MIGRAINES

Summary

The veteran, who served from August 1985 to May 1997 and again from February 2003 to June 2004, appeals the denial of an initial compensable rating for migraines. The veteran sought a higher rating for his service-connected migraines, which were initially granted a noncompensable rating in July 2024. The appeal focuses on the period beginning December 19, 2023. The Board reviewed the evidence of record as of the July 2024 rating decision. The veteran's migraines are rated under Diagnostic Code 8100, with the Board interpreting "characteristic prostrating attacks" as attacks causing extreme exhaustion or powerlessness. The veteran reported intermittent headaches, memory problems, and pain that worsens with physical activity, but the Board found these symptoms did not meet the criteria for a 10 percent rating, which requires characteristic prostrating attacks averaging one in two months. A March 2024 VA examination concluded the veteran experienced less frequent attacks and did not have completely prostrating and prolonged attacks. The Board found the VA examination adequate, noting the examiner considered the frequency and impact of headaches, and that any memory complaints were already compensated as a residual of a service-connected other specified trauma and stressor related disorder, preventing pyramiding. The Board concluded the veteran's migraines occurred with less frequent attacks, warranting only a noncompensable rating. Service connection for migraines was not disturbed, but the appeal for a higher compensable rating was denied.

Rationale

Migraines rated under DC 8100.; Attacks did not meet criteria for 10% rating (less frequent attacks).; Memory complaints already compensated under separate service-connected disorder (other specified trauma and stressor related disorder).

Full Decision Text

Citation Nr: A26028806
Decision Date: 03/31/26	Archive Date: 03/31/26

DOCKET NO. 251205-612109
DATE: March 31, 2026

ORDER

Entitlement to an initial compensable rating for migraines is denied.

FINDING OF FACT

During the appeal period, the Veteran experienced migraines with less frequent attacks. The migraines did not manifest in characteristic prostrating attacks averaging one in 2 months over the last several months.

CONCLUSION OF LAW

The criteria for an initial compensable rating for migraines have not 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 1985 to May 1997 and from February 2003 to June 2004.

The rating decision on appeal was issued in July 2024 and constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies. See 38 C.F.R. § 3.2400(a)(1).

In September 2024, the Veteran submitted a VA Form 20-0996, Decision Review Request: Higher-Level Review (HLR), and requested review of a July 2024 decision. In December 2024, the agency of original jurisdiction (AOJ) issued the HLR decision on appeal, which considered the evidence of record at the time of the prior July 2024 decision. 

In the December 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 July 2024 AOJ decision, which was subsequently subject to higher-level review. 38 C.F.R. § 20.301. If evidence was submitted during the period after the AOJ issued the decision, which was subsequently subject to higher-level review the Board did not consider it in its decision. 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. 

Entitlement to an initial compensable rating for migraines is denied.

The Veteran is seeking a higher initial rating for his service-connected migraines.  In a July 2024 rating decision, the AOJ granted service connection for migraines and assigned a noncompensable rating from December 19, 2023. The current appeal stems from this grant of service connection; therefore, the period on review begins December 19, 2023. 

The Veteran's migraine headaches are rated pursuant to 38?C.F.R. §?4.124a, Diagnostic Code (DC) 8100, for migraine. Under DC 8100, a noncompensable rating is warranted for migraines with less frequent attacks. A 10 percent rating is warranted for migraines with characteristic prostrating attacks averaging one in 2 months over the last several months.  

The rating criteria of DC 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 phrase "characteristic prostrating attacks" is used in the criteria corresponding to 10 percent and 30 percent ratings under DC 8100 to describe the nature and severity of migraines, but it is not defined in the regulation. Pursuant to Dorland's Illustrated Medical Dictionary 1531 (32d ed. 2012), prostration is defined as "extreme exhaustion or powerlessness." Thus, the phrase "characteristic prostrating attacks" is understood to describe migraine attacks that typically produce extreme exhaustion or powerlessness.

The rating criteria for a 50 percent rating contain several undefined phrases. The descriptive phrase "very frequent" connotes a frequency at least greater
 Johnson, 30 Vet. App. at 252.

