21 Vet. App. at 312.

The matters are REMANDED for the following action:

Schedule the Veteran for a VA examination(s) to determine the nature and etiology of his respiratory and dizziness conditions. The evidentiary record, including a copy of this remand, must be made available to and reviewed by the clinician(s).

After examination of the Veteran and record review, the clinician(s) must:

(a.) Identify all current respiratory and dizziness disabilities. The clinician should consider the Veteran's lay statements, VA and private treatment records, and imaging results discussed in the body of this remand.

(b.) For each diagnosed disability, opine whether it is at least as likely as not (at least an approximate balance of positive and negative evidence) that the disability had its onset in or is otherwise related to active service, to include his in-service exposure to herbicides or any other verified TERAs.

In rendering the above opinion, the clinician must address the synergistic, combined effect of all
made available to and reviewed by the clinician(s).

After examination of the Veteran and record review, the clinician(s) must:

In rendering the above opinion, the clinician must address the synergistic, combined effect of all of the Veteran's TERAs. The clinician is reminded that the fact that any diagnosed condition is not on the presumptive list of conditions related to a TERA exposure cannot by itself be the sole basis for a negative nexus opinion. Rather, the clinician should consider the Veteran's specific military history, medical history, risk factors, and any other circumstances deemed relevant by the clinician in rendering an opinion.

(c.) The clinician must opine whether the Veteran's diagnosed disability is at least as likely as not (an approximate balance of positive and negative evidence) caused OR aggravated by his service-connected disabilities, to include hypertension and diabetes mellitus.

Note that the phrase "caused by" reflects a "but-for causation" standard that is not limited to a single cause and effect, but rather contemplates multi-causal links, including action and inaction. This includes the inability to treat the non-service-connected disability because of the service-connected disability. Aggravation means any incremental increase in disability in non-service-connected disabilities (i.e., any additional impairment in earning capacity, worsening of functionality) resulting from service-connected conditions. Any "incremental increase in disability" need not be permanent.

The clinician is advised that the Veteran is competent to attest to factual matters of which he has first-hand knowledge, including observable symptomatology. These reports must be acknowledged and considered in formulating any opinion (to include the Veteran's lay statements described in the body of this remand). If the clinician finds any medical reason to reject the lay reports, then an explanation must be provided.

The clinician is reminded that a lack of evidence or medical documentation cannot be corroborating to conclude that there is no relationship between the Veteran's current disability and his military service.

The clinician is further reminded that the absence of a diagnosis in service is not fatal to a service connection claim and is insufficient as a rationale.

If an opinion cannot be provided without resorting to speculation, the clinician must provide a complete explanation for why an opinion cannot be rendered. In so doing, the clinician must explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that the limits of current medical knowledge in providing an answer to that particular question have been exhausted.

A. J. Spector

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Garcia, M. A.

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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