The phrase "characteristic prostrating attacks" is used in the criteria corresponding to 10 percent and 30 percent ratings under DC 8100 to describe the nature and severity of migraines, but it is not defined in the regulation. Pursuant to Dorland's Illustrated Medical Dictionary 1531 (32d ed. 2012), prostration is defined as "extreme exhaustion or powerlessness." Thus, the phrase "characteristic prostrating attacks" is understood to describe migraine attacks that typically produce extreme exhaustion or powerlessness.

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).

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). More recently, the Court stated that the "the Board [is] obligated to discount the beneficial effects of the medication taken for each disability and evaluate the baseline severity of those disabilities." Ingram v. Collins, 38 Vet. App. 130 (2025).

In Holmes v. Wilkie, 33 Vet. App. 67 (2020), the United States Court of Appeals for Veterans Claims held that DC 8100 contemplates all migraine symptoms. Therefore, to evaluate migraines under DC 8100, VA must consider all symptoms experienced due to migraine attacks and then rate the symptoms based on the frequency, duration, and economic impact of those attacks.  

Although the Board has an obligation to provide reasons and bases supporting its decision, there is no need to discuss, in detail, every piece of evidence of record. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). The analysis below focuses on the most salient and relevant evidence and on what this evidence shows, or fails to show, on the claim. The Veteran must not assume that the Board has overlooked pieces of evidence that are not explicitly discussed herein. See Timberlake v. Gober, 14 Vet. App. 122 (2000).

The Board concludes that the Veteran's migraines have occurred with less frequent attacks during the appeal period, corresponding to the criteria for a noncompensable rating under DC 8100.  

During the period on review, the Veteran's available treatment records are silent for information relevant to the current severity of his service-connected migraine disability.

However, the Veteran underwent a VA examination in March 2024. During the examination, the Veteran reported intermittent, episodic, and throbbing migraine headaches with irritability to bright lights. He also reported problems with his memory. The examiner indicated that the Veteran's treatment plan includes taking Ibuprofen for his migraine disability. The examiner noted that the Veteran experiences pulsating or throbbing head pain, pain on both sides of the head, and pain that worsens with physical activity. The examiner also noted he experiences sensitivity to light and nausea. The examiner found that the Veteran's head pain lasts for less than one day on both sides of the head. 

Based on an in-person examination and reviewed records, the March 2024 VA examiner concluded that the Veteran has characteristic prostrating attacks of migraine/non-migraine headache pain with less frequent attacks. The examiner further concluded that the Veteran does not have completely prostrating and prolonged attacks of migraines/non-migraine pain. The examiner also found that the Veteran does not have any other pertinent physical findings, complications, conditions, signs, or symptoms related to his migraine condition.

After a review of the evidentiary record, the Board concludes that the Veteran's migraine symptoms most nearly approximate less frequent attacks of migraines
 and nausea. The examiner found that the Veteran's head pain lasts for less than one day on both sides of the head. 

Based on an in-person examination and reviewed records, the March 2024 VA examiner concluded that the Veteran has characteristic prostrating attacks of migraine/non-migraine headache pain with less frequent attacks. The examiner further concluded that the Veteran does not have completely prostrating and prolonged attacks of migraines/non-migraine pain. The examiner also found that the Veteran does not have any other pertinent physical findings, complications, conditions, signs, or symptoms related to his migraine condition.

After a review of the evidentiary record, the Board concludes that the Veteran's migraine symptoms most nearly approximate less frequent attacks of migraines, corresponding to the criteria for a noncompensable rating under DC 8100. 

The Veteran is competent to report readily observable symptoms. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). In this case, the Veteran has reported intermittent headaches without indicating that the headaches result in symptoms approximating characteristic prostrating attacks averaging one in 2 months over last several months. The March 2024 VA examiner clearly indicated that the Veteran experiences less frequent characteristic prostrating attacks. Although the Veteran reported difficulty with concentration and focus during headaches and pain that worsens with physical activity, the Veteran did not exhibit or describe extreme exhaustion or powerlessness during headaches averaging one in 2 months over last several months. 

Regarding the reported problems with his memory, the Board observes that during an April 2024 traumatic brain injury (TBI) examination, the examining neurologist indicated that the Veteran's subjective memory difficulties can occur in the aftermath of both TBI and posttraumatic stress disorder (PTSD), making it difficult to distinguish without speculation whether to attribute that cognitive complaint to either PTSD or TBI. However, during an April 2024 VA mental disorders examination, a VA psychologist determined that memory loss is a symptom of the Veteran's mental disorder- other specified trauma and stressor related disorder.  The Board notes that the Veteran is service-connected for other specified trauma and stressor related disorder. He has a 70 percent disability evaluation and his memory loss is rated as a residual of that disability. When disabilities have duplicative or overlapping symptoms, the rule against pyramiding prohibits VA from compensating a veteran more than once for the same symptoms or functional impairment. Thus, any additional consideration for memory problems in this case would be prohibited under the rule against pyramiding. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994).

A compensable rating under DC 8100 is not warranted unless there are migraines with characteristic prostrating attacks averaging one in 2 months over the last several months. Considering all relevant evidence of record, the Board finds the Veteran's migraine symptoms do not more nearly approximate migraines with characteristic prostrating attacks averaging one in 2 months over the last several months. Accordingly, the Board concludes that the Veteran's migraine headaches occurred with less frequent attacks throughout the appeal period, corresponding to the criteria for a noncompensable rating under DC 8100. Accordingly, a compensable rating under DC 8100 is not warranted.

In reaching this conclusion, the Board acknowledges the Veteran's contention that the March 2024 VA examination is inadequate for adjudication because the examiner failed to get a specific number regarding frequency from the Veteran and failed to ask the Veteran anything about restrictions to his work or social life during migraines. See December 2025 VA Form 10182. However, the Board disagrees. The March 2024 VA examiner clearly indicated that the Veteran experiences less frequent attacks of migraine, which suggests a frequency less than averaging one in 2 months over the last several months. When addressing whether the Veteran's headache condition impacts his ability to work, the March 2024 VA examiner also indicated that the Veteran reported difficulty with concentration and focus during headaches, which clearly suggests the examiner considered the restrictions to the Veteran's work and social life during migraines. 

Furthermore, the Board finds that the VA examination report does not raise doubts regarding the examiner's credibility or the examination's reliability. Factors for assessing the probative value of a medical opinion are the physician's access to the claims folder and the thoroughness and detail of the opinion. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000); Nieves-Rodriguez, 22 Vet. App. 295 (2008); Prejean v. West, 13 Vet. App. 444, 448-9 (2000). In this case, the examination findings are based on a review of the Veteran's claims file and an in-person examination of the Veteran. The March 202
 finds that the VA examination report does not raise doubts regarding the examiner's credibility or the examination's reliability. Factors for assessing the probative value of a medical opinion are the physician's access to the claims folder and the thoroughness and detail of the opinion. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000); Nieves-Rodriguez, 22 Vet. App. 295 (2008); Prejean v. West, 13 Vet. App. 444, 448-9 (2000). In this case, the examination findings are based on a review of the Veteran's claims file and an in-person examination of the Veteran. The March 2024 VA examination was also provided by a VA medical professional who possesses the necessary education, training, and expertise to provide the requested examination. As such, the Board finds the March 2024 VA examination adequate for adjudication.

Finally, in making the above findings, the Board is cognizant of the fact that the Veteran has used medication to treat his headache pain. In this case, there is no indication that the ameliorating effects of the Veteran's medication was not appropriately discounted by the examiner. As such, the Board concludes the VA examination of record is adequate. See Jones, 26 Vet. App. at 63; see also Ingram, 38 Vet. App. at 131.

In conclusion, the Board finds that the Veteran's migraines did not occur with characteristic prostrating attacks averaging one in 2 months over the last several months at any time during the appeal period. Accordingly, an initial compensable rating under DC 8100 is not warranted. The appeal is denied.

 

 

D. JOHNSON

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	M. Aoughsten, 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.